Design: www.haiwyre.com Design:

Emergency Supports

It is inevitable that, at some point, a young person or their family will be looking for help or advice late on a Friday or just before a holiday period. Guidelines and procedure to support At these times, sources of help include:

Psychiatric Liaison Nurses Emergency Social Work Services young people who are self-harming Monklands Hospital, Airdrie We deal with emergencies which Telephone: 01236 748 748 are too urgent to await action by the or engaging in suicide behaviours social work locality office on the next Wishaw General Hospital working day. Telephone: 01698 361 100 in Lanarkshire Service operates outwith office hours Childline and at weekends. Telephone: 0800 1111 www.childline.org.uk Who we are The team is made up of experienced Breathing Space and qualified social work staff. Telephone: 0800 83 85 87 www.breathingspacescotland.co.uk What sort of emergencies can we help with? Samaritans – Child protection Telephone: 08457 909 090 www.samaritans.org – Adult protection – Older people who are at risk Cruse or need immediate help Telephone: 01698 303 099 – Mental health assessments www.crusescotland.org.uk – Major incidents (civil emergencies) NHS 24 North Lanarkshire contact details Telephone: 08454 24 24 24 Freephone: 0800 121 4114 www.nhs24.com

South Lanarkshire contact details Parentline Plus Freephone: 0800 678 3282 Telephone: 0800 800 2222 www.parentlineplus.org.uk

Dial 999 in emergency situations

South Lanarkshire Lifelines intervention flowchart This flowchart should be used in conjunction with the supporting Lifelines Guidelines. In the case of Child Protection, please use your agency’s guidance.

This flow chart assumes that all users will be trained on ASIST and Supporting young people who are self-harming.

Concerns identified

– Through discussion with young – See young person in private – Senior management informed and person, observation of behaviour co-ordinator arranged for support or reports from others, e.g. peers worker to support young person

Nature and level of concern – – Provide basic first aid, if required – Check if the young person – Support worker will support young Discuss and agree level of concern is looked after or looked after person’s peers, as required – Check if the young person is with other members of the support known to the social work away from home – Support worker will liaise with team or colleagues from other agencies department or other services co-ordinator – Support worker will explore – These consultations will be recorded the nature and level of concern – Be alert to changes in level of concern (suicide and deliberate self harm)

Low level Medium level High level Emergency

– Any act of self-harm – Any act of self-harm – Any act of self-harm – Evidence of serious suicide attempt

– Unlikely to cause serious – Self-harm could cause – Immediate risk of accidental death – Serious laceration/self-injury harm or death accidental death – Intent to complete suicide – Ingestion/overdose of drugs – No thoughts of suicide – Thoughts of suicide – Clear suicide plan – No suicide plan – No suicide plan – Previous suicide attempt See checklist page 32 – History of alcohol or drug misuse – History of alcohol or drug misuse

See checklist page 33 See checklist page 34

Action Action Action Action

– No immediate action required – Do not send home alone – Access emergency medical – Dial 999 attention, if required – Access immediate medical – Provide and secure advice on – Provide and secure advice on intervention appropriate care of any injury appropriate care of any injury – Do not send home alone – Do not leave alone – Link with most appropriate – Involve appropriate external agency for further assessment agencies e.g. GP, CAMHS, A&E – Inform parents/carers e.g. GP, CAMHS, A&E – Liaise with Social Work – Liaise with Social Work – Liaise with Social Work – Decide with Social Work on informing parents/carers

Reporting Reporting – Agree Safe Plan with young – Agreed action made to monitor – Provide information leaflets – Referral to supportingagency, person (Page 31) young person and by whom and contact cards where appropriate – – Record all actions fully Agree multi-agency Support Plan with– Referral to supporting agencies, – Record all actions fully relevant sta! (Page 15), as required where appropriate – Report findings to co-ordinator – Report findings to co-ordinator who will inform relevant agencies – Complete Record of Meeting – Inform parents/carers with who will inform relevant agencies, – Agree multi-agency Support Plan form (Page 29), as required young person’s permission as required – Attend multi-agency review (Page 24) – Refer to Lanarkshire Assessment and Treatment Pathway (page 13)

Follow up

– Maintain contact with young – Liaise with other agencies involved – If there are changes in Levels of – Follow up on commitment to person during this period Concern work through Flowchart again multi-agency support plan, – Be alert to changes in as required – Maintain contact with parents/carers, Levels of Concern – Young person and support worker as appropriate follow up commitment to Safe Plan – Multi-agency reviews, as required

Remember

– Try to make them feel safe – Listen and take their – Remember self-harming is – Don’t make them promise

concerns seriously usually a coping mechanism not to do it again – Try to be calm and reassuring 1

3–Foreword 4–How to use Lifelines 5–Self-harm and Suicide 6–Initial assumptions 9–Intervention 10 – Support Strategies 11 – Role and training of Support Staff 12 – Intervention Flowchart 13 – Lanarkshire Suicide Assessment 14 – Supporting Young People and Staff 15 – Support Plan 16 – Emergency Contacts 19 – Monitoring of Young People 20 – Concern, Consent and Confidentiality 22 – Involvement of Parents 24 – “Please don’t tell my Mum!” 27 – Use of Record forms 29 – Recording of meeting with Young Person 31 – My Safe Plan 32 – Checklists of Action 37 – Looking after Ourselves and Others 38 – The ABCs of Self Care 39 – Services Available 51 – Training 52 – ASIST Training 53 – SafeTALK 55 – Contacts 58 – Legal Issues

chooselife Foreword How to use Lifelines Self-harm and Suicide Initial Assumptions 3

Foreword

Lifelines arose from discussions with staff supporting young people, engaging in self-harm or suicide behaviours, who explained that there was very little guidance available.

Staff reported this shortfall as a primary There are unique versions of the –All members of the staff know to source of personal and professional protocol for North and South take immediate action when risk anxiety and a fundamental barrier to Lanarkshire due to services often is identified. effective joint working. being specific for either locality. –Decisions about young people ‘at risk’ are made by teams, not It is felt the Lifelines will improve the Key Aims individuals. support given to young people, their families and peers. In addition it will –To assume a shared responsibility –Case conferences and ‘Safe Plans’ enhance the skills and knowledge for the care of those ‘at risk’ of are the means by which support is organised and reflect the assessed base of staff, resulting in improving self-harm or suicide. needs of the young person and the support they provide. –To work together to provide a level of risk. person-centred caring environment North Lanarkshire’s Choose Life –Staff are supported if monitoring Implementation Group had discussed based on individual assessed need, of a young person is necessary, these concerns of staff regarding where young people who are in recognising also that a young self-harm and the need to develop distress can ask for help to avert person with self-harm or suicidal guidelines. The working group’s a crisis. behaviour may unsettle others. membership drew on a number of –To identify and offer assistance in –It is essential to generate an key agencies and the joint work has advance, during and after a crisis. understanding amongst young resulted in the creation of Lifelines. people, which involves them and their families in responses. Lifelines have been piloted with staff, Key Objectives giving comments and feedback to –Care is central to everything we do –To develop a community approach the working group ensuring that the and can only be achieved through is recommended, which enables guidelines are user friendly. effective partnerships with children, everyone, including young people, young people, parents, guardians, to work together to identify Early in 2009, discussions took and other agencies. self-harm, share information and place to extend the availability of the –Since assessment techniques alone encourage those “at risk” to accept guidelines to South Lanarkshire staff. are not enough to reduce suicides, help and support. Through a series of meetings it has the aim is to create an environment proven possible to integrate South where young people feel safe and Lanarkshire’s protocol with Lifelines confident to ask for help. thus creating a pan Lanarkshire –Multi-disciplinary working and approach to supporting young sharing of information are people engaging in self-harm or recognised as essential. suicide behaviours.

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How to use Lifelines

This document is for all staff in statutory and voluntary agencies who are working and supporting young people, e.g. educational psychologists, group workers, home school partnership officers, public health nurses, pupil support staff in schools, social workers and youth counsellors.

Lifelines supports practitioners in Lifelines must be used with the person Please remember these forms and identifying their concern of self-harm who is self-harming. A Safe Plan form checklists are a guide and prompt only, and suicide and so enables them to is available for the young person to it is not essential they are completed work together on shared approaches complete and keep. at a set time, so long as you have a and protocols. The Lifelines Flowchart, clear record of your contact and agreed Lifelines may be used to support your record forms and guidance are provided actions. It may be that you chose to write own professional judgement and to facilitate this multi-agency collaboration this up after the young person has left. existing local practice. The individual and decision making. For ease of use, If you feel it is not appropriate or helpful assessment and plan of care should the Intervention Flowchart is within the to complete these during your contact be recorded in your agency’s young inside back cover beside the page for with the young person, then don't. person’s record, for example, using Key Contacts and also as a poster. This the young person’s single agency They are there to support your document and the poster version of the assessment framework. record keeping, not to take the flowchart are available as pdf versions. place of meaningful and supportive Unless it inappropriate to do so, copies Lifelines is designed to be used by conversations. Remember to keep of the Record Forms and other key staff who have completed the ASIST the young person at the centre of the information should be passed to the and Supporting Young People who contact you have with them, and do co-ordinator (see page 11) at the young are Self-harming training programmes. what you would usually do to enable person’s school. The co-ordinator will It builds on the approaches and you to maintain a supportive relationship arrange for this information to be copied knowledge gained on these courses with them, and to build up trust. The only to other staff known to be working and focuses on the key issues and form that should routinely be completed with the young person. In this way, strategies relevant to effective and reviewed with the young person is all professionals will be aware of other multi-agency support and support the Safe Plan. services supporting an individual plans for these vulnerable young young person and be able to support Completing this may take several people. Since it is written to be used them in a more co-ordinated and sessions and should be done as a reference aide, some information effective way. sensitively and meaningfully if it is to has been repeated in a number of be of use. Remember you already sections and, where appropriate have the skills you need to engage with reference made to more detailed a young person who is self-harming, information or recording forms they are the same skills you would use elsewhere in the guide. with any young person in distress. chooselife 5

Self-harm and Suicide

Both these behaviours occur where an individual is struggling to cope with the significant problems in their life. Indeed, they can feel overwhelmed and powerless to change their situation.

In both cases, the individual carries The rate for self-harm varies with age, Vulnerable Groups out a deliberate and intentional act to gender and membership of vulnerable In addition, we know that some groups harm themselves. However, there is groups. Recent figures indicate that 1 in are more vulnerable to self-harm and a fundamental and crucial difference 10 Scottish adolescents self-harm and suicide, for example, those young between these two behaviours. that girls are 3 times more likely than people who: boys to do so. Current figures indicate –have experienced abuse, Self-harm that between 5% and 10% of those For the vast majority of people who who die by suicide have a history –know someone who has is are self-harming, they do so in order of self-harm. or was self-harming, to cope. Their intention is to stay alive –know someone who attempted and to hope for an improvement in Suicide or completed suicide, their situation. Self-harm can include Those who act on thoughts of cutting, burning and self-poisoning. suicide generally do so in order to kill –come to be looked after, or themselves. For them, the intention For them, their self-harming behaviour –have gender uncertainties. is to end their life, to stop the pain, or can have one or more of the following because they have decided there is types of functions: no point in living. –To achieve a relief of feelings, even for a fleeting moment. The rates of death by suicide in North Lanarkshire and South Lanarkshire are –To exert a measure of control over some aspect of their life. very similar and tend to be a little lower than the Scottish average. Each week, –To communicate their distress in each council area, there is one death and/or problems. by suicide. –To achieve comfort and nurture. –To help them feel real or alive. –To stop flashbacks. –To suppress painful emotions or memories. –To have tangible evidence of their emotional pain. –Having a pain that can be cared for. –To have the opportunity to watch their pain heal.

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Research2 highlights the particular importance of peers, family and the school environment. The young people surveyed suggested that having someone to talk to, who would listen to their problems and who was accessible at home or school, was the best way to prevent young people from feeling that they wanted to hurt themselves3.

–Children and young people who –Talking about their self-harm or suicide –However, you may also need to engage in self-harm and suicide thoughts or behaviours is NOT likely to take action to keep them safe. behaviours generally are vulnerable (will not) put them at more risk. In fact, –If you suspect someone may be and in need of support. the opposite is true – talking and being at risk of self-harm or suicide, listened to is a positive and saving –They need to feel that their concerns it is important to ask them directly process. are listened to, heard and taken about thoughts of self-harm or seriously. –They need help to feel good about suicide. themselves and to feel that they –They need to feel that people are Do not avoid using the word self-harm can and will cope. there for them. or suicide. It is important to ask the –They need encouragement and question without dread, and without –Their concerns and problems may support to plan for their future – expressing a negative judgement. be short term but often span months today, tomorrow... The question must be direct and to and years. Periods of crisis tend to the point. be brief but, at these times, they need –They need to feel that there is a a listening ear and supportive adults positive future for them and you For example, you could ask: are critical. believe that they can make it happen. “Are you having thoughts of harming yourself?" or "Are you thinking about –Some may need intensive –If you feel that they are self-harming killing yourself?" counselling or therapy but, even or are feeling suicidal, remember: these young people, still depend on If you don’t ask their daily contact with supportive You don’t know and listening peers and/or adults. If you don’t know You can’t help

2. Carried out by Fortune et al (2005). chooselife 3. Truth Hurts – Report of the National Inquiry into Self-harm among Young People (2006).

Intervention Support Strategies Role and Training of Support Staff Intervention Flowchart Lanarkshire Suicide Assessment and Treatment Pathway Supporting Young People and Staff Support Plan Emergency Supports 9

We are here to identify and support young people, first and foremost, who are vulnerable and at risk. The primary aim is to ensure that they are safe and supported and then, and only then, to look more closely at the problems or traumas affecting them and also their self-harm and/or suicidal behaviours.

In our assessments, we need to Action Attending, observing, understanding, determine: –Help young person define their and responding with empathy, problem and concerns. genuineness, respect, acceptance, –whether this behaviour is a one-off nonjudgment, and caring are important incident or part of a pattern. –Examine alternative coping strategies. elements of listening. Action steps are –our level of concern because of carried out in a nondirective and the risk to their health or because –Make plans, ensuring continuing safety. collaborative manner, which attends of their behaviour. –If appropriate, gain commitment to the assessed needs of clients as to the plans. well as the environmental supports –any changes in their behaviour available to them4. or mood. Administrative – Alert school co-ordinator (see page 11). Key steps in this approach, therefore, are: –Identify and involve support worker (see page 11). Listening –Request support from other – Initial contact and connection agencies, if required. – Active listening –Even if the initial concerns have –Keep young person safe and ceased and the self-harm or suicide reassured behaviours have stopped, monitor the young person and remain vigilant. – Provide support –Carry out review as outlined in the Intervention Flowchart (page 12). –Complete appropriate Checklist of Action with copies to your young person file and school co-ordinator (page 32 to 34).

4. James & Gilliland, 2005 chooselife 10

Support Strategies

The following pages address the support strategies that should be in place in all secondary schools which would enable school staff, with the support from external agencies, to identify and support young people as soon as there is a concern that these young people could be self-harming or contemplating suicide.

The roles and training of staff are –There should be several key staff Experts suggest to enhance outlined and an Intervention Flowchart trained in supporting young people engagement with a young person is provided to clarify the support routes who self-harm (course provided (we recognise that staff who work for 3 levels of concern – low, medium by North or South Lanarkshire closely with young people will already and high. psychological services on request, be highly skilled in engaging and and via the Advisory service in supporting young people): While these guidelines focus on South Lanarkshire). school-based support, the booklet –Exhibit friendliness, warmth and an has been written in such a way that –All this training should be continually interest in the activities and concerns the principles and guidance, perhaps offered on a rolling programme to of the young person. with some adaptation, can be applied ensure new staff are kept skilled in –Listen carefully, compliment the to supporting young people in other these areas. young person on their strengths settings. and avoid arguments. The Support Worker is any appropriate The approach is predicated on the level member of the school staff (e.g. pupil –Be yourself and do not attempt of training of key members of staff. support teacher or partnership officer) to adopt the young person’s –There should be at least one person or an external service (e.g. psychologist, colloquialisms. in the organisation on duty at any public health nurse or social worker) –Keep communication at a level that time who is trained in ASIST, and who meets these training requirements the young person can understand, there should be forward plans in and is involved in working with these avoiding the use of professional place to train all key staff members in young people. More specifically, it may jargon. this approach as soon as possible. be used to denote the person identified to be the key support and contact – Be clear and precise in communicating –There should be several staff trained person for an individual young person. with a young person who may be in safeTALK with forward plans for the very distressed and vulnerable, school or organisation to ensure all When beginning an interview, it is because they may often be confused staff are trained in this approach as important that the support worker or in a state of chaotic feelings soon as possible. indicates how much time they have because of a recent stressful event. available but that if more time is needed there are ways to accommodate this.

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Role and Training of Support Staff

Role of Co-ordinator School based support worker General Points Usually, the lead profession will be school They should be a member of the pupil Lifelines should be the set of guidelines staff. In some situations, for example, support team or a partnership officer. and procedures which staff will use when during a child protection investigation, In most schools, pupil support staff will supporting and assessing young people the Social Work Department is likely to take on this role for the groups of young who may be self-harming or thinking take on this responsibility. people they are responsible for. of suicide. In most cases, the co-ordinator will be a It is good practice for staff to have training The staff involved in supporting young senior member of school staff, most likely in Supporting Young People who are people should be involved in a formal the Depute Head Teacher responsible for Self-harming and in ASIST. Details of peer supervision process. For staff in co-ordinating the Pupil Support Team and these training programmes are some agencies, particularly schools, the school’s multi-agency group, or in the provided on page 51. this is not common practice. However, staff are often supporting vulnerable case of the primary school, a member of In addition they should also have been young people, and in order to avoid burn the primary school Senior Management. given further training and information on out, organisations need to try wherever Otherwise, the co-ordinator will be a senior related topics such as bereavement and possible to create an ethos where staff member in the service with lead responding to critical incidents. responsibility. This role is primarily a receiving support and supervision for management and supervisory function. There is a need for a sufficiently large this challenging work is seen as standard group of such staff who are accessible practice. (See also the section on Looking Role of Lead Professional enough to provide support but small after Ourselves and Others on page 37). The lead professional is the key contact enough to develop the expertise and These guidelines recommend that over person for the family and responsible knowledge of assessing the complexity time as many members of school staff for monitoring the child’s or young of needs and concerns. (including ancillary staff) as possible person’s progress and for putting the receive input on how to support young plan into effect. Other professions External Support Staff people who self-harm and are suicidal. providing support will liaise with the lead It is good practice to have staff trained All school staff, teaching and ancillary professional. This role focuses on the in Supporting Young People Who Are should receive information during inset direct service and support to the child, Self-harming and be ASIST trained. days on the approach to support young young person or family. The expectation is that schools and people exhibiting suicide and deliberate The multi-agency team5 which meets in services will move to ensure that their self-harm behaviours, and the relevant secondary schools is a primary forum to key staff will be trained to this standard referral steps. discuss pupils for whom there is concern by 2012 and will continue this training programme thereafter. All teachers will report to the school regarding some aspect of their learning or based Co-ordinator (or a Support Worker) behaviour. It comprises key school staff who will liaise with other external such as the head teacher or depute head agencies. However, the person teacher, pupil support staff, support for contacted may vary according to learning staff as well as, as appropriate, each school’s structure, staff availability, psychologist, home school partnership the nature of the incident or the concern officer, social worker, and speech and about the young person. language therapist.

5. Previously, a number of titles were used for such meetings, e.g. Joint Assessment Team (JAT) or Extended Support Team (EST) chooselife 12

Intervention Flowchart

The Intervention flowchart is located on the inside back cover of Lifelines.

In schools, the Support Worker will be Alert: Since bullying and, more Definitions one of the members of school staff who importantly, abuse are major reasons The following definitions are used on has been trained as detailed previously. for self-harm and suicide behaviours, the Intervention Flow Chart. Some External workers/staff could provide staff may also have to invoke the examples have been given, but they support either in the school or in the current Child Protection and Bullying should be seen only as a guide. community. procedures. Low Level of Concern The Support Worker will explore nature As a guide, the follow up reviews Young person is harming themselves to and level of concerns, self-harm and/or should be: an extent that is unlikely to cause death suicide behaviours. or serious harm and they do not have a.After one week to ensure initial The Support Worker may need to thoughts of suicide or a suicide plan. assessment and strategies remain contact services who have information appropriate. Revise as required, about the young person and their family. Medium Level of Concern including a new working through the Young person is harming themselves The Support Worker will share findings intervention flow chart. Complete to an extent that could cause accidental with identified colleagues for peer checklist and copy as required. death if undetected or untreated, and support and will liaise throughout b.Longer term support requires no they do have thoughts of suicide but no with the co-ordinator. later than three monthly checks plan or intent. The end purpose of the support to until two “no actions” are achieved. High Level of Concern every young person is to develop a Young person is harming themselves Safe Plan (see page 31). The timescale to an extent that could cause immediate for this will differ in each case, depending accidental death or they intend to on the young person’s willingness to complete suicide. engage in this work and their rapport with the support worker, however this is an important part of any intervention.

The follow-up reviews are carried out as agreed with the young person.

After the incident, Support Worker will liaise with the school co-ordinator and jointly complete the appropriate checklist – pages 32 to 34.

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Lanarkshire Suicide Assessment and Treatment Pathway

Lifelines and its Intervention Flowchart By comparison, Lifelines focuses When the assessments indicate a works in conjunction with the Lanarkshire exclusively on young people and high level of concern or when there is Suicide Assessment and Treatment covers a much wider range of immediate risk of suicide or significant Pathway and its associated guidance. concerns. The lead professionals harm to them, the Lanarkshire Suicide supporting young people will be Assessment and Treatment Pathway The purpose of the Pathway is to assist education staff or staff from other should be used. staff in the assessment of people of agencies (statutory and voluntary) all ages who desire to kill themselves If required, phone 999. working within educational and to ensure appropriate and timely establishments, for example, Information about and copies of the treatment is provided within appropriate educational psychologists, group Lanarkshire Suicide Assessment and timescales. workers, home school partnership Treatment Pathway are available from It will be used by staff across North and officers, public health nurses, the elament website: South Lanarkshire, primarily by health pupil support staff in schools, social www.lanarkshirementalhealth.org.uk and social care staff. workers and youth counsellors.

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Supporting Young People and Staff

Throughout Lifelines we have focused on the support worker as a key person in helping the young person. The focus is also to ensure that the young person is safe and receives the help, advice and support they require, and that these change in response to the continuing assessment by staff involved.

While one member of staff acts as the In over 80% of cases, when a young In addition, these friends may benefit primary support worker, it is essential to person first discloses their suicide or from help to understand suicide and ensure that at least one other member self-harm behaviours, it is to a friend. self-harm behaviours by way of of staff (school or external) is known to Their peers can be involved in discussion with staff, information leaflets, the young person, and other colleagues encouraging the individual to seek and, if appropriate, attending a safeTALK are available for consultation and help from an adult whether this is, session, which is suitable for people supervision with the support worker. for example, a member of the young 16 years and older. However this may The involvement of other staff ensures person’s family or staff in a school or not always be possible for example that the young person can receive support agency. Usually, the peers within the constraints of the school support if the key support worker is continue to support their friend. curriculum. In those cases an unavailable for any reason. Some young This is an onerous and challenging awareness from support staff that people do benefit from the security responsibility. These peers should peers might be anxious and require provided by a team approach. be given help to realise that their role reassurance is protective, however is to be a friend while adults take on this is provided. The advice in terms the key responsibilities of caring for of Self Care (page 38) could be and helping the young person. modified for these young people.

Furthermore, support staff also require supervision and support: they are often dealing with complex, demanding and emotionally stressful situations (see page 38). This support is not always provided formally within an organisation however there is great benefit in informal peer support as well, although it would be best practice for formal support structures to be in place.

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Support Plan

Low level of concern Medium level of concern High level of Concern As indicated in the Intervention One person will take the lead in Immediate action and involvement Flowchart, it is very unlikely that the supporting the young person, with of other services may be essential to young person is at risk of seriously colleagues available as described ensure that the young person is safe: harming themselves but they are previously. The young person requires –medical needs are addressed vulnerable. They require support to more frequent planned support including an emergency admittance ensure that their problems and sessions and is able to access to hospital concerns are addressed and so support outside these sessions. minimise the likelihood that the level –any child protection, domestic It may be important to ensure that of concern increases. violence and/or bullying issues medical staff are in touch with and are dealt with according to current One person will take the lead in available to the young person (and their procedures supporting the young person but family) to address any issues such the young person knows who and as caring for wounds. If the immediate action above is how to contact other support staff, Since a number of agencies are likely required, then the co-ordinator should if necessary. The young person to be involved, it will be vital that good call an urgent multi-agency meeting or requires regular planned support communication and joint-planning instigate Child Protection procedures, sessions and is able to access takes place. The co-ordinator performs if appropriate. support outside these sessions. a central role in these processes. A multi-agency support plan is Within schools, the multi-agency group essential, with a high level of ongoing meetings and regular review meetings communication and co-ordination. should be used to ensure that the most Regular reviews and explicit monitoring appropriate support is and continues to are also essential to ensure that the be provided. When another service is young person is being helped and the taking the lead, their own mechanisms level of concern can reduce. and procedures will be followed, ensuring that regular multi-agency Long term monitoring and reviews meetings take place. will be essential. Explicit checks every 3 months have been found to be very A planned programme of monitoring effective in identifying deterioration in (page 19) and ongoing support is very mood and increased level of risk of important until staff are confident that serious self-harm or suicide intent. there is no, or minimal, concern about the young person. Alert: particularly when there is or have been concerns of suicide intent, a change to a more positive and buoyant mood may NOT indicate improvement but rather that the young person has settled on a firm suicide plan.

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It is inevitable that, at some point, a young person or their family will be looking for help or advice late on a Friday or just before a holiday period.

At these times, sources of help include:

Psychiatric Liaison Nurses Emergency Social Work Services Monklands Hospital, Airdrie We deal with emergencies which Telephone: 01236 748 748 are too urgent to await action by the social work locality office on the next Wishaw General Hospital working day. Telephone: 01698 361 100 Service operates outwith office hours Childline and at weekends. Telephone: 0800 11 11 www.childline.org.uk Who we are The team is made up of experienced Breathing Space and qualified social work staff. Telephone: 0800 83 85 87 www.breathingspacescotland.co.uk What sort of emergencies can we help with? Samaritans – Child protection Telephone: 08457 90 90 90 www.samaritans.org – Adult protection –Older people who are at risk Cruse or need immediate help Telephone: 01698 303 099 – Mental health assessments www.crusescotland.org.uk –Major incidents (civil emergencies) NHS 24 North Lanarkshire contact details Telephone: 08454 24 24 24 Freephone: 0800 121 4114 www.nhs24.com

South Lanarkshire contact details Parentline Plus Freephone: 0800 678 3282 Telephone: 0800 800 2222 www.parentlineplus.org.uk

Dial 999 in emergency situations chooselife

Monitor and Review Concern, Consent and Confidentiality Involvement of Parents “Please don’t tell my Mum!” 19

Given the episodic nature of self-harm and that it can recur some years later, it is important that each agency’s case file and the school’s pupil records include reports of the student’s self-harm and suicide behaviours. This documentation could include the proformas outlined in section beginning on page 29.

The identified support worker will provide This recording form is useful in agreeing If there is a change in the young support and monitor the young person’s a summary of our meeting with them, person’s circumstances, their behaviour progress. After each meeting with a identifying next steps from them and or an increase in the level of concern, young person, it may be helpful to use us, and agreeing any action involving a multi-agency meeting should be called. the Record of Meeting Form (page 29) family members or other staff. A school based multi-agency case to record your contacts with a young discussion or conference is likely to be External support staff working in a person who is self-harming, or you may the most appropriate forum. A formal school should also provide a record chose to continue to use your agency’s record of the meeting will be made and of their assessment and input for current recording procedures. copied to all involved in supporting the inclusion in the school file. Such staff young person. would include home school partnership Where there is an update on the officer, psychologist, group worker, situation or a change in our assessment Overview public health nurse and social worker. of level of concern, a copy should also It may be useful to monitor within school be sent to the school co-ordinator and If the situation changes or the level of the number of young people causing all professionals known to be supporting concern has increased, it is important medium and high levels of concern, the young person. to make the young person aware that and for the school co-ordinator to have an it is now necessary to involve other overview of these cases. For more high This distribution of information must members of staff or other services. tariff cases it is recommended that there take account of: They may need to be helped to is a formal discussion at the start of each a.our agreement about who should understand that this action is in their session that involves the co-ordinator, be kept informed, best interests. If there are Child school and external key support staff. Protection issues, we are required to Again, a multi-disciplinary meeting is likely b.when and about which issues act according to current procedures, to be the appropriate forum. At this type c.the content and, in particular, even if the young person is not in of meeting, staff may wish to discuss the agreement on consent and agreement with this course of action. particular types/patterns of self-harm or confidentiality made with the suicide behaviours in order to formulate young person. a shared support plan for any young person presenting with these types of behaviours. chooselife 20

Concern, Consent and Confidentiality

In this and subsequent chapters, it is important to be aware of a number of legal issues. These will be addressed within each section as they are relevant to the issues being considered.

The key issues relate to Informed consent Confidentiality It is imperative that each professional There are various pieces of legislation6 a.Our duty of care for children and supporting a young person makes which make clear that we must respect young people of all ages clear the reason and nature of their the views of all children and young b.Capacity, Consent and Confidentiality, involvement and the support they people and must take their views including information sharing can or will be providing. For example, into account. These imperatives c. Data protection they are there to provide support, are regardless of the age and ability advice and information. of the child or young person. Detailed legal information is provided It is also vital to make explicit: in the section titled Legal Issues on In addition, we are required to hold page 58. –Why we would wish to share private the conversations we have information. with them and only pass on Central to these three issues is that information given by them: –With whom information would be decisions and actions should be taken shared. –With their explicit agreement and in the best interests of the child or young after we are sure that they have –What information would be passed person. We have legal and professional understood what will be shared, to or available to others, e.g. shared obligations to keep them safe and to take with whom and why. their views and wishes into account. case notes. –Any recommendations we will be –When information they have given The Lanarkshire Information Sharing making and to whom us means that we must act to Protocol provides full details of good keep them, or someone else, safe. –Any actions that we will be taking. practice in obtaining consent and Usually, these situations are covered related issues of confidentiality. – Any boundaries or limitations we have. by Child Protection procedures.

–If we feel that they are at risk of Within this context, we should be seriously harming or killing making them aware that we have to themselves, we must act7. ensure their safety and that of other (Details are given in the section children and young people. Therefore, Support Plan on page 15 and in the we should be explicit in letting them Intervention Flowchart, page 12). know that we may be required to let others know if someone is at risk. As stated previously, we may then have to follow Anti-Bullying and/or Child Protection procedures.

6. Age of Legal Capacity (1991). Data Protection Act (1998). Children Scotland Act (1995) chooselife 7. Condition 4, Section 2. Data Protection (1998) 21

Our primary responsibility is to keep Evidence supports an approach and –Self-harm and similar behaviours them (or other young people) safe strategies that recognise that: are coping mechanisms, necessary for surviving personal problems and Clearly, these requirements may be felt –It is paramount to ensure the young traumas. While we will be working to be in tension or even clashing with person is safe and risk to them is with young people to find and use normal expectations/assumptions that minimised: this has priority over less harmful coping strategies, the parents will be automatically informed a commitment to contact parents. priority is to address their primary and involved when concerns are raised –The young person may be very problems and enable them to better about their child. However, as discussed accurate in their appraisal of their cope with them. several times earlier and especially in situation and risks of contacting their the section on page 15, when young –These young people are very parents. There could be the potential people are self-harming or engaging vulnerable, often very isolated and for an increase in the risk to them in suicide behaviours, we need to very poorly supported. They may from e.g. abusive parents. In addition, proceed with much greater caution, well have needed courage and a we have to be aware that the young we act only after much more great deal of encouragement to person may wish to be protective comprehensive assessments and access and work with staff. In going of e.g. a parent who has mental or formal case discussions of if, when against their wishes, not only may physical health problems. and how parents can be informed we exacerbate an already troubled and then involved in the support to –Legally and professionally, we have or abusive family situation but put their child. to listen to, respect and, where them at risk of withdrawing from appropriate, accept and work with contact with any service. Therefore, their decisions rather than those of there is a risk of compounding their their parents. vulnerability and isolation, and, –We are not acting “in loco parentis”, in so doing, increasing their stress. even when we are fulfilling our duties The likelihood becomes that the as a corporate parent. Rather, we self-harm and suicide behaviours are required to fulfil our professional increase and become riskier. responsibilities as set out in any Council or Service policies, our professional codes of practice or legislation.

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Involvement of Parents

Parents will usually be important Agreeable Reluctant sources of support for their child In most cases, we will be able to In other cases, the young person will be receive the young person’s agreement reluctant for this to happen because of When we ask young people to involve to informing and involving their family. anxiety, embarrassment or uncertainty their family, we have to be ready to We can then decide the best strategies about how the adult(s) will react. respond to three reactions: to support that young person and Here, staff will have to help both the 1.They will agree and may even their family. young person and their family by: be keen/relieved that their family will be involved. –Reassuring and supporting the young person through this process. 2. They will be reluctant. –Signposting adults in the family to 3.They will refuse to have their family other sources of support and contacted, let alone be involved. information.

It may be helpful or even essential to identify adult family members such as an older sibling, aunt or grandparent to act as a bridge and longer term mediator.

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Refusal However, it is important to recognise In a few cases, it will never be possible b.Take steps to reassure the young that the young person’s resistance to to inform or involve the parents. person, if required, about the value their family being contacted can be of informing and involving their family. In considering our course of action, realistic and appropriate. Our priorities it is important to: c.Provide support to the young are to ensure their safety and that they person while working with them to continue to seek help and engage with a.Ensure that there are no factors which understand how they can discuss support staff. For some young people, would prevent parents from being their problems and needs with we may have to respect this refusal contacted at this point (level of anxiety their parents. while continuing to seek ways to of young person or concern that encourage them to inform and e.g. abuse could occur). At the time of the discussions with the young person, they may not be involve their family. It is crucial to be alert to the fact that ready to involve their family and let In some situations, we may be able a major reason for self-harming and them know about their self-harm to engage in long-term intensive suicide behaviours in young people or suicide behaviours through, multi-agency work with the whole is abuse by family members. If there for example, fear of their reaction family before it is safe and appropriate is knowledge or any anxieties about or embarrassment. They may not to explicitly consider the young’s this possibility, it is imperative that staff feel emotionally and psychologically person’s self-harm and/or suicide take active steps to clarify the situation prepared, at this point, to disclose behaviours. and ensure the young person’s the behaviour and discuss their safety before making the family aware feelings with family members. of the situation. The involvement of and advice from the social work team d.Take steps to support family are likely to be central to this process. members to understand the young person’s behaviour and then give them appropriate help to support their child.

Where young people are looked after within a children’s house, it is essential that key staff on every shift are aware of the safe plan, the assessed level of concern and their support needs.

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Given the tension between the possible need to agree to this type of request and the valuable contribution that parents can make, how do we decide on the best course of action?

Low level of concern The best course of action may be to Regular multi-agency meetings and Here, we may be in a good position to agree to the young person’s request formal case discussions will be vital to agree to the young person’s request. but to make it very explicit that, if co-ordinate the support plan and ensure We are likely to have time to gather appropriate, one element of their the continued safety and support to the more information and extend our support plan will focus on how and young person. The frequency of these assessment of them. As we have when their parents can be involved. meetings is best agreed through initial discussed (page 15), the aspiration joint planning taking into account the Nonetheless, for others, it may never will be to help the young person individual case circumstances. The be possible or appropriate to involve become accepting of the involvement frequency of these meetings and those their family. These young people will of their parents, perhaps with the invited may vary as the situation and require a higher level of supervision mediation and support of a member planning changes. and more frequent and formal case of the support staff or another discussions. It is likely that several member of family. Samaritans Confidentiality agencies will be involved and that, This summary is provided by way of for the wider issues, a shared Medium level of concern background to the unique position taken multi-agency single plan will be in Often, the reality is that we will be faced on confidentiality by the Samaritans. place. The above support strategies with a great deal of uncertainty and a may form part of that plan – but only All information relating to a caller is paucity of information. The Intervention if the details of the self-harm and/or confidential to Samaritans unless: Flowchart (back cover) provides a suicide behaviours are not an explicit structure for such considerations and –We have informed consent from entry in a document to which the family decisions. However, it is vital that, where a caller to pass on information. could have access. staff are grappling with such a request, –We call an ambulance because a they do not do so in isolation but formally High level of concern caller appears to be incapable of discuss the request with colleagues These situations are such that the making rational decisions for him and then record their response to it. parents will be quickly and formally or herself. The school co-ordinator should be informed and their involvement sought. –We receive a court order requiring made aware of the issues, the decision However, these circumstances could us to divulge information. and the support plan. The issues of also involve the invoking of Child if, when and how to involve parents –We are passed information about Protection procedures. may need to be reviewed regularly in acts of terrorism or bomb warnings. response to more information, updates Regardless of the background to the –A caller attacks or threatens in the assessment of the level of incident(s) leading to this assessment volunteers. concern and changing circumstances. of a high level of concern, the young –A caller deliberately prevents the person will require a high level of support service from being delivered to for a long period with close supervision other callers. and regular reviews thereafter. Samaritans maintain confidentiality even after the death of a caller. chooselife

Use of Record Forms Distribution List Recording of meeting with Young Person My Safe Plan Checklist of Action 27

Use of Record Forms

A brief description of the record forms can be found below.

Record of Meeting Safe Plan Checklists This form is designed to aid the support This form can be used with the young Low, medium and high level of concern. worker in recording a summary of their person to develop and make explicit These forms are used at: contact with any young person. When their safe plan. The form should be given this is completed it is recommended to the young person, with a copy kept by –the point of first identification of that copies are passed to a line manager the support worker involved. If agreed concern about a young person’s or co-ordinator, and to other professionals with the young person, copies could be self-harm known to be involved in working with shared with the family and/or other –following a formal monitoring of a young person. professionals. their progress

Where staff are supporting a high There is no space included for the –when an increase in the level number of young people it may not be young person’s name. This approach of concern is identified Use of Record Forms practical to complete this after every was felt to be useful to protect the young contact, so long as some record is kept. person’s privacy and confidentiality in The support worker or co-ordinator will Distribution List For cases where concern is high, a case they lose the form or it is discovered usually co-ordinate this assessment system of formal recording and sharing by someone else. In addition, if it is their and support process, ensuring that Recording of meeting with Young Person of information with other appropriate plan, they do not need the administrative the various actions are carried out and agencies is advised. Always work formality of the line for their name. Since recorded. Copies will be given to staff within your child protection guidelines. it is their plan, they can customise it in involved in supporting the young My Safe Plan any way they wish. person. The support worker should ask the Checklist of Action young person for a copy of this plan – for their record and, as a backup, in case the young person loses theirs. Alternatively, the young person may wish for the master to be kept by the support worker. This Safe Plan must be treated with respect and trust and confidentiality respected.

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Distribution List

Distribution Young person Co-ordinator Pupil Support Pupil’s school Other List (School or external agency) Teacher file (PPR)7 supporting staff* (*as appropriate; HSPO, psychologist, public health nurse, or social worker)

Support Plan ••• • •

Record of meeting • • • •

Checklists • • • •

While other school staff and those from They should liaise with the co-ordinator In particular, these staff should be alert other agencies will have access to before meeting with the young person to any request by the young person these reports in the pupil’s PPR8, it is or their family. Indeed, it is likely that the regarding the involvement of their family imperative that they too fully respect this best course of action is to leave any and the information to be shared with trust and confidentiality and to handle discussion of the Safe Plan and its them. Support staff should make them any information contained with utmost contents to the staff directly supporting aware of any such issues and make sympathy and understanding. the young person. these other staff members aware of their legal responsibilities when handling such consent and confidentiality issues.

chooselife 8. PPR: Pupil’s Personal Record 29

Recording of meeting with Young Person Concern: self-harm and/or suicide behaviours

Name of young person

Place of meeting Date and time

Interviewed by Post

Overall appearance

Description of suicide/self-harm behaviour, including injury (if applicable) Describe e.g. any physical injury and medical support required.

Needs identified Practical, physical and emotional support needed – both immediate and long-term.

Continued over chooselife 30

Recording of meeting with Young Person continued Concern: self-harm and/or suicide behaviours

Function of the young person’s behaviour Possible questions could include: – How do you think your self-harm helps you? – Do you know why suicide is important to you? – Does that make sense? – Do you know how it helps you?

Other points/issues from discussion

Next steps (agreed with young person and professional steps) Detail what information can be shared and with whom

Name of agreed adult contact Telephone

Recommendations or advice given

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My Safe Plan

Risks to Avoid How to keep myself safe

My resources Things that I can do that will help

Who can help me and how

Safety contacts

Childline 0800 1111

Breathing Space 0800 83 85 87

Samaritans 08457 909090 [email protected]

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Low level of concern Checklist of action on self-harm or suicide

Name of Young Person

The following provides a quick overview of the action you should take when assessing and providing support to a person who is self-harming to a degree which is not likely to cause serious harm, have long term health implications or result in accidental death.

Task Date Completed Date Action undertaken by & Signature

Joint discussion and agreed assessment and support plan

The young person has been asked if they are self-harming. You have established that currently there is low level of concern. The self-harm is not likely to cause permanent harm or accidental death.

You have asked the young person if they have any suicidal thoughts or plan. You have established that currently there is low level of concern. Their behaviour is not likely to cause permanent harm or accidental death.

Findings reported to co-ordinator. Co-ordinator

If young person is under 16 years old or is still at school, discussion about involving parents has been extensive and parents are informed only if young person gives permission.

Person named who will continue to monitor the young person. Name

The support needed and who will provide it is agreed with the young person. Support Worker

Young person is supplied with details of support agencies which they can contact on a voluntary basis.

Referral is made to supporting agencies, if appropriate

Advice on care of injuries is given or, if necessary, care is provided. Remember this should be given by a first aid trained professional or health professional.

All action and findings are fully documented. chooselife 33

Medium level of concern Checklist of action on self-harm or suicide

Name of Young Person

The following provides a quick overview of the action you should take when assessing and providing support to a person who is self-harming to a degree which could cause serious harm, have long term health implications or result in accidental death if immediate action and care are not secured.

Task Date Completed Date Action undertaken by & Signature

Joint discussion and agreed assessment and support plan

The young person has been asked if they are self-harming. You have established that currently there is medium level of concern. The self-harm is not likely to cause permanent harm or accidental death.

You have asked the young person if they have any suicidal thoughts or plan. You have established that currently there is medium level of concern. Their behaviour is not likely to cause permanent harm or accidental death.

Findings reported to co-ordinator. Co-ordinator

If young person is under 16 years old or is still at school, discussion about involving parents has been extensive and parents are informed only if young person gives permission.

Person named who will continue to monitor the young person. Name

The support needed and who will provide it is agreed with the young person. Support Worker

Young person is supplied with details of support agencies which they can contact on a voluntary basis.

Most appropriate agency is contacted to facilitate further assessment. Agency

Contact person

Advice on care of injuries is given or, if necessary, care is provided. Remember this should be given by a first aid trained professional or health professional.

All action and findings are fully documented.

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High level of concern Checklist of action on self-harm or suicide

Name of Young Person

The following provides a quick overview of the action you should take when assessing and providing support to a person who is self-harming to a degree which could have implications or cause immediate accidental death.

Date Action Task Date Completed undertaken by & Signature

Seek support immediately. Do not leave young person alone. Name the person who assists you. Support Workers

Joint discussion and agreed assessment and support plan

Young person has been asked, and you are certain of the intentionality of their self-harm actions. This initial discussion with young person makes evident that permanent harm or accidental death could be imminent due to self-harm.

You have asked the young person if they have any suicidal thoughts or plan. You have established that currently there is high level of concern. Their behaviour could or is likely to cause permanent harm or death.

You have established whether or not that the young person has a history of suicide attempts or there is a history of suicide attempts or completed suicides by someone close to them.

Seek support immediately. Do not leave young person alone. Name the person who assists you. Support Workers

Access immediate medical attention or treat wounds appropriately. (Remember this should be given by a first aid trained professional or health professional)

Inform parents or guardians. If there are good reasons not to, then alternative arrangements have been made as this person should not be alone. Automatic alert to social work.

A named person has agreed to take the young person home or to a safe place to stay, agreed by social work. Named Person

Person named who will continue to monitor the young person. Name

The support needed and who will provide it is agreed with the young person. Support Workers

Findings reported to co-ordinator. Co-ordinator

All action and findings are fully documented. chooselife

Looking after Ourselves and Others The ABCs of Self Care Services Available 37

Looking after Ourselves and Others As highlighted in the introductory section, supporting young people who are engaging in self-harm and/or suicide behaviours can have an impact on our normal ability to function, psychologically, socially and emotionally.

Experience and research have both Organisation structures Warning Signs identified the steps that should be All the evidence underlines the reality The negative impact of caring varies from taken if staff are able to cope with that staff cope better and recover quicker individual to individual and can affect such difficulties and to recover as if their organisation has the following them in a number of different ways: quickly as possible from them. characteristics: –Physically level of energy, ability to sleep, and tendency to fall ill. Personal – A positive and supportive ethos The steps that we should take to look where staff feel supported and valued. –Cognitively struggle to remember, after ourselves are straightforward and –The organisation encourages staff difficulty in coping with demands of unsurprising: to discuss concerns and work their post, and task avoidance. –Keep alert to the potential for such collaboratively within a collegiate –Emotionally tendency to irritability, Compassion Fatigue framework. anxiety, depression and an overwhelming sense of sadness. –Talk to others about these issues –The organisation recognises that and how you feel there can be a cost to caring and –Socially avoidance of social situations, –If needed, look for more professional providing pastoral care to vulnerable preference to be on one’s own or far support and debriefing after sessions young people. Therefore staff’s need more gregarious than before. –Ensure that you maintain a positive for support is a normal not abnormal Rather than looking to a checklist of work – life balance correlate of caring. indicators, it is more important to be –Take care of yourself – diet, sleep, –Support plans and decisions about aware of significant and lasting changes exercise and careful use of alcohol these young people should arise in mood, behaviour and performance. and medication. from careful discussions with other If you are concerned about yourself, support staff and the responsibility discuss these concerns with an Care of colleagues for the care of these young people understanding and helpful colleague, Ideally, your organisation will have formal rests, not with one individual, but a colleague from another service support structures, in particular: rather with the support team. who has psychological or counselling – Peer support where you have regular training, use your staff or union’s and formal session in which you and a welfare service or your GP. colleague can take turns to discuss and reflect on your professional practice. Similarly, if you are concerned about a colleague, approach it sensitively but –Peer supervision where a colleague with the knowledge that you can find from your organisation or another help and support for them. provides regular sessions in which you are asked to discuss your professional activities and receive supervision, coaching or mentoring. chooselife 38

The ABCs of Self Care

There is a cost to caring. Professionals who listen to clients stories of fear, pain and suffering may feel similar pain, fear and suffering because they care9.

At these times it is crucial that you Awareness Connection look after yourself and use the support Be alert to one’s needs, limits and Connection to oneself and to others available from your colleagues or other emotions. decreases isolation and increases hope. services. Pay attention to all aspects of your Connection is supported by open Similarly, it is crucial that you ensure a experience including thoughts and communication. colleague, who may be struggling from feelings. Connection with others, both personally the impact of this caring, is offered and It helps to have quiet time and space and professionally is essential. helped to accept support. for positive self-reflection. Connection with others enables us to This straightforward approach was be empathetic and to provide effective developed by Saakvitne and Pearlman10. Balance support. Maintain a balance and diversity of activities at work. We cannot do this work alone Balance your energies between work or unsupported and play, between activity and rest, When we look after ourselves, we are between focus on self and focus better able to care and support others. on others.

Balance provides stability and helps us be more resilient when faced with high levels of stress.

9. Charles Figley (1996), Treating Compassion Fatigue, New York chooselife 10. Saakvitne, K. W. & Pearlman, L. A. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York: W. W. Norton & Company. 39

Services Available

Services provided to Children The following pages provide key Each section includes a brief overview and Young People who engage in information about services that of the services available, contact details self-harm or suicide behaviours, support young people who are and a quick summary on the flowchart and to their families. self-harming or threatening suicide. on page 48.

Educational Psychologists

South Lanarkshire Council Some work will be with children, Psychological Services Psychological Services are part of parents or school staff, individually Brief Therapy Team the Inclusion Service within Education and/or in groups. Consultation and The Brief Therapy Team within Resources. Psychological Services collaboration with professionals from Psychological Services in South have four main levels of input (child and other departments is a crucial part of Lanarkshire offers a variety of family, school, locality, local authority). our support to children and young therapeutic approaches, including In relation to each of these four levels people who are engaging in self-harm Solution-focused, possibility therapy, of work psychologists have five core or suicide behaviours. Another key narrative therapy, CBT, EMDR. Referrals functions: consultation & advice, area of work is the development and are made by case psychologists, not assessment, intervention, training and provision of a range of training and directly via the school or parents. research. Educational psychologists development packages for schools, have a number of statutory roles, for parents and other professionals. We Times example, in assessing children’s have a team within the service who Mondays to Thursday 8.45am to individual support needs and in specialise in supporting young people 4.45pm, Friday 8.45am to 4.15pm. providing advice to Children’s Hearings. who are Looked After, and all Children’s Houses within the Council have a link Contact details Educational Psychologists all have an psychologist. honours degree and a post-graduate Hamilton qualification in psychology and are Psychological Service Target Group and Age Range both chartered by the British Woodside Primary School 0 to 19 years, (16+ attending a local Johnstone Road Psychological Society and registered authority educational establishment) Hamilton ML3 7JR with the Health Professions Council. Telephone: 01698 423666 As applied psychologists, they work Each primary, secondary and additional both within the school system and support needs school has a link East Kilbride in the community to effect positive psychologist. Psychological Service change in the learning, development Cedarwood Centre Preschool children are supported on an Cedar Drive and emotional well-being of children individual basis. Some nurseries have East Kilbride G75 9JD and young people. a link psychologist. It is hoped eventually Telephone: 01355 236 984 All schools have a link psychologist. to be able to provide all local authority Lanark Educational psychologists will work nurseries with a link psychologist. Psychological Service at various levels within a school or The Post School Psychological Service 1 Albany Drive community and apply a range of Lanark ML11 9AQ offers consultation, training and advice knowledge and skills. Telephone: 01555 661 673 to FE colleges for young people up to the age to 24. Email: [email protected]

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NHS Lanarkshire Child & Adolescent Mental Health Service (CAMHS)

NHS Lanarkshire CAMH Service From this assessment a range Contact details provides a range of services across of interventions can be provided to meet Children and Young People South Lanarkshire. the needs of the child and their family. Specialist Services East Glasgow Child and Adolescent Interventions include: Mental Health Crisis Services Mental Health Services Each CMHT will have a dedicated duty – Medication 90 Kerr Street, Bridgeton person who can deal with calls and – Psychodynamic Psychotherapy Glasgow G40 2QP enquiries during the day with staff in the – Family Therapy Telephone: 0141 531 3300 hospital available 24hours – Cognitive Behavioural Therapy 8.30am–6.30pm Monday to Friday – Interpersonal Therapy CAMHS Reach Out Team and 8.30am-5pm at weekends. – Parenting Interventions The Reach Out Team provides a non This also includes an assessment team – Psycho-Education clinic based (out-reach) specialist for North and South Lanarkshire based service to children and young people with the Out Of Hours Service, but will living with a parent with a diagnosed respond to mental health crisis at Although services are delivered within a mental illness. The team are based at Accident and Emergency (A&E) and Out clinic based model the approach taken Coathill Hospital and accept referrals of Of Hours as well as provide a liaison by staff is to work within a normalising young people up to their 16th birthday service 24/7. framework, using a diagnostic approach from any professional working with where relevant. The teams also offer a children and families. They will also For individual enquiries please contact consultation service to colleagues in accept self-referrals. The team provide your local CMHT for further information. other agencies, where appropriate. a range of therapeutic interventions and support for this vulnerable group Child & Family Clinics Contact details of young people. The service is available Three multi-disciplinary CFC Teams 194 Quarry Street to families living within the following provide a specialist service to children, Hamilton localities; Airdrie, Coatbridge, young people and their families who are Cumbernauld/Kilsyth, Hamilton/Blantyre, experiencing significant and complex Telephone: 01698 426753 Lanark and Douglas and Nethan Valley. mental health problems/mental illness such as Anorexia Nervosa, Depression, Department of Child and Contact details Psychosis, Self Harm, Anxiety Disorders Family Psychiatry (DCFP) CAMHS Reach Out Team and a range of neurological- Children and young people living in Coathill Hospital developmental disorders. Rutheglen and Cambuslang will receive Coatbridge CAMHS services from NHS Glasgow. All teams accept referrals from any The services is the same multi-agency Telephone: 01236 707 760 professional working with children of service as the one offered by children and young people from birth Lanarkshire CAMHS. to their 16th birthday. An initial, holistic assessment is carried out covering biological, psychological and social background issues of the child and family. chooselife 41

CAMHS for Accommodated Young CAMHS Primary Mental Health Team CAMHS Learning Disability Team People Team (CAYP Team) The PMH Team provide an early The CAMHS LD Team provides a The CAYP Team provide a specialist intervention service to children and specialist multi-disciplinary mental multi-disciplinary service to children and young people with less serious and health service to children and young young people who are looked after and complex emotional/behavioural people with a moderate to severe accommodated within local authority problems. The team is currently set up learning disability. Children (up to their children’s houses across Lanarkshire. to provide school based interventions 18th birthday) who attend additional The team accept referrals, normally and training in a few South Lanarkshire support needs provision only, can be through social work services, of young Schools. The service will be rolled out referred by any professional. The people up to 18th birthday. The team across South Lanarkshire in 2010. team provide a range of biological provide staff training and professional The team accept referrals from any and psycho-social interventions, consultation as well as the same direct professional working with children and as well as consultation and advice therapeutic service to young people as families, of young people up to 18th to other agencies. those which are available within the birthday if they are still in school based CFC Teams. education, and often work closely with Contact details the link Educational Psychologist for the CAMHS Learning Disability Team Contact details school and other agencies via the Airbles Road Centre CAYP Team Joint Assessment Team system in 49 Airbles Road Airbles Road Centre secondary schools. Motherwell 49 Airbles Road Telephone: 01698 244 320 Motherwell Contact details CAMHS Primary Mental Health Team Telephone: 01698 244 321 For children and young people in Gate House the Rutherglen and Cambuslang Cleland Hospital area of South Lanarkshire, the Cleland relevant LD CAMHS is located at: Telephone: 01698 863 286 Building 3, 4th Floor Templeton Business Centre 62 Templeton Street Glasgow G40 1DW

Telephone: 0141 277 7515

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Community Mental Health Teams

Hamilton Clydesdale Resource Network East Kilbride High Patrick Street Woodstock Medical Centre 4th Floor, Atholl House Hamilton ML3 7JA Woodstock Road Churchill Avenue Telephone: 01698 455 459 Lanark ML11 7DH East Kilbride G74 1LU Telephone: 01555 667 150 Telephone: 01355 233 354 Larkhall Health Centre Low Pleasance Larkhall ML9 2HW Telephone: 01698 884 731

Home School Partnership Workers

Home School Partnership Workers Their core business is to engage with Times support young people in their local parents and carers in their own and their Monday to Friday, 8.45am to 4.45pm secondary school. children’s learning, to raise attainment (school term) and achievement levels for all. Out of hours support can be Support offered arranged, if required. They can offer support to parent and Target Group and Age Range families at difficult times, as well as All pupils and families from nursery Out of school learning and school signpost to other agencies. Home to secondary. holiday programmes. School Partnership Workers can make links with a variety of agencies within Contact details communities to ensure support is A senior who oversees the work of home school partnership workers is provided at the level required for the available for contact in each of the four length of time required. localities in South Lanarkshire.

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Housing

Shelter Scotland Education SLC Housing Office contact details Hamilton Support Service 1 Leechlee Road, Hamilton ML3 0XB Blantyre Working with homeless children Telephone: 01698 452 710 45 John Street, Blantyre G72 0JG and families, to help address the Email: housing.hamilton@ Telephone: 01698 527 304 barriers to learning caused by southlanarkshire.gov.uk Email: housing.blantyre@ homelessness. This service works southlanarkshire.gov.uk Lanark with children of families who have South Vennel, Lanark ML11 7JT approached Shelter for advice and Cambuslang Telephone: 01555 673 563 support as well as children who have 24 Stonelaw Road, Rutherglen G73 3TW Email: housing.lanark@ been referred from outside agencies. Telephone: 0141 613 5541 southlanarkshire.gov.uk Email: housing.cambuslang@ Jacqueline McGrath southlanarkshire.gov.uk Larkhall Education Liaison Worker Leechlee Road, Hamilton Ml3 0XB South Lanarkshire Council Carluke Telephone: 01698 880 000 9 Kirkton Street, Carluke ML8 4AB Telephone: 0844 515 2500 Email: housing.larkhall@ Telephone: 01555 777 800 southlanarkshire.gov.uk Email: housing.carluke@ southlanarkshire.gov.uk Rutherglen 24 Stonelaw Road, Rutheglen G73 3TW East Kilbride Telephone: 0141 613 5560 Council Offices, East Kilbride G74 1AB Email: housing.rutherglen@ Telephone: 01355 806 000 southlanarkshire.gov.uk Email: housing.eastkilbride@ southlanarkshire.gov.uk

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Public Health Nurses (PHNs)

Public Health Nurses (PHN) are a jointly Target Group and Age Range Hunter Health Centre qualified Health Visitor and School Nurse. Child to older adult but mainly 0 to 19 Andrew Street They are mainly employed by the health years and their families. East Kilbride G74 1AD Telephone: 01355 906 600 board to work with pre- and school age children and their families. Public Health Times Greenhills Health Centre Nurses are post registered nurses with Monday to Thursday 8.45am to 5pm, 20 Greenhills Square East Kilbride G75 8TT a Degree or Post graduate certificate in Friday 8.45am to 4.30pm Telephone: 01355 234 325 Community Nursing. Contact details Alison Lea Medical Centre Calderwood Road PHN’s work both within the school Rutherglen East Kilbride G74 3HW system and in the community to Rutherglen Primary Care Centre Telephone: 01355 233 547 effect positive change in the learning, 130 Stonelaw Road Strathaven development and emotional well-being Glasgow G73 2PQ Telephone: 0141 531 6000 Strathaven Health Centre of children and young people. They are The Ward, Strathaven ML10 6AS responsible for assessing the children’s Cambuslang Telephone: 01357 529 911 development and health needs. North Avenue Surgery 16/18 North Avenue, Cambuslang Larkhall Glasgow G72 8AT Larkhall Health Institute Public Health Nurses utilise their range Telephone: 0141 641 3037 Larkhall ML9 2HW of knowledge and skills to deliver health Telephone: 01698 884 731 education thus encouraging parents Lesmahagow The Glebe Medical Centre Blantyre and young people to make informed Lesmahagow ML11 0DB Blantyre Health Centre decisions regarding their health choices. Telephone: 01555 895 985/895 663 Victoria Street, Blantyre G72 0BS Some work will be with children, parents Telephone: 01698 823 583 Carluke or school staff, individually and/or in Carluke Health Centre Bothwell groups. Consultation and collaboration Market Place, Carluke ML8 4AZ Kirklands Hospital with professionals from other Telephone: 01555 770 635 Fallside Road, Bothwell G71 8BB departments is a crucial part of their Forth Telephone: 01698 855 601 support to children and young people Forth Clinic, Forth ML11 8AA who are engaging in self-harm or Telephone: 01555 811 476 Hamilton Kelvin Unit, Udston Hospital suicide behaviours. Lanark Farm Road, Hamilton ML3 9LA Lanark health Centre Telephone: 01698 723 163/4 Woodstock Road, Lanark Ml11 7DH Telephone: 01555 667 176/7 Biggar Biggar Health Centre Southcroft Road, Biggar Ml12 6BE Telephone: 01899 229 536 East Kilbride Red Deer Centre Alberta Avenue East Kilbride G75 8NH Telephone: 01355 593 450 chooselife 45

Pupil Support Staff

Pupil support staff offer pupils and Any services provided to young people Target Group and Age Range parents a wide range of services who self-harm, or anyone having To ensure all 11 – 18 year olds in high including, curricular advice, personal thoughts of suicide or planning a suicide, school education are supported as advice, careers advice and information are considered part of their personal care individuals and are offered these on access to various bodies which for pupils. services on a personal level. may assist the individual. They liaise Contracted hours with various organisations to ensure They also have a teaching commitment Monday to Friday 9am to 3.30pm appropriate dissemination of information. in both their specialised curricular area during school term time. and Personal Social and Health Education These organisations include A further 35 hours, the timing of which psychological services, social work, health (PSHE), is a vehicle which helps to raise is agreed at school level. Although in board, Reporter to the Children’s Panel, awareness of issues with pupils and reality most pupils support staff work Careers Scotland, Child and Family clinic, allows a forum to discuss these issues. longer hours than these. colleges, universities and training bodies. Contact details Contact your local secondary school.

Samaritans

Samaritans is a registered charity, It is the aim of Samaritans to make Contact details founded in 1953, which offers 24 hour emotional health a mainstream issue. Lanarkshire Samaritans confidential emotional support to They have a team of volunteers who 4 Selkirk Place anyone in emotional distress. deliver talks and information sessions Hamilton to schools and organisations. There are 203 branches in the UK Telephone: 01698 429 411 and the Republic of Ireland. Everyone, Target Group and Age Range Email: [email protected] regardless of background, is offered Persons, of any age, who are www.samaritans.org the time and space to talk through their experiencing difficulties in their lives, problems. Samaritans do not judge or ranging from those which cause them By letter: give advice: they allow people to work to feel generally vulnerable to those Chris out their own way forward. which cause feelings of distress or Correspondence Branch despair and can lead to suicide. Samaritans believes that offering PO Box 90 90 people the opportunity to be listened to Times Stirling FK8 2SA in confidence, and accepted without Phone, email or text – 24 hours each day. National Number: 08457 909 090 prejudice, can alleviate despair and suicidal feelings. In offering this service Call back option is available with only the number appearing on the phone bill. they hope to achieve their vision of a society where fewer people die by Visits to Hamilton branch are available suicide, where people are able to every day from 10am to 9.30pm. No explore and express their feelings and appointment is needed but it is helpful to where people are able to acknowledge phone ahead so that you are expected and respect the feelings of others. and don’t have to wait.

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Social Work Services

Emergency Social Work Service Blantyre Hamilton 0800 678 3282 45 John Street 1 Leechlee Road Blantyre G72 0JG Hamilton ML3 0XB This number should only be used in Telephone: 01698 527 400 Telephone: 01698 455 400 an emergency. The emergency social Email: swloblantyre@ Email: swlohamilton@ work service is only available when the southlanarkshire.gov.uk southlanarkshire.gov.uk local offices are closed, at weekends and on public holidays. All other Clydesdale Larkhall enquiries should be made to your local South Vennel Claude Street social work office during office hours. Lanark ML11 7JT Larkhall ML9 2BU Telephone: 01555 673 400 Telephone: 01698 884 656 Email: swloclydesdale@ Email: swlolarkhall@ southlanarkshire.gov.uk southlanarkshire.gov.uk East Kilbride Rutherglen & Cambuslang Andrew Street 380 King Street East Kilbride G74 1AB Rutherglen G73 1DQ Telephone: 01355 807 000 Telephone: 0141 613 5000 Email: swloeastkilbride@ Email: swlorutherglen@ southlanarkshire.gov.uk southlanarkshire.gov.uk Young Person’s Counselling

Children and Young Person’s counselling, and where appropriate misuse. There are counsellors and Counselling Service parent and child family work. Group therapists available in most secondary This service offers individual counselling work is sometimes available where the schools in South Lanarkshire from and group work to children and young referrals would support this approach. 2010. Types of therapy include people from 0 to 21, with priority given The service is based in Calder House, psychodynamic, person centred, to vulnerable children and families Blantyre. integrative, play therapy, EMDR, art who are recovering from trauma, and therapy. Young people can see the children who are looked after or looked Contact details counsellors in school or another after away from home. Referrals can be Telephone: 01698 527 400 suitable community location. Young made by schools or other agencies like people can be referred by other social work or psychological services, Lanarkshire Youth agencies or self refer. but priority is given to self referrals. Where Counselling Service Contact details an agency refers, a case discussion LYCS provides confidential therapeutic LYCS is usually held before involvement is counselling to young people aged Wester Moffat Hospital agreed to ensure all services are 11–18 who have experienced or are Towers Road working appropriately. Children can experiencing difficulties in their life, Airdrie ML6 8LW be seen either in clinic or in school or for example school refusal, family another suitable location of their choice. breakdown, depression, self harm, Telephone: 01236 771 064 Therapists offer CBT, psychodynamic anger management, drug and alcohol Tel/text: 07795 968 529 therapies, play therapy, person centred chooselife 47

Young Person's Drug and Alcohol Services

The Young Person's Drug and Alcohol Young people highlighted due to Contact details Services was initiated and developed, concerning behaviours within schools, Peter Gough funded from the changing children's from Joint Assessment Teams, or Calder House services monies, for the most Social Work Area Resource Groups. Bardykes Road vulnerable young people across Blantyre G72 South Lanarkshire. The service was Services Provided Telephone: 01355 807 000 developed in response to a growing Comprehensive assessments for need across children's services young people affected by substance Email: peter.gough@ regarding misuse of alcohol and/or misuse issues, and with problematic southlanarkshire.gov.uk drugs. The services aims to contribute issues; Groupwork programmes and to the reduction of the levels of one off initiatives for the most vulnerable Liber8 problematic drug and alcohol use young people, living in care and/or 1 Station Road, Blantyre G72 9AA of young people, and provide a residential school placements; Family Telephone: 01698 825 114 direct service to looked after and support to vulnerable families in crisis, accommodated young people. due to substance misuse issues; Substance misuse teams This service offers group and One to one support for children and Blantyre individual work. structured family work, in partnership 01698 527 400 with children/families social workers; Service Criteria Provision of detailed reports for statutory Cambuslang/Rutherglen Young people looked after and bodies, such as children's hearing 0141 613 5130 accommodated, misusing substances. system and Youth Court; Specialist East Kilbride training/consultancy for the staff, Young people living in their communities, 01355 807 000 especially residential staff within the on statutory measures, who misuse children's units; Psychological Hamilton substances on a regular basis. inputs/training to staff and young 01698 455 466 Young people at risk of being looked people where appropriate. Lanark after by the local authority. 01555 673 400 Young people coming to the attention Larkhall of the Youth Court, or the persistent 01698 884 656 young offender's data, due to problematic substance misuse.

chooselife 48 Psychological Psychological Service CAMHS Service CAMHS Home School School Home Officer Partnership Public Health Public Nurse Pupil Support Pupil Staff Samaritans Type of Support Person’s Young Councilling

Information • • • • •

Advice • • • • • •

Emotional • • • • • • • Support

Counselling • •

Psychological Support •

Medical Care • •

Assessment • • • • •

Group work • • •

Referral to other • • • • • • • agencies

Family Care, Liaison and • • • • • Support

Other, research •

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Training ASIST Training SafeTALK Training 51

Training Supporting young people who are deliberately self-harming

This course focuses on children Key Target Groups for training Main Objectives and young people who are deliberately The course participants should be Enable staff to: self-harming. The course looks at staff who are working directly with raising awareness of the current children and young people, 11 to 18 –Understand the nature of self-harm research, issues and support years. Staff will come from statutory in young people. strategies for these young people. services (e.g. education, social work –Understand why some young people and health) as well as local voluntary might engage in this type of behaviour. Aims – Supporting Young People groups. This short (2–3 hour) training course –Highlight skills needed to positively For example: has been developed from current intervene and provide support. research. The aim is to provide –Pupil support staff and co-ordinators –Be aware of resources and participants with an understanding in all secondary schools in South referral systems. of self-harming behaviours and how Lanarkshire Council. best to intervene. The session will –Social Work: staff working in area Outcomes conclude with a case discussion child care teams; residential workers; –Improved confidence, knowledge session where participants can raise and staff working with looked after and skills of staff taking part in the concerns they may have about and accommodated young people. training. particular young people they are working with. –Youth Workers, for example Active –Improved joint agency co-operation Breaks staff, Universal Connections, and networking to support these Home-School Partnership. young people.

–Public health nurses and similar Current contact details NHS staff. Psychological Service –Partnership officers and other Station Road community workers. Blantyre G72 9AA

–Educational Psychologists, Telephone: 01698 710 568 quality improvement officers, Facsimile: 01698 712 511 housing officers. Email: [email protected]

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Applied Suicide Intervention Skills Training (ASIST) ASIST (Applied Suicide Intervention Aims Outcomes Skills Training) was developed in Canada –Promoting greater public Evaluation has shown that the workshop in 1983 by a partnership of four mental awareness and encouraging increases caregivers’ knowledge and health professionals (Richard Ramsay, people to seek help early. confidence to respond t o a person at Bryan Tanney, Roger Tierney and William –To help when responding to risk of suicide, that intervention skills are Lang) in conjunction with the Canadian an immediate crisis. retained over time and that they are put Mental Health Association and the –Assisting in the reduction of the to use to save lifes. rates of Suicide in Scotland. government of Alberta. They worked For an evaluation of ASIST in Scotland, –Improving support for hope to develop a suicide intervention training please see: www.chooselife.net/web/ and recovery. programme that would be suitable for files/pdf_reports_general/ both professional and other caregivers. asist_evaluation__information_sheet.pdf Key Target Groups for training The partnership evolved to create ASIST provides practical training LivingWorks Education Inc. in 1991, for caregivers seeking to prevent North Lanarkshire contact details a community services organisation the immediate risk of suicide. Choose Life aimed at providing suicide prevention Participants often include: Room 3.12 , Dalziel Building education and consultation. 7 Scott Street –people concerned about family Motherwell ML1 1PN ASIST is now by far the most widely or friends. used suicide intervention skills training – Natural helpers and advisers Telephone: 01698 267 748 in the world with 3,000 registered – Emergency service workers Email: [email protected] trainers in Canada, USA, Australia, – Counsellors, teachers and ministers New Zealand, Norway, Ireland and the – Mental health practitioners South Lanarkshire contact details South Lanarkshire Council UK. The programme has been refined – Workers in health, welfare or justice over a 23 year period with feedback Corporate Training Team – Community volunteers from over 500,000 participants Floor 2, Council Headquarters worldwide. Working mostly in small groups of one Almada Street trainer to no more than 15 participants, Hamilton ML3 0AA The first Scottish workshops were ASIST uses many different teaching Telephone: 01698 454 213 held in Shetland in 2003 and, to date, processes to create a practice-oriented Email: [email protected] there have been over 576 workshops and interactive learning experience. throughout the country and over 11,500 participants trained. There are ASIST Main Objectives Trainers in each local authority area in The emphasis of the ASIST workshop Scotland. Working in partnership with is on suicide first aid, on helping a person key national agencies such as the at risk stay safe and seek further help. Attendance at the full two days is Scottish Association for Mental Health essential. (SAMH), ChildLine and the armed forces has led to training being delivered in Learn how to: increasingly broad community settings. – Recognise invitations for help This work will continue being developed – Reach out and offer support over the next few years. – Review the risk of suicide – Apply a suicide intervention model – Link people with community resources chooselife 53

SafeTALK Training SafeTALK is a half day session aimed at Aims Outcomes giving participants the skills to recognise SafeTALK prepares you to be a Most persons with thoughts of suicide that someone may be suicidal and to suicide alert helper. You are aware that go unrecognised — even though most connect the person to someone with opportunities to help a person with all are, directly or indirectly, requesting suicide intervention skills (ASIST). thoughts of suicide are sometimes help. Without SafeTALK training, these SafeTALK can be delivered to a group missed, dismissed and avoided. You invitations to help are too rarely of people from the same organisation want persons with thoughts to invite accepted, or even noticed. With more and even the same office. One person your help. You know the TALK steps suicide alert helpers, more people with in the room must also be an ASIST (Tell, Ask, Listen and Keep Safe) and can thoughts of suicide will get connected trained person. SafeTALK addresses activate a suicide alert. As a part of the to the intervention help they want. the myths surrounding suicide and KeepSafe step, you connect persons Suicide alert helpers are part of a provides skills of what to do if you think with thoughts to persons trained in suicide-safer community. someone is thinking about suicide. suicide intervention. Helpers trained in suicide intervention complete the North Lanarkshire contact details Key Target Groups helping process or connect the Choose Life In only a few hours, you will learn how person with more specialised help. Room 3.12 , Dalziel Building to provide practical help to persons 7 Scott Street with thoughts of suicide. Expect to Why use SafeTALK to learn to Motherwell ML1 1PN leave SafeTALK more willing and able become alert? Telephone: 01698 267 748 to perform an important helping role A carefully crafted set of helping steps Email: [email protected] for persons with thoughts of suicide. and the use of creative educational processes make it possible for you and South Lanarkshire contact details Key groups are: up to 30 others in your community to South Lanarkshire Council – Reception staff leave SafeTALK willing and able to be Corporate Training Team suicide alert helpers. SafeTALK is the Floor 2, Council Headquarters – Taxi drivers result of some twenty years of work at Almada Street – Hairdressers learning how to develop useful suicide Hamilton ML3 0AA – School pupils (over 16years) prevention abilities in a short programme. Telephone: 01698 454 213 Email: [email protected] – Voluntary staff What happens at SafeTALK training? Expect to be challenged. Expect to – Unemployed have feelings. Expect to be hopeful. – Those in mental health recovery See powerful reminders of why it is – Those in substance misuse recovery important to be suicide alert. See how to activate an alert. Ask questions and – Anyone enter discussions. Learn clear and practical information on what to do. Practice the TALK steps. Conclude with practice in activating a suicide alert. General Contacts Self-harm Organisations Suicide Organisations Legal Issues 55

General Contacts

Samaritans 08457 909 090 Breathing Space 0800 83 85 87 Childline 0800 1111 Samaritans are confidential and can Offers a free and confidential phone line Sometimes you can sort out a problem help 24 hours a day all year round. for anyone who is feeling down, covered on your own. But if you have a worry you For help with: by a dedicated team of Special Phone can’t cope with, don’t bottle it up. If you Line Advisors from a range of mental are a child or young person needing –Relationship and family problems health, counselling and social work help please call our free 24-hour helpline –Loss including loss of a job, a friend backgrounds. Callers are offered advice, on 0800 1111. Lines can be busy but or a family member through guidance and support underpinned by please keep trying and you will get bereavement empathy and understanding. Advisors through. also provide a signposting service to –Financial worries You can talk to ChildLine about anything, other agencies. The focus is to provide no problem is too big or too small. –Job-related or study stress skilled assistance at an early stage and or overwork prevent problems escalating. Breathing If you are feeling scared or out of control or just want to talk to someone you can You can email, write a letter or Space also recognises its important role call ChildLine. General Contacts even visit the local office. in helping family members, partners and friends who are concerned about the Calls are free and confidential. By letter: well-being of people they care about. Self-harm Organisations Chris, Correspondence Branch www.childline.org.uk PO Box 90 90 Breathing Space opening hours: 24 hours at weekends Stirling FK8 2SA Cruse Bereavement 0845 600 2227 Suicide Organisations 6pm – 6am (Friday – Monday) Cruse Bereavement Care Scotland Local office: 6pm – 2am (Monday – Thursday) Legal Issues 4 Selkirk Place is a registered charity which offers free Hamilton bereavement care and support to Lanarkshire ML3 6RQ people who have experienced the Telephone: 01698 429 411 loss of someone close. Email: [email protected] www.crusescotland.org.uk www.samaritans.org Young Minds 0800 018 2138 Young Minds is a free, confidential telephone service providing information and advice for any adult with concerns about the mental health of a child or young person.

www.youngminds.org.uk

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Self-harm

Organisations Publications

National Self-harm Network 42nd Street All of the listed agencies produce a PO Box 7264, Nottingham NG1 6WJ Second Floor, Swan Buildings, range of excellent books and information Email: [email protected] 20 Swan Street, Manchester M14 5JW leaflets. Many other publications on Telephone: 0161 832 0170 self-harm and related issues are A survivor-led organisation, founded in Helpline: 0161 832 0170 available from: Mind Publications, 1994. Committed to campaigning for Minicom: 0161 831 7616 15-19 Broadway, Stratford the rights and understanding of people Email: [email protected] London E15 4BQ who self-harm. Produces leaflets and Telephone: 020 8221 9666 information. Also publishes The Hurt A mental health service for young Yourself Less Workbook. people aged 15 to 25 (in Manchester) Bodies Under Siege – Self-mutilation facing a broad range of problems and Body Modification in Culture A comprehensive list is available including self-harm and suicide. and Psychiatry. from the National Self-harm Network. (1996) Armando Favazza www.fortysecondstreet.org.uk www.nshn.co.uk ISBN 0-8018-5300-1

The Language of Injury – The Basement Project Selfharm.org Comprehending Self-Mutilation PO Box 5, Abergavenny NP7 5XW A user-led voluntary organisation (1997) Gloria Babiker & Lois Arnold Telephone: 01873 856 524 founded to raise awareness about ISBN 1 85433 234 1 Email: [email protected] self-injury and help people who rely on self-injury by providing a safe, friendly Cutting the Risk – Self-harm, Provides support groups, training, message board. Resources include Self-care & Risk Reduction publications, consultation and guidance for friends, family, teachers (2000) National Self-harm Network supervision for workers. Also and carers, with downloadable ISBN 0 9534027 1 2 hosts the Self-Injury Forum. factsheets. Healing the Hurt within www.basementproject.co.uk www.selfharm.org (1999) Jan Sutton Telephone: 01752 202 301 Bristol Crisis Service for Women The Site www.siari.co.uk PO Box 654, Bristol BS99 1XH Is a new online resource centre The Scarred Soul – Understanding & National helpline: 0117 925 1119 developed for and with young people Ending Self-Inflicted Violence Friday and Saturday Evenings featuring information, advice and (1997) Tracy Alderman 9pm to 12.30am, Sunday 6pm to 9pm. guidance on a range of issues including ISBN 157224 079 2 Set up in 1986 to respond to the self-harm. TheSIte.org also features SHOUT for Women Newsletter needs of women in emotional distress, a confidential question and answer (Self-harm Overcome by with a particular focus on self-injury. service and a moderated online community offering instant peer Understanding and Tolerance) Text and email service available on support. PO Box 654, Bristol BS99 1XH 0780 047 2908 charged at normal Bimonthly newsletter for women who rate and an email service available www.thesite.org/selfharm self-harm and their supporters. Includes from the website. articles, pen pals, contacts, letters, details www.selfinjurysupport.org.uk of helplines, groups and resources. chooselife 57

Suicide

Organisations Publications General Information

PETAL After a Suicide ChooseLife (People Experiencing Trauma and Loss) Booklet for people bereaved by suicide. The Scottish Government's Choose Provide practical and emotional support, Includes practical information, coping Life strategy was launched in December self help, group support, information and strategies and details of agencies for 2002 and forms a key part of the advice to people (children and adults) further support. Produced by Scottish National Programme for Improving affected by suicide and murder. Association for Mental Health. Mental Health and WellBeing Action Plan in Scotland. Telephone: 01698 324 502 www.samh.org.uk Choose Life is a 10 year plan aimed Survivors of Bereavement Not Just a Cry for Help at reducing suicides in Scotland by by Suicide (formally SOBS) Booklet for anyone who knows 20% by 2013. It is the product of Is a self-help, voluntary organisation someone who had made a suicide over 2 years work which drew on for people bereaved by suicide. attempt. Gives guidance on how to the experience and expertise of a They offer emotional and practical help them and where to get help. broad range of partners including support through telephone contacts, Produced by Papyrus. the family members of people who bereavement packs, group meetings, had attempted or completed suicide, www.papyrus-uk.org one-day conferences, residential events health and social care workers, and information relating to practical teachers, young people, suicide issues and problems. Thinking of Ending it All? survivors, public health specialists, Information for young people who voluntary and community agencies, www.uk-sobs.org.uk have attempted suicide or are having and many others. thoughts of suicide. Produced by The strategy and action plan aims Papyrus. to ensure we take action nationally www.papyrus-uk.org and locally to build skills, improve knowledge and awareness of what How to help someone who is suicidal works to prevent suicide, improve A question and answer form booklet opportunities to prevent premature for anyone who wants to gain an loss of life and provide hope and understanding of suicide. Topics include, optimism for the future. Why do people become suicidal? The Choose Life website is an How do I know if someone is suicidal? information and education resource. How can I help? Produced by MIND. Choose Life staff do not provide www.mind.org.uk/Information/ treatment, counselling or advice Booklets/How+to/How+to+help+ for those in crisis. someone+who+is+suicidal.htm www.chooselife.net

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Legal Issues

Capacity and Consent of action. It is suggested that a similar generally be able to discharge their Reference has been made at page 20 test would apply in determining whether legal obligations in this respect, even of this document to the attitude of a a young person or child has capacity to in the absence of certain information. young person in question with regard withhold consent for parents or family It has been argued as a very general to informing members of their family, members to be informed. rule that this becomes more the case particularly their parents, of disclosures as children become older. As previously stated, young people will made to professionals about and should be encouraged wherever The nature of the information and the self-harming feelings or behaviour. possible to inform and involve family circumstances in which it is provided The law on capacity is dealt with under members. There is a presumption that will very much determine the status the Age of Legal Capacity (Scotland) children above the age of 12 will have of information as confidential. Personal Act 1991. Broadly speaking, the Act such capacity but this presumption or private information provided to the provides that a person under 16 years can clearly be rebutted where the child professional on the understanding of age shall not have capacity to enter is not considered to have sufficient (implied or explicit) that there shall be no into transactions. There are, however, maturity and understanding of the further disclosure without the consent a number of significant exceptions to issues and consequences. Equally, of the individual will be confidential. that general rule whereby an individual it is quite possible that the presumption There are situations where breach under the age of 16 can enter into a may be rebutted in the case of a child of confidentiality can be justified. Most transaction having legal effect. Notably, under the age of 12 years where notably, where there is a reasonable this would include the right to raise civil they are considered to have such concern that a child or young person proceedings, including instruction of understanding. may be at risk of significant harm any a solicitor, and to consent on their professional requirement to maintain own behalf to medical treatment or Confidentiality confidentiality will be overridden. It is procedures. The test is essentially, Children and young people have suggested that professionals need to in the case of medical treatment, similar rights to confidentiality as adults. ensure that children and young people whether the individual understands the The obvious complicating factor is that are informed at the outset that nature and possible consequences of parents of children have a legal obligation confidentiality cannot be absolutely such treatment. A similar test would be to safeguard and promote the health, guaranteed but that every reasonable applied in respect of the raising of legal development and welfare of the child attempt will be made to discuss with proceedings, namely, the individual until they reach the age of 16. There is them beforehand a situation where having been deemed by the qualified accordingly potential for tension between, absolute confidentiality cannot professional (solicitor) to have a general on the one hand, any withholding of reasonably be maintained. It is open understanding of what it means to do information from a parent relating to the to professionals to revisit the issue of so. (Norrie - Parent & Child, Second health, development and welfare of the consent with the young person prior Edition). child and, on the other, an ability by the to any proposed breach. Children and parent to adequately discharge their young people should also be made Capacity in such situations is therefore parental responsibilities. It is not possible aware at the outset of any requirement largely to do with the individual having to fully explore this difficult legal question by professionals to share information an adequate understanding of the within this document, however, it is which they provide with other relevant consequences of a particular course probably fair to say that parents will agencies. chooselife 59

Data Protection The Data Protection Act contains eight Individuals have a right to know what Data protection is a vast and complex fundamental principles, seven of which information is held about them. As subject in its own right. The rules under are as follows: previously stated, if information held the Data Protection Act 1998 about the about individuals is likely to be shared –Personal data should be processed capacity of an individual to exercise with other agencies, the individual fairly and lawfully. rights in relation to information held about should be so aware. Professionals them are similar to the terms of the Age –Personal data shall be obtained only are referred to existing guidance and of Legal Capacity (Scotland) Act 1991, for one or more specified lawful procedures within their service relating already described. A person of 12 years purposes, and shall not be further to data protection and the holding, shall be presumed to be of sufficient processed in any manner disclosure and sharing of personal mental capacity to be able to exercise incompatible with that purpose information. Further guidance is available their rights and make decisions or those purposes. from the website of the Information regarding their own information. –Personal data shall be adequate, Commissioner at: www.ico.gov.uk Section 66 of the Data Protection Act relevant and not excessive in relation Advice is also available to Council provides that where a question fails to the purpose or purposes for which Services from Corporate Services to be determined in Scotland as to the they are processed. Legal Services Division. capacity of a person under the age of sixteen years to exercise any right –Personal data should be accurate and, conferred by any provision of the Act, where necessary, kept up to date. that person shall be taken to have that –Personal data processed for any capacity where he has a general purpose or purposes shall not be understanding of what it means to kept longer than as necessary for exercise that right. Without prejudice to that purpose or those purposes. that generality a person of 12 years of –Personal data should be processed age or more shall be presumed to be in accordance with the rights of the of sufficient age and maturity to have data subjects under this Act. such understanding. –Appropriate technical and Information held about individuals under organisational measures shall be this protocol may constitute sensitive taken against unauthorised or unlawful personal data under the Data Protection processing of personal data and Act and, needless to say, must be held against accidental loss of destruction and stored securely, whether in manual of, or damage to personal data. or electronic form. –The eighth data protection principle is considered irrelevant for the purposes of this document.

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Key Contacts

Name Post Address Telephone Email

chooselife Design: www.haiwyre.com Design:

Emergency Supports

It is inevitable that, at some point, a young person or their family will be looking for help or advice late on a Friday or just before a holiday period. Guidelines and procedure to support At these times, sources of help include:

Psychiatric Liaison Nurses Emergency Social Work Services young people who are self-harming Monklands Hospital, Airdrie We deal with emergencies which Telephone: 01236 748 748 are too urgent to await action by the or engaging in suicide behaviours social work locality office on the next Wishaw General Hospital working day. Telephone: 01698 361 100 in Lanarkshire Service operates outwith office hours Childline and at weekends. Telephone: 0800 1111 www.childline.org.uk Who we are The team is made up of experienced Breathing Space and qualified social work staff. Telephone: 0800 83 85 87 www.breathingspacescotland.co.uk What sort of emergencies can we help with? Samaritans – Child protection Telephone: 08457 909 090 www.samaritans.org – Adult protection – Older people who are at risk Cruse or need immediate help Telephone: 01698 303 099 – Mental health assessments www.crusescotland.org.uk – Major incidents (civil emergencies) NHS 24 North Lanarkshire contact details Telephone: 08454 24 24 24 Freephone: 0800 121 4114 www.nhs24.com

South Lanarkshire contact details Parentline Plus Freephone: 0800 678 3282 Telephone: 0800 800 2222 www.parentlineplus.org.uk

Dial 999 in emergency situations

South Lanarkshire Lifelines intervention flowchart This flowchart should be used in conjunction with the supporting Lifelines Guidelines. In the case of Child Protection, please use your agency’s guidance.

This flow chart assumes that all users will be trained on ASIST and Supporting young people who are self-harming.

Concerns identified

– Through discussion with young – See young person in private – Senior management informed and person, observation of behaviour co-ordinator arranged for support or reports from others, e.g. peers worker to support young person

Nature and level of concern – – Provide basic first aid, if required – Check if the young person – Support worker will support young Discuss and agree level of concern is looked after or looked after person’s peers, as required – Check if the young person is with other members of the support known to the social work away from home – Support worker will liaise with team or colleagues from other agencies department or other services co-ordinator – Support worker will explore – These consultations will be recorded the nature and level of concern – Be alert to changes in level of concern (suicide and deliberate self harm)

Low level Medium level High level Emergency

– Any act of self-harm – Any act of self-harm – Any act of self-harm – Evidence of serious suicide attempt

– Unlikely to cause serious – Self-harm could cause – Immediate risk of accidental death – Serious laceration/self-injury harm or death accidental death – Intent to complete suicide – Ingestion/overdose of drugs – No thoughts of suicide – Thoughts of suicide – Clear suicide plan – No suicide plan – No suicide plan – Previous suicide attempt See checklist page 32 – History of alcohol or drug misuse – History of alcohol or drug misuse

See checklist page 33 See checklist page 34

Action Action Action Action

– No immediate action required – Do not send home alone – Access emergency medical – Dial 999 attention, if required – Access immediate medical – Provide and secure advice on – Provide and secure advice on intervention appropriate care of any injury appropriate care of any injury – Do not send home alone – Do not leave alone – Link with most appropriate – Involve appropriate external agency for further assessment agencies e.g. GP, CAMHS, A&E – Inform parents/carers e.g. GP, CAMHS, A&E – Liaise with Social Work – Liaise with Social Work – Liaise with Social Work – Decide with Social Work on informing parents/carers

Reporting Reporting – Agree Safe Plan with young – Agreed action made to monitor – Provide information leaflets – Referral to supportingagency, person (Page 31) young person and by whom and contact cards where appropriate – – Record all actions fully Agree multi-agency Support Plan with– Referral to supporting agencies, – Record all actions fully relevant sta! (Page 15), as required where appropriate – Report findings to co-ordinator – Report findings to co-ordinator who will inform relevant agencies – Complete Record of Meeting – Inform parents/carers with who will inform relevant agencies, – Agree multi-agency Support Plan form (Page 29), as required young person’s permission as required – Attend multi-agency review (Page 24) – Refer to Lanarkshire Assessment and Treatment Pathway (page 13)

Follow up

– Maintain contact with young – Liaise with other agencies involved – If there are changes in Levels of – Follow up on commitment to person during this period Concern work through Flowchart again multi-agency support plan, – Be alert to changes in as required – Maintain contact with parents/carers, Levels of Concern – Young person and support worker as appropriate follow up commitment to Safe Plan – Multi-agency reviews, as required

Remember

– Try to make them feel safe – Listen and take their – Remember self-harming is – Don’t make them promise

concerns seriously usually a coping mechanism not to do it again – Try to be calm and reassuring Lifelines intervention flowchart This flowchart should be used in conjunction with the supporting Lifelines Guidelines. In the case of Child Protection, please use your agency’s guidance.

This flow chart assumes that all users will be trained on ASIST and Supporting young people who are self-harming.

Concerns identified

– Through discussion with young – See young person in private – Senior management informed and person, observation of behaviour co-ordinator arranged for support or reports from others, e.g. peers worker to support young person

Nature and level of concern – – Provide basic first aid, if required – Check if the young person – Support worker will support young Discuss and agree level of concern is looked after or looked after person’s peers, as required – Check if the young person is with other members of the support known to the social work away from home – Support worker will liaise with team or colleagues from other agencies department or other services co-ordinator – Support worker will explore – These consultations will be recorded the nature and level of concern – Be alert to changes in level of concern (suicide and deliberate self harm)

Low level Medium level High level Emergency

– Any act of self-harm – Any act of self-harm – Any act of self-harm – Evidence of serious suicide attempt

– Unlikely to cause serious – Self-harm could cause – Immediate risk of accidental death – Serious laceration/self-injury harm or death accidental death – Intent to complete suicide – Ingestion/overdose of drugs – No thoughts of suicide – Thoughts of suicide – Clear suicide plan – No suicide plan – No suicide plan – Previous suicide attempt See checklist page 32 – History of alcohol or drug misuse – History of alcohol or drug misuse

See checklist page 33 See checklist page 34

Action Action Action Action

– No immediate action required – Do not send home alone – Access emergency medical – Dial 999 attention, if required – Access immediate medical – Provide and secure advice on – Provide and secure advice on intervention appropriate care of any injury appropriate care of any injury – Do not send home alone – Do not leave alone – Link with most appropriate – Involve appropriate external agency for further assessment agencies e.g. GP, CAMHS, A&E – Inform parents/carers e.g. GP, CAMHS, A&E – Liaise with Social Work – Liaise with Social Work – Liaise with Social Work – Decide with Social Work on informing parents/carers

Reporting Reporting – Agree Safe Plan with young – Agreed action made to monitor – Provide information leaflets – Referral to supportingagency, person (Page 31) young person and by whom and contact cards where appropriate – – Record all actions fully Agree multi-agency Support Plan with– Referral to supporting agencies, – Record all actions fully relevant sta! (Page 15), as required where appropriate – Report findings to co-ordinator – Report findings to co-ordinator who will inform relevant agencies – Complete Record of Meeting – Inform parents/carers with who will inform relevant agencies, – Agree multi-agency Support Plan form (Page 29), as required young person’s permission as required – Attend multi-agency review (Page 24) – Refer to Lanarkshire Assessment and Treatment Pathway (page 13)

Follow up

– Maintain contact with young – Liaise with other agencies involved – If there are changes in Levels of – Follow up on commitment to person during this period Concern work through Flowchart again multi-agency support plan, – Be alert to changes in as required – Maintain contact with parents/carers, Levels of Concern – Young person and support worker as appropriate follow up commitment to Safe Plan – Multi-agency reviews, as required

Remember

– Try to make them feel safe – Listen and take their – Remember self-harming is – Don’t make them promise

concerns seriously usually a coping mechanism not to do it again – Try to be calm and reassuring Design: www.haiwyre.com Design:

Emergency Supports

It is inevitable that, at some point, a young person or their family will be looking for help or advice late on a Friday or just before a holiday period. Guidelines and procedure to support At these times, sources of help include:

Psychiatric Liaison Nurses Emergency Social Work Services young people who are self-harming Monklands Hospital, Airdrie We deal with emergencies which Telephone: 01236 748 748 are too urgent to await action by the or engaging in suicide behaviours social work locality office on the next Wishaw General Hospital working day. Telephone: 01698 361 100 in Lanarkshire Service operates outwith office hours Childline and at weekends. Telephone: 0800 1111 www.childline.org.uk Who we are The team is made up of experienced Breathing Space and qualified social work staff. Telephone: 0800 83 85 87 www.breathingspacescotland.co.uk What sort of emergencies can we help with? Samaritans – Child protection Telephone: 08457 909 090 www.samaritans.org – Adult protection – Older people who are at risk Cruse or need immediate help Telephone: 01698 303 099 – Mental health assessments www.crusescotland.org.uk – Major incidents (civil emergencies) NHS 24 North Lanarkshire contact details Telephone: 08454 24 24 24 Freephone: 0800 121 4114 www.nhs24.com

South Lanarkshire contact details Parentline Plus Freephone: 0800 678 3282 Telephone: 0800 800 2222 www.parentlineplus.org.uk

Dial 999 in emergency situations

South Lanarkshire