Procedures

• Non-Suicidal Self Injury definition
• NSSI response procedures
• Suicide definition
• Suicide response procedures

Non-Suicidal Self Injury definition

Non-Suicidal Self Injury (NSSI) means any behaviour which deliberately causes pain or injury to oneself but not intended to cause death. This includes cutting, burning or hitting oneself, overdosing on prescription or illegal drugs, binge-eating or starvation, abusing drugs or alcohol, or repeatedly putting oneself in dangerous situations¹ . 

NSSI is usually a response to distress. In the short-term, some people find that it provides temporary relief from the psychological distress they are experiencing. While people who use NSSI do not necessarily mean to kill themselves, it often becomes a compulsive and dangerous activity, and requires careful professional help. 

1 Sane Australia: https://www.sane.org/mental-health-and-illness/facts-and-guides/self-harm


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NSSI response procedures

• Protect yourself from blood. Use rubber gloves or plastic bags on hands, or cover wound with towel. 
• Assess the wound for depth and/or severity and determine if it is necessary to call an ambulance. 
• If superficial encourage the child to attend to any damage they have done and provide the means to do this. 
• If assessed as more serious, bandage the wound and provide first-aid and seek medical attention. 
• Follow the procedure for 5.4 Medical Emergency. Continue to monitor the child if he or she is not taken for medical attention. If taken for medical attention, monitor on return. 
• Remove any objects that could be used for NSSI. Following an incident of NSSI, residential care workers must continue to make sure that the child does not have any access to an object that could be used for further injury, monitor the child's mood and seek further advice as appropriate. 
• Assess the physical and emotional needs of the child at regular intervals. 
• Residential care workers must not give any child in a heightened state permission to leave the residential home if unaccompanied by a staff member. If the child runs away and is at risk of harm, complete the 'missing' or 'unaccounted for' risk assessment. 
• Make regular bed checks and record observations in the home's Log Book and in the child's case notes. Observations should be made more frequently if the level of risk warrants this and a record made. This must be logged in the home's Log Book and documented in the child's case notes. 
• Notify by email the relevant psychologist, manager, Assistant Director, Director Residential Care and case manager at the earliest possible opportunity. 
• Record the incident. Depending on the nature of the incident this will require completion of a "log entry", a case note, a Critical Incident summary/Report and a SOLVSAFETY report. 

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Suicide definition

Suicide is defined as the act of intentionally ending one's own life. Suicidal thoughts and behaviours are classified more specifically into three categories: 

• Ideation, which refers to thoughts of engaging in behaviour intended to end one's life; 
• Communications, which refers to the formulation of a specific method through which one intends to die; and 
• Behaviours, which refers to engagement in potentially self-injurious behaviour in which there is at least some intent to die 

Children accommodated in the Department's residential care services may have suicide risk factors, given their life experiences. 

Signs of an imminent risk of suicide are present when a person: 

• expresses an intent to die 
• has a plan in mind (when) 
• has access to lethal means (how/plan) 
• is impulsive, aggressive or shows anti-social behaviour 
• has been using alcohol or other drugs, and/or 
• has a history of a previous suicide attempt/s. 

Not all suicides can be prevented or predicted. Most people exhibit warning signs, but these may be subtle. Impulsivity and alcohol and other drug substance misuse are also seen as risk factors for suicide. 

For more information refer to the related resources Suicide Information Sheet and Suicide and Aboriginal People in Casework Practice Manual entry Suicide and self harm. 

Particular times residential care workers should be mindful of suicide concerns include: 

• when a child is being forensically interviewed about disclosure of harm/abuse 
• when a child is placed into the care of the CEO 
• when there is placement instability or transitions (including out of Secure Care) 
• a child with a mental illness is discharged from in-patient care or an emergency department 
• when significant anniversaries occur 
• when a sibling or other family member attempts, or dies by suicide; or if someone the child knows, or who is from their community, attempts or dies by suicide, and 
• when funeral or 'Sorry' events occur. 

The Aboriginal practice leader must be consulted to discuss cultural considerations when Aboriginal children plan to attend funeral or Sorry events. The Aboriginal practice leader can advise on spiritual, cultural and practical issues relating to these events.

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Suicide response procedures

• Residential care workers must treat all suicidal thoughts and behaviours seriously, no matter how frequently these threats are made. Suicide and NSSI behaviour are indicative of underlying distress and a need for urgent assistance. 
• An ambulance must be called if immediate medical attention is required. 
• If the child requires urgent medical treatment but refuses this treatment, other professionals will assess and determine whether the child should be taken involuntarily to hospital. 
• The Crisis Care Unit, the home's manager, the Assistant Director and Director Residential Care, psychologist and case managers must all be informed. 
• The child must receive discharge forms from the hospital to return home. The Individual Crisis Support Plan must be reviewed by the home's psychologist and key workers as soon as possible. 
• Residential care workers must monitor the child's emotional state until the risk of harm has been removed or appropriate intervention has been implemented. 
• Residential care workers should check that the external doors of the property are locked. The child cannot be prevented from leaving the home and the doors must be opened if the child requests to leave. Residential care workers must not give any child in a heightened state and at risk of suicide permission to leave the residential home if unaccompanied by a residential care workers member. If the child runs away and is at risk of harm, workers must complete the 'missing' or 'unaccounted for' risk assessment
• Remove any objects that could be used for self-harm. 
• Residential care workers should talk to the child and provide support in a calm and understanding manner. 
• Increase frequency of bed checks. The frequency of these bed checks must be carried out as deemed necessary by the senior residential care worker on shift, as per Manual entry 6.7 Bed Checks. Record observations in the home's Log Book and in the child's case notes. Notify by email the relevant psychologist, manager, Assistant Director, Director Residential Care and case manager at the earliest possible opportunity. 
• Record the incident. Depending on the nature of the incident this will require completion of a "log entry", a case note, a Critical Incident summary/Report and a SOLVSAFETY report. Residential care workers must also seek advice when concerned about the child's wellbeing from senior residential care workers. After hours this may include seeking advice from: the on-call manager, Crisis Care Unit, Acute Response Team (ART) 1800 048 636 or the Psychiatric Emergency Liaison Officer at the nearest hospital Emergency Department. 
• In all cases the following should be notified as soon as possible: The child's case manager, Crisis Care Unit, on-call manager, the manager, the Director and Assistant Director Residential Care, and the home's psychologist should be notified as soon as possible via email. 
• A psychological or psychiatric assessment should be arranged, and the child's Individual Crisis Support Plan must be updated.

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