臺北市自殺企圖者自殺防治網絡運作圖像之研究

Abstract

自殺一直是個難解的議題，對於在社區中服務的社工員而言，面對自殺企圖者常常感到焦慮與不知所措，不曉得該怎麼協助他們才對，也不知道該如何讓自殺企圖者不再自殺。目前有關自殺的研究大多以量化研究為多數，與自殺有關的服務亦多以醫學或輔導觀點為主，有關網絡合作及與自殺企圖者互動經驗則付之闕如。 本研究採用質性研究方法，深度訪談三位併經濟需求的自殺企圖者及五位自殺防治網絡人員，藉由自殺企圖者回溯自殺故事，得以蒐集其在自殺危機期間的求助歷程及與自殺防治網絡聯繫經驗，並探討各自殺防治網絡協助自殺企圖者之過程及各網絡間的互動情形，藉以勾勒出自殺防治中心與社福中心等自殺防治網絡在協助自殺企圖者之實際運作的圖像。 本研究結果發現，自殺企圖者與自殺防治網絡間的求助過程是一個複雜的多角關係習題，不論是自殺防治網絡主動關心或是自殺企圖者向自殺防治網絡求助，一旦相互接觸就有不斷重複的議題和協助發生，循環不已，剪不斷理還亂。此外，這些併經濟需求的自殺企圖者經常有其理性選擇的思考，會排斥無法給予實質幫助或無法獲得關懷的網絡，自行選擇自己想要接觸的網絡，甚至聚焦於某些可以提供實質幫助的固定網絡人員身上。臺北市的自殺防治網絡之直接服務體系，大致以衛生體系的自殺防治中心和社政體系的社會福利服務中心為主，這兩大自殺防治網絡因機構角色、任務、助人觀點、工作模式等差異，以及服務對象的不同特性，致使雙方的溝通合作出現落差及斷裂，加上缺乏多元網絡共同討論自殺企圖者之橫向連結機制，致網絡合作功效有限。 故本研究提出以下幾點建議： 一、增進網絡人員自我覺察，調整與自殺企圖者專業關係，並增加團隊共同討論處遇計畫，減少網絡人員承受之壓力及負擔。 二、為提升網絡人員之專業能力，與網絡間建立工作默契，建議採取專精社工制度協助自殺企圖者。 三、針對個別困難處理且需要網絡共同協助之自殺企圖者，進行個案研討，邀請各網絡主責人員參與，以增強自殺防治網絡橫向連結之合作機制。

For community social workers, it is challenging to serve suicide attempters. Frequently, social workers are not specialized in helping the suicide attempters who need in-depth counseling services. Most studies about suicide issues are in a quantitative way so far, and counseling services designed to help them are based on perspectives of medicine or counseling psychology. However, few studies focused on the network collaboration in helping attempters with economic difficulties in the community. The method of this study is qualitative. By in-depth interviewing with three suicide attempters with economic needs and five network workers from the suicide prevention networks in Taipei City Government, the researcher described stories of how the suicide attempters seek help from the networks and the network workers provide help to them. Based on their narratives, this study discussed how the suicide prevention networks responded to the attempters’ needs and how the networks work together to help the attempters. The findings of this study show that the suicide prevention network responded to the attempters with economic difficulties is not as straightforward and simplified as it was intended to help the attempters. First, the suicide prevention network in Taipei City Government included several service subsystems, however, mainly Social Welfare Service Center and Suicide Prevention Center. Each subsystem has its own working style in terms of institutional mission, working style, and working method. In operation, on the one side, the suicide attempters with economic difficulties preferred to seeking the help from community social workers in the Social Welfare Service Center, because they could receive actual economic benefits and counseling services. On the other side, the Social Welfare Service Center expected the Suicide Prevention Center played a key role in providing counseling services to the attempters, who however turned down counseling services from the latter Center. The Suicide Prevention Center expected the Social Welfare Service Center took care of the attempters in need of economic benefits. The two direct service systems did not collaborated with each other as the networks expected to do so due to lacking of communication and coordination. The suggestions of this study are as following: 1.We need to improve the teamworkhip among networkers, adjust the professional relationship between professionals and suicide attempters, and build a teamwork culture to lessen the stress and burden on the workers. 2.To improve the professional ability of networkers and the consensus between systems, we need to advocate a specialized social work system in the Social Welfare Service Center to serve the suicide attempters. 3.For attempters with economic difficulties, case conference between subsystems is needed to improve collaboration and coordination in suicide prevention networks in Taipei City Government.