By Dr Chong Shin Yuet, Senior Consultant, Department of Anaesthesiology, SGH, and Dr Evangeline Lim, Senior Consultant, Department of Paediatric Anaesthesia, KKH.
(The below information was gleaned from an online 3-hour CRAFD workshop “Helping the At-Risk Individual (For Faculty)” that Evangeline and I attended on 24th Nov 2020. Many thanks to Ms Joanne Goh (MSW, KKH) and Ms Phoon Wai Yee (CRAFD) for sharing with us their valuable experience and giving us useful tips on how to reach out to at-risk colleagues and residents)
Look, Listen, Link – these are the 3Ls to remember when you notice someone around you who may be struggling or overwhelmed by stress (the ‘at-risk’ individual).
It is useful also to bear in mind the barriers to seeking help which include the fear of stigma and threat to professional development, lack of confidentiality and time. As someone initiating the offer to help, we need to be trustworthy, respect people’s rights to make their own decisions, be aware of our personal prejudices, respect privacy and confidentiality, and make it clear that even if they refuse help now, they can always seek it in the future.
As someone initiating the offer to help, we need to be trustworthy, respect people’s rights to make their own decisions, be aware of our personal prejudices, respect privacy and confidentiality, and make it clear that even if they refuse help now, they can always seek it in the future.
LOOK
Pay attention to changes in behavior, emotions, physical appearance and cognition – has the individual become more withdrawn, quieter, more irritable or moody, more brusque, appears chronically tired and run down, unable to concentrate, more prone to making mistakes?
Reach out to the individual by asking an opening statement that builds rapport:
“I notice you have been looking tired/ troubled lately. What’s going on? Would you like to chat?”
“Who or what has been on your mind most recently?”
“How are you feeling?”
*Try and find a private conducive space for this conversation so that there are no distractions or inadvertent eavesdroppers in the immediate environment.
LISTEN
‘Tell me more’ – the three simple but very effective words to say to encourage the individual to share his/her problems
A good listener acknowledges the speaker’s feelings, paraphrases what the speaker says to show understanding and empathy, and questions to clarify. Do not be in a rush to give reassurance or advice. Listen also for what is not said.
Other questions that can encourage sharing include:
“Would you like to share more?”
“What happened next?”
“How are you taking care of yourself?”
“What has changed for you recently?”
“What’s your biggest source of stress right now?”
“What is disturbing you most?”
“What are your biggest priorities right now, not just in work but in life outside”?
LINK
The next step after listening is to link the individual to resources. Check if he/ she has spoken to anyone else to ask for help and ascertain if the help sought would be useful.
Questions and statements that introduce the link include:
“How are you coping?”
“What will you do next?”
“Have you talked to anyone about this?”
“What you are experiencing now is normal/ expected but you do not have to stay that way with some help”.
Direct the individual to helplines or possible sources of help such as:
SGH SAFE Peer Support 88793342
KKWCH Carer’s Support Programme 81817655
CGH PEER network 81258452 , Trauma Recovery and Corporate Solutions (TraCS) 92990041
SKH PALS 69303577
Singhealth Staff Care Centre (S2C2) helpline 97203360
Family doctor/ general practitioner
END WITH A POSITIVE THOUGHT
“What’s the best thing you have seen today?”
“Is there a staff member or student who is inspiring you lately?”
“What’s keeping you going/ giving you energy/ putting a smile on your face?”
This will remind the individual to feel that there are still bright spots in his/ her life and the individual will walk away from the conversation feeling more hopeful.
WHAT TO DO IF YOU GET A SENSE THAT THE PERSON MAY BE SUICIDAL OR HAVE THOUGHTS OF SELF HARM
Verify by asking:
Do you have thoughts of killing yourself or harming yourself?
What’s your plan?
When are you intending to carry out this plan?
If the person is able to answer you without hesitation, this is a red flag and the person needs further professional help. Encourage the person to seek professional help by stating that if help is sought now, he or she can get through this and there will be a good chance of recovery. Give reassurance that you are willing to stay with the person and accompany the person to seek professional help.
If suicide intent is strong, you should stay with the person until professional help is available. You may have to break confidentiality in order to truly help this person in crisis. Remove the person from direct patient care.
Possible avenues of professional help include:
Consultation with hospital psychologist on call/ psychiatrist
Samaritans of Singapore
Institute of Mental Health
A&E of any hospital with in-house psychiatric support
Family doctor/ general practitioner
RESOURCES
“An empty teapot cannot pour.”
It is important for us to practice self-care (which isn’t the same as self-indulgence!) We can only create a better world when we are the best versions of ourselves!
An 8-part series on self-care:
https://www.mindful.org/mindful-self-care-with-shelly-tygielski/
Online resources for calming the mind during stressful times:
5-minute meditation
Loving kindness meditation for self-compassion
Calming GIFs
Box breathing for taking a brief break and mitigating stress reactivity