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BarnsleySafeguarding Children Partnership Policies and Procedures Manual

Barnsley Intervention Protocol Following a Suspected Child Suicide

SCOPE OF THIS CHAPTER

This protocol has been developed to support professionals and direct responses following a suspected child suicide. The overarching purpose of this protocol and multi-agency response is to minimise community distress and contagion.

It was added to the procedures manual in October 2019.

Contents

  1. Introduction

  2. Overview of Current Statutory Child Death Review Processes

  3. Local Notification Process

  4. Initiation of Contagion Response and Contact with School
  5. Providing Support and Useful Resources to Schools
  6. The Multiagency Contagion Response Group
  7. Learning and Reflection Debrief
  8. Review of Protocol
  9. Contagion Response Group Checklist
  10. References
  11. Appendix 1: National Confidential Inquiry Suicide by Children and Young People: Infographics

  12. Appendix 2: Sample Terms of Reference Suicide Contagion Response Group

  13. Appendix 3: Example Letter to Parents

  14. Appendix 4: Sample Agenda for First Meeting

  15. Appendix 5: Blank Circles of Vulnerability Matrix

  16. Appendix 6: Spreadsheet to capture information on Vulnerable Individuals

1. Introduction

A child suicide is a rare event; however, when it does occur the impact of it can be widespread. Literature acknowledges that the effect among peers can be potentially devastating. The occurrence of an adolescent suicide in itself is a known risk factor for suicide contagion. Suicide contagion refers to the social, or interpersonal, transmission of suicidality from one victim to another, which can then also lead to suicide clusters. One of the more well-known suicides clusters in the UK relates to a spate of teenagers taking their own lives in Bridgend, Wales.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) published a report in July 2017 specific to suicide by children and young people. One of the key messages from the report is that 'suicide in young people is rarely caused by one thing, and that it usually follows a combination of previous vulnerability and recent events'. The report identifies a number of important themes for suicide prevention: support for or management of family factors (e.g. mental illness, physical illness, or substance misuse), childhood abuse, bullying, physical health, social isolation, mental ill-health and alcohol or drug misuse. The report also highlights some specific actions for the following groups: young people who are bereaved, especially by suicide, greater priority for mental health in colleges and universities, housing and mental health care for looked after children and mental health support for LGBT people. Please refer to Appendix 1: National Confidential Inquiry Suicide by Children and Young People: Infographics for further information and statistics from the NCISH report.

Following the suicide of a young person, the National Suicide Prevention Strategy highlights that effective post suicide interventions at a community level can help to prevent copycat suicides and suicide clusters. Furthermore, the Samaritans highlight the importance of post suicide intervention protocols in their Step by Step guide. Consequently, this protocol has been developed to support professionals and direct actions following a suspected child suicide. The overarching purpose of this protocol and multi-agency response is to minimise community distress and contagion.

2. Overview of Current Statutory Child Death Process

Following the sudden death of a young person under the age of 18 years there is a nationally agreed statutory process in England overseen by a county-wide safeguarding partnership. The Local Safeguarding Children Partnership (LSCP) is responsible for ensuring that a review of each death of a child normally resident in the LSCP area is undertaken by a Child Death Overview Panel (CDOP). See Child Death Reviews - Barnsley Guidance.

This document provides additional guidance to be followed where a suspected suicide of a child may have occurred.

3. Local Notification Process

Where a child death is a suspected suicide, it is essential that the Head of Public Health (Health improvement) is notified via this email address, Suicide@barnsley.gov.uk. This is to be done in addition to the usual CDOP process in order to trigger the contagion response. The responsibility to do this cannot fall to one agency so it is essential that any agencies made aware of a suspected child suicide notify public health to coordinate a response. An email should always be sent to the email addresses provided but a phone call where appropriate is also recommended.

4. Initiation of Contagion Response and Contact with School

The school should be notified via the CDOP process, this should then be followed by contact from the Public Health Senior Practitioner in relation to suicide contagion. In the event that a suspected suicide occurs outside of term time, Children's Social Care should be contacted to make relevant arrangements with school representatives who are available outside normal schools hours. Early notification is crucial in ensuring the school receives accurate information from a reliable source and can plan how they will support other pupils and staff. The school will play an important role in reducing the likelihood of copycat behaviour, in mitigating contagion, and aiding recovery, but only if they are able to respond to the situation appropriately. Therefore, by making immediate contact with the school, we can ensure that they are best equipped to deal with the devastating aftermath of a suspected suicide and that other vulnerable children can be identified and safeguarded. 

Click here to view the Early Alert for Suspected Child Suicide Flowchart.

5. Providing Support and Useful Resources to Schools

One of the first steps should be to ensure that the school, and other schools in the local area where relevant, are provided with support. This may come from Mindspace, Educational Psychology, School Nursing Service (0-19), and CAMHS (please refer to the Agency Process to Assist Agencies to Respond to a Critical Incident Regarding a Child). Additionally, the school should be signposted to appropriate resources such as the ones detailed below and in Appendix 4: Sample Agenda for First Meeting. Schools may wish to use the sample letter in Appendix 3: Example Letter to Parents. The Public Health Senior Practitioner will coordinate the response for Pupils, Parents, teachers and the wider community.

5.1 The Samaritans 'Step by Step' Service

The Samaritans' 'Step by Step' service is available to schools and colleges in the UK and offers practical support and advice to schools, colleges and other youth settings that have been affected by a suspected suicide or an attempted suicide. With the support of local branch volunteers, Postvention Advisors are able to offer support in the following ways: providing communications and talks to staff, parents and students, advice on how to handle the media, advice on responding to social media, and support with memorials and anniversaries. The Samaritans 'Step by Step' booklet can be accessed via the Samaritans Website.

Tel: 0808 168 2528 / E-mail: stepbystep@samaritans.org                                              

5.2 PAPYRUS Guide for Teachers and Staff

PAPYRUS have recently developed guidance to support teachers and school staff in building suicide safer schools as part of their #Classof2018 campaign. Some of the topics within this resource include: helpful language when talking about suicide, where to seek professional advice and support, what to do when there is concern about a child, and advice and support on what to do following a schoolchild's suicide or suicide attempt. The postvention section of the guidance provides some key suggestions of what to do after the suicide of a school pupil. This includes how best to inform other students (including agreeing with staff on the words used to tell students and the importance of being consistent with the information given), how to support students (reassurance that grief is normal and that there is no right or wrong way to grieve), how to communicate with the media, and how to appropriately remember a schoolchild. The PAPYRUS guide is entitled 'Building Suicide-Safer Schools and Colleges: A guide for teachers and staff' and can be downloaded from the PAPYRUS website.

5.3 Letter to Parents/Carers

A sample letter to parents/carers of pupils from the school can be found in Appendix 3: Example Letter to Parents. If a school decides to write their own letter, it is worth emphasising that distress and anxiety are 'normal' bereavement responses, and ensure that sources of support are signposted. In addition the letter should highlight that the school will be meeting with other agencies to try to ensure they are doing everything possible to safeguard children in the school and community.

5.4 National Confidential Inquiry Report on Suicide of Children and Young People

As noted within the introduction, the NCISH have published a specific report relating to suicide of children and young people. The findings may be useful for school staff and a copy of the full report can be accessed on the NCISH Website.

6. The Multiagency Contagion Response Group

The multiagency contagion response group should be convened as soon as possible, ideally within 2 working days of the death.

6.1 Contagion Response Group Membership

The contagion response group should have a fixed core membership, with the flexibility to co-opt other relevant professionals depending upon individual circumstances. The core membership should include individuals from the following agencies as appropriate:

  • BMBC: Children's Services, Early Help, Public Health, Safeguarding, 0-19 PHNS and Educational Psychology;
  • NHS Integrated Care Board: Designated Nurse;
  • Barnsley Hospital NHS Foundation Trust – Safeguarding Team;
  • South West Yorkshire Partnership NHS Foundation Trust – CAMHS and Safeguarding Team;
  • South Yorkshire Police;
  • School(s): Head teacher(s), Deputy Head teacher(s) and Safeguarding Lead;
  • Communication department relevant agencies; 
  • Representatives from the third sector and other agencies as appropriate;
  • Postvention Suicide Support Provider.

6.2 Purpose of the Group

The purpose of the group is to coordinate actions which are focused on preventing mental distress and prevent any further deaths by suicide 'contagion'. The group will identify and ensure that appropriate and targeted support is available for individuals, communities and populations most likely to be impacted by the recent death. Additionally, to ensure that agencies are communicating effectively and that best practice is being adopted with regard to post suicide prevention and support. It is important to emphasise that the group is about collaboration. All agencies become mutually accountable for delivery of a common goal to which they were all committed: to prevent suicide contagion.

6.3 Terms of Reference

Having some Terms of Reference (TOR) for the multiagency contagion response group will ensure clarity regarding the overall purpose of the response group, its membership and accountability. A set of clear TOR should be circulated to all group members prior to the first meeting. At the first meeting all members should agree on the TOR. If any amendments are required, the TOR should be recirculated. See Appendix 2: Sample Terms of Reference Suicide Contagion Response Group for sample TOR.

6.4 Location of Meetings

The location of the contagion response group meetings should be considered carefully. If possible, it is advised that the meetings take place within the school. Not only is this supportive and helpful for the teachers and staff who are at the centre of dealing with a child death and further vulnerable children as a result, but it also provides a neutral meeting ground for all other organisations involved within the response. It is recommended that all members attend the meetings physically, however 'dial in' facilities should also be available should a member find it problematic to attend.

6.5 Chairmanship

The meeting should be chaired the Head of Public Health (Health Improvement) or the Head of Public Health (Children and Young People).

6.6 Preparing for the First Meeting: Information Required

The Public Health Senior Practitioner will be responsible for coordination of the meeting and should send out invitations to the first meeting, along with the TOR (see Appendix 2: Sample Terms of Reference Suicide Contagion Response Group) and background information on the Circles of Vulnerability model (see Section 6.7.2, Circles of Vulnerability Mapping) and Appendix 5: Blank Circles of Vulnerability Matrix. Also See Appendix 4: Sample Agenda for First Meeting for example agenda.

It is important that a school representative (e.g. head teacher or deputy head teacher) is able to attend the first meeting. This person should come prepared to share information and intelligence regarding any young person who may be vulnerable, in order that efforts can be made to identify and provide any support needed without delay. Information regarding family members (including siblings and extended family) and any social connections and groups that the schoolchild had should be gathered (including close friends, boy/girlfriends, social media connections/activity, extracurricular clubs, church or other community affiliations, hobbies/interests of the child which may have resulted in affected persons, any cultural or language issues that need to be addressed, and anyone who might feel blame or responsibility for the death). Note that this information may also come from police or other sources. 

6.7.1 Confidentiality and Information Governance

It is advised that all agencies abide by their existing information governance structures. Whilst it is important that multiple agencies work together and share essential information, it is also crucial that confidentiality and data protection are considered. This should be discussed with the family and consent obtained where possible. If consent is refused safeguarding processes should be followed as appropriate.

6.7.2 Circles of Vulnerability Mapping

The Circles of Vulnerability Model is a systematic approach to identifying vulnerable groups and communities who are most at risk of suicide contagion and is featured in national guidance 'Identifying and Responding to Suicide Clusters and Contagion'. Once vulnerable groups are collectively identified, the model then enables the group to capture action that has already been taken, determine what further action is needed and agree what respective organisations are committed to doing. The model is based on the idea that every suicide is like a stone cast into a pool of water – ripples spread out across the pool all the way to the edge, but the effects are larger closer to the point of impact. The original model consisted of three intersecting circles of risk: geographical, psychological, and social proximity. Due to similarities and cross-overs, the psychological and social domains have been combined to form 'psychosocial proximity'. 

The Circles of Vulnerability should become an on-going mapping process for the duration of the contagion response. The Public Health Senior Practitioner and relevant admin support should be responsible for capturing and updating the correct information and then sharing this with the group after the meetings. It is advised that any confidential information is excluded from the Circles of Vulnerability matrix. (Use initials in reports).

Vulnerable groups to consider include:

  • Home educated children;
  • Gender fluid children;
  • Social groups/clubs;
  • Social media contacts/groups;
  • Looked After Children;
  • Children known to be in Mental Health Services.

Any vulnerable community groups identified should then be contacted and signposted to sources of support.

Please refer to pages 26-31 of the National guidance 'Identifying and responding to suicide clusters and contagion: a practice resource' for examples of vulnerability matrices and further information about the model.  A blank Circles of Vulnerability matrix can be found in Appendix 5: Blank Circles of Vulnerability Matrix and Appendix 6: Spreadsheet to capture information on Vulnerable Individuals. Where young people reside out of area considerations need to be made as to which agencies this information can be passed on to in order to appropriately support those at risk outside of Barnsley's boundaries.

6.7.3 Identification of Individuals at Risk

As noted in section 6.7 the school(s) should have prepared a list of potentially vulnerable individuals for the first meeting. It is then the responsibility of the group to go through each individual and accurately capture the following:

  • Full name;
  • Known aliases / also known as;
  • Date of birth;
  • Address;
  • Contact number;
  • GP;
  • School;
  • Reason for inclusion on list (e.g. close friend, sibling, school concern, CAMHS concern);
  • Open to CAMHS (yes, no);
  • Name of Care Coordinator;
  • Issues/status (e.g. previous self-harm, previous suicide attempt, anxiety, gender identify, school refusal, parental concerns);
  • CAMHS history;
  • Contact made with individual following the death – date of contact and brief notes;
  • Actions noted within meeting (to be updated each meeting);
  • Known vulnerabilities.

A template for capturing the information in relation to individuals at risk can be found in Appendix 6: Spreadsheet to capture information on Vulnerable Individuals; this can then be copied and pasted into Microsoft Excel for data entry. For information governance purposes identifying details should be removed and initials only used.

Mitigation Considerations and Risk

The school will own this list and public health will assist with the coordination of considerations and risks.

6.7.4 Minutes of Meetings

The minutes of meetings should be captured by an experienced minute taker and emailed out to the group at the earliest opportunity. This would ideally be by the following day, in order that any actions can be followed up, and where a member was unable to attend, that member can quickly be brought up to speed. These should be circulated to all members of the group using secure e mail via Public Health Senior Practitioner and relevant admin support. 

6.8 Social Media

With modern communications the contagion effect may not simply be among those who attended the same school, or lived in the same town or village. Connections via social media are very important to consider. Any relevant social media connections should be considered when working through the Circles of Vulnerability matrix. The police may have information following their interrogation of devices in terms of social media, and therefore any potential vulnerable groups or individuals. It is important that a standard social media response is adopted, and that agencies (e.g. police, schools, NHS, council) are conveying the same messages and highlighting relevant sources of support on their social media accounts. A lead communication person should be assigned at the contagion meeting.

6.9 Engaging with the Media

As noted within the National suicide cluster and contagion guidance, news about suicide via the media is 'probably the most important influence prompting clusters to develop'.  There is therefore a need for sensitive and factual reporting in order to minimise community distress and also to increase awareness in terms of suicide prevention. Any potentially damaging media reporting of suspected suicides need to be addressed as early as possible.[1] The contagion response Group must consider any possible media attention. It is recommended that communications leads within each agency link together to ensure that there is a coordinated approach to ensure consistency.  Throughout the response period, an on-going dialogue with local media will help to ensure sensitive and responsible reporting. The chair-person of the multi-agency response group should refer Communication Leads to the Samaritans best practice Media Guidelines, which can be found on the Samaritans website.

[1] Public Health England (2015) Identifying and responding to suicide clusters and contagion. 10 September 2015. Available from: www.gov.uk/government/publications/suicide-prevention-identifying-and-responding-to-suicide-clusters [Accessed: 12 March 2018]

6.10 Funeral and Memorial Arrangements

Once the school (or other agency) are made aware of the details for funeral and/or memorial, the rest of the multi-agency group should be informed.  Depending on the circumstances, provisions for additional support may need to be in place and some communication with the media regarding reporting and sensitivity may be appropriate. It is important that the group work closely with the school and other partnership to plan and provide support for the funeral and (if applicable) memorial arrangements.

6.11 Frequency of Meetings

There may be more than one meeting during the first week of the response, as appropriate to the circumstances of the case. After this, meeting once a week may be sufficient, however the date of each subsequent meeting should be discussed and agreed by all members of the multi-agency response group. 

6.12 Duration of Response

As explained within the TOR, the group is time-limited and should meet for as long as is necessary. There is currently no national guidance on how long a contagion response should be. The length of the response will depend upon the contagion level and risk within the community. Group members should remain vigilant and use the contacts of the group as a platform to raise any concerns and the decision to step down should be agreed by the group/or chair. Once stepped down, normal safeguarding procedures should resume. See section below on stepping down the response. The group must be prepared to reconvene if there is any evidence of increased risk.

6.13 When and How to Step Down the Response

The contagion response should only be stepped down when it is agreed by all members of the contagion response group that there is no longer evidence of continuing contagion, and that all individuals who were identified as being at risk have been appropriately safeguarded.  The decision to close down should ultimately be made by chair in conjunction with group. 

Following that decision a stepping-down strategy should be implemented. The national guidance on identifying and responding to suicide clusters and contagion recommend that a stepping-down strategy should include the following:

  • Ensuring that where necessary, agencies continue to work together to support those affected;
  • Planning support for significant dates and anniversaries;
  • Ensuring community agencies (i.e. police, schools, healthcare teams etc.) are aware of how to communicate future concern;
  • Providing the group with an opportunity for reflection and documenting that learning;
  • Ongoing surveillance of suicide and self-harm in the area, especially as geographical areas that experience a suicide cluster may be at risk of further ('echo') clusters in the future. It might also be advisable for the group to ensure vigilance around anniversaries of suicide clusters. [1]

[1] Public Health England (2015) Identifying and responding to suicide clusters and contagion. 10 September 2015. Available from: www.gov.uk/government/publications/suicide-prevention-identifying-and-responding-to-suicide-clusters [Accessed: 12 March 2018]

7. Learning and Reflection Debrief

Following the death of a child the usual CDOP process will be adopted as shown in Section 2, Overview of Current Statutory Child Death Review Processes. In addition to this, any information and learning as an outcome of the review will be fed into Barnsley's Suspected Suicide Panel (SSPL) where any lessons learned can be fed into the local suicide prevention action plan for the Barnsley suicide prevention group to action as a multiagency strategic group. This learning should also be fed into the CDOP panel. This will also allow an opportunity to de-brief and support will be offered by relevant agencies such as Samaritans and the suicide bereavement support service.

8. Review of Protocol

Following each contagion response learning and reflection event, this protocol should be reviewed and updated accordingly. The protocol should then be distributed to the group members for dissemination (if appropriate) within their organisations. 

9. Contagion Response Group Checklist

Click here to view the Contagion Response Group Checklist.

References

  1. Askland KD, Sonnenfeld N, Crosby A.  A public health response to a cluster of suicidal behaviors: Clinical psychiatry, prevention and community health. J Psychiatr Pract 2003; 9:219-227.
  2. Gould M, Jamison P, Romer D: Media Contagion and Suicide Among the Young. Am Behav Sci 2003; 46(9):1269-1284.
  3. Robertson S, Skegg K, Poore M, Williams S, Taylor B.  An Adolescent Suicide Cluster and the Possible Role of Electronic Communication Technology. Crisis 2012; 33(4):239-245.
  4. Swanson SA, Coleman I.  Association between exposure to suicide and suicidality outcomes in youth. Can Med Assoc J 2013; 21 May.
  5. Joiner TE. The clustering and contagion of suicide. Curr Dir Psychol 1999; 8(3):89-92.
  6. Jones P, Gunnell D, Platt S et al. Identifying Probable Suicide Clusters in Wales Using National Mortality Data. PLoS One 2013; 8(8): 1-9
  7. National Confidential Inquiry – suicide of children and young people
  8. National Suicide Prevention Strategy
  9. Samaritans. June 2016. How to prepare for and respond to a suspected suicide in schools and colleges. [Accessed: 15-06-18]
  10. HM Government. Working Together to Safeguard Children. March 2015. [Accessed: 15-06-18]
  11. Public Health England (2015) Identifying and responding to suicide clusters and contagion. 10 September 2015.  [Accessed: 12 March 2018]
  12. Lahad M, & Cohen A. 25 years of community stress prevention and intervention. In O Ayalon, A Cohen, M Lahad (Eds.) Community Stress Prevention Vol.5. Kiryat Shmona, Israel: The Community Stress Prevention Center, 2004

Appendices

Appendix 1: National Confidential Inquiry Suicide by Children and Young People: Infographics

Appendix 2: Sample Terms of Reference Suicide Contagion Response Group

Appendix 3: Example letter to parents – To be adapted by the school - ENSURE THAT THOSE PARENTS WHO ARE AFFECTED ARE ASKED IF THEY WISH TO RECEIVED THE LETTER

Appendix 4: Sample Agenda for First Meeting

Appendix 5: Blank Circles of Vulnerability Matrix

Appendix 6: Spreadsheet to capture information on Vulnerable Individuals