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1.4.5 Suicide and self harm

Last Modified: 03-Jul-2018 Review Date: N/A

Purpose

To guide child protection workers in responding to children, young people and adults with suicidal thoughts and behaviours, and those who self-harm.

Practice Requirements

 
  • All expressed suicidal thoughts and behaviours must be taken seriously, further explored with the suicidal person and should be discussed with a team leader.
  • Where possible an actively suicidal person must not be left alone while processes are underway.
  • The district director must be informed when a serious suicide attempt or suicide has occurred.
  • The district psychologist, team leader, district director, and Aboriginal practice leader, where Aboriginal children are involved, must be notified of any suicide attempt by a child or young person in the Chief Executive Officer's (CEO's) care or otherwise in contact with the Department of Communities, Child Protection and Family Support divison. 
  • Child protection workers must not promise to keep suicide concerns confidential.
  • If medical attention is required following a non-suicidal self-injury (NSSI) or suicide attempt, a medical practitioner should be involved to provide immediate attention or as part of review and follow-up.
  • The Aboriginal practice leader or other appropriate Aboriginal officer must be consulted about Aboriginal children in the CEO’s care attending funeral or Sorry events.
  • For children in the CEO's care, information on triggers, assessments, plans to address suicide concerns, supports accessed, points of decision making and any medication, must be added to the case file, with updates made to care plans in a timely manner.
  • Child protection workers should consider and plan for the potential impact of emotive discussions on vulnerable parents when we are undertaking protective action. For example, does the parent have a support person, particularly if the parent has a history of suicide attempts, and provide the person with contact numbers for emergency services. However, the safety of the child is the primary consideration and must not be compromised.
  • Team leaders should consider additional supports for staff managing actively suicidal clients.
  • The district director must arrange appropriate supports for all affected staff and carers if a suicide occurs within the district, including information on Employee Assistance Programmes in the Administration Manual entry Critical incident debriefing. The option of attending a funeral or memorial service should also be considered.

 

Process Maps

PMH Emergency Department Contact Process for Children in Care
Acute Response Team - Referral Pathway

Procedures

  • Overview
  • Recognising suicide concerns
  • Gathering information on suicide concerns
  • Accessing a risk assessment
  • Transporting a child or young person for a risk assessment
  • Ongoing management of suicide concerns
  • Suicide attempts and suicide
  • Information sharing and communication
  • Working with parents and caregivers with suicide concerns
  • Self-care and debriefing
  • Non-suicidal self-injury (NSSI)
  • Overview

    Suicide is where a person has died as a result of a deliberate act to cause his or her own death.  

    Child protection workers will have contact with children, young people and adults who express suicidal thoughts and behaviours.  All suicidal thoughts and behaviours must be taken seriously, assessed and appropriately responded to.

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    Recognising suicide concerns

    Children and young people in the CEO's care or who otherwise come into contact with us may have increased suicide risk factors, given their life experiences, and the potential for cumulative harm from physical, sexual, psychological and emotional abuse, and/or neglect.

    An imminent risk of suicide may include one or more of the following:

    • an expressed intent to die
    • a plan in mind (when)
    • access to lethal means (how/plan)
    • impulsive, aggressive or anti-social behaviour
    • been using alcohol or other drugs (AODs), or 
    • a personal or family history of self-injury and/or suicide attempt/s.

    Refer to the Suicide Information Sheet and Suicide and Aboriginal People (in related resources) for more information on suicide risks. 

    Particular times child protection workers should be mindful of suicide concerns include when:

    • a child or young person is being forensically interviewed about disclosure of harm or abuse
    • a child or young person is placed into the CEO's care
    • there is placement instability or transitions (including out of Secure Care)
    • a child or young person with a mental illness is discharged from in-patient care or an emergency department
    • significant anniversaries occur
    • a sibling or other family member attempts, or completes suicide
    • someone the child knows, or who is from their community, attempts or completes, suicide and funeral or Sorry events occur, or
    • a child or young person is being ostracised, bullied or perceiving significant rejection from peers and/or family.

    Some funerals or Sorry events may be conducted with high levels of alcohol and drug misuse and the Aboriginal practice leader can advise on relevant family and community considerations relating to the event.  This provides critical contextual information for decision making when balancing child safety with cultural considerations and obligations. 

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    Gathering information on suicide concerns

    If contacted about a child or young person’s suicidal thoughts or behaviours, child protection workers should:

    • gather information about the extent of the concerns about the child or young person
    • review any chronology of past incidents of harmful events or experiences, reports of abuse or neglect
    • where possible meet with the child or young person to discuss the concerns about them, (other professionals known to the child or young person may also attend where appropriate)
    • contact other individuals to gather information about the extent of the child or young person’s suicide concerns
    • if the child or young person resides in another district, organise for the appropriate district office to respond, and
    • ask the contacting individual if they require any follow-up support, and refer them to an appropriate service.

    Personal Levels of Concerns About Suicide (in related resources) outlines specific questions that can be used to assist with the above process.  This document can also assist with:

    • making an informed decision about whether there is sufficient concern for a formal suicide risk assessment, and
    • gathering information that will assist in supporting the young person in an ongoing way.

    The team leader must be informed if a child or young person expresses any suicidal thoughts or behaviours.  The senior practice development officer, district psychologist,  district director, and Aboriginal practice leader may also be consulted.  In the absence of an Aboriginal practice leader, the AEC directorate can also be contacted. 

    Where possible an actively suicidal child or young person should be appropriately supervised  while these processes are underway. 

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    Accessing a risk assessment

    Child protection workers can assist children and young people to access a formal risk assessment through the following individuals and agencies:

    • a GP or medical practitioner
    • the district psychologist, senior consultant psychologist or residential psychologist (if not suitable or available in the time required, please refer to an agency below)
    • a children’s hospital if the child is under 16 years of age and in the metropolitan area, or 
    • local hospital emergency department for young people above 16 years of age living in the metropolitan areas and all those living in country areas.

    The Aboriginal Medical Services (AMS) or other Aboriginal health service  may also be able to undertake a risk assessment. 

    After an assessment, the child protection worker should work with the individual or agency who conducted the risk assessment, the team leader, district psychologist, district director, and where Aboriginal children are involved, the Aboriginal practice leader to determine next steps. 

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    Transporting a child or young person for a risk assessment

    Child protection workers must be mindful of their safety and the safety of a child or young person when transporting them to a risk assessment.  Wherever possible, two adults should travel in the car in the event the child or young person needs to be restrained.  Doors should be centrally locked to prevent the child from attempting to jump from a moving vehicle.  If the child is aggressive or impulsive do not transport but contact the Acute Response Team or police.

    Suicide or Non-suicidal self-injury (self-harm) risk assessment for a child or young person who has an acute mental health episode

    The Acute Response Team (ART) is a metropolitan service that operates 24 hours per day, seven days a week. The service conducts acute mental health assessments in emergency departments and community settings.

    The ART can be a first response option when a child or young person is self-injuring or at suicidal risk and a child protection worker believes the child or young person requires immediate mental health assessment. The ART can be contacted on 1800 048 636.

    Two flowcharts are available in related resources that step out the process:

    • The Acute Response Team – Referral Pathway (mental health information and triage), and  
    • PMH Emergency Department Contact Process for Children in Care (including mental health intervention).
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    Ongoing management of suicide concerns

    Child protection workers must make appropriate referrals and check whether appropriate arrangements have been offered and followed up for children or young people with suicide concerns.  If children are not in the CEO's care, permission must be sought from parents.  Child protection workers should work in partnership with other agencies to assist them in developing plans to address a child or young person’s suicide concerns. 

    Refer to Mental Health Services for Young People in Western Australia (in related resources) and Chapter 4.2: Engaging with private practitioners for treatment/therapeutic services for information on services and supports available (in some cases, district psychologists will work therapeutically with a child or young person).

    Child protection workers should also work in partnership with residential care workers, where relevant, to develop a Residential Care Service Safety Plan to address a child or young person’s suicide concerns.

    If  a plan is not in place to respond to a child or young person’s suicide concerns, the child protection worker should consider developing one, including:

    • support people
    • formal support services and/or a multi-disciplinary response
    • 24 hour support lines and/or emergency contacts
    • actions for foster carers to promote a supportive environment and other protective factors
    • whether the young person will be safe within their placement or whether secure care arrangements are required as outlined in Chapter 3.3: Secure care arrangements
    • clear roles and responsibilities, identification of a lead agency, and
    • plans for monitoring and review of suicide concerns.
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    Suicide attempts and suicide

    If medical attention is required following a self-injury or suicide attempt, a medical practitioner should be involved to provide immediate attention or as part of review and follow-up. 

    Child protection workers should advise a child or young person’s parents of any suicide concerns, unless there is good reason not to (for example, when revealing the information could compromise the safety of the child).

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    Information sharing and communication

    Information sharing is critical for promoting the safety of children and young people in relation to suicide.  Information sharing considerations are outlined below:

    • Child protection workers must not promise to keep suicide concerns confidential
    • Child protection workers should work closely and collaboratively with any other agency engaged with a child or young person to address suicide or mental health concerns
    • Child protection workers should communicate openly with foster carers and residential care staff about any suicide concerns and any relevant decision making
    • For children in the CEO's care, information on triggers; assessments; plans to address suicide concerns; supports accessed; points of decision making; and medication must be added to the case file and updates made to care plans in a timely manner. This information should form the basis of any new risk plans developed when children or young people transition to a new placement
    • Case plans for children and young people we are working with who are not in the CEOs care should include information on any suicide concerns, and 
    • If a district psychologist is involved with a child or young person, they should be kept informed of the young person’s progress. 
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    Working with parents and caregivers with suicide concerns

    Parents and caregivers in contact with us may also be at risk of suicide.  The suicide of a family member will impact on a child or young person’s wellbeing.

    Child protection workers should consider and plan for the potential impact on vulnerable parents and caregivers when protective action is being undertaken.  However, the safety of the child is the primary consideration and cannot be compromised due to a parent’s or caregiver’s threat of suicide.    

    Particular times child protection workers should be mindful include:

    • when assessments or discussions about sensitive or emotive issues are taking place, including those that relate to past trauma of a parent or caregiver
    • when a parent or caregiver is being investigated by childFIRST
    • when protection proceedings are initiated or a child is placed into the CEO's care, and
    • after the birth of a child, given this can be  a vulnerable period for parents in relation to mental health concerns.

    When working with parents and caregivers in these circumstances, child protection workers can:

    • acknowledge any grief and loss the parent or caregiver may be experiencing
    • ask parents or caregivers how they are feeling and whether they would like to be referred to support services
    • ask parents or caregivers to nominate a support person, including a community member for someone from an Aboriginal or culturally or linguistically diverse background
    • focus on any positives, such as the reunification process and that the young person still needs the parent or caregiver in their life, and 
    • outline supports for parents and caregivers during safety planning.

    If a suicide threat is made, child protection workers should:

    • take all threats seriously
    • where possible make sure a person who is actively suicidal is not left on their own, and 
    • with the permission of the parent or caregiver:
      • discuss the issue with other services involved with the parent or caregiver, or with a support person (such as a family members detailed in the genealogy)
      • assist the parent or caregiver to access support services, and 
      • consider assessing their personal level of concern through the related resource Personal Level of Concern About Suicide (in related resources).

    If the child or young person is in the care of a parent or caregiver who is expressing suicidal thoughts or behaviours, child safety must be assessed.  Refer to Chapter 1.4: Mental health issues for further information about working with parents with these concerns.

    Once the immediate safety of a child has been achieved, the Signs of Safety Child Protection Framework should be used to identify appropriate next steps for the family.

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    Self-care and debriefing

    Suicide can affect all involved.  Child protection workers or other staff may feel traumatised by the event or feel guilty at not preventing self-injury or suicide.  Knowing someone who has attempted or completed suicide is a risk factor for suicide.  The district director must arrange appropriate supports  for staff and carers.

    Support available includes:

    • Children and young people – district or residential psychologists and services in Mental Health Services for Young People in Western Australia (in related resources)
    • Carers can access support through Benestar (formerly Davidson Trahaire Corpsych), and 
    • StandBy Response Service in some rural areas. 

    Staff - regular supervision, targeted debriefing activities, involvement of the district psychologist or Chief Psychologist, or the Employee Assistance Program.

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    Non-suicidal self-injury (NSSI)

    NSSI (also referred to as self-harm) may be an issue for children and young people who are in contact with us.  NSSI refers to the attempt to inflict physical harm to one’s self and is often done in secret. The intent behind self-injury is often different to suicide, but is a risk factor for suicide. Refer to Non-suicidal Self-injury and Suicide (in related resources) for more information.

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