CASE #1 SUICIDE ASSESSMENT

Social Work Referral

Priority:

Immediate XXX

Urgent ___

Non-urgent, Arrange Outpatient Appointment____

Referred By:

Sarah Smith M.D.

Reason for Referral:

Assessment of Depression and Suicide Potential

Referral Summary:

Mr. H.K. is a 33 year old Cantonese gentleman who presented to the Emergency Department with tiredness, dizziness, generalized weakness, pains in the upper back, a sensation of heaviness in his feet, 20 pound weight loss, and insomnia of 6 months duration. He denied any emotional complaints. Past medical history was noncontributory. Medical evaluation was unrevealing, except that the patient seems anxious and depressed. Mr. H.K. denied feeling anxious or depressed, and initially refused to speak with a social worker until it was agreed that he would also receive medications. He stated that talking therapy would not help, but it would be helpful to know what would happen to his wife's U.S. residency status if something were to happen to him.

During the course of his illness, Mr. H.K. had consulted with his family and with traditional Chinese experts. He believed he was suffering from "wind" (fling) and "not enough blood" (m-kau-huet). He had begun treating his illness with traditional Chinese herbs and diet therapy, and was planning to visit an acupuncturist. He had frequently been told by Chinese friends and neighbors that Western medicine could not help his illness, and indeed he had been disappointed by his visit to a local walk-in clinic because, despite the lengthy work-up, almost nothing had been explained to him and he had received no medications.

The patient was born into a family of educated farmers and teachers in Kwangtung Province. His family moved to Canton when he was young, and then to Hong Kong after his father was killed. He had been in the U.S. for 10 years. His wife has had two miscarriages and no children, and two years ago he lost most of his savings. His symptoms of anxiety, fearfilness, and irritability began around the time of his wife's second miscarriage and their financial problems. The symptoms were attributed to "not enough blood.

At the conclusion of my interview with this patient, he again raised the question to me about what would happen to his wife if something were to happen to him. I said that was something the social worker might provide him guidence on, but I wanted to know what he meant by "something happening to him". After a long silence, he said he was referring to death from an illness or an accident. I was not sure how to interpret this remark, which to me seemed evasive. I am very concerned both about this patient's depression and potential for suicide and would like the social worker's assessment and recommendation.