[insert organisation name/logo]
Client Suicide and Self Harm Policy
Document Status:
Draft or Final
Date Issued:
[date]
Lead Author:
[name and position]
Approved by:
[insert organisation name] Board of Directors on [date]
Date for Review:
[date]
Record of Policy Review:
Date Policy
was Issued
[month, yr]
Date of
Review
[month, yr]
Reason for Review
[for example, incorporate changes
to new legislation]
Client Suicide and Self Harm Policy – [month/year]
Lead
Reviewer
[name]
Additional Comments
[for example, policy
now covers details
related to new
legislation].
Page 1 of 14
Client Suicide and Self Harm Policy
1.
Purpose and Scope
This policy provides guidance for [insert organisation name] in responding to client
observation, allegation and disclosures indicating potential self harm and/or suicide.
This policy applies to all programs and services operated by [insert organisation
name] and all staff, students and volunteers involved in client support.
This policy is to be implemented in conjunction with the Client Intake and
Assessment Policy, Client Intervention Policy and Client File Management Policy.
This policy does not prescribe client treatment planning, intervention goals and
strategies, or specific counselling techniques and theories.
2.
Definitions
Postvention – interventions to support and assist the bereaved after a suicide has
occurred.
Risk factors – factors such as biological, physiological, social and cultural agents that
are associated with suicide/suicide ideation and increase their probability
Self harm – deliberate damage to one’s body without the intent to die (also referred
to as self injury)
Suicide – the act of purposely ending one’s life
Suicide attempt - a potentially self-injurious act intended to end one’s life but which
does not result in death
Suicidal behaviour - includes the spectrum of activities related to suicide and self
harm including suicidal thinking, self harming behaviours not aimed at causing death,
and suicide attempts
Suicidal ideation – thoughts about attempting or completing suicide
Suicide prevention – actions or initiatives to reduce the risk of suicide among
populations or specific target groups
3.
Principles
Client Suicide and Self Harm Policy – [month/year]
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[insert organisation name] is committed to good practice in the prevention of
suicide and self harm through the development, implementation and review of
policies and procedures based on current evidence.
When responding to suicidal and self harming behaviour, the physical and emotional
safety of the client, staff, students and volunteers is paramount.
[insert organisation name] ensures staff, students and volunteers receive a level of
training and supervision appropriate to their role in responding to clients at risk of
suicide and self harm.
4.
Outcomes
[insert organisation name] identifies and responds to clients at risk of suicide or
self harm, and clients with suicide behaviour or suicide attempts.
Staff receive adequate training and supervision in responding to clients at risk of
suicide or self harm, and clients with suicide behaviour or suicide attempts.
5.
Functions and Delegations
Position
Delegation/Task
Board of Directors
Management
Endorse Client Suicide and Self Harm Policy.
Compliance with Client Suicide and Self Harm Policy.
Ensure staff receive adequate training and supervision.
Facilitate provision of staff supervision and/or debriefing
following client suicide or suicide behaviour.
Recognise and manage limits of individual staff roles,
knowledge and skills in responding to client suicide or suicide
behaviour.
Staff supervisor
Provide support and supervision to staff, students and
volunteers working with clients at risk of suicide and self-harm.
Staff
Compliance with Client Suicide and Self Harm Policy.
Undertake client assessments with the knowledge of suicide risk
factors.
Develop and review client case management plans.
Client Suicide and Self Harm Policy – [month/year]
Page 3 of 14
Respond to client suicide or suicide behaviour in line with good
practice.
Risk Management
The organisation acknowledges, and is prepared for, clients disclosing suicide or self
harm through a range of avenues including disclosure to staff, students, volunteers
and/or other clients.
Assessment and responses to suicide and self harm risk is undertaken by staff who
are appropriately trained and qualified, using evidence based assessment and
response practices.
All indications of suicide, suicide behaviour and self harm are taken seriously.
A first aid kit is accessible in public areas.
All staff are supported to recognise the limits of individual roles and competencies
and actively facilitate links to further levels of care where necessary.
6.
Policy Implementation
This policy is developed in consultation with all staff and endorsed by the Board of
Directors.
This policy is part of all [insert organisation name] staff, student and volunteer
orientation processes and all are responsible for understanding and adhering to this
policy.
This policy should be referenced in relevant [insert organisation name] policies,
procedures and other supporting documents to ensure that it is familiar to all program
staff and actively used.
7.
Policy Detail
7.1
Triggers and precipitating events
The different types of precipitating events and circumstances that are linked to the
increased likelihood of suicidal behaviour are shown in the diagram below (they do
not necessarily occur sequentially).
Client Suicide and Self Harm Policy – [month/year]
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Risk factors
Mental health problems
Gender – male
Family discord
Family history of suicide
Alcohol or other substance abuse
Social or geographical isolation
Financial stress
Bereavement
Prior suicide attempt
Warning signs
Hopelessness
Feeling trapped – like there’s
no way out
Withdrawing from friends, family or
society
Increasing alcohol or drug use
Uncharacteristic or impaired
judgement or behaviour
No reason for living, no sense
of purpose in life
Tipping point
Relationship ending
Loss of status or respect
Debilitating physical illness or
accident
Death or suicide of relative or friend
Suicide of someone famous or
member of peer group
Argument at home
Being abused or bullied
Media report on suicide or
suicide methods
Imminent risk
Expressed intent to die
Has plan in mind
7.2
Has access to lethal means
Impulsive, aggressive or antisocial behaviour
Assessment
Clients presenting with suicidal behaviour are assessed to determine the level and
immediacy of suicide and/or self harm risk.
Objective and subjective evidence is used to determine a client’s risk of suicide
and/or self harm. A comprehensive assessment draws on all available information
including: interviews with the client; observation; medical, psychiatric and personal
history; feedback from other staff; and information from family and carers.
If a client is assessed as being at risk of suicide and/or self harm, intervention
strategies to decrease the risk are developed and implemented.
If staff are unsure about a client’s suicide or self harm risk, the staff member ensures
client physical safety before consulting with their supervisor or other nominated
Client Suicide and Self Harm Policy – [month/year]
Page 5 of 14
personnel. Local mental health professionals may also be consulted to assist in
determining risk.
In conducting client suicide and self harm risk, cultural considerations are addressed
as part of the assessment process.
Client risk assessment is undertaken on an ongoing basis to monitor a risk status
and to ensure the clients’ support needs are met.
The Suicide and Self Harm Risk Assessment Form is used to assess the clients’
suicide risk. This tool provides a risk rating to guide staff responses.
7.3
Risk Rating
The client suicide risk rating, obtained by completing the Suicide and Self Harm Risk
Assessment Form is categorised in the following levels:
1.
2.
3.
4.
5.
7.4
Non existent
Mild / low
Moderate
Severe / high
Extreme / very high.
Intervention
7.4.1 Initial Response
If a client is assessed as being at risk of suicide or self harm, staff member notify
their supervisor or other nominated personnel to jointly develop a plan for further
assessment and intervention.
Risk assessment ratings of mild/low indicate that the client is to be reviewed
frequently, and for staff to assist in identifying potential supports and to provide
contact details. A Client Safety Contract may be entered into.
If the risk of suicide or self harm is assessed as being moderate or above, an
immediate referral is made to a specialist mental health service for assessment and
emergency intervention. A Client Safety Contract may be entered into.
If the risk of suicide or self harm is assessed as being high or above, the client is not
to be left unsupervised.
Client Suicide and Self Harm Policy – [month/year]
Page 6 of 14
If risk of suicide is confirmed, employees are guided to perform a combination of the
following activities according to the risk rating:
o Review the client regularly
o Identify potential supports and provide contact details
o Contract with client to seek immediate assistance if fleeting thoughts become
more serious or depression deepens
o Request permission to organise a specialist mental health status assessment
o Contact the mental health crisis team
o Ensure that the client is not left alone
o Call an ambulance and/or police
o Consult with a colleague or supervisor for guidance and support.
Immediate safety concerns are addressed before developing longer term case
management plans.
Clients who present with self harm injuries receive necessary medical attention as a
high priority.
7.4.2 Developing a Safety Plan
Once an immediate suicide and/or self harm crisis has passed, clients are assisted to
develop a safety plan which identifies a particular course of action they can follow if
they are again at risk of suicidal or self harming behaviour.
The safety plan may include entering into a Client Safety Contract and includes
details support contacts such as family, friends, carers and service providers.
Clients are actively involved in decision making processes about how to protect their
safety and prevent suicide or self harm.
7.4.3 Case Management Plans
Client case management plans detail the types of support provided, how client
improvement or deterioration will be monitored and who will be involved in providing
care.
Case management plans are regularly reviewed and updated to include new
assessment findings and intervention strategies.
Families, carers and support persons of the client are involved in case management
planning wherever possible and appropriate. Consideration is given to the support
needs of family members and carers in the development of case management plans.
Client Suicide and Self Harm Policy – [month/year]
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Family members and carers are assisted to access available supports as
appropriate.
7.4.4 Client Safety Contract
Client safety contracts provide a written or verbal agreement for the client not to
engage in suicidal or self harming behaviour. A client safety contract depends on an
established worker-client relationship and capacity of the client to provide informed
consent.
A written Client Safety Contract template is used by [insert organisation name] where
the client is able to provide informed consent.
7.4.5 Maintaining Client Contact
A client who has been assessed as being at risk of suicide and/or self harm and does
not attend their scheduled appointments will actively followed up by the case
manager or other nominated staff member to ascertain safety needs.
Relevant staff members are informed of specific client arrangements where
necessary. For example, reception/administrative staff are instructed to give priority
to particular client’s calls.
7.5
Referral
If risk of suicide or self harm is assessed as being moderate or above, an immediate
referral is made to a specialist mental health service for priority assessment and
intervention. The client is to be accompanied to the mental health service and/or
hospital by a staff member, or arrangements are made for the assessment to take
place at [insert organisation name], or other safe arrangements are made for the
client to attend the specialist mental health service.
Relevant staff obtain information from the mental health service or hospital about
what action has been taken with the client.
Clients are actively assisted to follow up referrals to external organisations by staff
making initial telephone or written contact with the external provider and the client is
supported to attend the first appointment.
[insert organisation name] maintains links and has established referral protocols
with external services including:
- Hospital and community based mental health services
- Hospital emergency departments
Client Suicide and Self Harm Policy – [month/year]
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-
General practitioners
Local police
Counselling and support services such as [insert services]
Organisations supporting specific diverse population groups
Other relevant services and programs.
[insert organisation name] maintains an up-to-date database and resource manual
of emergency and support services available for clients who are at risk of suicide
and/or self harm.
7.6
Confidentiality
[insert organisation name] has a duty of care to do everything reasonable to
prevent a client’s suicide or self harm.
The right of confidentiality is not absolute and is balanced against duty of care.
[insert organisation name] has a legal and professional responsibility to disclose
information where not reporting might cause harm to a client or another person.
Clients are advised of the limits of confidentiality during intake, assessment and if a
suicide and/or self harm situation arises. Reasonable steps are taken to obtain client
agreement for information to be disclosed to a third party.
Confidential information is disclosed to those in a position to assist in client safety
and the information provided is restricted to that which elicits assistance.
Privacy legislation requirements are considered in the disclosure of confidential
information.
7.6.1 Mandatory Reporting
Where immediate danger to a child or young person is evident the police and/or the
Child Protection Helpline (phone 132 111) is contacted immediately. Refer to the
Child Protection Policy for further detail.
7.7
Identifying and Responding to Risk of Harm to Others
Threats to harm others at the organisation are taken seriously and will be reported to
the appropriate authorities. All staff, students and volunteers respond to identified
potential harm to others arising from a client’s suicidal or self-harming behaviour.
Staff, students and volunteers report the identified potential harm to their supervisor
and/or other identified personnel.
Client Suicide and Self Harm Policy – [month/year]
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7.8
Suicide Postvention
[insert organisation name] recognises that a client’s suicide may impact on other
clients, staff, students, volunteers, the client’s family and friends, and the wider
community.
Postvention responses are implemented with the aim of supporting those bereaved
by suicide and preventing further suicide events.
Expert advice about appropriate and safe postvention responses is provided by
mental health organisations, other relevant organisations and specialists consultants.
Staff, students, volunteers and clients are provided with written information and
resources about suicide bereavement where appropriate.
7.8.1 Initial Actions for Staff
Following the death of a client from suicide, the manager provides staff, students and
volunteers with a factual briefing concerning the circumstances of the death.
Professional group and/or individual debriefing for staff, students and volunteers is
provided for those wanting to access that service
Staff are encouraged to independently contact an employee assistance program or
other relevant support service as needed.
7.8.2 Initial Actions for Clients
Following the death of a client from suicide, the [insert position(s)] provide other
current clients with relevant information about the death. Information is given to
individuals or small groups of clients, rather than large assemblies. The emphasis is
on developing understanding without condemning or glorifying the suicidal event or
client.
The [insert position(s)] is to arrange professional group debriefing session for clients
where relevant. Participation in this session is voluntary.
Clients are also provided with opportunities for individual debriefing and support as
required.
The organisation recognises that some staff members may not feel comfortable or
have the capacity to discuss a client’s suicide with other clients. This decision is
respected and alternative sources of support are arranged for clients.
Client Suicide and Self Harm Policy – [month/year]
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Following the death of a client from suicide, the organisation identifies clients who
may be at increased risk of suicide and/or self harm and assist them to access
appropriate support.
7.9
Professional Development and Training
Staff, students and volunteers receive training in suicide risk assessment and
interventions appropriate to their role.
Administrative staff and volunteers receive mandatory introductory training to assist
in identifying warning signs and for referring clients to appropriate staff members.
The CEO/Manager ensures staff, students and volunteers attend training programs
delivered by providers with an appropriate level of expertise.
[insert organisation name] recognises that suicide risk assessment and
interventions are core skills for staff with direct client contact, and that knowledge and
practice is reviewed and updated regularly.
Staff participate in client case management meetings for clients who are at risk of
suicide and/or self-harm to ensure appropriate service delivery and to maintain
knowledge and skill capacity.
7.10 Professional Supervision and Support
[insert organisation name] recognises that supporting clients who are at risk of
suicide and/or self harm can be challenging and demanding. The organisation is
committed to monitoring and attending to the impact of client suicide and self harm
on staff, students and volunteers.
7.10.1 Supervision
Staff, students and volunteers notify their supervisor or other nominated personnel
once a client suicide or self harm risk is identified to develop immediate and longer
term case management planning.
Staff, students and volunteers are provided with internal supervision and debriefing to
address the emotional impacts that may arise from working with clients in distress.
Staff are provided external professional supervision to review client cases and
address the emotional impact of working with clients in distress.
7.10.2 Debriefing Support
Client Suicide and Self Harm Policy – [month/year]
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Following an emergency incident involving a client who is suicidal or self harming,
staff, students and volunteers are offered access to immediate debriefing support.
Staff, students and volunteers are encouraged to remain aware of their own
emotional reactions and seek support from their supervisor, colleagues and other
avenues as required.
7.11 Media and Community Education
Media enquiries relating to suicide and self harm are managed by the CEO/Manager.
Any public or media discussion the organisation engages in aligns with the
Mindframe media guidelines for discussing and reporting suicide and self harm.
7.12 Record Keeping
[insert organisation name] maintains comprehensive and accurate documentation
of client assessments, case plans, interventions, referrals and outcomes.
Consideration is given to the potential need for record sharing and freedom of
information access. Refer to the Client File Management Policy for further details.
7.13 Policy and Practice Review and Evaluation
[insert organisation name] reviews its policies, procedures and practice based on
feedback from staff, students and volunteers, as well as results of service evaluations
and new or emerging evidence in suicide and self harm prevention and management.
9.
References + Resources
9.1
Internal
Child Protection Policy
Client File Management Policy
Client Intake and Assessment Policy
Client Intervention Policy
Privacy and Confidentiality Policy
9.2
External
LIFE Suicide Prevention in Australia website:
www.livingisforeveryone.com.au
Mindframe website:
www.mindframe-media.info/
Client Suicide and Self Harm Policy – [month/year]
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Mills, K., Deady, M., Proudfoot, H., Sannibale, C., Teesson, M., Mattick, R., and
Burns, L. (2009) Guidelines on the management of co-occurring mental health
conditions in alcohol and other drug (AOD) treatment settings. National Drug and
Alcohol Research Centre, University of New South Wales, Sydney
NSW Health 2005. Framework for Suicide Risk Assessment and Management for
NSW Health Staff. NSW Health, Sydney.
Queensland Government 2008. Principles for developing organisational policies and
protocols for responding to clients at risk of suicide and self-harm. Department of
Communities, Brisbane.
Ross, J., Darke, S., Kelly, E., and Hetherington, K. (2010) Suicide Risk Assessment
and Intervention Strategies: Current Practices in Australian Residential Drug and
Alcohol Rehabilitation Services. National Drug and Alcohol Research Centre,
Sydney.
9.3
Quality and Accreditation Standards
EQuIP4
Provided by the Australian Council on Healthcare Standards (ACHS)
Standard 1.1: Consumers/patients are provided with high quality care throughout the
care delivery process.
Criterion 1.1.1: The assessment system ensures current and ongoing needs of the
consumer / patient are identified.
Health and Community Service Standards (6th edition) – Quality Improvement
Council
Provided by Quality Improvement Council (QIC)
Standard: 2.1: Assessment and planning are undertaken at individual and community
levels to ensure services and programs are responsive to identified needs.
Evidence Question: What is the evidence that:
b) services and programs are developed to respond to identified needs.
Standard: 2.2: Services and programs are provided in an effective, safe and
responsive way to ensure positive outcomes for consumers and communities.
Client Suicide and Self Harm Policy – [month/year]
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Evidence questions: What is the evidence that:
a) interventions and actions are based on assessment and planning?
b) services and programs are managed to ensure positive outcomes for consumers
and communities?
e) services and programs are safe and risks are identified and addressed?
Client Suicide and Self Harm Policy – [month/year]
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