Suicide Prevention Strategy and Prospects % % universal selective indicativebertolote, 2004;

Transcription

1 自殺防治策略推動現況與展望 李明濱戴傳文 * 廖士程 ** 江弘基 *** 摘要 : 自殺防治是當代公共衛生以及心理衛生工作之重要課題, 鑒於目前國人自殺死亡率逐年提高, 且自殺已連續八年列入國人十大死因之列, 行政院衛生署特委託台灣憂鬱症防治協會辦理自殺防治工作, 成立全國自殺防治中心 而我國自殺防治策略, 與世界其他國家一致, 主要分為三個主要層面擬定方 案, 分別為全面性 (universal) 選擇性 (selective) 與指標性 (indicative) 策略 全面性自殺防治策略 之標的為全體民眾, 涵蓋導正媒體報導, 宣導 自殺是可以預防的 重要概念, 減少致命性物品之可 近性 降低自殺與精神疾病的社會污名化程度, 促進社會大眾心理健康, 以及自殺概況與相關資訊的 有效監測 選擇性自殺防治策略以高風險群為對象, 包括憂鬱症共同照護體系之推行 精神疾病的早 期診斷與有效處置 指標性自殺防治策略主要在於追蹤自殺企圖者, 強化偏遠地區之緊急救護能力, 以及自殺相關個案管理, 以期給予自殺企圖者有效的身心醫療及社會介入措施, 以防止其再度試圖自 殺 整體而言, 自殺防治工作必須能促進各種網絡間 網網相連 之有效功能性連結, 以提供完整而 持續之關懷服務 透過全民的參與, 以及照護系統之整合, 多方面提升我國心理衛生與精神醫療, 活 絡社區支持網絡, 落實於以病人為中心 家庭為單位 社區為基礎之全人醫療, 並有效對自殺企圖者 進行妥善照顧, 展現社會文化互助價值與溫暖 關鍵詞 : 自殺防治 心理衛生 通報 全人醫療 200 Bertolote & Fleschmann, 2002; Cheng, 1 Cheng, Mann, & Chan, Cheng, Chen, Chen, & Jenkins, 2000 World Health Organization, global burden of health Years of Life Lost, YLL Years of Life with Disability, YLD 2 Bertolote, 2004; World Health Organization, , * ** ***

2 Suicide Prevention Strategy and Prospects % % universal selective indicativebertolote, 2004; Mrazek & Haggerty, 14

3 Years of Life Lost, YLL Years of Life with Disability, YLD Disability-Adjusted Life Years, DALY Brief Symptom Rating Scale, BSRS- Lee et al, 2003 BSRS- 30% BSRS

4 Suicide Prevention Strategy and Prospects 200 gatekeeper % 30% 1% 2% 12% Bruce et al, 2004 Byrne, Regan, & Livingston, 200 collaborative care Craven & Bland, 200

5 Hall, O Brien, Stark, Pelosi, & Smith, 1; Hawton et al., 2003; Ostamo & Lönnqvist, 2001; Wilcox & Anthony, 2004 Beautrais, 2001Buglass & Horton, 14 1% 100 Guthrie et al, 2001; Vaiva et al, Bertolote, , , % % %.1% 20.%.2% 12, 2,2 1, ㈠ 4

6 10 Suicide Prevention Strategy and Prospects ㈡ ㈢ 4 ㈣ ㈤ Excel ㈥ standard operation procedure, SOP BSRS- 1 Mann et al, 200

7 Beautrais, A. L. (2001). Suicides and serious suicide attempts: Two populations or one? Psychological Medicine, 31, Bertolote, J. M. (2004). Suicide prevention: At what level does it work? World Psychiatry, 3(3), Bertolote, J. M., & Fleischmann, A. (2002). Suicide and psychiatric diagnosis: A worldwide perspective. World Psychiatry, 1(3), Bruce, M. L., Ten Have, T. R., Reynolds, C. F., Ⅲ, Katz, I. I., Schulberg, H. C., Mulsant, B. H., et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. The Journal of the American Medical Association, 291, Buglass, D., & Horton, J. (1974). The repetition of parasuicide: A comparison of three cohorts. British Journal of Psychiatry, 125, Byrne, N., Regan, C., & Livingston, G. (2006). Adherence to treatment in mood disorders. Current Opinion in Psychiatry, 19, Cheng, A. T. (1995). Mental illness and suicide. A case-control study in east Taiwan. Archives of general psychiatry, 52, Cheng, A. T. A., Chen, T. H. H., Chen, C. C., & Jenkins, R. (2000). Psychosocial and psychiatric risk factors for suicide: Case--control psychological autopsy study. British Journal of Psychiatry, 177, Cheng, A. T. A., Mann, A. H., & Chan, K. A. (1997). Personality disorder and suicide: A case-control study. British Journal of Psychiatry, 170, Craven, M., & Bland, R. (2006). Better practices in collaborative mental health care: An analysis of the evidence base. Canadian Journal of Psychiatry, 51, 7S 72S. Guthrie, E., Kapur, N., Mackway-Jones, K., Chew-Graham, C., Moorey, J., Mendel, E., et al. (2001). Randomised controlled trial of brief psychological intervention after deliberate self poisoning. British Medical Association, 323, Hall, D. J., O Brien, F., Stark, C., Pelosi, A., & Smith, H. (1998). Thirteen-year follow-up of deliberate self-harm, using linked data. British Journal of Psychiatry, 172,

8 12 Suicide Prevention Strategy and Prospects Hawton, K., Harriss, L., Hall, S., Simikin, S., Bale, E., & Bond, A. (2003). Deliberate self-harm in Oxford, : A time of change in patient characteristics. Psychological Medicine, 33, Lee, M. B., Liao, S. C., Lee, Y. J., Wu, C. H., Tseng, M. C., Gau, S. F., et al. (2003). Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity. The Journal of Formosan Medical Association, 102(10), Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., et al. (2005). Suicide prevention strategies: A systematic review. The Journal of the American Medical Association, 294, Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks from mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press. Ostamo, A., & Lönnqvist, J. (2001). Excess mortality of suicide attempters. Social Psychiatry and Psychiatric Epidemiology, 36(1), Vaiva, G., Vaiva, G., Ducrocq, F., Meyer, P., Mathieu, D., Philippe, A., et al. (2006). Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: Randomised controlled study. British Medical Association, 332, Wilcox, H. C., & Anthony, J. C. (2004). The development of suicide ideation and attempts: An epidemiologic study of first graders followed into young adulthood. Drug and Alcohol Dependence, 76, S53 S67. World Health Organization. (2001). The world health report: 2001: Mental health: New understanding, new hope. Geneva, Switzerland: Author.

9 13 The Strategy and Prospects of Suicide Prevention in Taiwan Ming-Been Lee Chuan-Wan Tai * Shih-Cheng Liao ** Hung-Chi Chiang *** Abstract: Suicide mortality rates have been steadily rising in Taiwan, and suicide has been among the top ten causes of death for the last consecutive eight years. In response to this situation, the Taiwan Department of Health assigned the Taiwan Association Against Depression the task of setting up the Taiwan Suicide Prevention Center. The mission of the Center, suicide prevention, is advanced by its establishment of efficient networks nationwide capable of delivering related care services. Suicide prevention strategies can be categorized, based on coverage, as universal, selective or indicated interventions. The Center also plans to standardize the national suicide report format and care delivery system, improve mental health service quality, and organize community support networks. It pursues an encompassing health care mechanism model, where clients are considered the first priority, the family a fundamental supporting unit, and the community a solid foundation. The Center will offer a helping hand for individuals who have attempted suicide by maintaining a spirit of positive values and achieving mutual benefits. Key Words: suicide prevention, mental health, surveillance, holistic care. MD, Director, National Taiwan Suicide Prevention Center; Visiting Staff, Department of Psychiatry, National Taiwan University Hospital; Professor, Department of Psychiatry & Department of Social Psychiatry, College of Medicine, National Taiwan University; *MS, Deputy Director, National Taiwan Suicide Prevention Center; **MD, Deputy Executive Director, National Taiwan Suicide Prevention Center & Visiting Staff, Department of Psychiatry, National Taiwan University Hospital; ***MS, Deputy Executive Director, National Taiwan Suicide Prevention Center & Doctoral Candidate, Institute of Epidemiology, College of Public Health, National Taiwan University. Received: October 30, 2006 Revised: November 9, 2006 Accepted: November 10, 2006 Address correspondence to: Ming-Been Lee, No. 7, Chung-Shan S. Rd., Taipei 10002, Taiwan, ROC. Tel: 886(2) ext. 6784; mingbeen@ntumc.org