Elderly Suicide Prevention Programme 长者防止自杀计划 / 老年精神科速治服务 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 Background 背景 Development of program 计划发展 Contents of program Statistics 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 Age年龄60+(%) Age年龄75+(%) 1998 968,000(14.5%) 701,200(10.4%) 2001 1,004,300(14.9%) 747,052(11.1%) 2016 1,593,800(19.9%) 1,076,700(13.4%) 2021 1,936,000(22.9%) 1,322,500(15.7%) 2029 2,341,100(25.9%) 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 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 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 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 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 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 First tier 24 hours elderly hotline Home helpers and volunteer visits General Physicians Second tier Counselors provides services for Elderly Third tier Specialist Psychogeriatric services 第一层 24小时长者热线 家务助理员和义工探访 家庭科医生 第二层 辅导员队伍为长者 提供服务 第三层 老年精神科专科服务

ESPP 老年精神科速治服务 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。 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 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。 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 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 H.A. cluster based program 医管局属下划分为不同联网区域 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 Fast Track Clinics 速治诊所

服务对象及特式 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

GOPD/GP/AED/CGAS/SOPD/ CNS with medical referrals 由普通科门诊部 / 普通科医生 / Refer system 转介系统 Professionals 专业人员 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 Direct contact with nurses 由速治诊所转介直接联络 专科护士 Ward Consultations 病房咨询 Triage分流 No 否 Yes 是 Yes 是 No 否 Fast Track Clinic 速治诊所 老年精神科

Characteristics of our clients 病人的特征 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 Heavy work load, Sudden influx of cases 突然涌入的个案增加工作负担 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" 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 Language barrier, dialects 语言障碍 -- 方言 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 Take in new cases with risk of suicide 有自杀风险的个案 Follow the protocol of the FTCs in case management 跟据预定的执行程序, 作个案管理 Assess the suicidal risk of the clients continuously 持续评估自杀风险 Provide supportive counseling and psycho-education about depression 支持性的辅导及心理教育 Provide information about the community resources 提供社区资源的资料 Referral to appropriate services 转介其他的服务

Services to professionals 服务 - 专业人士 Information collection for assessment and case monitoring 评估和个案监测, 作资料收集 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 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 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 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 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 支持性的辅导 给与防范自杀的知识 解释紧急的应变计划 作工作联盟 Supportive counseling Advice on suicidal precautions Explain the contingency plan in case of emergency Work alliance for case management

NTE cluster新界东联网 香港地图 Hong Kong Map

NTE catchment area 新界东集中区 NTE cluster includes the north east region of the territory Sheung Shui Fanling Tai Po For Tan Shatin Ma On Shan 新界东联网包括新界区东北地区 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 22 The highest monthly cases number under the care of suicide prevention nurse 每月最高跟进个案数目(由预防自杀护士处理) 173 175 177 Home visits paid 家访数目 1202 1429 1654

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 At least every 3 months 最少每三个月一次 At least tel check monthly 最少每月电话跟进一次

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 速治诊所活跃个案 (每年年结) Suicidal death cases 自杀死亡个案 2002 174 2003 619 5 2004 1167 2005 1807 7 2006 2138 (Up to Sept 2006) (直至2006年9月) 8

Reference 參考文獻 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. 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