When suicide risk is identified
Updated: 22 August 2019
What's important to us
When suicide risk is identified, we need to work together with the young person, their family/whānau and other professionals to secure the immediate safety of the young person and then develop a robust plan to safely restore their wellbeing.
Risk may be identified when we are first involved with a child or young person, or they may become apparent for a child or young person at any time while we are working with them.
When a child or young person reports suicidal ideation or is identified at risk of suicide a suicide risk management plan is developed. This key information provides guidelines for the development of that plan.
Each child or young person will have specific needs and a context that informs their plan. The child or young person and, where appropriate, supportive family/whānau caregivers and other professionals are included in any planning. Consider the following:
- What needs to happen immediately to clarify the risk, seek information for further planning and reduce the immediate risk of self harm?
- Who else should be involved e.g. Towards Wellbeing, mental health services, alcohol and drug services, family/whānau, caregivers, other staff and other professionals?
- How will these groups work together and communicate over time?
- How will the child or young person’s plan be reviewed?
- Who is responsible for completing any actions in the plan and by when? If the child or young person is currently monitored by Towards Wellbeing they can help with planning each of these stages.
Immediate points of action in the case of suicide risk
- Within 24 hours of identifying the risk complete the Substances and Choices Scale and Kessler and Suicide Screens (SKS) and add a person characteristic to the child or young person’s CYRAS record to record the risk.
Suicide risk factors
- Contact a Towards Wellbeing advisor within 24 hours of identifying the concern to refer or seek advice.
- Within seven days of identifying the risk work with the parents/caregivers and others (e.g. school, Police, mental health provider) to develop and agree on a plan to monitor and manage the child or young person's risk. This might include increased supervision, reduced access to means, and reduced access to alcohol and drugs.
- Consider any placement issues. Is the current placement supportive of the plan for the child or young person? Are additional supports required? Should another placement be arranged?
- If the child or young person goes missing, alert the police to their risk of self-harm. This will aid in assessing the child or young person if picked up and placed in the police cells.
- Consultation with a supervisor and consideration of any issues regarding the child or young person's legal status.
Remember, even if a child or young person is already engaged with a mental health service in relation to a suicide attempt or concerns related to suicide ideation, a referral to Towards Wellbeing is still required so that a co-ordinated and planned approach for immediate and longer term support can be put into place.
Other professionals who can help the child or young person
Such professionals might include:
- mental health and other specialists such as paediatrician, a particular treatment centre or ACC counselling
- drug and/or alcohol assessment and counselling
- general practitioner review of both physical and mental health, and treatment if the child or young person does not meet the criteria for referral to mental health services
- formal, family/whānau and community support services such as cultural groups, mentors, church/other religious organisations
- other areas related to general wellbeing or supporting personal strengths such as education, cultural support, health, sport.
Consultation and communication with others concerning the child or young person at risk
- Ensure key parties are aware of the child or young person's suicide risk, their unique risk factors and triggers, and Towards Wellbeing involvement. Parties informed may include, but are not limited to other Oranga Tamariki staff e.g. youth justice, care and protection, residential, family/whānau/caregivers, general practitioner, school staff, counsellors, Police and other agencies.
- Provide specific instruction for families/whānau and caregivers and have this reflected in the child or young person’s plan.
- Seek clear and specific commitments from agencies and copies of written reports to help inform your work with the child or young person.
- Inform the child or young person and their family/whānau about Toward Wellbeing's involvement and engage them in developing the child or young person’s plan.
- Alert key agencies to any change in risk level and request that they do the same; discuss management and review timeframes.
- Use review meetings involving family/whānau and professionals to ensure risk is monitored and addressed by all parties.
Reviewing the child or young person's plan
- Work through the child or young person’s plan (developed in consultation with Towards Wellbeing) and respond to monitoring calls from Towards Wellbeing at the agreed frequency. A review of the child or young person’s plan occurs every three months.
- Continue to talk with the child or young person (and others important to them) about what is underlying their distress and ways to manage this. Also work on supporting and developing the child or young person's strengths.
- Maintain contact with the child or young person/agencies at agreed intervals,
- Keep clear and up-to-date notes on CYRAS which can inform Towards Wellbeing, afterhours and duty social workers and supervisors.
- Continue to review the plan to reduce the child or young person's risk until it is agreed with Towards Wellbeing that such a plan is no longer necessary.
Aspects of successful intervention
- early intervention
- specific attention to raising achievement levels
- a healthy school environment
- active parental and family/whānau involvement
- giving high risk adolescents real responsibility
- connection to the world of work (if relevant)
- social and life skills training
- attention to staff training and supervision.
Our booklet 'Towards wellbeing: Responding to the needs of young people' (pages 56-58) also has useful prompts to consider.
Decision response prompts for suicide or self-harm
These prompts from the decision response tool may also help.