Upcoming changes for this guidance
This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this guidance. The following resources provide support:
Practice for working effectively with Māori
Our practice shift
Being aware of suicide risk factors
Tamariki and rangatahi we work with often have complex emotions and issues to deal with, so it’s important we:
- are aware of the suicide risk factors
- know how to assess tamariki and rangatahi for this risk
- help them to keep safe.
Knowing the risk factors, triggers and indicators of suicide is important when assessing the safety of tamariki and rangatahi.
Towards Wellbeing resources – Clinical Advisory Services Aotearoa (CASA) website
If you're worried someone may be suicidal – Ministry of Health website
Tihei mauri ora: Supporting whānau through suicide distress – Ministry of Health website
We also need to gauge our own level of comfort with talking about suicide by:
- using supervision and practising self-care
- working as a team
- using consults
- considering who else needs to be involved.
Preventing suicide and self-harm
When we are concerned that te tamaiti or rangatahi has thoughts of killing themselves and we recognise suicide risk factors, we assess te tamaiti and make a plan that will help them to get back to wellness.
1 Raise suicide risk concerns
When concerns about te tamaiti include self-harm or thoughts about killing themselves we have to talk to them about this. We can be direct and ask te tamaiti about their thoughts – we listen, acknowledge their feelings and don't judge.
Intake decision response tool
When a concern about te tamaiti is reported, we use the intake decision response tool to decide what the appropriate action is and in what timeframe.
2 Screen and assess for suicide
We use one or more of the following screening and assessment tools.
Safety and risk screen
When we have concerns (and we recognise the signals that te tamaiti or rangatahi may be at risk of self-harm, suicide, alcohol or drug abuse, or psychological distress) or someone else has raised a concern about the safety and wellbeing of te tamaiti or rangatahi, we use the safety and risk screen to identify whether immediate action is required to secure their safety.
Tuituia framework health domain – Suicide ideation
We can identify suicide risk using our main assessment tool for te tamaiti and rangatahi – Tuituia and the subdomain under the health domain: Suicide ideation.
SACs, Kessler and Suicide screens
When we’re worried that te tamaiti or rangatahi may have thoughts about killing themselves, and if we score under 5 in the Tuituia framework health domain – Suicide ideation, then we further assess them using our main suicide screening tool, the Substances and Choices Scale (SACS) and Kessler and Suicide (SKS) screens.
The suicide screen helps to identify whether te tamaiti or rangatahi has active thoughts of suicide and includes questions and prompts that we can ask directly to te tamaiti or rangatahi. This screen does not determine the risk level — it helps us to decide whether we need a more thorough assessment, identify the level of help and support needed, and how urgently we need to act.
When a suicide risk is identified then we notify the Towards Wellbeing team for follow-up and planning.
Towards Wellbeing is a suicide risk assessment and monitoring programme that is delivered by Clinical Advisory Services Aotearoa (CASA). Towards Wellbeing aims to reduce the number of suicides and suicide attempts by tamariki and rangatahi in our care.
Contact the Towards Wellbeing programme by email email@example.com or contact the Towards Wellbeing clinical advisor in your area.
3 What we do when suicide risk is identified
When suicide risk is identified, we work with te tamaiti or rangatahi, their whānau or family and other professionals to secure immediate safety for te tamaiti and then develop a plan to safely restore their wellbeing.