8.2 Response to a suspected suicide

This policy should be considered alongside Sussex Child Death Review Practice Guidance.  There are well established national and local statutory Child Death Review procedures in place for responding to suspected suicides by children. However, given the impact of a suspected suicide on the emotional and mental health of others, including increased risk of subsequent suicide, there are also a number of actions necessary to reduce risk. It is important to stress that the procedures below should be referred in addition to and not in any way replace those outlined in Sussex Child Death Review Practice Guidance.

This policy should be initiated when a child’s death is a suspected suicide.

Whilst the statutory response to a death of a person aged 18 or over is very different to that of a child, the approaches and actions outlined in this policy can be applied to young people aged 18 or over where appropriate.

Following the Joint Agency Response Initial Information Sharing and Planning Meeting (IISPM) meeting triggered by the suspected death by suicide of the child (see section 11.1.62 Sussex Child Death Review Practice Guidance), a further multi-agency group should be convened, with the aim of the rapid mitigation of any additional risks, identifying those affected by the death and ensuring appropriate support is offered to them. A further aim is to identify any possible links to other deaths by suicide of suspected deaths by suicide.

The initial multi-agency group meeting should take place as close to the  Joint Agency Review (JAR) IISPM as possible.

The group should meet on a regular basis until there is an agreed decision to step down the response. It is recognised that in the first few days and weeks, the situation and response may evolve rapidly and new information may come to light.

Consideration should be given at any time to convene a Strategy Discussions  should there be information that abuse, or neglect may have been a factor in the death.

Membership of the group should include:

• Head of Children’s Safeguarding or delegate (Chair)
• Police representative
• Child death review team lead
• Public health consultant
• Local authority education lead/ Educational Psychologist, Wellbeing lead officer
• Designated Paediatrician for child deaths
• Local authority communications lead
• Mental health trust leaad

Additional membership may be required dependent on the circumstances of the suicide.

The meeting should not be convened without the presence of the Head of Children’s Safeguarding or delegate, a police representative or a Public health consultant.

The death or serious harm of a child is a distressing event for everyone. Staff attending the multi-agency response group are encouraged to discuss issues of support within their usual line management arrangements and make use of any additional support offers in place within their agency. It is expected that offers of support should be ongoing and able to be accessed at any time.

It is important to recognise that not all members of the multi-agency response group work in safeguarding day to day, e.g schools. Therefore, there needs to be careful consideration about the level of detail shared about the death.

Staff should be proactive in sharing information as early as possible to help identify, assess and respond to risks or concerns about the safety and welfare of children.  Please see the  Information Sharing  protocol for more information. 

The aim of the multi-agency response group is to mitigate the risk of further completed suicides and self-harm.

The role of the multi-agency response group is to:

1. provide a forum for the exchange of information to ensure a shared single view of the situation, identify individuals, groups, organisations potentially affected by the death, identify geographical areas and themes of increased risk following the suspected child suicide and ensure that groups are offered bereavement support and specialist services when necessary
2. maintain oversight and provision of communications
3. provide updates to other relevant organisations and governance bodies
4. ensure that those involved in the response have access where necessary to psychological support and supervision
5. decide when to step-down the response and ensure relevant agencies are aware of how to direct future concerns.

The multi-agency response group should oversee actions in the following areas:

• Cluster identification
• Identification, assessment and support of vulnerable / at-risk individuals
• Bereavement and specialist support
• Online activity and social media
• Family support
• Support to school
• Community support
• Staff support
• Communications
• Events
• Environmental modifications
• Letters / gifts
• Crossing geographical and operational boundaries
• Closure / step-down

Cluster identification: At the initial meeting of the response group there should be assessment as to whether this death by suspected suicide is linked to any other deaths by suspected suicide and as such constitutes or is part of what is known as a suicide cluster. These links may be: in time (ie occurring in close succession); geographical; through family, friendship or other social networks including dispersed online social networks; or institutions including schools, clubs and care settings. If a cluster is identified then 8.51 Responding to a potential cluster of suicides for children and young people aged under 18 | Sussex Child Protection and Safeguarding Procedures Manual  should be initiated. If the death is thought to be part of a cluster that has already been identified then actions to mitigate risk should occur as part of pre-existing cluster work.

Identification, assessment and support of vulnerable / at-risk individuals: An important role of the group is oversight of the identification, assessment and support provided to vulnerable and at-risk people linked to the incident. This includes witnesses and responders to the death, family, friends and members of the social network and professionals involved with the child including educational and health and care staff. Child Death Review Team leads supporting the family and educational staff are important sources of information. It is worth noting that vulnerabilities may be due to the event itself i.e. being a family member of close friend, but may also be due to pre-existing vulnerabilities which could be exacerbated by the child’s death.

Bereavement and specialist support: When someone under the age of 18 years old completes suicide the child death process is triggered. This means the family receive support from a Child Death Review Specialist Nurse (CDRN), if they  family choose to engage with the service. This involves the CDRN meeting and listening to the family and signposting them to the most appropriate bereavement service for their needs at the most meaningful time for the family. The CDRN acts as a keyworker for the family throughout the child death process. A bereavement support offer should be in place for anybody requiring support after the death including one to one support, referral on to specialist psychological support such as counselling where appropriate and also highlighting agreed resources such as the ‘Help us at Hand’ booklet. Anyone who is under specialist social or clinical care should be passed back to their relevant professional lead.

Online activity and social media: Any risk assessment of a child or young person should take into account their online activity. This assessment should include risks and protective factors associated with their previous online history, what devices they have access to, what oversight of use is in place and the skills and understanding of family members and professionals involved with the child or young person.

Family support: Provision of support to the family of the child who has completed suicide is the remit of the Child Death Review team (see Pan Sussex Child Protection and Safeguarding Policy 11.1 Sussex Child Death Review Practice Guidance) and also the police family liaison officer. However the group should maintain ongoing oversight of the impact of the death on family members taking into account any characteristics of the family that may be relevant including separation or adoption.

Support to school: Support to a school should be provided as soon as possible following an incident and include supporting the school through the child death process, providing support to staff and assisting the staff to support pupils, as well as working with staff to identify those pupils who are vulnerable / at-risk and whom may require additional support. 

Community support: one or more suicides has the potential to cause distress in the wider community and the group should work with local authority communities leads, police neighbourhood support leads and any relevant voluntary and community sector groups to provide support and address community tensions. This may include increased signposting to relevant services.

Staff support: Staff involved in the multi-agency response should be alerted to and encouraged to make use of any emotional and mental health support offers in place. Meetings should be carried out in a way that minimises potential distress to attendees i.e. where possible not referring to the method, specificities of the death, or impact on family members. 

Communications: The role for communications includes: having oversight of wider messaging and reporting relating to the incident to ensure it is in line with Samaritan’s Media Guidelines; to promote positive mental health and wellbeing including increasing awareness of relevant resources and services; and also updating relevant professional groups around response activity including GPs.  

Events: Key dates or events related to the suspected suicide have the potential to impact on friends, family and professional’s mental health and wellbeing. These include the child’s birthday, memorial events, the funeral, inquests. If there is the potential for either distress of attendees or community safety issues relating to events then blue light services should be alerted and the group should consider the possibility of youth / outreach worker presence.  

Environmental modifications: These might need to take place dependent on the method of suicide, for example increased use of barriers on tall structures.  

Letters / gifts: While any letters or gifts left by the deceased are the property of the family, their effect on others should be assessed by social care or mental health professionals. Where there is an assessment of increased risk resulting from receipt, then social care and / or mental health leads should work with the family to agree a plan for so that thewy can be passed on in way that minimises risk.

Crossing geographical and operational boundaries: It may be recognised at the outset, or during the response that there are young people requiring support in more than one geographical area – for example, on-line friends or friends who have recently moved out of the area. In such cases the responsibility of responding to risk and providing support should be agreed by Children’s Services and Police.

Closure / step-down: There must be a clearly defined exit strategy not only in relation to the closure of the response, but also with regard to the young people who have been supported. Clear safety plans will be drawn up for all of those young people together with the agency(ies) who will support the young person moving forward.