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   เรื่อง : การช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตาย

การช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตาย
บรรณาธิการ : รศ.นายแพทย์มาโนช หล่อตระกูล ภาควิชาจิตเวชศาสตร์ คณะแพทย์ศาสตร์ รพ.รามาธิบดี
เจ้าของ :
กรมสุขภาพจิต กระทรวงสาธารณสุข


การช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตาย

การทำร้ายตนเองหรือการฆ่าตัวตาย เป็นปัญหาทางสุขภาพจิตที่เกิดจากสาเหตุต่างๆ เช่น เศรษฐกิจ สังคม การเจ็บป่วยทางร่างกาย หรือทางจิตใจ แม้จะมีสาเหตุหลายอย่าง การทำร้ายตนเองหรือการฆ่าตัวตายก็สามารถป้องกันได้ ทั้งในรายที่ยังไม่เคยลงมือกระทำและในรายที่พยายามฆ่าตัวตายมาแล้ว โดยเฉพาะอย่างยิ่งถ้าผู้ที่เสี่ยงต่อการฆ่าตัวตายอยู่ในสถานบริการสาธารณสุข เพราะบุคลากรทางการแพทย์จะสามารถประเมินภาวะโรคซึมเศร้า ซึ่งนำไปสู่การฆ่าตัวตายและประเมินความเสี่ยงต่อการฆ่าตัวตายตลอดจนให้การช่วยเหลือได้

กรมสุขภาพจิต ตระหนักถึงความสำคัญของการให้การช่วยเหลือผู้มีความคิดและพยายามฆ่าตัวตาย จึงได้จัดทำคู่มือการช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตายสำหรับสถานบริการสาธารณสุขขึ้น เพื่อเป็นแนวทางให้แพทย์ พยาบาล และบุคลากรในสถานบริการสาธารณสุขได้ใช้เป็นแนวทางในการปฏิบัติงาน โดยพยายามปรับแบบการประเมินให้กะทัดรัด ใช้สะดวก และนำเสนอเทคนิคการพูดคุย การรักษา และการให้ข้อมูลกับญาติ กรมสุขภาพจิตหวังเป็นอย่างยิ่งว่าคู่มือนี้จะเป็นประโยชน์ในการให้บริการของบุคลากรทางการแพทย์ต่อไป

คณะ DMH Staff ขอนำเสนอบทความ การช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตาย ซึ่งเขียนโดย. รศ.นายแพทย์มาโนช หล่อตระกูล ในคู่มือการช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตาย ของกรมสุขภาพจิต ดังต่อไปนี้

ปัจจุบันปัญหาการฆ่าตัวตายเป็นปัญหาสำคัญระดับประเทศที่ทำให้สูญเสียทรัพยากรบุคคลเป็นจำนวนไม่น้อยในแต่ละปี โดยที่ปัญหาการฆ่าตัวตายนั้นส่วนหนึ่งเป็นปัญหาที่สามารถป้องกันได้ โดยเริ่มจากการสังเกตสัญญาณเตือนที่จะนำไปสู่การฆ่าตัวตาย การประเมินความเสี่ยงต่อการฆ่าตัวตายหรือการรู้แหล่งหรือบุคคตลที่จะให้ความช่วยเหลือ

ในการดูแลผู้ป่วยที่ฆ่าตัวตายในสถานพยาบาลหากบุคลากรสาธารณสุขในสถานบริการให้การดูแลด้วยความเข้าใจ รู้ถึงสาเหตุของการทำร้ายตนเอง ให้ความเห็นอกเห็นใจ ไม่ตำหนิความคิดการกระทำและรู้ถึงความต้องของผู้ป่วย จะสามารถให้การช่วยเหลือและเป็นที่ปรึกษาแก่ผู้ป่วยได้อย่างดี ตลอดจนสามารถสร้างความเข้าใจให้แก่ญาติเมื่อผู้ป่วยกลับไปอยู่บ้าน ซึ่งจะเป็นการป้องกันปัญหาการฆ่าตัวตายซ้ำของผู้ป่วยได้

ความต้องการด้านจิตใจของผู้ติดฆ่าตัวตาย
1. ผู้คิดฆ่าตัวตายต้องการความเห็นอกเห็นใจ และต้องการผู้เข้าใจปัญหาและความรู้สึกของเขาแต่ไม่ต้องการถูกซ้ำเติมจากคนรอบข้าง
2. ผู้คิดฆ่าตัวตายต้องการคนที่หวังดี ยินดีรับฟังและช่วยเหลืออย่างจริงใจ
3. ผู้คิดฆ่าตัวตายต้องการระบายความทุกข์ออกมาไม่ทางใดก็ทางหนึ่ง เช่น การพูด เขียน ร้องไห้ หรือทำร้านตนเอง
4. ผู้คิดฆ่าตัวตายต้องการคนที่มีเวลาให้กับเขา ให้ความสนใจและเอาในใส่ดูแล เนื่องจากเขาจะมีความรู้สึกเหงาและโดดเดี่ยวเดียวดายมากกว่าปกติ
5. กรณีผู้ป่วยมีพฤติกรรมที่ไม่เหมาะสม เช่น เรียกร้องความสนใจ วุ่นวาย หวาดระแวง แสดงถึงความต้องการความเข้าใจเหตุผลของการกระทำ

ผู้คิดฆ่าตัวตายส่วนหนึ่งไม่ได้มารับการรักษาที่โรงพยาบาลด้วยสาเหตุของการฆ่าตัวตายโดยตรง แต่อาจมาด้วยสาเหตุอื่นๆ ซึ่งผู้รักษาควรตระหนัก และให้ความช่วยเหลือที่เหมาะสมต่อไป

ลักษณะผู้ที่เสี่ยงต่อการฆ่าตัวตาย
1. ผู้ที่เจตนาฆ่าตัวตายแต่ไม่สำเร็จ (Attempted suicide) พบได้ทุกแผนก เช่น ดื่มยาฆ่าแมลง ผูกคอ เชือดข้อมือ กระโดดตึก เป็นต้น
2. มีความตั้งใจฆ่าตัวตายชดเจน โดยพิจารณาจากปัจจัยต่างๆ ต่อไปนี้
   - ทำในสถานที่หรือเวลาที่ยากแก่การพบเห็นหรือช่วยเหลือ
   - เตรียมการเรื่องทรัพย์สินหรือจดหมายลาตาย
   - เตรียมการเรื่องการฆ่าตัวตาย เช่น หาซื้อยามาสะสมไว้ใช้
   - วิธีการที่รุนแรง
3. เคยมีประวัติพยายามฆ่าตัวตายมาก่อน พบว่า 1 ใน 3 ของผู้ฆ่าตัวตายสำเร็จ เคยพยายามฆ่าตัวตายมาก่อนและการกระทำครั้งที่ 2 มักเกิดภายในเวลา 90 วัน หลังจากครั้งแรก ผู้ที่เคยพยายามฆ่าตัวตายมาก่อนมีโอกาสจะทำได้สำเร็จมากกว่าผู้ที่ยังไม่เคยทำมาเลย
4. โรคทางกาย พบว่าโรคทางกายโรคใดโรคหนึ่งใน 3 โรคต่อไปนี้มีปัจจัยเสี่ยงที่จะทำให้คิดฆ่าตัวตาย
   - โรคที่รักษาไม่หาย โดยเฉพาะโรคเอดส์
   - โรคทางกายระยะสุดท้าย
   - โรคที่ก่อให้เกิดความเจ็บปวดทรมาน
5. โรคทางจิตเวช พบว่าโรคทางจิตเวชโรคใดโรคหนึ่งใน 4 โรค ต่อไปนี้มีปัจจัยเสี่ยงที่จะทำให้คิดฆ่าตัวตาย
   - โรคซึมเศร้า (major depressive disorder) อาจมีความกดดันหรือไม่ก็ได้ ผู้ป่วยมีอารมณ์ซึมเสร้าหรือเบื่อหน่าย ที่มักเป็นตลอดวันนานกว่า 2 สัปดาห์ ร่วมกับมีอาการนอนไม่หลับ อ่อนเพลีย เบื่ออาหาร สมาธิบกพร่อง หรือรู้สึกตัวเองไร้ค่า เป็นต้น พบว่าผู้ที่เสียชีวิตจากการฆ่าตัวตายกว่าครึ่งมีโรคซึมเศร้าร่วมด้วย
   - โรคจิต (psychosis) อาจมีความหวาดระแวง หลงผิด คิดว่ามีคนปองร้าย ประสาทหลอน ที่สำคัญคือ หูแว่วมีเสียสั่งให้ทำร้ายตนเอง
   - ผู้ติดสุรา (alcoholism) มักจะมีความรู้สึกว่าตนเองไม่มีคุณค่าเป็นพื้นฐานอยู่แล้ว ประกอบกับฤทธิ์ของสุราที่มีผลต่อสมอง เมื่อเผชิญปัญหาชีวิต เกิดความเครียดอาจทำให้มีอารมณ์เศร้า หรือหงุดหงิดได้ง่ายและอาจรุนแรงจาเกิดความคิดฆ่าตัวตายได้
   - บุคลิกภาพผิดปกติ (personality disorder) มักเป็นกลุ่มผู้ที่มีอารมณ์อ่อนไหว ไม่มั่นคง หุนหัน พลันแล่น หรือสนใจแต่ตนเองเรียกร้องต้องการความสนใจจากผู้อื่นทำให้มีการกระทำโดยขาดความยั้งคิดได้

ข้อมูลจาก: คู่มือการช่วยเหลือผู้มีพฤติกรรมการฆ่าตัวตายสำหรับสถานบริการสาธารณสุข
บรรณาธิการ: รศ.นายแพทย์มาโนช หล่อตระกูล ภาควิชาจิตเวชศาสตร์ คณะแพทย์ศาสตร์ รพ.รามาธิบดี
เจ้าของ: กรมสุขภาพจิต กระทรวงสาธารณสุข


ผู้แต่ง: รศ.นายแพทย์มาโนช หล่อตระกูล ; กรมสุขภาพจิต กระทรวงสาธารณสุข - dmhstaff@dmhthai.com - 13/9/2004

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เรียน คุณผกาสรณ์
กรมสุขภาพจิตมีคู่มือการช่วยเหลือผู้ที่พยายามฆ่าตัวตาย โดยสามารถดาวน์โหลดเอกสารคู่มือการดูแลช่วยเหลือ ได้จาก E-Book
ชื่อเอกสารการดูแลช่วยเหลือ
ผู้ที่มีความเสี่ยงต่อการฆ่าตัวตาย
สำหรับเป็นแนวทางในการดูแลช่วยเหลือได้เลยค่ะ
อนึ่ง กรมสุขภาพจิตได้รับเอา CPG หรือแนวทางการรักษาผู้ที่มีความเสี่ยงต่อการฆ่าตัวตาย ของราชวิทยาลัยจิตแพทย์ แห่งประเทศไทย เป็นแนวทางในการปฏิบัติที่ปรากฎอยู่ในคู่มือค่ะ

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