Skip to main content

 

Caption: floating buttons
   
View Working Together View Working Together
 
  View Hertfordshire Safeguarding Children Partnership website

5.5.2 Suicidal Thoughts and Behaviour

RELATED CHAPTERS

This chapter should also be read in conjunction with Safeguarding Children Abused Through Sexual Exploitation Procedure.

Please note: a new chapter on Self Harm is to follow.

AMENDMENT

This chapter was updated in November 2023.


Contents

  1. Introduction
  2. Prevention
  3. Intervention
  4. Postvention (after a suicide or attempted suicide)

    Appendix 1: Legislation and Guidance

    Appendix 2: Guidance, Resources and Further Reading


1. Introduction

Suicidal thoughts and behaviour in children and young people are a public health concern which needs to be addressed promptly and effectively to reduce the risk in children and young people of taking their own lives. In the Hertfordshire 2019-21 suicide audit there were 7 suicides of children and young people aged 17 and under: 4 females and 3 males. The average age was 16 years.

In the 2019-21 Hertfordshire suicide audit 5 of the 7 young people had previous mental health issues. In England, a quarter of 11–16 year olds, and nearly half of 17-19 year olds (46.8%), with a mental disorder reported that they have self-harmed or attempted suicide at some point in their lives. [1]

Mental ill health is not always present in people who die by suicide. However, the figures fluctuate, There are usually various factors in a person’s life that lead to suicidal thoughts and behaviour. Key risk factors which increase the risk of suicide, highlighted in the Hertfordshire suicide audit, were mental health issues*, family/relationship problems, bereavement, abuse, and school problems. These risk factors are not exhaustive; additional risk factors include having a learning disability, being LGBTQ, and having a history of previous suicide attempts.

This guidance is intended for use by anyone working with children and young people up to the age of 18, or 25 for those with learning difficulties or disabilities in Hertfordshire. To support a child or young person with suicidal thoughts or behaviour does not require you to be a mental health professional. This guidance will offer an informed and systematic approach to addressing the needs of children and young people at risk of suicide. It also sets out how to ensure that children and young people gain appropriate support and are assessed and referred appropriately where needed.

The aims of the guidance are to:

  • To work towards the Hertfordshire vision to make Hertfordshire a county where no one ever gets to a point where they feel suicide is their only option (Hertfordshire Suicide Prevention Strategy, 2020-25);
  • To improve the quality of support, advice and guidance offered to children and young people who have suicidal thoughts;
  • To ensure that there is a consistent offer of support to children and young people no matter what point of contact, to standardise the response of agencies regardless of what type of agency;
  • To increase knowledge, skills and confidence of staff to recognise the signs and respond appropriately when working with a child or young person who has suicidal thoughts.

1.1 Use of Language

We need to talk more about suicide and provide safe places for this to occur in a manner that is helpful and healthy. This includes paying careful attention to the language used to describe suicide so that it does not stigmatise, constrain thinking or restrict help-seeking behaviour. Terms such as kill/commit, succeeded, success and threat should be replaced with words such as ‘end own life’, ‘took own life’, ‘talk about/show intent’.

Stigmatising language Alternative
Committed suicide Died by suicide
Succeeded in killing themselves Took their own life
Tried to kill themselves Attempted suicide
Talked about killing themselves Talked about taking their own life

1.2 Definitions

Suicide - In the UK, suicide is defined as deaths given an underlying cause of intentional self-harm or injury/poisoning of undetermined intent. (ONS, 2016)

Suicidal intent - This is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a suicide note) and choosing a violent or aggressive means of deliberate self-harm allowing little chance of survival. Suicide intent can be hidden, not stated or stated; in these circumstances professionals should sensitively look for behaviours reflecting suicide intent (reflected intent). [2]

Postvention - Postvention refers to activities which reduce risk and promote healing after a suicide death. Although postvention is implemented after a suicide it is essential that we prepare for postvention before a suicide.

[1] stateofchildhealth.rcpch.ac.uk/evidence/mental-health/suicide
[2] Uncovering Suicidal Intent - A Sophisticated Art By Shawn Christopher Shea, MD | December 3, 2009

1.3 Three-Pronged Approach to suicide prevention

For children and young people, it is important to have a three-pronged approach to suicide prevention through prevention, intervention and postvention support:

  • Promotion of good mental health and wellbeing in a supportive, safe, and positive environment;
  • Early intervention that will support early recovery, enabling self-help tools, access to effective interventions and referral processes;
  • Postvention support to ensure that children, young people and staff receive bereavement and wellbeing support which is timely and effective to meet their needs and reduce their risk of suicide later (People bereaved by the sudden death of a friend or family member are 65% more likely to attempt suicide if the deceased died by suicide than if they died by natural causes).


2. Prevention

2.1 Mental Health and Wellbeing

For the mental health and wellbeing of children and young people the best approach is to ensure that we are providing positive messages and support to help them to have good mental health and be resilient. There are a number of services which can provide health and wellbeing support.

A service directory for professionals can be found here April 2023 v1 Mental Health Support: Guidance for professionals working with children and young people (CYP) (justtalkherts.org).

The Just Talk website has information and support on mental health and wellbeing. Please familiarise yourself with the website and explain to the child or young person what support and information is on the website. Please provide the child or young person with the link for the website and give support in navigating it if needed: Just Talk (justtalkherts.org).

2.2 Recognising the Signs

Suicide Prevention in relation to a child or young person is concerned with recognising the signs that they might be having suicidal thoughts, being able to assess the child or young person and knowing where to access support and provide ongoing support.

The following key principles are drawn from the Hertfordshire Suicide Aware Prevention and Postvention Charter for schools:

  • Ensure each child and/or young person is respected and listened to and involved in decision making around support, as appropriate to their development;
  • Make children and young people aware of confidentiality & information sharing policies in relation to serious risk;
  • Ensure the implementation of equal opportunities, understanding how some groups may be disproportionately affected by mental health and wellbeing needs;
  • Commit to safe, open and honest dialogue about suicide and attempted suicide, carefully considering the language used;
  • Understand that mental health and well-being support needs to be provided at different levels of a system (community, school, family and individual level). Please see the iThrive framework - a web guide;
  • This is an animation explaining the iThrive framework.

It can be difficult to tell if a change in behaviour is part of growing up, or a sign that something else is affecting a child or young person. If the behaviour change continues over a longer period or the child or young person has stopped engaging in their usual activities, then it is worth checking in to see how they are. A staff member may also be approached by a child, a peer or a parent about their concerns.

Professionals should be curious about the following signs of distress:

  • Changes in eating and sleeping habits;
  • Withdrawing from groups;
  • Displaying aggression towards others;
  • Self-harming behaviour;
  • Significant changes in mood, behaviour or personality;
  • Decline in attendance;
  • An increase or change in the nature of risk taking behaviours.

If you notice a child or young person is not themselves, don’t assume they’re talking to someone about how they feel. Showing you care and offering a listening ear empowers the child or young person to choose to speak to you, if they want. [3] Outward signs may not always reflect the feelings a person is experiencing so pay attention to your instincts also.

Internet Use

Internet use should be investigated by professionals, showing an interest in what websites and social media young people are using. Suicide-related internet use was reported in around 80 suicides by young people each year. This was most often searching for information about suicide methods or posting messages with suicidal content. There are also issues relating to pro-suicide groups which encourage dangerous behaviours. [4]

To understand more about risk factors and protective factors in the context of suicidal thoughts and behaviours, click here to view a guide.  Please note, this is not a diagnostic tool.

If you feel concerned about a child or young person, or a child or young person has explicitly told you about suicidal thoughts, then it is important to have a prompt and direct conversation with them to assess the situation and their needs. This should take place to ensure the child or young person gets timely and appropriate support. 

Information from this assessment should be documented in all records and case files.

[3] www.youngminds.org.uk/professional/resources
[4] sites.manchester.ac.uk/ncish/reports/suicide-by-children-and-young-people

2.3 Conversation Prompts

Conversation points to consider
  • Find an appropriate time and space to talk with someone – somewhere quiet where you won’t be interrupted;
  • Discuss confidentiality;
  • Discuss Child Protection if necessary;
  • Discuss who knows about this and discuss contacting parents;
  • Discuss who you will contact i.e., the school/college nurse;
  • Discuss contacting the GP;
  • Demonstrate warmth and compassion.
Initial questions

General

Find an appropriate time and space to talk with someone – somewhere quiet where you won’t be interrupted.

Ask about the child or young person’s situations and thoughts:

  • I’ve noticed you don’t seem yourself – what can I do to help?
  • What’s been happening?
  • How are things today?
  • Tell me more about…

Explore how they are feeling. If something has happened to them, ask how it made them feel. Listen attentively.

Is something troubling you? - (family, school, social, consider use of child protection procedures).

What has been happening?

Who knows about this?

Ask the Suicide question

As with all safeguarding situations it is essential to ask direct questions in order to receive a definite response. This may feel uncomfortable for you, but it is required to ensure a clear understanding of the situation. Asking directly about suicide does not give people thoughts they didn’t already have. The child or young person may respond with surprise and that is ok.

  • Are you having thoughts of suicide?

If you establish the child or young person is having suicidal thoughts, then assess for risk (see FIDO questions below). It is important to remember that when assessing suicide risk, this is only valid at the time of the assessment, and a child or young person’s risk can reduce or increase at any time after this.

If the child or young person says no, they are not having thoughts of suicide but you still have concerns (instinct, child’s body language etc.) it is ok to ask again and it is ok to say that although they have said ‘no’, you still have concerns. It is a myth that people that say they are feeling suicidal will not act upon their thoughts. All disclosures of suicidal thoughts and behaviour must be taken seriously and acted upon.

FIDO Questions about suicidal risk:

Frequency of thoughts or behaviours (how often?):

  • How often do you think about taking your life?
  • Would you say your thoughts are persistent, fleeting, or somewhere in between?

Intensity of the thoughts or behaviours:

  • When you think about ending your life, how strong are these thoughts?
  • When you think about ending your life, how strong is the urge to take action?

Duration of the thoughts or behaviours:

  • How long have you been thinking about ending your life?
  • Have you been suicidal in the past? If so, how long ago and what helped you get through them?

Objective planning:

  • Have you made plans?
  • Have you thought about where, when and how you would take your life?

Explore any other safeguarding concerns:

  • Are you at risk of harm from others?
  • Are there any problems with inappropriate use of the internet or social networking sites?

Further questions (as relevant)

Exeter University have produced this leaflet about conversations about suicide which may be a helpful back ground resource for professionals. See: "It’s safe to talk about suicide".
Responses

Offer reassurance

  • Someone in distress needs to hear from you that you care. Letting them know they’ve done the right thing in being open is important. Reminding them there is always hope for recovery is even more important. Perhaps say something along the lines of:
    • “I can’t imagine what you’re going through, but I’d like to know more so I can help”

Be patient

  • This might be the first time someone is opening up, which can be very hard. It can take a while before someone is ready to access support.

Be non-judgemental

  • Although this may be hard for you, it’s important to offer a compassionate listening ear without judging how or why someone has come to thoughts of suicide. Just be there, show warmth and kindness.

Leave silence

  • Silence can feel uncomfortable, but it’s very important. Silence and space allows someone to think and respond in their own time.

Don’t make false promises or minimise someone’s pain.

Things not to say/do:

  • Come on, things aren’t that bad are they?
  • Think about everything you have going for you;
  • There’s always someone worse off than you;
  • I promise everything will be fine;
  • I know exactly how you feel;
  • This is all just in your head;
  • Minimise their distress or brush it off;
  • Guilt trip into staying alive (think about your family..);
  • Debate whether suicide is right or wrong;
  • Call them selfish;
  • Swear to secrecy;
  • Lecture them on the value of life;
  • Immediately panic and call the police/ambulance (depending on risk).

Things to say/do…

  • Remain as calm as possible;
  • Be patient;
  • You could say things like:
  • Thank you so much for being honest;
  • It’s not always easy to open up and reach out;
  • You are doing the right thing by asking for support;
  • I want to help, and I know there are places that can support;
  • You do not have to be on your own with this;
  • Even if you’re not sure what to say, be human…;
  • I don’t even know what to say right now, I’m just so glad you told me. You are not alone;
  • There is always hope that things will feel better, even though it might not feel like that now;
  • You are important, and I care about you and your safety;
  • Let’s think about what we have agreed and what we’re going to do next to keep you safe (for now).

Planning (seek collaboration and empowerment):

  • What would you like to happen next?
  • What can we do to keep you safe for now? – Safety planning.

Communicating about next steps:

  • Say who you will have to share this with (e.g. designated person) and when this will happen. They may want to do this together with you;
  • Say who and when the right person will speak with them again to help and support them;
  • Check what they can do to ensure they keep themselves safe until they are seen again e.g. stay with friends at break time, go to support staff.

If an urgent medical response is needed:

  • If there is a physical need, call an ambulance;
  • If there is not a physical need, call Single Point of Access (SPA) on 0300 777 0707;
  • Make sure the child or young person is not alone;
  • Remove anything the child or young person could use to take their own life.

2.3 Reflecting on the Assessment

The following table can be used to help professionals reflect on the assessment and consider possible actions. Please note that the assessment is only valid at the time and can change.

  Thoughts / behaviour Action
Early warning signs
  • Suicidal thoughts are fleeting and soon dismissed;
  • No plan;
  • Few or no signs of depression;
  • No signs of psychosis (delusional thoughts and behaviours);
  • No self-harming behaviour;
  • Current situation felt to be painful but bearable.
  • Ease distress as far as possible. Consider any actions that could be taken to resolve difficulties;
  • Link to other sources of support; including self-help resources (see Just Talk);
  • Make use of line management or supervision to discuss particular cases and concerns;
  • Review and reassess at agreed intervals; work towards establishing a trusting relationship;
  • Consider completing a Family First Assessment;
  • Consider further awareness of potential risk and protective factors.
Warning signs
  • Suicidal thoughts are frequent but still fleeting;
  • No specific plan or immediate intent;
  • Evidence of current mental ill health, especially depression or psychosis;
  • Significant drug or alcohol use;
  • Situation felt to be painful, but no immediate crisis;
  • Previous, especially recent, suicide attempt;
  • Current self-harm.
  • Ease distress as far as possible. Consider any actions that could be taken to resolve difficulties;
  • Consider safety of young person, including possible discussion with parents/carers and professional network;
  • Create a Safety Plan with the child or young person
  • Seek specialist advice;
  • Possible mental health assessment - discussion with, for example Child and young person Mental Health Service  or G.P.;
  • Consider consent issues for the above;
  • Consider increasing levels of support/professional input;
  • Review and reassess at agreed intervals - likely to be sooner than if risk is low, maintain supportive relationship.
Increased warning signs
  • Frequent suicidal thoughts, which are not easily dismissed;
  • Specific plans with access to potentially lethal means;
  • Evidence of current mental illness;
  • Significant drug or alcohol use;
  • Situation felt to be causing unbearable pain or distress;
  • Increasing self-harm, either frequency, potential lethality or both.
  • Ease distress as far as possible. Consider any actions that could be taken to resolve difficulties;
  • Safety - discussion with parents/carers or professional network more likely;
  • Create a Safety Plan with the child or young person
  • Specialist CAMHS referral and conversation with Single Point of Access (SPA);
  • Consider consent issues;
  • If already open to mental health services, consider sharing information to clarify risk (with consent preferable but not essential if deemed to be child protection, let the CYP know it is your intention);
  • Consider increasing levels of support/professional input in the meantime;
  • Monitor in light of level of mental health service involvement, maintain supportive relationship.

Imminent risk

  • If there is a physical need, call an ambulance;
  • If there is not a physical need, call Single Point of Access (SPA) on 0300 777 0707;
  • Make sure the child or young person is not alone;
  • Remove anything the child or young person could use to take their own life.
N.B. at any time during assessment and review emergency medical treatment may be found to be necessary or child protection concerns may be raised – see 3.5.3.


3. Intervention

Staff should feel confident to know how to respond to information provided through the assessment and where to seek support, advice and guidance as required. At this stage it is strongly recommended that the professional should ask the child or young person who else is aware of their circumstances or has been involved to avoid risk assessment duplication.

A designated member of staff should be identified who can provide advice and support to other professionals in the child’s network e.g. the school/college nurse.

Responses to the risk assessment questions together with an assessment of the presentation and behaviour of the child or young person will lead to either:

  1. An increased awareness of the child's or young person's needs which can be responded to through signposting to support and ongoing monitoring; or
  2. An increased awareness of the child's or young person's needs and an on-going support and potential re-assessment system being put in place; or
  3. A recognised need for the child or young person to be referred  for a more in-depth assessment and support. Initial support can be provided through safety planning (please see below);
  4. The need to respond to imminent risk / crisis.

Please remember that risk factors are not, nor can they ever be, tools for prediction. Also, any risk assessment can only be valid for the moment at which it is carried out and so may need to be repeated at suitable intervals according to professional judgement or advice. Risk of suicide is not the same as risk of mental illness, and one does not need to be mentally ill to have suicidal thoughts, although there may be links.

3.1 Imminent risk / mental health crisis

Mental health crisis means that a person is in a mental or emotional state where they need urgent help. They may be feeling at breaking point. Mental health crises may take the following forms:

  • Suicidal behaviour or intention;
  • Panic attacks/extreme anxiety, flashbacks;
  • Psychotic episodes (loss of sense of reality, hallucinations, hearing voices);
  • Other behaviour that seems out of control or irrational and that is likely to endanger the self or others (Mind).

Where there are concerns about imminent risk of suicide and / or a mental health crisis, follow the advice below from the Children’s Crisis Assessment Team:

Important information to share with families:

  • The quickest way to get mental health support at any time of the day or night in Hertfordshire is to call freephone number 0800 6444 101 or Call NHS 111 and select option 2 for mental health support;
  • In Case of serious illness, injury or harm call 999 for emergency services;
  • As a safety precaution – always ensure that prescribed and over the counter medicines are locked away securely at home.

When a child or young person is experiencing mental health crisis, this can be extremely distressing for them, as well as family members and professionals who are supporting them. Getting the right help at the right time in the right place is critical.

Serious Illness/Injury/overdose - Call Emergency Services
What to expect – Physical health tests and treatments will be completed at a general hospital and CCATT will assess mental health and risks in A&E.

Deterioration in mental health and known to mental health services
Please contact care coordinator or duty worker at the mental health team who are providing support Monday – Friday 9-5. Outside these hours – please contact Single point of Access (SPA) 0800 6444 101
What to expect – Mental health team will advise further based on information provided and their knowledge and involvement with the child and family including safety planning and any further assessment or increase in support required during period of crisis.

Deterioration in mental health and not known to mental health services
Please contact Single point of Access (SPA) 0800 6444 101
What to expect – A telephone triage will be completed by SPA and they will advise based on the information provided. This could include safety planning, a referral to CAMHS (including urgent referrals) or a telephone assessment by the crisis team.

CCATT Crisis Telephone assessment
What to expect – once a telephone triage has been completed by SPA, if indicated a call back will be made usually within 1 hour by a crisis team clinician. An initial assessment will be undertaken by phone. The clinician will advise based upon the information provided. This could include safety planning, same day/next day face to face crisis assessment in the community, initiate referral to mental health services or to attend A&E.

3.2 Safety Planning

When supporting a child or young person who is showing suicidal behaviour it is important to provide some immediate support whilst also signposting to relevant services.

Providing a brief intervention with the child or young person by developing a safety plan is one key element in the support process. A safety plan allows a child or young person to stay safe when having suicidal thoughts by setting out how they would like to be supported and how they can help themselves stay safe. It is also a place to keep important information and contacts for when they need it. A safety plan should not be created during a time of crisis but when the child or young person is in a safe calm environment which allows them to think clearly about what to put into their plan.

Suicide Safety plan from Papyrus, UK Charity for prevention of young suicide. This plan is specific for suicidal ideation and reducing risk.

The NHS website also link to stayingsafe.net with lots of videos and resources about safety planning which is good for professionals to review and / or to direct adults experiencing suicidal thoughts.

Another type of intervention that could be used is the Wellness Recovery Action Plan. This is a framework to develop an effective approach to manage distressing symptoms and understand behaviour. It can be used to help the child or young person have more control over their problems. Wellness Recovery Action Plan (getselfhelp.co.uk). This plan is more general and holistic. It is useful when risk is lower.

3.3 Ongoing Support Systems

On-going support systems need to be put in place irrespective of the level of risk taking into account that the level of risk could change.

On-going support may take many forms and may be offered via numerous sources and will be dependent on the child or young person's needs and wishes. It is important to ensure there is a professional in the child’s system who has ongoing oversight of the support being given.

Where the assessment does not lead to referral for more in depth assessment it is essential that communication with the child or young person remains strong and that a supportive adult remains in contact with the child or young person on a regular basis.

If a child or young person has been admitted to hospital, mental health services might continue to offer support, but equally the school/college nurse, the child's GP, or in some cases the child's social worker, may be best placed to offer on-going support. One key worker should be named and identified to offer an on-going point of contact for that child, with an alternative person stipulated should the key worker not be available. This needs to be agreed locally between key professionals and in consultation with the family and child or young person. A planning meeting may need to be convened for this purpose, and further review meetings where required.

It is also acknowledged that parents / carers, staff and other pupils may require support themselves when supporting children or young people at risk of suicide (see staff wellbeing section).

3.4 Children and Young People Mental Health Services (CYPMHS) Support

There are a number of providers delivering mental health support to children and their families in Hertfordshire. Before making a referral to Specialist CAMHS, please consult this service directory to explore the level of mental health need and appropriate interventions and providers: April 2023 v1 Mental Health Support: Guidance for professionals working with children and young people (CYP) (justtalkherts.org).

It would be helpful to discuss the options with the child or young person and agree which service they are most comfortable to engage with. Some of the services require a professional referral which can be completed by any professional (it does not need to be the GP) and others are accessed via self-referral. Professionals may wish to help self-referral processes by either helping with forms, creating a space for a phone call etc. if desired.

It is possible that the first time any community health or education professionals learn of a child or young person in need may be after attempted suicide that has resulted in assessment in Accident and Emergency or admission to hospital. Irrespective of the entry point to the Referral Pathway, where a child or young person has been deemed to need a mental health assessment, it is essential that we do not lose sight of that person post assessment. For children and young people accessing non statutory mental health and wellbeing services, it is also important to check in on engagement and outcomes with the young person, particularly for the nominated lead professional.

3.5 Consent Issues

If a child or young person is deemed to need support from other professionals the staff member supporting the child or young person will:

  • Seek consent from the child or young person to share information;
  • Tell the child or young person what information will be shared, why it should be shared and the consequences of sharing.

Sometimes concerns of significant harm may lead to a referral being made without consent. Please note, referrals to non-crisis mental health services require consent from the parents or competent child.

3.5.1 Parental consent

Professionals should encourage children and young people to make their parents aware of their thoughts and feelings. The professional could support or facilitate this conversation if the child or young person desires. The majority of parents will want to support their child; they may require information or support to understand the situation and how best to help. However, if a competent child or child over 16 wants to limit the information given to their parents or does not want them to know it at all; the child's wishes should be respected, unless the conditions for sharing without consent apply.

3.5.2 Guidance on Sharing Information

In line with Hertfordshire Continuum of Need for Children and Young People and consistent with Working Together to Safeguard Children every family (child/young person and their parent/carer) has the right:

  • To be told when a professional is worried about the safety or wellbeing of their child by that professional;
  • To have their consent obtained when someone wishes to make a request for support on their behalf;
  • To be front and centre of the plan to keep their child safe and well.

Purpose of Sharing Information

The purpose of sharing information is to ensure young people in need and in particular young people who have suicidal thoughts and behaviours or are perceived to be at risk of suicide are given the help and support they are entitled to.

What will be shared?

Information shared will be no more than is necessary. All information will be handled with respect and care.

Unrecorded observations, which may not at first seem significant, will be freely shared on a need-to-know basis within statutory agencies and between partners in the interests of meeting the statutory functions of the partners.

Information, particularly how judgments and decisions were reached should be recorded if it is significant.

Consent

The Hertfordshire Continuum of Need for Children and Young People guidelines are intended to strengthen the respectful relationships that we build as professionals with families, including transparency and honesty about concerns and the help and support needed for a child or young person to thrive and be safe.

Where partner agencies are requesting additional and intensive services, targeted early help or child in need support for a family, this must include parental consent to be accepted by Hertfordshire’s multi agency safeguarding hub, the Gateway. Consent to make a request for support on their behalf should also be sought from the children and young people, wherever they are of an age and level of understanding to give it.

Where referrals are made for Specialist services because a practitioner believes a child is suffering, or is at risk of suffering, significant harm, it is good practice to seek parental consent and it will usually be appropriate to do so.

For a small number of children, seeking parental consent would not be appropriate if the child would be placed at increased risk of significant harm through the action of gaining this consent, there would be an impact on a criminal investigation or a delay in making the referral would impact on the immediate safety of the child.

The Gateway will inform referrers if they have submitted a contact or referral that is missing the necessary parental consent. No record of these contacts or referrals will be held by the Gateway. The referrer will need to submit a fresh contact or referral once they have secured parental consent. 

Sharing without Consent

Informed consent should be sought from the competent child to share recorded information unless;

  • The situation is urgent and there is not time to seek consent; or
  • Seeking consent is likely to cause serious harm to someone or prejudice the prevention, detection of serious crime.

If consent to sharing recorded information is refused by the competent child, or can/should not be sought from the child, information should still be shared in the following circumstances;

  • There is reason to believe that not sharing is likely to result in serious harm to the child or someone else or is likely to prejudice the prevention or detection of serious crime; and
  • The risk is sufficiently great to outweigh the harm or prejudice to anyone that may be caused by the sharing; and
  • There is a pressing need to share the information.

When is a child "competent" to give consent?

Consent for information sharing: Anyone under the age of 18 is a child. A judgement must be made as to whether a particular child in a particular situation is competent to consent or refuse consent to sharing information. Consideration should include the child's chronological age, mental and emotional maturity, intelligence, vulnerability and comprehension of the issues. A child at serious risk of suicide may lack emotional understanding and comprehension (Gillick Competence should be used).

Consent for treatment: The Mental Capacity Act 2005 - Capacity and consent in 16 and 17 year olds

The Mental Capacity Act (MCA, 2005) applies to young people aged 16 years and over and in law they are presumed to have capacity to consent to or refuse treatment, including hospital admission. Mental capacity is present if a person can understand information given to them, retain the information given to them long enough to make a decision, can weigh up the advantages and disadvantages of the proposed course of treatment in order to make a decision, and can communicate their decision.

Parents cannot override consent or refusal from a competent 16/17-year-old. Neither can they consent on behalf of their competent 16/17-year-old. However, the Department of Health recommends that it is good practice to encourage children of this age to involve their families in decisions about their care, unless it would not be in the child’s interests to do so.

16 and 17-year-olds who do not have capacity

If a child lacks the capacity to consent, they may be treated without their consent under the MCA as long as the treatment does not involve a deprivation of liberty. Treatment can also proceed with the consent of someone with parental responsibility as long as the treatment falls within the scope of parental responsibility. While only one person with parental responsibility needs to be approached, it is good practice to involve all those close to the child if possible. The definition of ‘parental responsibility’ is set out in the Children Act 1989.

Children under the age of 16 years who are competent

For children under 16 years the MCA does not apply. Instead, a child needs to be assessed whether they have enough understanding to make up their own mind about the benefits and risks of treatment – this is termed ‘Gillick competence’. Parents cannot override a competent child’s refusal to accept treatment. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the recommendation for treatment, there should be evidence that providers have attempted to understand both the child’s and parents’ position. There should also be evidence that alternative treatments have been considered or a compromise is not possible. However, ultimately the decision rests with the competent child (CQC, 2020 Brief Guide Capacity and consent in under 18s v3).

3.5.3 Child Protection

After the risk assessment, or at any stage of the care pathway, if a professional is concerned that the child or young person is in need of protection, they should call the Customer Call Centre on 0300 123 4043. For out of hours service (after 8 pm) calls will automatically be diverted to an agency, who can contact the Children's Services Out of Hours Service (SOOHS) on your behalf (except textphone/minicom, callers need to redial 01992 632150).

The usual child protection procedure should then be followed whereby a section 47 enquiry / assessment will be carried out by Children's Social Services in consultation with the Police and other agencies.


4. Postvention (after a suicide or attempted suicide)

Postvention relates to interventions conducted after a suicide, mainly in the form of support for those bereaved (family, friends, professionals, and peers). It is aimed at reducing the risk of suicide in this group by helping those affected by the suicide cope with their loss, encourage help seeking behaviours and raise awareness of the support available. It is also important after an attempted suicide to provide support to those affected.

Suicide Bereavement Support

There is a countywide service for those who have been bereaved by suicide. The service is free and all age.

CHUMS: Hertfordshire and West Essex Suicide Bereavement Service

The CHUMS Suicide Bereavement Service provides emotional and practical support to those affected by a suicide or suspected suicide death. CHUMS support adults and children, residing in Hertfordshire and West Essex.

Website: Hertfordshire and West Essex Suicide Bereavement Service. There are referral forms on the website.
E-mail: hsbs@chums.uk.com
Telephone number: 01279 212170

Postvention in schools

The Suicide Aware Prevention and Postvention Charter provides a consistent framework to support schools in their whole school approach across the different levels of intervention. It is accessible to all schools.

In the event of a suicide, attempted suicide or other critical incident linked to suicide, Hertfordshire County Council provides support to schools through the Educational Psychology Service (whole school support and planning for staff and pupil wellbeing) and Safe Space (counselling support for individuals directly affected). Support can be accessed via the following numbers:

  • East Herts, Broxbourne, Welwyn and Hatfield: 01992 556998;
  • North Herts and Stevenage: 01438 843379;
  • St Albans and Dacorum: 01442 453904;
  • Watford, Three Rivers & Hertsmere: 01442 453043.

Samaritans provide postvention support to schools: Step by Step service and ‘Creating a response plan’.

Papyrus provide a helpline (Hopeline UK) and a Schools Guide.

4.1. Training

4.1.1 Schools Training

It is recommended that all Hertfordshire schools nominate a Mental Health Lead to access the following training and resources:

  • Mental Health Leads training is available to all education settings in Hertfordshire. Dates are sent out throughout the year and places can be booked by e-mailing: hweicbhv.schoolsmh@nhs.net;
  • The training aims to provide Mental Health Leads with the tools to plan and action a whole school approach to emotional and mental wellbeing;
  • The Level 2 Mental Health First Aid training course can also be booked by e-mailing: hweicbhv.schoolsmh@nhs.net;
  • Senior Mental Health Leads training is also available via the DofE. See GOV.UK, Senior mental health lead training.

4.1.2 Suicide Prevention Training for All

The Suicide Prevention website provides information on training available within Hertfordshire.

4.1.3 Staff Wellbeing and Supervision

When supporting issues like suicide and related issues it is really important that staff prioritise their own wellbeing and are supported to do so. It is impossible to provide effective support to others if your own wellbeing is low. Burnout, compassion fatigue and blocked care can occur when staff are not adequately supported, and this need is heightened at stressful times such as following a suicide or attempted suicide.

The following links provide quality assured funded resources to support staff wellbeing:

Parents may also need to access support for themselves in order to provide the best support they can to their children. Parents of children with mental health and wellbeing needs can access a support service from NESSie.


Appendix 1: Legislation and Guidance

1.

Children Act 1989 Section 17

A child is defined as 'in need' by Section 17 of the Children Act (1989) if:

  • He or she is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him/her of services; or
  • His/her health or development is likely to be significantly impaired, or further impaired, without the provision for him/her of such services; or
  • (S)he is disabled.

2.

Children Act 1989 Section 47

Where a local authority has reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm, the authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the child's welfare. 'Harm' is defined as Ill treatment, which includes sexual abuse, physical abuse and forms of ill-treatment which are not physical, for example:

  • Emotional abuse; or
  • Impairment of health (physical or mental); or
  • Impairment of development (physical, intellectual, emotional, social or behavioural).
This may include seeing or hearing the ill treatment of another (s120 Adoption and Children Act 2002).

3.

Mental Health Act 1983

The Mental Health Act 1983 is the principal Act governing the treatment of people with mental health problems in England and Wales. The Mental Health Act covers all aspects of compulsory admission and subsequent treatment. Besides these emergency procedures, there are other sections of the Act under which a person can be detained in hospital without their consent. (In November 1999 the Government issued a White Paper called 'Reforming the Mental Health Act', which was intended to act as the basis for a new Act. In June 2002 this was superseded by a draft Mental Health Bill).

The Mental Health Act of 1983 covers the detention of people deemed a risk to themselves or others. It covers four categories of mental illness: severe mental impairment, mental impairment, psychopathic disorder and mental illness. The first two are generally interpreted as people with learning difficulties who have aggressive tendencies. Psychopathic disorder relates to people who have a "persistent disorder or disability of the mind" which leads to aggression.

Mental illness itself is not defined by the Act. However, it does state what it does not cover, which includes people who may be deemed to be mentally ill "by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs".

The Act allows people considered to be mentally ill to be detained in hospital and given treatment against their will. They do not have to commit a crime or have harmed anyone. They are usually detained because it is considered in their interests and for their own safety, but they may be held because they are deemed a risk to others.

4.

Mental Capacity Act 2005

The Mental Capacity Act 2005 for England and Wales come into force in 2007. The Act will generally only affect people aged 16 or over and provides a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves, for example, people with dementia, learning disabilities, mental health problems, stroke or head injuries who may lack capacity to make certain decisions. It makes it clear who can take decisions in which situations and how they should go about this. It enables people to plan ahead for a time when they may lack capacity. The Act covers major decisions about someone's property and affairs, healthcare treatment and where the person lives, as well as everyday decisions about personal care (such as what someone eats), where the person lacks capacity to make the decisions themselves. 

The Act was amended in 2019 and replaces the deprivation of liberty safeguards (DoLS) with a new administrative framework for authorising deprivation of liberty, the Liberty Protection Safeguards (LPS).


Appendix 2: Guidance, resources and Further Reading

Hertfordshire Suicide Prevention Network website is a one stop shop containing resources, training and information.

Hertfordshire Suicide Prevention strategy

GOV.UK, Suicide Prevention Strategy for England

GOV.UK, Suicide prevention: resources and guidance

Suicide by Children and Young People 2017 (HQIP)

Suicide prevention resources and services

End