Many people may have thoughts about suicide at some point in their life, without actually wanting to go through with completing suicide. Whilst thinking about suicide is relatively common, very few young people will actually attempt to take their own lives. Suicidal thoughts can stem from a range of underlying difficulties and can range from fleeting thoughts to more considered plans. Young people with suicidal thoughts may feel unable to talk to family or friends but may seek out someone they trust in school to share their thoughts about wanting to end their life. Young people who are having thoughts of suicide may or may not also be behaving in a way that puts their life in danger (suicide behaviours) and are potentially at risk of acting on these thoughts. Those who are already engaging in suicide behaviours are clearly at greater risk of harm or death.

Approximately one in ten (11%) teaching professionals said, on average, a student shares suicidal thoughts with them at least once a term. However, only half (53%) said they would feel confident they could support a student who had shared suicidal thoughts with them (Papyrus, 2017).

Look out for children or young people who:

• have experienced a stressful event associated with a feeling of loss, including bereavement;

• show significant changes in behaviour which suggest they are asking for help, for example self-harm or giving away their possessions;

• use language associated with suicide, such as “I wish I wasn’t here” or “It does not matter anymore”;

• show physical indicators such as sleep disturbance and weight loss; and/or

• have overwhelming feelings of anger, hopelessness, loneliness or worthlessness.

Papyrus, a national charity for the prevention of young suicide, refers to the above indicators as ‘invitations’ which children and young people may use to ask for help. They advise that there is no definitive guide on how to know if somebody is thinking about suicide, however the above indicators are worth looking out for. Often young people might refer to ‘not wanting to be around anymore’ or state ‘I wish I was dead’ as a way to express their distress. When young people make statements such as these, they should be explored further with them to accurately identify what they are trying to communicate rather than making your own interpretations. Research has shown that asking a young person about their suicidal thoughts does not increase the likelihood that they will think about suicide more or act on their thoughts.

Research indicates that the best way to protect life is to promote positive mental health. This can be done at the whole school level and through individual support for children and young people.

Whole school level

De-stigmatisation

A whole school approach to destigmatise talking about suicide and mental health is crucial. This may include taking opportunities through PSHE and other aspects of the curriculum to talk openly and honestly about suicide, without glorifying the act or public figures that have died through suicide.

Develop a school policy

Papyrus recommends that schools and colleges have a policy statement which is known by the whole community and which shows a strong commitment to suicide prevention. A model policy and further guidance about this can be found in the Papyrus guide: Building Suicide Safer Schools and Colleges

Improve connectedness

Connectedness is the extent to which a child or young person is able to connect with other individuals; to their family members; to community organisations (i.e. schools); and to their cultural traditions and history. Below are some ways to support connectedness:

• Support relationships between the young person and positive adults in their lives.

• Help build positive attachments between the young person, their family and school.

• Provide a range of activities that help the young person increase and strengthen their social networks, e.g. access to extracurricular activities and community clubs/organisations.

Build Resilience

Research has shown that using a preventative approach focused on building resilience in the school community can help to reduce the risk of suicide. Whole school approaches such as Emotionally Friendly Settings can help to promote the emotional wellbeing of the whole school community, including staff (contact the Educational Psychology Service for further information).

BACE – Body, Achievement, Closeness, Enjoyment

To support and maintain positive emotional wellbeing, it is recommended that people aim to include a regular balance of activities in their life which give them feelings of:

• taking care of their body e.g. eating well, exercise, resting.

• achievement, e.g. completing homework, learning a new skill;

• closeness, e.g. meeting up with a friend, phoning a family member; and

• enjoyment, e.g. playing computer games, watching TV, playing music.

It is helpful to communicate this idea to all children and young people and work with them to help them think about the kinds of activities they do in their lives and how these relate to BACE. It can be helpful to keep a log of activities under these headings so that they can see whether they have a good balance or would benefit from seeking new activities in a particular area. This could be done as a whole class or group PSHE activity as well as a more targeted activity for young people where you have concerns.

Risk assessment prompts

Prior to embarking on a conversation with a young person about their suicidal thoughts, ask yourself whether you feel confident and competent enough to have the conversation. If the answer is no, it may be that a colleague needs to step in to help you to navigate this difficult conversation, for your own and the young person’s wellbeing. There are training courses you can access to help you increase your confidence in having these conversations. At the beginning of the conversation, it is important to re-visit and re-iterate confidentially (see ‘Managing Self-harm’ section for further information.) During the conversation, ask questions such as the following to try to assess the risk of the young person acting on any suicidal thoughts.

• Be patient and give them time to talk so that it does not feel like an interrogation.

• Are they saying that they have a desire to end their life?

• How often do they feel like this? Is it constant, frequent, occasional or rare?

• Are they talking about wanting to end their life now?

• Have they thought about how they intend to attempt suicide?

• Have they made definite plans? If so, have they already started preparing (e.g. writing a note, gathering medication)? The greater the evidence of planning for a suicide attempt, the greater the risk of the young person acting on their thoughts.

• Have they made any attempts in the past? Was there something that helped to keep them safe?

• Are there any protective factors which can help to keep the young person safe? Protective factors are very varied and specific to the individual, but could include family, friends, pets, a sense of responsibility or religious/spiritual beliefs.

• Do they have any plans for the future? How far into the future? For example, are they thinking about a holiday planned for next year, an event in a few months (e.g. a birthday or festival) or is there no evidence that they plan to be around for future events?

Generally speaking, higher risk correlates with greater frequency of suicidal thoughts, greater evidence of planning and preparation for suicide, less evidence of future plans, and less access to support and protective factors. If they have already taken steps to end their life, follow the responding to a suicide attempt flowchart.

Individual level

It is important for people experiencing thoughts of suicide to first be encouraged to meet their basic needs of looking after themselves, such as eating, sleeping and keeping hydrated, as these can be difficult for someone in this situation. To ensure thoughts of suicide and low mood do not worsen because these basic needs are not being met, encourage the child or young person to do these first, and then think about some of the following distraction techniques:

• Physical activities, e.g. yoga, swimming, gym, scream/shout to loud music.

• Creative activities, e.g. painting, mindfulness colouring, blog, make a playlist of music that makes them feel good.

• Productive activities, e.g. cook/bake, rearrange their room, write a to-do list.

• Relaxing activities, e.g. bath with candles, use their Hope box (see below), cuddle up in a blanket.

Distraction techniques allow us to focus on something else and can sometimes quieten intrusive thoughts enough to access support. It is important to explain that distraction techniques are useful when people are feeling overwhelmed, but generally it is better to acknowledge and feel our emotions at other times.

You can help a child or young person to create, decorate and fill a Hope box with things that can make them feel better when they are having suicidal thoughts. It is important that the box is personalised in whichever way the child or young person wishes. The Hope box can be filled with a variety of self-soothing items, based on the five senses. Here are some ideas of things to include:

• See – images of loved ones, images that make you feel calm.

• Hear – relaxing sounds, favourite songs, audio books.

• Smell – scented candles, aromatherapy oils, scented lotion, favourite perfume.

• Taste – chocolate, sweets, hot chocolate.

• Touch – stress ball, soft fabrics, play dough, hand lotion, rubber bands to flick, fidget toys.

Helping a child or young person to make a support plan can contain the overwhelming feelings and plan some practical steps to help keep them safe. By creating a support plan and encouraging the child or young person to put it somewhere where they can find it easily, you are helping them with steps to follow to enable them to feel supported and stay safe when things become overwhelming. This will help them to get through the moment, prevent them from acting on thoughts of suicide and then allow them to access long-term support. This plan should be personal to the young person and as detailed as possible. It should be reviewed with the young person regularly and changed when they think of new things to add, or things to remove which they no longer find helpful. With the young person’s permission, it can be shared with key people in their life. An example of a support plan can be viewed on page 18. It is important when working with young people around suicidality to be mindful of key dates and anniversaries that might be important for them and to be extra vigilant around their wellbeing around these times. It is advised that support plans are created alongside outside agencies such as CAMHS.

Following discussion, if you have urgent concerns regarding a child’s mental health please contact CAMHS on 0161 716 1100 and ask to speak with a member of the duty team. Outside of office hours please call 111.

In cases of emergency where your child feels unable to keep themselves safe please visit your local A&E department for an urgent mental health assessment.

During office hours if the child does not require a medical examination, we would recommend contacting CAMHS in the first instance to consider a referral to the rapid response team (RRT) as an alternative to A&E attendance.

Pennine Care Mental Health Support line is open 24 hours a day, 7 days per week on 0800 014 9995 and can make a referral to RRT if required. You should also follow safeguarding procedures as the risk of harm to self is a child protection issue. Use the prompts on the following page to guide your assessment of risk.

This section has been informed by the Emotionally Friendly Settings manual and the Papyrus guide (400734-Schools-guide-PAPYRUS.pdf (papyrus-uk.org).

Further support and advice can be accessed via Bury CAMHS. For urgent concerns regarding a child’s mental health/risk you can contact the CAMHS duty team Monday – Friday, 9am – 5pm on 0161 716 1100 For non urgent concerns whereby the child is not currently open to CAMHS Bury please contact the consultation line for professionals on 07912453942 available Tuesday-Friday 2.30-4.30 pm.