The Towards Wellbeing suicide prevention programme
Updated: 08 February 2017
The Towards Wellbeing suicide prevention programme is currently delivered by Clinical Advisory Services Aotearoa to support social workers working with mokopuna who are experiencing suicidal ideation or have attempted suicide.
Support is provided by Towards Wellbeing clinical advisors (clinical psychologists and mental health social workers) with exertise in the field of prevention of youth suicide.
About Towards Wellbeing
The programme includes:
- a help desk for referrals and consultations services during office hours, with personal contact within one to two hours (firstname.lastname@example.org)
- help in assessing and understanding suicide risk based on known risk factors
- help to develop a dynamic suicide risk management plan focusing on increasing current safety and protective factors, as well as reducing long term risks
- ongoing support and advice reviewing the risk and protective factors for the mokopuna, and the plan in place to manage these
- providing knowledge in mental health and suicide, including access to resources
- assistance in liaison with mental health services when needed
- advice around case closure planning to minimise risk when Oranga Tamariki end their involvement with the mokopuna
- one-off consultations for social workers around managing suicide risk when the mokopuna is not taken onto the Towards Wellbeing programme.
Clinical Advisory Services Aotearoa also:
- monitors Substances and Choices Scales, Kessler and Suicide screens and Suicide Person Characteristics to help identify which mokopuna may be at risk
- monitors CYRAS casenotes when a mokopuna is on the programme to check for changes in risk or progress (NB - Towards Wellbeing do not receive the casenotes until a few days after they have been written and do not receive all of the casenotes, so this is not a substitute for monitoring when a mokopuna is considered at medium to high risk of suicide)
- reports to the Suicide Prevention Steering Committee to identify/understand trends, practices and performance against the contracted services
- engages with sites, regions and National Office when practice issues are identified
- makes site visits to enhance usage of Towards Wellbeing (by arrangement and subject to available resources)
- delivers training to new social workers as part of the Oranga Tamariki Practice Curriculum training
- delivers practice clinics on an as needed basis to build knowledge, confidence and practice depth in identifying and managing suicide risk.
The role of social workers
Social workers need to:
- identify mokopuna who may be at risk for suicide and complete the Kessler and Suicide screens and a suicide risk assessment
- refer to Towards Wellbeing any mokopuna for whom there is a concern about suicide risk and place a suicide alert on CYRAS
- bring knowledge of the mokopuna, their family and whānau, community, resources and supports to the management of suicide risk
- develop a risk management plan with the Towards Wellbeing clinical advisor to manage the identified risks and build protective factors
- engage the mokopuna, their family and whānau, caregivers and any involved agencies in the planning around risk
- inform the mokopuna, their family and whānau, caregiver and any involved agencies that they will be liaising with Towards Wellbeing for support
- communicate with the clinical advisor regarding the current situation for the mokopuna and progress with the tasks outlined in their risk management plan
- inform the clinical advisor if any event occurs which increases the risk for the mokopuna (e.g. a relationship breakup, transitions, placement breakdown, discharge from services, etc)
- consult with Towards Wellbeing prior to Oranga Tamariki ending its involvement with the mokopuna.
The role of supervisors
Supervisors need to:
- support social workers with the above tasks
- ensure mokopuna in high risk groups (see below) have been screened for suicide risk
- ensure that anyone with possible risk has been referred to Towards Wellbeing and undergone further assessment as necessary
- monitor and support social workers to implement risk management plans for mokopuna at risk of suicide
- ensure casenotes setting out progress with the plan are present and up-to-date on CYRAS, particularly when a mokopuna has an acute risk
- ensure the Towards Wellbeing clinical advisor is contacted when a mokopuna on the programme is being considered for discharge from Oranga Tamariki.
High risk groups
Those groups at greatest risk of dying by suicide are:
- mokopuna who have previously attempted suicide or self harmed: immediate referral to the Towards Wellbeing help desk is required, even if a mental health service is currently involved
- mokopuna with a mental health diagnosis (including alcohol and drug abuse)
- mokopuna who have offended: this group is deemed to be at particular risk of suicide
- mokopuna in transition: transitioning between sites, to and from residences, and out of the service require joint work between site staff, residence staff and the clinical advisors to ensure robust monitoring and planning is in place for the mokopuna
- mokopuna excluded or about to be excluded from school/alternative education, or those who are chronically truant: the absence of appropriate day-time activity increases suicide risk, particularly when there is substance abuse or offending
- mokopuna Māori: this is a group that presents as high risk, and this risk is compunded when other risk factors are present
- mokopuna who have been exposed to suicidal ideation/behaviour or death by suicide within their family, whānau and/or peer group.
Practitioners need to be aware that mokopuna who fit a number of the above categories are at the highest risk of suicide.
The above groups are not intended to minimise the risks for other mokopuna; rather it is to stress that some groups are at particular risk. In deciding which mokopuna should be involved with the Towards Wellbeing programme, priority will always be given to those deemed at greatest risk and with the least ammount of supports in place. Accordingly, the Towards Wellbeing help desk will continue its practice of triaging and determining which mokopuna can be managed by the social worker, which meeds the services of a clinical advisor, which mokopuna require weekly, fortnightly or monthly monitoring, and which mokopuna can be managed via the monitoring of casenotes only.