Role as Mediator in Suicide Prevention
Project team of Suicide Prevention in GP at Doshisha University
Akiko ICHINOSE,
Ran TANABE,

Emi HIKITSUCHI,

Takashi OKURA,

Ritsu YAMAMURA,

Erino KANEKO,

Katsunobu KIHARA

Backgrounds of the research
Our project team is one of research project of GP (International theory and practices
circulated education system provided by the Ministry of Education, Science andTechnology) at Doshisha University.
First, I will explain the background of our research. We, the members of this project
team have the experience of helping profession in common. In the process of reviewing
research in suicide prevention, we realize there is little research that refers to role ofsocial work in suicide prevention.
Historically, suicide has been attributed to personal problems such as weakness ofpersonality. And in Japan, only the medical approach toward mental diseases has been
regarded as suicide prevention. Therefore, social workers also tend to recognize thatpreventing suicide is not their concern but medical doctors’ one. However, in 2008,
LifeLink( one of the non profit organizations that initiated suicide prevention incurrent Japan) conducted a survey on the process of the suicide. They interviewed 305
families of the bereaved and analyzed how and why suicide occurred. An outcome of
their research is that suicide is a social problem. It means that causes of suicide can’t
be attributed to individuals, but rather to social-structural problems underlying asuicide. According to the perspective that suicide is a social problem, we can consider
the possibility of the prevention of suicide through helping the interface between aperson and society. In this presentation, I will examine role of social work in suicide
prevention.

Purpose of this presentation
Today, I argue “What are roles of social workers in suicide prevention?” First, I lookat the current situation of suicide in Japan according to some statistics. Second, I show
the outcomes of our research, in which we interviewed helping professionals regarding
their practices and consciousness of suicide prevention. Third, I will examine roles ofsocial workers in suicide prevention and present a conclusion.

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What are trends of suicide in Japan

Suicide rates in countries
Figure 1 and 2 are a comparison of countries’ suicide rates per 100,000 people by age
group according to country reports and charts in WHO. According to this comparison,
the suicide rate in Japan is high in 40’s to 60’s male. In the case of the female, thesuicide rate is relatively high rate in 60 and over. However, those countries have incommon in that the male’s suicide rate is remarkably high than female (attention toscale in left side). According to these figures, Korea shows remarkably high in
population 60 and over. And it is interesting that high rate in old age can be seen alsoin China.

Relationship between suicide and unemployment
Figure 3 shows the relationship between number of suicide and unemployment inJapan. Trend of numbers of suicidal persons (in case of male) is correlated with trendof unemployment to some extent.

Process that crises are composited to suicide
Figure 4 show the outcome of the research of pathway of suicide by Life Link(LifeLink,2008). They say that there is no single risk factor of suicide, and number offactors are weighted and linked with each other. Figure 4 shows the process that eachcrisis is composited. “Crisis composite degree” refers to the number of risk factors eachcrisis has. For example, if the crisis is the first, the crisis composite degree is 1. If anew crisis is linked to the first one, then the crisis composite degree increases to 2. The
average of number of composited crisis is 4 (average of 289 people). According to thisresearch, if the 4 risk factors become linked then the person is pushed to suicide.
Medical treatment of depression is one of most important to prevent suicide. However,this result tells us that it is also important to intervene each factors which consists of“composited crises” such as work environment, economic problems or humanrelationship in family and workplace.

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How do practitioners help suicidal people?

Second, I will focus on what practitioners do in helping suicidal people by showing
the research that we conducted.

Purpose of interviews
We conducted the interview to helping professionals in 2008-2009.The purpose of theresearch was to figure out practices and awareness of professionals in helping suicidalpeople. Content of research is shown in slide 10.

2Interviewees
We conducted interviews with practitioners who work in different kinds of fields andbelong to various kinds of institutions (see the table of slide 11), such as theEAP(Employee Assistance Program), emergency medical services, psychiatric medicalservices and psychiatric mental health in the community.

Procedure of analysis
The procedure of analysis is in slide 12. Slides 13 and 14 show categories according to
the 5 themes “perspectives of social work in preventing suicide”. We classified
categories to practitioners’ attitudes and skills.
Perspectives of social work in preventing suicide
According to this research, 3 major features of practice are drawn from theperspective of social work in preventing suicide. One is “assessment of suicidal risks”.
Second is “recognizing social aspects of problems”. And third is “creatingrelationships”.

1)Assessment of suicide risks
Most of practitioners assessed suicidal risks during the interviews with clients. All
practitioners

inEAP

useguideline,

suchasM.I.N.I(MINI

international

neuropsychiatric interview) to assess the degree of seriousness and urgency. Other
practitioners assess suicidal risk according to what they say if clients said somethingrisky, such as “I want to disappear” or “I want to go out” (P). When people said such arisky words, the practitioner dared to reply “Do you mean that you want to commit
suicide?” to clarify their state of mind (P). Some practitioners ask about suicidal
ideation directly or indirectly and help to verbalize the suicidal ideation or experiences(A,B,H,I,J,K,O,P).

Most

practitioners

assesspsychiatric

medicalneeds( A,B,C,E,G,H,I,J,K,L,M,Q).For example, a practitioner who works in medical
emergency center said “I think it is impossible to support them without psychiatricevaluation”(E).

2) Recognizing social aspect of problems
At the same time, practitioners acknowledge their problems in listening to theirstories(H,I,J,O,P）. And practitioners have compassion regarding the difficulty of living
daily life (A,E,F,G,H,I,J,L,O,P,Q）as well as assessment of medical needs. Someinterviewees pointed out that they need to practice focusing on problems in social life
(E,G,H,I,J,K,L ） , including “changes of social states, relationship with family
members or self-evaluation”(L).

3) Creating relationships
Some of practitioners ask with the client to promise not to die or next3

appointment(A,B,G,H,I,J,K）. A interviewee pointed “the relationships work to prevent
suicide as ties”(L). Another practitioner said “The most important thing is how to givethe person the massage there are people who consider your life is precious”(G). It
implies that promising and compassion could build a relationship between the clientand practitioner and which would result in preventing to a suicide.
Some practitioners indicated that they were helpful with living issues such as
economic problems or a secure place to live（D,E,F,H,I,J,K,L）. A interviewee said “Weask how they earn their daily living and how is their daily living. Sometimes there is aclue in the answer”(E). Practitioners also create an objective relationship “between theperson and society”. And most of interviewees indicated the necessity of collaboration
with institutions that are related to the person including the company, clinic orprofessionals of mental health in a community(A,B,C,D,E,F,G,H,I,J,K,L,M,N,O,P,Q）

3Examine roles of social work in suicide prevention

Finally, based on the interview, I will examine roles of social work in suicide
prevention. The first one is “advocating people against deprivation”. Second is“mediating gaps of social security”. And third is “improving the environment”. I don’t
think they are ideal concepts, rather they are practical matters.

Advocating people against deprivation
An interviewee pointed out the role of social worker in suicide prevention such as“suicide prevention in mental health field neglects the lack of human relationship.
How could we make a place for deprivation of social relationships?”(L)One of the important roles of practitioners in suicide prevention is “To advocatepeople against deprivation”. Suicidal people have been hurt deprivation from thehuman relationship in family, work place or other significant relationship. And some ofthem are deprived of social rights including livelihood, housing or continual jobs.
Social workers need to compassionate regarding the difficulty of his/her living intaking the place of the client. And they need to advocate against deprivation in socialcontext as well as assess psychiatric medical needs.

Mediating gaps of social security
As a concrete form of advocacy, social workers have the role of “mediating gaps ofsocial security”. In their daily practice, social workers connect the person to thesocial security system such as the welfare, unemployment benefits or other kinds ofbenefits.

Social workers’ concrete and important role is to focus on the deprivation ofbasic social rights and to secure dwelling place or livelihood by connecting clients tothe social security system.

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Improving the environment“Improving the environment” is also important role of social worker. An interviewee
indicated “In the current situation, there are fewer companies to set up a system tosupport for employees who leave work for mental health problems. However, even if
there isn’t a system, companies often provide a opportunity of rehabilitation to worksomething shorter such as half of a day”.(K) He and other EAP practitioners assisted
the person to go back to the work. He/She sometimes had overwork, difficulty ofworking because of their disease or because of human relationship in workplace.
Practitioners in EAP referred to their daily practice to contact the client’s boss or thehuman resource department of the company. Practitioners explain them to thecharacteristics of depression or propose improvement of the person’s work setting.
Collaboration with the related institution and improvement their environment areimportant work.

4Conclusion
Suicide has strongly correlated with depression or other mental diseases(WHOstatistics). Appropriate psychiatric medical treatment is one of the most importantpractices in suicide prevention. However, there are 4 composited psycho-social crisesto suicide. It means that it is important to intervene during the composited process ofcrises (such as hardship of life, human relationship in family or work setting).
According to our interview, practitioners recognize social aspects of the problems andintervene to secure the clients’ social life and improve the environment. However, notso many social workers are aware that their practice could be suicide prevention :“Honestly, I have not been conscious of suicide specially”(N). I emphasize it isimportant to recognize that helping “interface between the person and society” could
be preventing suicide.

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