Social workers' duty of care in suicide prevention and intervention

Suicide: Duty of Care vs. Self-Care

Social Work and the Duty of Care

The social work profession aims at promoting social change, solving problems in human relationships, empowering and liberating individuals in order to enhance well-being (IFSW 2004). Social work intervenes at points where individuals interact with their respective environments through appropriate theories of human behavior and social systems. Principles of human rights and social are the fundamental guides of the practice and profession. Social workers are bound by these responsibilities in relation to the society and the people with whom they work (IFSW). The Australian Association of Social Workers now has a membership of 6,000 nationwide (AASW 2011). It is committed to the principles of justice, the enhancement of quality life and the realization of the full potential of every individual, group and community it serves (AASW).

American negligence law recognizes the duty of reasonable care of others in danger as a moral duty (Word Press 1988). It is also a legal duty if a special relationship between the parties. A court of law recognizes a therapist's duty to care and warn her patient of imminent harm on his life. This is comparable to a doctor warning a patient about a contagious or serious disease (Word Press).

Suicides and the Social Worker

A social worker's experience of seeing a client fall to his death through her office window in a building is not unusual. Suicide rates have gone up drastically in the last three decades, especially among adolescents and young adults (Rentsch 2011 p 2). Australia has among the highest rates of suicides in the world in the last 10-15 years. In response, the Commonwealth Government has allotted substantial funds for research, suicide prevention and support programs in the last 5 years. Nonetheless, suicide rates have remained high and this trend indicates a serious social problem. Current statistics say that more than 500 young people commit suicide every year. This means that there are more deaths from suicides than from road accidents and from drug overdoses. It implies a lack of meaning in life among these young people (Rentsch).

In 2008, the Australian Bureau of Statistics also noted an increased incidence of suicide and self-harm at 70% in aboriginal communities with a high level of mental problems and alcohol and substance use (Journalism Education Team 2009). Most of the fatalities were males. This high level of intentional self-harm or self-destruction indicates mental problems and community distress. Hospitalization correspondingly increases with the rise in incidence. Knowledge of the extent of suicides is, however, unknown because of limited official methods of collecting pertinent data. These limited data indicate that suicide is more frequent in the earlier adult years among this group of inhabitants than for other Australians (Journalism Education Team).

In Queensland, higher levels of suicides have been identified among certain population groups (Department of Communities 2008). These are young people, indigenous people, older people, those from culturally and linguistically diverse ethnic groups, people in custody, the mentally ill, and homosexual people. Certain factors also predispose individuals to suicide. These are social isolation, psychological or emotional conflict, poor health, life stresses, marriage troubles, unstable family environment, residence in a rural area, drug or alcohol problem, financial worries, abuse, interpersonal loss, financial disadvantage, job loss or some other traumatic event or experience (Department of Communities).

Laws in virtually every State specify that healthcare professionals have the duty to protect or warn persons of any form of impending violence (Striefel 2008). Violence includes client suicide or a threat of suicide. The duty of the healthcare professional, the social worker in this case, is to take reasonable steps to protect potential victims from potential perpetrators of violence. Her responsibility includes warning these potential victims, to hospitalize or secure the patient from the possible scene of violence. It may also include the revelation of confidential information in the interest of the potential victim. She must promptly conduct an evaluation of dangerousness by asking the potential victim about violent fantasies and the content of these fantasies. She should determine the quality of these fantasies, the person's preoccupation with them, his level of planning and the details of this plan, and any history of past suicidal behavior. She should check other factors, such as a loss of relationship, mood disorders, substance abuse, he person's level of distress and compulsiveness towards certain actions. The courts expect a social worker, as well as other health professionals, to capably predict the potential dangerousness or harm her client may impose on himself (Striefel).

The Ethical Climate of Social Care

Nurses and social workers are essential to the delivery of quality health care and its continuum (Ulrich et al. 2007). Complexities in the delivery have also introduced difficult ethical issues and situations in patient care. These complexities also limit these professionals respect in their work and induce job dissatisfaction. A recent study investigated 1,215 nurses and social workers in four census regions of the U.S. On ethical issues confronted at work. It found that almost 2/3 of the respondents expressed frustration and fatigue over some of ethical issues they could do nothing about (Ulrich et al.).

Those without institutional support for adequately handling these issues and stress were more likely to leave their jobs than those who did not confront the problem (Ulrich et al. 2007). Of the 25% who would like to leave their current jobs, most were young workers and those who worked full time. The frustration, fatigue, disrespect and dissatisfaction over their job lead them to consider the many opportunities available in the outside. Analysis showed that the quality of ethical climate determines the relationship between ethical stress and job satisfaction. Job satisfaction, on the other hand, completely mediates ethical stress and the intent to resign. Nurses and social workers who enjoy support and resources in the ethical issues they confront are likelier to endure the stress involved in ethical situations and remain satisfied in their jobs. Findings also revealed that nurses and social workers in hospital settings suffer more ethics stress than those in non-hospital settings. The volume of patients and the intensity of the ethical issues or situations, staffing levels, the size of the hospital, its location and organizational characteristics seem to explain the finding (Ulrich et al.).

Self-harm, a major social problem

Select social workers identified the top 5 social justice issues as diversity, child welfare, healthcare, poverty and social problems (Gutierrez & Abramovitz 2007). People who live in chronic deprivation or harsh living conditions feel insecure and powerless. Some of them cope with their situation or escape from it by harming themselves through suicide. Social workers have the training and professional obligation to help these individuals in their distress. A social worker does this by helping the individual change his negative coping behavior into a positive coping behavior. She does this helping him seek social, health, financial and social advocacy assistance (Gutierrez & Abramovitz).

Social workers realize that exposure to serious or extreme economic hardship and other adverse conditions often leads to a host of adverse individual and social problems rather than the reverse. Prevention and social change are called for (Gutierrez & Abramovitz).

Professional Self-Care

Dorothea Orem's Self-Care Theory lists major assumptions (Current Nursing 2011). These are that people are self-reliant and responsible for their own care and those of their family who needs it; people are distinct individuals; nursing or care is an interaction between two or more persons; successfully meeting self-care requisites are basic to primary care prevention and ill health; knowledge of health problems promotes self-care; and self-care and dependent care are both learned within some socio-cultural context (Current Nursing). Some social workers recognize the importance of self-care but at times feel selfish when caring for themselves (Jones 2008). They need to think about older caregivers who neglect themselves and reach the time when they have to care for themselves. They will be helped in better ways if self-care is given the attention it need before they get to that point of not being able to give it to themselves because of age. Every health professional draws care from herself as the only vehicle. This makes self-care her basic responsibility. Tending to one's care will turn out to be a privilege in her career of caring for clients (Jones).

Policy Support for Professional Self-Care

The National Association of Social Workers (2011) recognizes the vital role of professional self-care in the practice of social work. It is an essential component in the competent practice of the profession itself. It acknowledges the very nature of the work. It emphasizes primary prevention and implies the needed tools and strategies for the professional self-care plan. It is critical in maintaining correct behavior and providing competent services to clients in different settings. It is critical in the provision of care for traumatized populations. And it is an important step in preserving the integrity of social workers and in retaining them in the profession (NASW).

What Professional Self-Care Consists of Every social worker should be aware of signs of impairment on her own physical, mental or emotional make up, such as burnout (Zur 2011, Larkin 2008). When she does, she should stop offering or providing professional services as these are likely to harm others. She should instead seek assistance to resolve the impairment. If necessary, she should suspend or terminate her professional responsibilities until she can safely resume work. When she decides to terminate practice, she should follow a prepared plan to transfer her clients and files to another social worker (Zur, Larkin).

Pampering oneself will help relax the body bring about the relaxation response

(Scott 2007). The relaxation response can prevent chronic work stress from damaging health. This is why self-care is always good within and without. Self-care gives the social worker that badly needed sense of importance so she can feel good about herself. This lets others see the value she places on herself and her work. If she neglects her own physical and emotional needs, she exposes herself to greater dissatisfaction and unhappiness. She stands to lose more self-esteem and increase feelings of resentment. If she spends more time caring for others, she stands to burn out. Caring becomes more difficult both for her and those she takes care of (Scott).

Duty to Care and Professional Self-Care in Suicide Cases

Numerous and continuous stressors are ever present in the social work practice (NASW 2011). Long hours, time pressure and deadlines, large caseloads, limited resources, low pay, lack of recognition and poor safety are among these (NASW). The severity or intensity of the particular area of care is another and more defined stressor. Preventing a suicide and containing its consequences if successfully carried out try a social worker's commitment to care and warrant the backing of professional self-care. #