Any response to a young person who is experiencing suicidal ideation or distress should be informed by the level of risk. A plan to support the young person’s wellbeing may be appropriate or a box which could be filled with things to help the young person feel better, it could include items to help a young person self-soothe or include a list of phone numbers or support service that can be used if they would like to talk to someone about how they are feeling. This resource from Papyrus may be helpful for you to use: https://www.papyrus-uk.org/wp-content/uploads/2018/09/HOPEBOX-resource.pdf
A safety plan is a collaborative agreement including the young person, family and relevant practitioners and is more likely to be used where there is a raised or high risk of harm. An immediate safety plan can be “here and now” and can be reviewed once the young person has accessed any additional supports. Refer to the practitioners wakelet for a safety plan example.
When considering the use of safety plans, it can be helpful to gather information on the following areas:
The warning signs for distress: What are the triggers? What are the situations?
What actions the young person will take to maximise safety? Letting someone know, staying in public areas, focusing on a distraction task, ‘safe pain’ techniques, talking to positive friends etc.
What actions will family take? Remove access to lethal means, agree frequency of checks, keeping room door open, and spend time with the young person engaging in distraction, time to talk or listen, plan activities. Ensure the family has contact details for emergencies and a clear plan of action if they feel unable to keep the young person safe.
What actions others will take? Provide a safe space in school. Identify a named adult to talk to, to give encouragement to engage in lessons and activities, to address underlying issues and to review timetable as appropriate. Provide access to counselling or school nurse. All involved to build confidence and self-esteem through positive activity and responsibility. For school-age young people, when indicated, share an understanding of their wellbeing needs through a co-ordinated plan, using the Wellbeing Pathway.
Other Risks to Consider
Risk of suicide is not the only risk that needs to be considered when a young person may be so distressed that they are feeling suicidal. It is important to consider whether the young person is at risk of harm from others, including family, peers, online contacts or other adults. It is also important to consider if the young person is so distressed by their situation that they are a risk to others, using violent methods.
The Integrated Motivational-Volitional (IMV) Model (O’Connor 2011 and O’Connor & R.C, & Kirtley 2018) is a tripartite model that proposes that suicidal behaviour results from a complex interplay of factors, such as biology, psychology, environment, and culture. Further information can be found in the appendices section of this document.
Working with children and young people at risk of suicide can be a complex area often requiring multi agency working / risk management approaches / clinical interventions. All organisations must follow their respective protocols for responding to a critical incident. Multiagency pathways for responding and managing risk should be used to support young people and their families.
Other young people who may be affected
Encourage all young people to raise worries they may have about friends. If a young person is expressing thoughts of suicide, be alert to the possible impact on their peer group, especially if it is a friend who has come forward to pass on their concerns. Reassure them that they have done the right thing and you will respond sensitively. Let them know that their role is to be the young person’s friend and that adults will take key responsibility for acting on the concerns they have passed on.
In some instances, a young person expressing thoughts of suicide can be unsettling to other vulnerable young people. Be aware of this and offer support and guidance when needed. A shared strategy or approach across your colleagues can often be helpful to provide a consistent and predictable response.
Download
Responding to suicide risk - Fife multi-agency protocol - (18 years and under).
Talking to someone about suicidal thoughts and feelings can be extremely difficult. If you are unsure whether someone is suicidal, the best way to find out is to ask them if they are thinking about suicide. This shows you care and they are not alone. It allows the other person to talk about their feelings and plans - the first step to getting help.
Communicating suicidal intent can sometimes be a way of communicating distress.
Using the principles of Time, Space, Compassion; children and young people can be moved from a high or raised risk of concern to a lower risk with identified supports in place.
When a child or young person is expressing distress
Step 1: Create a compassionate space to pause and reassure
Step 2: Start a conversation
A helpful way to start the conversation is by checking in on them:
"I'm really worried about you, it must have been hard to share this with me, thank you."
"I wanted to check in with you because you haven't seemed yourself lately.
"I am really worried about you and need to ask you if you have been thinking about suicide."
Step 3: Enquire to inform level of distress
Sometimes people can say things like:
"I've had enough"
"I can't take this any more" or
"I wish I didn't feel like this any longer"
This can be an expression of despair without intending or thinking about self-harm or suicide.
If someone does not have any active suicidal thoughts, it is still important to offer support and referral services.
Questions to assist assessing presence of active suicidal thoughts:
Are you thinking about attempting suicide?
Do you have a suicide plan?
Have you identified a method?
Have you identified when you might act on a suicide plan?
If the person answers YES to any of the above, determine low, raised or high risk and take appropriate actions.
Step 4: Reflect/confirm
- consider whether you have the answer to the 5 GIRFEC questions
LOW
Link to indicators in case study document
Risk factors may be present This is an opportunityfor early intervention
Listen compassionately, ease distress
Consider additional support or therapeutic intervention
Complete documentation/assessment
Consider with child or young person who needs to know - UNCRC
Child Wellbeing Pathway
Follow up conversation
RAISED
Active suicidal thoughts are present. No clear plan, method or timeframe.
Consider individual risk and protective factors.
Consider other services that can support in the area eg third sector organisations
Choosing the right support alongside the child or young person.
Consider
Child Wellbeing Pathway
HIGH
Active suicidal thoughts are present.
This may include a plan, method and timeframe.
Consider individual risk and protective factors
Phone CAMHS
Consultation line Mon-Fri 9am - 5pm
01334 696019
Urgent referral: 01334 696250
Submit urgent CAMHS referral form
Safety planning - supported by parents/carers (if appropriate) and informed by Child Protection
Procedures
If young person contines to have active suicidal behaviours phone 999 or take them to A&E
Step 5: Check back and review
Download
If you would like to print out the following risks and actions as a PDF document please click on the link below.
Risk and actions (PDF)
Low risk
- No Suicidal thoughts or if so vague, reactive, meeting.
- No plan in place.
- Self-harm which is known and managed.
- Any mood changes are transient.
- Able to articulate future life plans.
- Current concerns were managed appropriately.
Possible actions
- Discuss plan to support wellbeing, self-help tools e.g. distraction plans.
- Provide advice on appropriate care of any injury.
- Inform parents/carers with young person's consent.
- Arrange meeting with parents/carers to discuss.
- Inform the named person with consent & link to sources of support in school.
- Single Agency Support Plan as per GIRFEC.
- Consult with relevant services e.g., Ed Psych, school nurse (drop in model), Primary Mental Health Worker, consider referral to counselling or other support services.
Raised risk
- Talking about suicide, thoughts are more frequent but still fleeting.
- May have considered method but no specific plan or immediate intent.
- Previous suicide attempts.
- Previous history of overdose or other significant sell-harm.
- History of impulsivity.
- Current self-harm with raised safety risk, e.g., deeper/more frequent cutting.
- Significant drug or alcohol use.
- Experience of trauma has been considered.
- Young person has significant other wellbeing concerns e.g., truancy, conflict at home or with peer group,
offending. - Current concerns are managed appropriately.
- Care experienced child/young person.
Possible actions
Actions to consider:
- As per Low-risk action points.
- Arrange Wellbeing Meeting.
- Link to sources of support in school/ notify named person and other relevant professionals. Consider contacting CAMHS consultation line for possible referral for further assessment.
- Discuss need for increasing level of support.
- Refer to relevant agencies and agree multiagency Child's Plan.
- Consider safety and support plan and who should be part of this.
- Review and reassess at agreed intervals.
- Complete checklist/document decision making.
- Consider how to access your own support needs.
High risk
- Frequent suicidal thoughts which are persistent, clear, and unrelenting.
- Strong desire to die indicates hopelessness.
- Specific/detailed plans in place.
- Increasing self harm with significant risk, frequency, severity or both.
- Previous history of suicidal behaviour, attempts, family history of suicide.
- Evidence of current mental health problem.
- Significant drug or alcohol use (including binge drinking).
- History or evidence of impulsivity.
- Situation felt to be causing unbearable distress.
- Lack of protective factors.
- Care experienced child/young person.
Actions
Actions to consider:
- Consider access to trained people in your organisation (e.g., ASIST trained).
- Stay with the young person, do not send home alone.
- Listen compassionately and ease distress as far as possible.
- Consider together what may be done to resolve difficulties.
- Provide advice on appropriate care of any injury.
- Discuss immediate plan to stay safe.
- Urgent referral to CAMHS - initially via phone and followed up with completed referral form.
- Inform parents/carers (unless this will increase present risk).
- Discuss immediate Safety & Support plan with parents/carers.
- Notify services as appropriate e.g., GP, Social Work.
- Decide on ongoing level of monitoring, increased support and by whom.
- Meeting/Child's Plan Review arranged-risk management processes may be required.
- Complete checklist/document decision making.
- Assess immediate risk and consider 999/A&E if urgent attention is required.
