Self-Harming and Suicidal Behaviour

Scope of this chapter

Note: This chapter should be read in conjunction with the Cheshire East Safeguarding Children's Partnership Procedures.

Regulations and Standards

The Positive Relationships Standard

The Protection of Children Standard

Related guidance

1. Introduction

Many children and young people who come into the 'looked after' system have experienced significant trauma in their lives and are often highly vulnerable. It is likely that these children will sometimes have multiple and complex needs and significant behavioural and emotional difficulties, which can lead to acting in ways that place themselves in situations of high risk.

Homes staff will undergo training during their probationary period and throughout their employment to raise awareness and to promote best practice with identifying risk of self-harm and suicidal behaviour in our Homes.

Training undertaken includes:

Safeguarding Children and young people;
Introduction to First Aid;
Introduction to Child and Adolescent Mental Health;
Self-Harm and risky behaviour;
Contextual Safeguarding.

It is vital that self-harming behaviour is acknowledged as a way of indicating emotional distress and is taken seriously and responded to in a supportive way. Early intervention can help a chid to manage distress in alternative ways.

Some signs that may indicate that a child may be self-harming include:

Poor functioning at school;
Unexplained or frequent injuries;
Keeping the skin covered (arms and legs especially) at all times;
Appearing lonely. Isolated, withdrawn or uninterested;
Difficulty handling emotions;
Elusive, evasive, or secretive actions especially if asked about injuries;
Carrying razors, lighters or sharp objects that are not normally needed;
Difficulty handling feelings;
Engaging in risk behaviours;
Eating disorder behaviours;
Engaging in abusive relationships;
Unexplained bruises, cuts, burns or bit marks on the body;
Blood stains on clothing, or finding tissues with blood in a child’s bedroom;
Avoiding friends and family;
Feeling down, having low self-esteem, or blaming themselves for things;
Having angry outbursts, or risky behaviour such as drinking or taking drugs;
Any major change in behaviour of any kind.

Signs of Suicide Potential

The following could be signs or indicators that a child is thinking about suicide. It may be helpful to consider these as “invitations” – behaviours inviting others to notice, hear or see how they are feeling:

Speaking about wanting to die, plans or threats to end their life, use of “hopeless” language;
Speaking about being a burden to others;
Saying goodbyes to family and friends, tying up loose ends/putting affairs in order;
Giving away possessions or meaningful items;
Preoccupation, focus on death via media such as art, poetry, music or writing about suicide, death blogs on internet or diary;
Changes in mood – particularly if the child is showing feelings of calm and contentedness followed by a period of distress or depression (as they may be feeling at peace with a decision to follow through with a plan of suicide;
Actively seeking out supplies or artefacts to assist with suicide e.g., stockpiling medication, searching online for methods;
Suicide notes or plans;
Increased use of alcohol or drugs;
Sudden changes in behaviour that may be linked to emotionally difficult situations;
Withdrawing or isolating themselves;
Expressing feelings of loneliness;
Loss of interest in hobbies or things that previously pleased.

2. Planning and Prevention

As part of Placement Planning, relevant information should be gathered and appropriate risk assessments put in place alongside relevant intervention strategies.

Children living in the Home who are at risk of self-harm or suicide will have an up-to-date safety support plan that will include person centred support, strategies and interventions to reduce the risk through education. 1:1 support and to provide guidance on the personalised steps to take for a child who is known to or expressed that they may self-harm of attempt suicide. Safety support plans should include triggers, help to build resilience, confidence and the encouragement of healthy coping mechanisms. If a child has self-harmed they are to be supported in line with their safety support plan. Safety support plans should be regularly reviewed and monitored.

In situations where staff are involved with a child who is actively self-harming or suicidal, they should, in consultation with other members of the team, ensure there is a plan to manage the effects such as distress or grief that an incident of self-harm or suicide may cause other workers, family members and other children and young people in the setting.

All reasonable measures should be taken to reduce or prevent continuation of the behaviour, and any distress caused to other children living in the Home.

This may include providing additional supervision, confiscation of materials that may be used to self-harm or, as a last resort, use of physical intervention or calling for assistance from the emergency services.

If a child presents in a manner that raises concern for their safety, or if they attempt an act of suicide, the emergency services are to be contacted immediately. The Homes procedures to report, record and inform all relevant professionals and family members should be followed once emergency support is available.If a child has ligatured or has a history of ligaturing, then systems will need to be in place to monitor them and record appropriately until there is a reduction in risk. When it is a known or identified that a child is at risk of ligaturing Homes staff will undertake training to ensure they know how to respond to safeguard the child. Ligature cutters will be available for Homes staff to use when a child has ligatured. Homes staff should be aware of the location of ligature cutters in the Home that should be checked daily as part of sharps checks to ensue they are in situ and fit for purpose.

In instances where a child has ligatured Homes staff are to call the emergency services for support and to have the child’s well-being assessed by a medical professional. Homes staff should act on any advice provided by medical professionals and remove any items that may be used by a child to ligature until the risk reduces.

Whilst a child is at risk of self-harm or suicide, searches of bedrooms should be increased and discussed with them before being added to the safety support plan. The frequency of the searches will depend on the level of risk presented by the child.

If any staff member believes a child may have secreted items to their bedroom for the purpose of self-harm, a room search must be completed immediately, regardless of any searches which are currently in place.

If there is any suspicion that the child may be involved in self harming or any attempts of suicide, the social worker must be informed and a risk assessment undertaken (if it does not already exist with a view to deciding whether a strategy should be adopted to reduce or prevent the behaviour. That strategy should be included in the child's safety support plan & Placement Plan.

If necessary, specialist advice or support should be sought.

3. Notifications, Recording and Review

3.1 Notifications of Minor or Non Persistent Self Harming

Minor or non-persistent self-harming should be notified to the manager at the first opportunity; the manager or Senior staff member will inform the relevant social worker.

3.2 Notifications of Serious or Persistent Self Harming

Serious or persistent self-harming or attempted suicide must be notified immediately to the Home's manager and the relevant social worker notified within 1 working day - the social worker should be consulted and consideration given to whether a Child Protection Referral should be made, if so, see Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

The Designated Manager (Self Harming) should also be notified and consideration given to whether the incident is a Notifiable Event, see Notification of Serious Events Procedure.