希死念慮から自傷行為に及ぶ女子高校生に対する復学支援—児童思春期精神科病棟における作業療法

Support for returning to school for a high school girl experiencing suicidal thoughts and self-harm: Occupational therapy in a child and adolescent psychiatric ward

要旨：今回，筆者は児童思春期精神科病棟において，学校のストレスなどから自傷行為に及ぶ女子高校生に関わる機会を得た．本介入では，対象者が興味関心を示す作業を基に自己肯定感と自己効力感を醸成し，このうえで自傷行為に及ぶ状況を明らかにした．また，自傷行為防止プランを用いて対象者が自傷行為に及ぶリスクを軽減した結果，高校の復学に繋げることができた．本介入から，作業療法士は具体的な作業を通して対象者の自己肯定感と自己効力感を醸成し，対人交流技能やストレス対処技能など復学に向けて必要な技能を向上し，様々な対処行動を示したプランの作成などを通して自傷行為に至るリスクを軽減することで復学を支援できると考えられた．

　In this report, I had the opportunity to interact with a high school girl in the child and adolescent psychiatry ward who self-harmed due to stress at school. In this intervention, she cultivated a sense of self-affirmation and self-efficacy based on the occupation that she showed interest in, and then clarified the situations that led to self-harm. Additionally, by using a self-harm prevention plan, I could reduce the risk of self-harm and enable her to return to high school. Through this intervention, it was thought that occupational therapists could support clients' return to school in several ways: by fostering the clients' self-affirmation and self-efficacy through concrete occupations, improving the skills necessary for returning to school, such as social interaction skills and stress coping skills, and by reducing the risk of self-harm through creating a plan that included various coping behaviors.