自殺通報個案關懷訪視員之身心安全與工作挑戰

Personal Safety and Work Challenge of Suicide Prevention Case Managers

吳姿儀(Tzu-Yi Wu)

指導教授 ： 汪淑媛

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2016年)

摘要

在台灣，自殺議題漸趨嚴重，民國94年底成立自殺防治中心，民國95年啟用自殺通報系統，自殺通報個案關懷訪視員（簡稱自關員）一職應運而生，自關員負責各縣市自殺防治通報系統通報個案的後續關懷及轉介服務，減少自殺高危險群重複發生自殺或自傷等行為，並提供其家屬情緒支持及評估等，以降低其危險性。然而，研究者從工作經驗中發現自關員在服務過程中充滿著許多身心安全的危機，也面臨到許多工作挑戰，但這部分卻鮮為人知。
本研究旨在透過自殺通報個案關懷訪視員的經驗重現，瞭解在服務過程中所遭遇的身心安全問題以及工作挑戰，探討後續造成的影響為何，並理解這份工作本身或機構是否提供相關協助和因應作為為何。另外也透過自殺通報個案關懷訪視員之分享與發想，探討面對自殺者時的工作方式為何。最後期望透過自殺通報個案關懷訪視員自身發聲，建構可以提供自關員足夠安全保護且協助自關員面對工作挑戰的職場環境。為了對自關員一職有更全面性且深入的了解，本研究採用質性研究中的深度訪談法作為研究方法，邀請五位訪談參與者分享其寶貴的實務經驗，以回應研究目的。
研究結果分為四節，第一節中發現自關員們受到來自體制、角色定位、勞動條件、實際服務、與資源單位合作的工作挑戰；第二節說明了自關員們正遭受著身體安全以及心理衛生的危險；第三節進一步反思這份工作與工作方式，包含對於自殺者以及自殺行為的想法、對於自殺防治的想法以及實際上自關員做了些什麼；最後一節，從訪談當中歸納出訪談參與者們在服務時的正向經驗以及對於未來的展望。
本研究發現自關員在與自殺者同行的路上面對許多挑戰，勞動條件不佳、服務案量普遍過高、專業督導以及訓練不足、與周遭資源單位合作不易，而角色本身定位的模糊，更導致自關員必須承擔過多的壓力與責任。另外也發現自關員也有遭受身體安全攻擊的可能性，而外界過多的期待、冗長的事後檢討，以及服務自殺者的心理壓力，更是造成自關員心理狀況不佳的原因。
最後本研究結論提出具體的理想藍圖，期許政府以及地方主管機關應重視自殺議題以及自殺防治的重要性，建構自關員合理且穩定的工作環境，改善目前一年一標的方案承包方式，自關員案量應在於20-30案左右，也應視年資以及工作風險調整工作待遇，並配有專業督導以及訓練的福利，重視其專業價值，且不應因服務個案的自殺身亡而向自關員究責，讓自關員成為社會自殺議題的代罪羔羊。
自殺從來就不是一個人或是一件事而已，自殺是由整個社會造成的，也是會影響整個社會的事，而社會對待高自殺風險者的不友善，也會增加更多的自殺者。一個人會選擇自殺，這當中牽涉到許多因素，單憑自關員要翻轉自殺者的生命，簡直是一場不可能的任務。因此自殺防治不單單是自關員的責任，陪伴自殺者跨過人生的斷崖，需要很多人一起來搭座橋，橋裡有許多人的支持與愛，人人都可以多做一點，來避免一個生命消失的遺憾，我們每個人都可以做的更多一點。

關鍵字

自殺 ； 關懷訪視員 ； 深度訪談

並列摘要

In Taiwan, the issue of suicide is increasing in case number. Since the establishment of the Suicide Prevention Center in 2005 and the initiation of the suicide report system, the new occupation of suicide prevention case managers was also conceived. Suicide prevention case managers will be in charge of post-event care and referral service of reported suicidal individual in each county or city, to reduce the repetitive behavior of suicide or self-inflicted injury in high-risk population, as well as providing support and evaluation for relatives to reduce the overall risk. However, from work experience, researchers found that there was actual issue of safety to the physical and psychological health of these suicide prevention case managers. The challenges from the job could be difficult to overcome and they were hardly reported.
The research aimed to re-investigate the issue of safety to the physical and psychological health of these suicide prevention case managers via interview of their experiences to understand the post-trauma effect, in order to evaluate if the job or the institution included necessary assistance for these personnel. In addition, by sharing and brainstorming with these suicide prevention case managers of reported suicidal individual, we would understand the work mode and environment in face with suicidal individuals. Lastly, we hoped with representing voices of these suicide prevention case managers of reported suicidal individual, that we could establish a more appropriate occupational environment with adequate protection and assistance to these personnel. In order to completely understand the job in depth, the research used in-depth interview as qualitative research method, involving 5 suicide prevention case managers to share the actual work experiences.
The research was divided into four sections. The first section discovered that these suicide prevention case managers were affected by challenges from the system, the role, the labor condition, the actual service, and the unit resource integration. The second section illustrated the actual physical and psychological health problem confronted by the personnel. The third section further explored the work, including the idea and behavior of suicide exhibited by these individuals, as well as the concept of suicide prevention and the actual act of prevention. And, the last section would focus on the conclusion of positive experience and future prospect in the job from interviewing these participants.
The research discovered that these suicide prevention case managers generally faced many challenges, including poor labor condition, high case number, inadequate professional supervision and training, and poor coordination between unit for sharing resource. The obscurity in role defining for the social workers further put more pressure and responsibility on the them. Furthermore, it was found that these suicide prevention case managers were prone to physical attack and could threaten their lives. And, high expectation from outside world, long post-event evaluation, and psychological pressure of servicing these suicidal individuals would cause poor psychological effect on the workers.
At the end of research, we proposed an actual ideal blueprint to expect the government and local institutions to pay attention to the issue of suicide and its prevention, to establish an appropriate and stable work environment. The current annual outsourcing method must be improved and the case number for each suicide prevention case managers should be controlled at 20 to 30. The job payoff should be based on the yearly experience and occupational hazard, to enjoy the benefit of professional supervision and training. Their professionalism should be highly valued and they should not be blamed for individual failure, as the society tend to turn them into scapegoat for the issue of suicide.
Suicide should never be regarded as an individual or an event, but rather should be the end result of societal problem and could affect the entire community. The unfriendliness toward high-risk population would only increase more suicide case. Many factors could involve in a case of suicide. By only relying on one suicide prevention case manager to save the life of a suicidal individual is almost mission impossible. Therefore, suicide prevention is not the sole responsibility of a suicide prevention case manager. To assist a suicidal individual to walk across the gap in life requires construction of a bridge of care by multiple people. The bridge will carry support and love and everyone should be involved, so that tragedy would not occur. We can all do more in assisting suicidal individual.

並列關鍵字

Suicide ； Suicide Prevention Case Managers ； In-depth interview

參考文獻

余麗華、陳文意、譚利光、林玉惠（2012）。台灣地區自殺死亡率相關因子探討。澄清醫護管理雜誌，8（1），26-35。

李明濱、戴傳文、廖士程、江弘基（2006）。自殺防治策略推動現況與展望。護理雜誌，53（6），5-13。

汪淑媛（2008）。論台灣社工教育對社會工作職業風險之忽視。臺大社會工作學刊，17，1-42。

高淑清（2001）。在美華人留學生太太的生活世界：詮釋與反思。本土心理學研究，16，225-285。

陶蕃瀛（2004）。行動研究：一種增強權能的助人工作方法。應用心理研究，23，33-48。