Social worker reveals how she deals with suicidal patients

SINGAPORE - When patients feel at their most vulnerable, Head of medical social services at Singapore General Hospital (SGH) Ms Esther Lim steps in to help them make sense of what is happening.

Such patients may have tried to take their own lives or showed signs of wanting to do so. Ms Lim also helps families cope when they have lost a loved one.

The 39-year-old's helping hand is extended not just to patients, but also to hospital staff who face challenges at home or at work, for instance, if they have been abused by a patient.

In 2003, she pioneered a programme in SGH to train health-care and social work professionals in suicide intervention. It is now also offered in SingHealth's Postgraduate Allied Health Training Institute.

Since becoming a social worker in 1995, Ms Lim, who leads a team of 85 medical social workers, has received more than 15 awards. Last year, she was one of two recipients of the Outstanding Social Worker Awards given out by the Singapore Association of Social Workers.

She is married to a 37-year-old police officer. They have a six-year-old daughter.

I specialise in suicide and crisis intervention because...

When I was working in the emergency department years ago, I saw how a crisis, such as a life-threatening illness, a serious road traffic accident or an attempted suicide, can throw a family off balance.

The sense of disbelief and loss can be overwhelming, so this is where I step in to help people make sense of what is happening.

The immediate goal is to reduce the intensity of the emotional, physical and behavioural reactions, while the long-term goal is to help families get back to as normal a life as can be.

A person's life is precious because...

We live only once, so we have to live it fully and with dignity, despite our circumstances.

One little known fact about suicidal patients is...

They are not mentally ill. Anyone facing a seemingly desperate situation can be vulnerable to feeling hopeless and helpless, which may escalate to suicidal acts if the person does not receive help or cuts himself off from others.

If I were to give an analogy for what I do, I would...

Be a bridge to connect the suicidal person with the resources around him, such as family service centres, care facilities and legal aid. Often, a person may think nobody can help him, which is not true.

The eventual goal is to reconnect the suicidal person with his family and loved ones through individual, couple or family sessions.

A typical day for me would...

Start at 8.30am with administrative duties, followed by morning staff meetings or journal club sessions. I meet senior staff members regularly to plan and implement assistance schemes which benefit patients.

Other medical social workers also come to me to seek advice on cases they are working on. I co-manage the difficult cases, such as those which may involve suicide, or in which patients or family members consistently display behavioural difficulties.

I also support hospital staff members who need help and teach them coping strategies.

I have come across all types of cases...

But I find that families with strong social support fare better in crises. After the initial shock and confusion, members organise themselves very quickly to protect the affected family member by providing physiological and emotional comfort.

I love patients who...

Make it a point to turn up for their follow-up counselling sessions because this shows their readiness and motivation for change.

Patients who are forthcoming, open to working with their families and willing to reflect on themselves often make better progress.

They pick up positive coping strategies to deal with life's challenges, which range from relationship discord, financial issues to mental health or addiction challenges.

Patients who get my goat are...

Those who blame everyone else for their problems, without realising that they have a part to play.

For instance, a suicidal husband may be domineering at home and may keep blaming his wife and children, without realising that he has failed to communicate properly with them.

This can also explain the persistent suicidal behaviour in some patients. This vicious circle may wear out their loved ones and cut patients off from the support they used to have.

Things that put a smile on my face are...

Receiving handmade cards from the children of one patient whom I saw for attempted suicide and depression over several years.

Every year, though the drawings and handwriting would mature, they always conveyed their appreciation to me for being there for their mother.

It breaks my heart when...

An elderly patient asks me if the doctor can help end his life because he does not want to burden his children.

I realise, through interaction with elderly patients, that they are so stoic and self-reliant that they feel useless when they cannot contribute financially, take care of their grandchildren or, worse still, become disabled.

They have laboured hard all their lives, yet they have not come to accept that there is a time to receive unconditional care in return.

I would not trade places for the world because...

There is still so much to be done that I cannot find enough time for everything. This is what I am trained for and playing a part to restore equilibrium to lives is a constant reminder to live mine fully.

My best tip is...

To learn to take charge of emotions, thus reducing the likelihood of acting on impulse when emotionally charged.

Some things which may help include taking slow, deep breaths, sharing your problems with a trusted mentor and putting vexing matters on the back-burner, that is, taking your mind off it and revisiting the issue when you are calmer.

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