Elderly Suicide Prevention Programme
长者防止自杀计划 / 老年精神科速治服务
Prof. Linda Lam
Department of Psychiatry
The Chinese University of Hong Kong
香港中文大学
精神科学系林翠华教授
Contents 内容
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Background
Development of program
Contents of program
Statistics
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背景
计划发展
内容纲要
数据统计
Aging population in Hong Kong
香港人口老化数据
1998
2001
2016
2021
2029
Age年龄60+(%)
968,000(14.5%)
1,004,300(14.9%)
1,593,800(19.9%)
1,936,000(22.9%)
2,341,100(25.9%)
Age年龄75+(%)
701,200(10.4%)
747,052(11.1%)
1,076,700(13.4%)
1,322,500(15.7%)
1,792,000(19.8%)
來源:1. 香港统计月刊1998年10月香港特别行政区政府统计处
2. 2001年人口普查,香港政府统计处网页
3. 2001年人口普查(推算数字)
Suicide rates and deaths by age group
按年龄组别分布的自杀率及死亡率
http://csrp.hku.hk/WEB/eng/statistics.asp#2
Background 背景
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Working Group on Elderly Suicide and Depression under the Elderly Commission in 1998
在1998年安老事务委员会的防止老人自杀和抑郁工作组成立
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A series of prevention strategies established, e.g the healthy ageing campaign
确立一系列的预防策略 例子:康健乐颐年运动
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Reduction of suicide rates after the training of GP in the Gotland Study
(Rihmer et al.,1995) 一项研究指出 - 在家庭科医生经培训后老人自杀率降低
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Italian telecheck program in decreasing the elderly suicide rate (De Leo et al., 1995)
意大利电话追踪跟进计划 - 长者自杀率降低
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Hong Kong Council of Social Service, Hong Kong Psychogeriatric Association and the
Social Welfare Department had initiated a 3-year joint project in 2001
在2001年,香港社会服务联会,香港老年精神科学会和社会福利署开始了一个为期3年的联
合项目
3-Tier Coordinated Service Model
三层 - 协调服务模式
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 第一层
First tier
 24小时长者热线
 24 hours elderly hotline
 家务助理员和义工探访
 Home helpers and volunteer visits
 General Physicians
 家庭科医生
 第二层
Second tier
 辅导员队伍为长者
 Counselors provides services
提供服务
for Elderly
 第三层
Third tier
 老年精神科专科服务
 Specialist Psychogeriatric services
ESPP 老年精神科速治服务
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To tackle the problem of elderly suicide from a mental health perspective,
the Hospital Authority launched an Elderly Suicide Prevention Programme in
Oct.,02. (ESPP)
在2002年10月,医院管理局开展了一项防止长者自杀的计划。
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Enhance early detection and treatment of depression in elders
该方案加强早期检测,和治疗抑郁症的长者
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Provide intensive follow-up services through its fast track clinics
并通过速治诊所,于有需要的长者提供密集式跟进服务。
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Telephone hotline and crisis intervention for elders with suicidal risks.
热线电话,危机干预长者自杀风险。
The ESPP-HK News
香港老年精神科速治服务快讯
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The news provides up-to-date information about the
program
提供关于治疗计划的最新信息
( http://www.ha.org.hk/espp/ )
香港老年精神科速治服务
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H.A. cluster based program
医管局属下划分为不同联网区域
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QM, PY, UC, KH, CPH, KCH, NTE
玛丽医院,东区尤德夫人那打素医院,
基督教联合医院,九龙医院,青山医院,
葵涌医院,新界东联网
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Fast Track Clinics
速治诊所
服务对象及特式
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New to the MHS
从未接受精神科服务的长者
Aged ≥ 65
年龄 ≥ 65
Suicidal risk present
自杀风险
Severe depression with GDS ≥8
严重抑郁症 (老年忧郁量表≥8 )
Initial home visit for assessments provided within 7 working
days
在7个工作天内提供初次的家访评估
FTC appointment arranged within 2 weeks from the time of
referrals received
从接获转介到安排到速治诊所只需两星期
Refer system 转介系统
Professionals
专业人员
Direct contact with nurses
由速治诊所转介直接联络
专科护士
No 否
Ward
Consultations
病房咨询
Referrals from
GOPD/GP/AED/CGAS/SOPD/
CNS with medical referrals
由普通科门诊部 / 普通科医生 /
急症室 / 社区长者评估服务/
专科门诊部 / 社康护理
作服务转介
Yes 是
Triage分流
Yes 是
Fast Track Clinic 速治诊所
老年精神科
No 否
Characteristics of our clients
病人的特征
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Suicidal ideations, suicidal attempts
有自杀意念, 企图自杀
Multiple physical problems (COPD, Renal Problem with CAPD, Stroke)
多种普通科病征 (慢性阻塞性肺病,肾病接受腹膜透析,中风)
Chronic pains
慢性疼痛
Poor interpersonal relationship
人际关系问题
Inadequate social support
缺乏社会支持
Negative thoughts
负面思想
Rigid in personality
固执性格
Poor coping skills
较差的应付技巧
Difficulties困难
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Heavy work load, Sudden influx of cases
突然涌入的个案增加工作负担
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Social stigma about psychiatric care, “I have no psychiatric
illness”
处理精神病患对面标签心理障碍 -- "我没有精神病"
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Inadequate knowledge about depression for clients and carers
服务对象及照顾者对抑郁症的知识不足
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Language barrier, dialects
语言障碍 -- 方言
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Inadequate community resources for elderly
对长者的社区支援资源不足
Services to clients
服务 - 服务对象
1.
Take in new cases with risk of suicide
有自杀风险的个案
2.
Follow the protocol of the FTCs in case management
跟据预定的执行程序, 作个案管理
3.
Assess the suicidal risk of the clients continuously
持续评估自杀风险
4.
Provide supportive counseling and psycho-education about depression
支持性的辅导及心理教育
5.
Provide information about the community resources
提供社区资源的资料
6.
Referral to appropriate services
转介其他的服务
Services to professionals
服务 - 专业人士
1.
Information collection for assessment and
case monitoring
评估和个案监测, 作资料收集
2.
Advice on suicidal precautions and safety
precautions
给与防范自杀和安全预防措施的引導
Services to community
服务 - 社区
1.
Organize the educational activities about
the depression and elderly suicide
组织关于抑郁症和长者自杀的教育活动
2.
Join with staff in local organizations x
promoting mental health for elders
与地方组织联合推广长者精神健康
Services to ESPP as a member
老年精神科速治服务
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Assist in evaluation studies relevant to the
ESPP
协助与老年精神科速治服务有关的评估研究
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Work with staff in other clusters x quality
improvement
与其它联网的职员合作, 达至质量改进
Services to caregivers
服务 - 照顾者
1.
Supportive counseling
1.
支持性的辅导
2.
Advice on suicidal precautions
2.
给与防范自杀的知识
3.
Explain the contingency plan
in case of emergency
3.
解释紧急的应变计划
4.
Work alliance for case
management
4.
作工作联盟
NTE cluster
新界东联网
香港地图 Hong Kong Map
NTE catchment area 新界东集中区
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NTE cluster includes the
north east region of the
territory
新界东联网包括新界区东北
地区
Sheung Shui
Fanling
Tai Po
For Tan
Shatin
Ma On Shan
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上水
粉岭
大埔
火炭
沙田
马鞍山
Fast Tract Clinics, NTE
速治诊所, 新界东
1 MO
1 Nursing Office
2 Nurses
1 位医生
1 位护士长
2 位护士
ESPP, NTE
老年精神科速治服务, 新界东
2004
2005
2006
Total new cases received by SPNs x screening /
monitoring
由专科护士总共接获的新个案 (检查/监测)
220
223
275
Average monthly new case
平均每月的新个案
18
18
22
The highest monthly cases number under the care of
suicide prevention nurse
173
175
177
1202
1429
1654
每月最高跟进个案数目(由预防自杀护士处理)
Home visits paid
家访数目
3 star monitoring system
监测系统
新界东,老年精神科速治服务
Number of star
星的数目
Tel Check
电话跟进
Home visit
家访评估
Progress report
进度报告
3
Weekly
每星期
At least every 3 weeks
最少每三星期一次
Available on each visit
适用每次家访
2
Regularly
定期
At least monthly visit
最少每月一次
At least every two
months
最少每两个月一次
1
At least home visit bimonthly
最少每两个月一次
At least every 3 months
最少每三个月一次
0
At least tel check monthly
最少每月电话跟进一次
At least every 3 months
最少每三个月一次
Suicidal death in the ESPP, H.K.
香港老年精神科速治服务 - 自杀死亡个案
Active FTC cases
by year end
Suicidal death
cases
速治诊所活跃个案 (每年年结)
自杀死亡个案
2002
174
2003
2004
619
1167
5
5
2005
1807
7
2006
2138
8
(Up to Sept 2006) (直至2006年9月)
Reference 參考文獻
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De Leo D, Carollo G, Dello Buono M. 1995. Lower suicide rates associated with a tele-help/tele-check
service for the elderly at home. Am J Psychiatry 152: 632-634.
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Rihmer Z, Rutz W, Pihlgren H. 1995. Depression and suicide on Gotland: and intensive study of all
suicides before and after a depression-training programme for general practitioners. J Affect Disord 35:
147-152.
Thank You
谢谢
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Geriatric Depression Scale GDS