14.3 Responding to a potential cluster of suicides for children and young people aged under 18

The term “suicide cluster” describes a situation in which more suicides than expected occur in terms of time, place, or both. Also in terms of method. It is difficult to precisely define a cluster. A suicide cluster usually includes 3 or more deaths; however, 2 suicides occurring in a specific community or setting (for example a school) in a short time period should also be taken very seriously in terms of possible links and impacts (even if the deaths are apparently unconnected), particularly in the case of young people. It is important to establish at a very early stage if there are connections between suicides. However, it is also important to recognise that there do not have to be clear connections for multiple deaths to constitute a cluster. Multiple unconnected deaths in a community can have similar consequences to a cluster in which links between deaths are apparent, such as media response, heightened local concerns and speculation, and influence on methods used for suicide. One of the challenges of identifying a cluster, especially in the early stages, is that they may present as single events of completed suicide.

Following the identification of a suicide cluster there is the need for significant specialist input and a dynamic multi-agency responses to assess a considerable number of young people who may be at increased risk due to the cluster.

Responding to a potential cluster of completed suicides requires a time critical response but prior allocation of capacity is essential to identify resources required in the event that a response is required, including the formation of dedicated teams of professionals from specialist mental health services, Police, Children's Services, Education, Early Help and other third sector organisations, for example, Samaritans, Mind etc.

There are established process already in place that outline the initial response to a completed suicide by a person under 18.

Within those established processes it is vital that consideration is giving to identifying individuals involved in the social networks of those who have completed suicide, both in real life and in the virtual world, and other young people known to the deceased, in order to provide specific support and undertake risk assessments where there are concerns. 

During the risk assessment process, professionals may identify a number of young people who are at significant risk of significant self-harm or who hold suicide ideation.

More often, schools will be the agency who undertakes the risk assessments and identifies those most at risk.

For those young people deemed most at risk a referral should be made 3.2 Making a Referral | Sussex Child Protection and Safeguarding Procedures Manual

A scoping strategy meeting should take place chaired by a Senior child protection manager, Children's Services, or their nominee

Suggested attendees should include school, children's serice, MASH, (IFD, FDFF, SPOA) local police command, Health, mental health serives and collagues from early help.

The purpose of the meeting will be to discuss the young people and the current risks.

Professionals attending will, where necessary, be expected to contribute resources from their agency to support the young person and manage risk.

Decisions will be made in this meeting as to whether separate section 47 meetings should take place for individual children.

Where no specific Section 47 is deemed necessary then a lead agency will be identified to progress the actions generated and monitor progress to support the young person.  Attendees should include:

• Senior child protection manager, Children's Services, or their nominee;
• Police detective chief inspector, Safeguarding Investigations Unit, or their nominee;
• Representative from the Child Death Review Team

Operational managers from any other agency with information to assist in determining the scale of the enquiry, including the referring agency.

The meeting needs to take account of the likely impact the cluster may have on young people, and identify action to reduce any identified risks.

The scoping meeting must:

• Assess the information known to date;
• Decide what further information is required at this stage;
• Arrange for its gathering;
• Undertake an initial mapping exercise to determine the scale of the response  and possible young people requiring specific support.
• Consider any immediate protective action required;
• Consider a plan for the response plan to be presented to the Strategic Management Group, including resource implications, if a  Cluster is identified.

Generate specific operational responses – for example police response to a high-risk young person who goes missing.

If the meeting decides that the response is likely to be sufficiently complex and resource intensive, then a full meeting of a Strategic Management Group should be convened.

If the meeting decides the case does not meet this threshold but does need a specific and focused operational response, an  Response Management Group  should be convened to identify and deploy the necessary resources to respond to and manage risk.

If, after further enquiries are made, it becomes clear that the situation is more complex, the scoping meeting should be re-convened, and consideration given to defining the response  as complex and convening a Strategic Management Group.

If the cluster response scoping meeting does not consider the circumstances  meet this threshold, then the response will be managed under the arrangements shown at 14.3.4 above

Where the extent of the complexity is unclear, there should be a further scoping meeting arranged to review the progress of the response. In some cases, it may be useful to put in place a Response  Management Group, where it would be helpful to the process.

If, after further enquiries are made, it becomes clear that the situation is more complex, the scoping meeting should be re-convened.

Once the decision has been taken at the scoping meeting to initiate a complex response, the lead officer for Children's Services must be informed. They must inform the safeguarding partnership Chair, the Director of Children's Services, head of the media / press office and senior managers of relevant agencies e.g., designated child protection professionals.

To ensure a coordinated response, a Strategic Management Group (SMG)  meeting must be convened as early as possible. This will be chaired by the Director of Public Health. The agency initiating the meeting will provide the administrative support. This will need to closely align with other governance structures involved with the cluster response.

The membership of the SMG should comprise senior staff able to commit resources and will normally include the following:

• Director of Public Health (Chair)
• Lead officer for Children's Services or nominee
• Consultant in Public Health
• Assistant Chief Police Officer or nominee;
• Police senior investigating officer (SIO);
• Senior child protection manager or nominee;;
• Assistant Director, Education or nominee;
• Mental Health Trust Chief Medical Officer
• Senior health representative;
• Press officer;
• Other individuals and agencies as appropriate.

The meeting must consider a wide range of issues and agree a plan that includes:

• A decision on the scale of the response  and the staff required for a Joint Investigation Management Group (see Investigation Management Group (below)
• The focus of the response
• Any cross-boundary issues and planning of appropriate liaison and sharing of resources;
• Identification of staff to manage the intelligence gathering from social media / live time surveillance (usually Police led) 
• Identification of sufficient trained staff for the response  (see below);
• Sufficient support, supervision and de-briefing of staff involved;
• Availability of expert advice where necessary;
• Liaison arrangements for inter-agency working;
• Time scales for the stages of the response
• Allocation of specific tasks to personnel involved in the response  together with line management responsibilities;
• Management of public relations and media interest in the case;
• Management of political arena;
• Confidentiality / need to know arrangements;
• Exit strategy;
• ensuring the safety and security of records 

The SMG must ensure that any current risks to children are acted upon immediately, whenever they emerge during the investigation and should consider developing a risk management protocol.

The SMG must make arrangements to convene regularly during the  response to:

• Monitor the progress of the response
• Ensure alignment with other governance structures involved in the response
• Review risk indicators for the children involved;
• Consider resource requirements;
• Consider the appropriate timing of the termination of the response;
• Plan a de-brief meeting with the response  management group to identify lessons learnt.
• Ensure that staff support structures and processes are in place and utilised.

This group should be chaired by a senior child protection manager, Children's Services or their nominee and include representatives in education, police, health and local authority legal services. Other agencies should be invited as appropriate, e.g. CAMHS, Samaritans

The role of this group will vary, but should include:

• A forum for the exchange of information, tactics and strategy, and to monitor the progress of the response
• Ensuring consistent strategy for responding to those identified at risk
• Updating the SMG of the progress of the response
• Updating other governance groups involved in the response
• Updating the SMG on any resource shortages;
• Ensuring consistent support for  families;
• Maintaining support for the response  team staff;
• Sharing information with agencies not represented on the SMG;

The SMG should identify individuals within and outside their organisation with the required expertise. This may include social workers, specialist mental health professionals, third sector organisations etc.

In selecting staff, consideration should be given to requirements arising from the individual needs of the relevant child(ren) - e.g., gender, culture, race, language, and where relevant, disability.

Structures and processes should be in place to ensure timely debrief and also support for staff involved in the response around their mental and emotional wellbeing.   

Normal information sharing protocols will remain in place for any cluster response.

Where staff are displayed to schools to meet with specific young people, protocols for informing parents / carers ahead of any such meeting will be generated ahead of the meeting.

Where are staff are deployed to schools as a means of ‘drop in’ support it is anticipated schools will inform parents / carers of this support before the first session takes place.

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.

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.

Staff involved directly in the response  need to be thoroughly debriefed at the conclusion.

At the conclusion of the response  each agency should undertake a review, with a view to identifying any changes to policy or that may be necessary / beneficial. Such a review will complement any safeguarding practice review that may be concurrent or have been completed.

The SMG should have a final meeting where concluding information and debriefing can be shared. An overview report should be compiled and presented to the safeguarding partnership.