Self Harming and Suicidal Behaviour
Scope of this chapter
Note: This chapter should be read in conjunction with the Multi-Agency Safeguarding Children Procedures for your area.
Related guidance
- Self-harm: Assessment, Management and Preventing Recurrence NICE Guidance
- Suicide Prevention in England: Fifth Progress Report of the Cross-Government Outcomes Strategy to Save Lives
- NHS Choices – Self Harm
- NHS Choices – Suicide
Amendment
This chapter was reviewed locally in September 2024 and updated where required.
Many children and young people who come into the 'looked after' system have experienced significant trauma in their lives and are often highly vulnerable. It is likely that these children will sometimes have multiple and complex needs and significant behavioural and emotional difficulties, which can lead to acting in ways that place themselves in situations of high risk.
As part of Placement Planning, relevant information should be gathered and appropriate risk assessments put in place alongside relevant intervention strategies.
This risk assessment is known as ‘Positive Behaviour Support Plan’ (PBSP). This should be regularly reviewed and monitored.
Staff need to ensure that they maintain professional boundaries with young people who harm to ensure there is a consistent approach to the prevention and support with such behaviours.
Staff must be familiar with this procedure to ensure the effective and responsive management of self-harm and suicide and have received appropriate training in recognition of signs of risks to safety and wellbeing.
All staff receive formal training within the area of suicide and self-harm during their initial training course. The training objectives include exploring research and facts/myths about self- harming/suicidal behaviour in adolescents, the risk factors and protective factors, how to respond to such behaviour, identifying sources of support, and raising awareness of policies for safety and wellbeing at the Home. Regular refresher training is delivered at required intervals in order to ensure that staff remain well informed and competent in dealing with Suicide and Self-Harm (SASH).
In situations where staff are involved with a child who is actively self-harming or suicidal, they should, in consultation with other members of the team, ensure there is a plan to manage the effects such as distress or grief, that an incident of self-harm or suicide may cause other workers, family members and other children and young people in the setting.
All reasonable measures should be taken to reduce or prevent continuation of the behaviour. This may include providing additional supervision, confiscation of materials that may be used to self harm or, as a last resort, use of physical intervention or calling for assistance from the Emergency Services.
If there is any suspicion that the child may be involved in self harming or any attempts of suicide, the social worker must be informed and a risk assessment undertaken (if it does not already exist with a view to deciding whether a strategy should be adopted to reduce or prevent the behaviour. That strategy should be included in the child's PBSP.
If necessary, specialist advice or support should be sought.
Any incidents of SASH will be discussed at local cluster meetings, reported on at the monthly Operations Governance meeting and Quarterly Strategy meeting so that Homes Managers can share best practice and consider lessons learned.
Minor or non persistent self-harming should be notified to the Manager at the first opportunity; the Manager will decide whether to inform the relevant social worker.
Serious or persistent self harming or attempted suicide must be notified immediately to the Home's Manager and the relevant social worker notified within 1 working day - the social worker should be consulted and consideration given to whether a Child Protection Referral should be made, if so, see Admission and Transition Procedure.
In the event of an incident of self-harm, staff will record this on Charms under relevant progress action (Notifiable - Self Harm), including the body map within this progress action. Staff must take into consideration that although some people who self-harm may be suicidal, self-harm is often used as a way of managing difficult emotions without being a suicide attempt. However, self-harming can result in accidental death
In the event of an incident of significant self-harm staff will in addition to writing a report complete SASH checklist assessment (Appendix 6: Suicide and Self Harm (SASH) Checklist Assessment ) this should be uploaded onto the Home’s Management Information System, CHARMS and signatures requested by all staff. The child’s PBSP should be updated and cover the risk assessment of items in the young person’s bedroom.
The PBSP will be regularly reviewed and updated as needed. The Registered manager will determine who is most suitable to carry out this task. The young person will be advised as to the level of concern and observation and staff will notify the Social Worker / EDT and parents/carers.
Observations will be recorded in the Safeguarding section of the young person’s Daily Diary as deemed necessary and a manager’s signature requested. These entries will allow the manager to ascertain if the young person’s emotional wellbeing is of concern or indeed if there are signs of improvement.
During office hours the Social Worker will be contacted and advised of any incidents and or concerns relating to SASH. This should occur immediately after the conclusion of the SASH assessment.
Outside of office hours the EDT should be contacted, and the named Social Worker will be informed the next working day, outlining details of the incident and the actions taken to safeguard and support the young person and the date when SASH conditions will be reviewed. This communication needs to be evidenced in the young person’s log.
The Social Worker will also be invited to provide written feedback at regular intervals whilst the young person is subject to a plan so that this can be fed into the review process.
Parent/carers (and those with parental responsibility) should be contacted as soon as practically possible regarding an incident or concern of SASH relating to their child. Parents/carers should be advised about the details of the incident of SASH and the actions that have been taken to safeguard their child.
It is good practice to keep parents/carers fully informed of the reasons for any decisions that have been made and ascertain from them whether there is any help they may be able to give to their child to support the plan (if any) implemented.
Where a child or young person has previously self-harmed and there is a further incident of self-harm, particularly where young people are repeatedly causing minor scratches or cuts in a pattern of behaviour then the process will recommence.
The first responsibility is to preserve and protect life, including administering first aid and removal of instrument of self-harm.
Request urgent medical assistance, via 999 in the meantime, continue first aid. If a ligature has been used, cut it to remove the pressure, but preserve the knot for forensic examination.
In the event of death, a qualified medical practitioner will certify this and then first aid can cease. The police must be immediately informed in order that they may commence a sudden death investigation.
In all cases evidence must be preserved as to how the incident occurred.
Inform the On-Call Manager / Responsible Individual who will inform the Managing Director and implement the Protocol for Reporting Serious and Significant Incidents.
Contingency Plans must be followed.
The Registered Manager / on-call will be informed immediately of any serious self-harm or near miss and will inform the Social Worker / EDT and parents or carers.
The Risk Assessments will be updated, with reference to the young person’s level of intent.
As part of the Risk Assessment, it is important to establish and assess the young person’s own views as to whether they thought the incident would be successful. Was the method chosen thought to be lethal, or was it thought to be reversible if medical help was given?
The young person’s bedroom must be thoroughly checked and all items presenting any risk of self-harm must be removed.
High levels of observation of the young person whilst in the bedroom or any other part of the home will be made until it is decided that the level of risk has subsided sufficiently to reduce frequency of monitoring. These will be recorded on the PBSP.
This information collated in this section allows the risk assessment to be updated and information to be passed to staff working with the young person.
The Home/ Deputy Manager are responsible for monitoring and analysing the effective response to and management of SASH incidents. This includes electronic signatures on records or incident documentations.
The Home/ Deputy Manager is responsible for governing how this policy is implemented into their homes and be able to evidence compliance for any internal or external audits.
The Independent Visitor (Regulation 44) attends the home monthly to complete a comprehensive review of the home’s performance and completes a monthly report following their visit; which is shared with Ofsted and all relevant external parties.
The Home / Deputy Manager are responsible for completing bi-annual Regulation 45 reports where any incidents of SASH are considered in a thematic manner against outcomes and progress of the young people in placement.
Homes2Inspire hold a monthly operations governance whereby all incidents throughout the company are reviewed and analysed to identify trends and triggers and any practise concerns form staff, it also helps to identify any home which may need further support or training.
Click here to view Appendix 1: Suicide and Self-Harm Management Flow Chart
Click here to view Appendix 2: Self-Harm Body Map
Click here to view Appendix 3: Self- Harm Incident Report
Click here to view Appendix 4: SASH Governance
Click here to view Appendix 5: Suicide and Self Harm (SASH) Checklist Assessment
Help for parents and carers
Professional Help: GPs, School Nurses, Counsellors/Therapists
Helplines and Online Information/ Support:
Royal College of Psychiatrists Self harm | Royal College of Psychiatrists (rcpsych.ac.uk)
Help for young people
Professional Help: GPs, School Counsellors, School Nurses, Children and Young People’s Mental Health Services (CYPMHS), Adult Mental Health Services;
Usually through referral by GP or other professional Helplines and Online Information/ Support:
Childline tel – 0800 1111
Samaritans Tel – 116 123
Further Reading: “The Parent’s Guide to Self-Harm” by Jane Smith, Oxford: Lion Hudson
For more information on the experiences of other parents and carers, go to Healthtalk.org
Last Updated: September 16, 2024
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