障害福祉サービスなどにおける精神障害者の自殺と対策の課題―ある大都市近郊地域での事業所調査から

Suicides by Mentally Ill Clients of Welfare Services Providers and Its Influence on the Staff：A study of service providers in a suburban area of a metropolis

抄録

　精神障害者向け障害福祉サービスなどの利用者の自殺関連問題の現状把握のため，ある大都市近郊地域の事業所170か所を対象に，自殺や自殺の職員への影響などについて質問紙法で調査した。117か所が回答し，事業所あたり年間自殺発生率は0.072，利用者10万人あたり年間自殺者は180人と算出された。自殺発生時期における秋から冬の季節の割合は，当該地域住民全体に比べ，利用者において有意に高かった。自殺発生後に，事例担当職員の多くは抑うつ気分，脱力感などを体験し，業務に支障を来した人もあった。事業所での自殺対策では，利用者の自殺リスクに関する職員の認識，危険要因への配慮，業務マニュアルの整備や外部機関の活用が課題と考えられた。

　Background：Mental disorders are significant risk factors of suicide attempts, but little is known about the suicidal tendencies among mentally ill clients of the community welfare services in Japan.

　Objective：This study aimed to assess the suicidal tendencies among mentally ill clients of institutions providing community welfare services, including consultation and support, day activity support, and group home with aid (group home). We also assessed the negative influence of such suicidal patients on the staffs of sach institutions.

　Subjects and Methods：The study subjects were 170 welfare service providers who serve patients with mental disorders in a suburban area of a metropolis. Each subject was provided a questionnaire to collect information about the services offered and its clients, number of clients who attempted suicide from April 2006 to December 2008, and suicide prevention activities employed (mandatory question). We also provided a suicide case report form requesting details about the method of suicide, their own experience, and the experience of their client (this was to be filled by the staff who was attending to the suicide case).

　Result：We received replies from 117 subjects. Their services had been used by approximately 4,500 clients, of which 62% were men and 72% were patients with schizophrenia. During a period of 33 months, 23 suicides cases were reported. Thus, the annual suicide rate was approximately 0.072 per service provider and 0.0018 per user. The detailed description was provided for 18 suicide cases, and it indicated that autumn and winter seasons may be related to the suicidal tendencies observed among the clients. Most of the staff in charge of the clients who committed suicide experienced depressive moods, guilt, and other general responses to trauma-related stress, which negatively affected their working efficiency.

　Conclusion：The number of suicide attempts by mentally ill clients of the welfare providers can be reduced by analyzing the risks of suicide among the mentally ill clients, revising work manuals to include management of suicidal tendency, and receiving active help from external specialist agencies.