Case background:
Ms. W, 40, from Jiangxi, has been divorced for many years, and has two daughters with her ex-husband, 1 child. At the beginning of 20 12, the case owner came to t town to run a health care center, and the business was booming, so he opened a new hotel. However, since the hotel and health center operated by the case owner have not obtained business licenses, they have been sealed up by the industrial and commercial bureau for many times since the beginning of 20 13. Since then, business has plummeted and hotels have closed down. Although the health care center has obtained a business license, the industrial and commercial bureau has repeatedly made surprise inspections on the grounds of improper operation, so the business in the store has not improved. At the same time, the relationship between the case owner and his children has been tense, and only the eldest daughter came to live with him in Guangzhou. According to the owner of the shop next door, the case owner often beats and scolds his eldest daughter. At the end of 20 13, the eldest daughter married a migrant worker and went to live in other places with him. Since then, the case owner has lost contact with his daughter. Subsequently, the boyfriend of the case owner suddenly fell in love with the good friend of the case owner, not only abandoned the case owner, but also cheated the case owner of all his savings. Since then, the mental state of the case owner began to have problems, and his words and deeds were even more self-destructive, which disturbed the public order and posed a certain threat to public safety. The main manifestations are as follows: (1) The case owner once injured the person who was beaten and had to be hospitalized, pestering and cursing others for no reason; (2) A Buddhist incense burner was placed in the middle of the road for worship, and there were more than a dozen lighters on it, which blocked passing vehicles many times; (3) Crying intermittently day and night, with decadent spirit and untidy clothes. According to residents, the owner of the case has not eaten in recent days and only relies on drinking water to maintain his physiological needs.
Problem analysis:
According to pathogenicity? Stress? Deal with it? According to the competency model, the mental state of the subjects with mental illness became worse, even mental illness appeared, leading to dominant and recessive diseases, mainly due to the following five factors: 1, physical and psychological pathogenic factors caused by not receiving psychotropic drugs; 2. There is a huge pressure on life, which is beyond the level that the recipients can bear; 3. The problem-solving ability and coping ability of the recipients are poor; 4. The support of family and friends declined and disappeared; 5. Lack of appropriate support services.
At the same time, the parties are under the pressure of economic shock, dysfunctional family system and emotional frustration, and their personal social support network and family support system are out of balance, which leads to mental problems of the parties.
Second, the process of social workers' intervention
(1) Pre-intervention: Social workers collected the basic information of the case owner through interviews with several shopkeepers nearby, and learned that the recent words and deeds of the case owner made everyone panic. The case owner was detained by the police station twice, but he still died after his release. By observing the words and deeds of the case owner, the social worker found that the case owner was in an unconscious state, so the social worker did not contact the case owner for the time being. The urgent actions taken by social workers include: on the one hand, social workers told the owners of nearby shops to always pay attention to the situation of the case owner and contact the police station or social workers immediately if there is any situation; On the other hand, social workers believe that at present, it is mainly to contact the family members of the case, and it is necessary to communicate and coordinate with relevant stakeholders in the community first. Social workers report the relevant situation by visiting neighborhood committees, police stations and Baiyun Psychological Hospital, and discuss solutions with them. Because of the new mental health law, hospitalization for mental disorders is decided by patients themselves. However, at present, the case owner can't identify or control his own behavior, and he is in danger of hurting himself or others and disturbing public order, so he can be involuntarily hospitalized. With the aggravation of the case owner's illness, the police station finally decided to send the case owner to the temporary rescue station of the mental hospital of the District Civil Affairs Bureau, and then contacted the case owner's family through the national network of ID cards, asking the case owner's family to take the case owner to a special mental hospital for treatment.
(2) Mid-term intervention: enhance the family members' sense of illness, and promote the family members to return to the medical system and receive medication. The family members of the case came from other places and knew nothing about the related medical resources in Guangzhou. Social workers integrate the relevant medical information about the treatment of mental illness, and the family members of the case choose the hospital suitable for the treatment of the case independently. Later, the family of the case owner told the social worker that the case owner was diagnosed with depression and emotional illness and needed to receive treatment for a period of time. Social workers know that the relationship between the case owner and the children has been very tense. Social workers believe that the support of family system plays an irreplaceable role in the treatment of the case owner. Therefore, they interviewed the children of the case owner many times, and used various interview skills to provide psychological support and emotional counseling to the children of the case owner, encouraging them to support the recovery and change of the case owner.
(3) Post-intervention: Through many home visits and telephone return visits, the support and cooperation of the family members of the case owner were obtained to consolidate the rehabilitation effect. The family of the case owner left Guangzhou after the case owner's condition was stable, and the case owner still stayed in Guangzhou to run a health care center. Through regular telephone interviews with the clients' daughters, social workers can understand the current situation of the clients' family support system and report the current living conditions of the clients' children. On the other hand, we visited the community and conducted one-on-one interviews and counseling for residents who were negatively affected by this incident, so as to promote the reconstruction of their mental health and their understanding and acceptance of the case owner.
Third, the effectiveness of the service.
Social workers based on pathogenicity? Stress? Deal with it? Competency model evaluates the current situation of the person in charge of the case and the service effect of the case.
1. The social worker in this case has been unable to establish a trust relationship with the case owner, but through a third party? The family members of the case involved in the case and achieved good service results. So far, the client has changed a lot, and there has been retrogression in the middle, but the social worker has gradually improved his mental condition through communication with the client's daughter, and then the daughter communicates with the client. The family support system of the case owner has been strengthened, and the pressure faced is relatively reduced. The family members of the case owner have changed a lot, devoted more care to the case owner, and given more attention and understanding. With the intervention of social workers, the shop owners in the community where the case owner is located have more understanding and acceptance of the case owner.
2. The protective factor of the case owner has been enhanced, and the sense of illness has been obviously improved. She can perceive her illness and take medicine on time, which shows that her ability to manage mental symptoms has improved.
3. According to the observation of social workers and the follow-up investigation afterwards, residents are satisfied with the community crisis intervention. Through the intervention of this community crisis, residents have a better understanding of social workers and improved their understanding. In the process of dealing with this community crisis, social workers have established good relations with stakeholders related to community events, laying the foundation for future work.
Fourth, case thinking.
1, about preparation? Emergency plan for community crisis intervention? the importance of
This incident made social workers aware of the establishment? Emergency plan for community crisis intervention? The importance of. First of all, the handling of community crisis events requires cross-departmental cooperation, and social work centers alone cannot be solved overnight. It is necessary to establish a good communication and coordination mechanism with the stakeholders of community events (the stakeholders of community events include police, hospitals, village committees, fire protection, schools, media, relevant government departments, etc.). ). When social workers intervene in community crisis, they first need to define their roles, what they can and can't do, and what functions they need to cooperate with. Because the center has just been established, the community emergency plan has not yet been established. Although the crisis has passed smoothly and the crisis intervention has basically achieved the goal, we still need to learn from the good experience of others, sum up the handling methods of this incident, and explore and formulate a universal community crisis incident handling model suitable for our community as soon as possible.
2. Thinking about the lack of medical security for the treatment of mental illness of migrant workers.
As we all know, mental illness has been paid more and more attention by the state, and the proportion of reimbursement for treatment has been increased year by year, or even completely exempted, which has greatly reduced the economic pressure of patients and their families, but most policies only benefit patients registered in their own jurisdictions. At present, there are many migrant workers in the social work service area, mostly migrant workers or bottom-level workers, with high life pressure and high rate of mental illness. However, because their right to purchase medical insurance is not guaranteed, they often flinch when they are ill, which makes their already difficult life more difficult, which often has a serious impact on the whole patient's family. Social workers hereby appeal to the society to give more attention and social support to this vulnerable group, hoping that more welfare benefits will be tilted towards this group in the formulation of national medical security policies.