This procedure relates to assessment and risk management of young people on community based orders who demonstrate risk of suicide or self-harm.

 

When to use this procedure

When young people demonstrate suicide risk or self-harm.

 

Practice context and legislation

  • Youth justice has a duty of care for a young person's safety, and to act responsibly to avoid or minimise the risks of injury or death, including taking all precautions to minimise any risk of harm.
  • Many young people involved with youth justice are vulnerable to self-harm. You need to be aware of behaviours or actions that should be identified, reported and responded to.
  • Suicidal behaviour covers a range of behaviours from:
    • self-harm – causing damage to oneself, which is not necessarily intended to result in death but has varying degrees of lethal intent and awareness of motive
    • a suicidal act with a fatal outcome.
  • Self-harm presents in different ways, such as:
    • self-injury from cuts, burns, self-battery
    • self-poisoning from alcohol, drugs, medications, toxic substances
    • deliberate recklessness and extreme risk-taking behaviour such as playing chicken with cars or train surfing, reckless drug and/or alcohol use.
  • Regardless of the extent of actual damage, self-harm should be reported because it might signal an underlying mental health problem needing urgent treatment.
  • You should also appreciate the many causes and fluctuations in risk of self-harm, which are affected by individual stressors and vulnerabilities including:
    • prior suicidal behaviour
    • a history of psychiatric illness and emotional problems
    • poor social and family support
    • recent experience of conflict, disciplinary infractions or adverse information.
 

Roles and key tasks

Youth justice case manager

  • Provide case management and supervision.
  • Ensure a thorough assessment of risk of the young person is completed.
  • Engage with care team to ensure cohesive response to young people's needs.

Team leader / team manager

  • Provide consultation and supervision to case manager.

Assistant Director / Manager Individual Family Support

  • Provide oversight, direction and monitoring of the area youth justice program.
  • Provide case consultation regarding young people exhibiting high-risk behaviours including significant mental health concerns.

Youth Justice Senior Practice Advisor

  • Provide case consultation regarding young people exhibiting high risk behaviours. This should occur subject to local area agreements between Assistant Director / Manager Individual Family Support and the Senior Practice Advisor.
 

The procedure in detail

Identification and assessment

Identification and prevention of risk of self-harm relies on ongoing assessment of the young person's attitudes and behaviours during the entire order.

Behaviours of concern include the following:

  • prior self-harm – the clearest indicator of increased risk of repeat behaviour
  • exposure to attempted or completed suicide by family or friend increases copycat behaviour
  • verbal indicators – talks about, hints or threatens self-harm
  • signs of mental illness – depression, psychotic symptoms from drug use, schizophrenia or bipolar disorder, substance abuse
  • personality characteristics such as impulsiveness, aggression, sensation seeking
  • family stressors and lack of support/stability
  • violence and relationship issues such as loss of girlfriend or boyfriend, family through death, divorce, rejection
  • interpersonal behaviour such as giving away belongings, marked behaviour changes.

Feelings of hopelessness, a narrowing of future prospects and a loss of options for coping are immediate alerts.

Young people who voice feelings of hopelessness or admit to self-harm or suicidal plans should be considered at high risk of suicide.

Client assessment and planning includes considering health and developmental needs.

The Victorian Offending Needs Indicator for Youth (VONIY) contains items relating to the young person's potential self-harm and suicide risk, as well as concerns about their mental health.

Assessments prepared by other professionals, such as mental health services, child protection and children's court clinic assessment report, also help to identify risk of self-harm.

Obtaining information about suicide and self-harm risk

Staff should check for any history or tendency to self-harm and attempt to obtain information about possible signs of suicide risk.

Explain the rationale for asking questions about self-harm. For example, 'I am going to ask you some personal questions that we ask all young people because we are interested in your health and safety'.

Be open, direct, speaking in a normal, matter-of-fact tone of voice. 'Have you ever deliberately harmed yourself or done something that might have even killed you?'

If the answer is yes, questions may then be asked like, 'Have you planned it?' If the young person discloses a plan, be open to ask about the methods they have contemplated.

Never rush, behave abruptly or use sarcasm.

Convey that you care and view their welfare positively.

Referral

You should be cautious and not underestimate the seriousness of risk. If there are any concerns about self-harm, you must inform your team leader and discuss referral, or contact an involved mental health professional.

Area or divisional procedures for referring potentially suicidal young people to mental health professionals must be followed. For example, make an immediate referral for clinical assessment by a mental health professional or, in an emergency, contact the Crisis Assessment and Treatment Team.

The manager of the youth justice unit must be notified of any young person assessed as a self-harm risk.

During an immediate crisis, it may be appropriate for the case manager to accompany the young person to an arranged support service appointment.

Communication

Clear, open and prompt communication of accurate information can prevent a crisis.

All staff concerned – case managers, health workers, youth justice team managers – act as a team whose goal is ensuring the young person's safety and health.

If self-harm risk is established at any time, the case manager must explain to the young person that they cannot be sworn to secrecy and that they are required to report this to their supervisor and/or manager in order to ensure the young person's safety.

Reporting and monitoring

Report concerns and actions to supervisors.

Place an alert on the young person's file on the Client Relationship Information System (CRIS).

If there are issues regarding the young person's safety and wellbeing, the case manager is responsible for informing others involved in the young person's care, such as any agency workers through the Youth Justice Community Support Service (YJCSS).

Document verbal communication and actions taken on the young person's file. The reasons supporting case plan decisions in relation to self-harm and risk management must be carefully recorded.

Include history of prior self-harm, current risk indicators, consultation with team leader/manager, mental health professionals, carers, accommodation and other services involved, referrals made and the management plan developed.

Ensure that roles and responsibilities are clearly stated and what further or ongoing action is required.

Any form of self-harm resulting in physical injury must be reported and all incidents of actual self-harm or attempted suicide will require the completion of an incident report.

Refer to procedure for 'Critical incident management' for more information.

Emergency intervention and follow up

If you find a young person engaging in self-harming behaviour, the first priority is to seek medical assistance and apply first aid.

Find out possible causes and any information that may assist in medical treatment, for example, the type of pills taken.

Notify the team leader or manager, even if the event happens after hours.

The team leader or manager will arrange for parents or significant others to be informed appropriately and will advise their line manager.

The team leader or manager will arrange staff debriefing and support, ensure case notes and an incident report are completed quickly and confirms that an appropriate risk management plan is in place to support the young person.

Non-emergency intervention and follow up

Non-emergency intervention includes listening, providing encouragement and support to produce a desire for self-care and optimism for the future.

Interventions for a distressed young person should:

  • enable specialist therapeutic support via appropriate referrals
  • help re-establish relationships with family and friends
  • provide access to educational and/or employment opportunities, recreational activities and stable living arrangements.

Talk with the young person and document their plan to manage self-harming behaviours.

This should include identifying triggers or behaviours that increase self-harm risk and relevant strategies to cope with and avoid risk situations.

As part of the personal plan, provide the young person with a list of phone numbers (laminated wallet size) that includes contacts and supports.

Included on the list could be:

  • a mental health professional or support service
  • friends or significant others
  • Lifeline, Crisis Line or Kids Helpline
  • Crisis Assessment and Treatment Team (CATT).

Consult with departmental programs, professionals and/or service providers.

As part of client service planning, develop a risk management plan and as appropriate, make referrals for services.

Risk management planning

In developing a risk management plan the following should be adhered to:

  • Identify the signs relevant to the young person that may indicate when an episode of self-harm is more likely. Refer to the fact sheet for 'Self-harm and suicide risk management' to check for immediate warning signs, personal risk factors and crises, and situational and environmental risk factors for self-harm or suicide.
  • Attempt to reduce, prevent and avoid the risk conditions.
  • Provide the young person with alternative strategies if they feel they may not be safe.
  • Assess how the young person can be supported through the event.
  • Consider forming a care team to monitor the young person's safety and to quickly make and activate service delivery decisions. Refer to procedure for 'Youth justice care teams 'for more information.
  • Consult with other professionals who may already be involved and have expertise to offer in supporting the young person and managing the reduction of self-harm behaviours.

In documenting the risk management plan include:

  • information on prior self-harm and current risk indicators
  • strategies for the young person's safety that support and promote addressing harmful behaviours and underlying causes
  • consultations and referrals made
  • roles and responsibilities of those involved
  • further action required.

Review the plan frequently, schedule regular planning meetings and be prepared to organise additional meetings at short notice as needed.

Include strategies to reduce risk on the Client Service Plan.

Dual-order young people

A multi-disciplinary approach is very important with dual youth justice / child protection young people who may be involved with:

  • After Hours Child Protection Emergency Service (AHCPES)
  • High Risk Adolescent (HRA) Register
  • Take Two
  • Intensive Case management Service (ICMS)
  • Home-Based Care
  • Secure Welfare Services (SWS).

Use the same risk management planning processes with dual-order young people as documented above.

Ensure that, as appropriate, all workers involved with the young person are privy to the documented risk management plan.

Brokerage funds

When service responses are unavailable through mainstream services, brokerage funds may be used to tailor a direct response that meets the young person's specific needs.

 Examples include purchasing psychological services and community support worker hours to assist the young person to attend day programs.

Aftercare and review

Aftercare following an incident can prevent further suicidal behaviour and the negative effects on staff and other young people of a serious or fatal incident.

Aftercare includes:

  • immediate consultation with the team leader and/or team manager
  • immediate counselling and support for the self-harming young person and opportunities for ongoing counselling
  • immediate defusing for affected staff within 24 hours of the incident and the option of debriefing or counselling
  • identification, appropriate support and debriefing of other youth justice young people affected by their peer's suicidal behaviour who may then be at increased risk themselves.

The case manager and their line manager must be proactive in ensuring a young person who has self-harmed has support and resources after they leave the youth justice unit.

If a young person suicides, a client death inquiry is followed to review case practice and identify practice improvements.

Professional development

Refer to the Child Protection and Youth Justice Professional Development Unit, Youth Justice Training Calendar, for information relating to Applied Suicide Intervention Skills Training (ASIST).

 

Additional information

  • Critical client incident reporting categorisation table 2012 (127.1 KB, PDF)
  • Critical Incident Response Management Service (intranet only)