Suicide prevention

Children and young people in secure care are likely to have experienced multiple difficulties, adversities, traumas and losses and often have additional mental and emotional health and wellbeing needs (Gough, 2016). Children and young people’s day-to-day functioning and emotional wellbeing has often been compromised by past trauma and they may need help and support to deal with distress, stress, depression, anxiety, self-harm and suicidal behaviour.

Inspections in 2015 by Care Inspectorate and Mental Welfare Commission found that the care provided by secure units was very good or excellent and that the mental health needs of children and young people were being met, although areas for improvement have been identified (Gough, 2017).

Practice

Secure unit staff are trained in suicide and self-harm awareness. Suicide and self-harm prevention policies and guidelines for dealing with injuries in each unit will include:

• Assessment of suicide and self-harm risk as part of admission processes
• Minimum risk management measures for children and young people when they enter secure care
• Risk management plans that are proportionate and tailored to levels of risk
• Guidance on how to deal with different types of injuries and fatalities
• Arrangements for recording and reporting serious incidents

Staff must be vigilant and monitor changes in a child or young person’s routine, mood and behaviour. They should provide support, seeking support from external mental health professionals as required.

Staff must also be aware of the impact of incidents of self-harm and suicide on other children, young people and staff members, and provide appropriate support.

The death of a child or young person in secure care must be subject to a fatal accident inquiry and be reported to Scottish Ministers and the Care Inspectorate.

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Family contact

Children and young people will often worry about their families when they are in secure care and vice versa (Gough, 2016). Family contact and support can reduce such concern and is extremely important to young people, although factors like being unable to access mobile phones, limits to internet access and distance between secure centres and home can make maintaining contact challenging. Under article 37, the United Nation Convention on the Rights of the Child (UNCRC) states children deprived of their liberty should be supported maintain contact with their families except in exceptional circumstances. Secure care centres and staff promote the value of family contact and support such contact as detailed in the Child’s Plan or as a condition of a Compulsory Supervision Order.

Contact lists should be agreed at the outset of the child or young person’s stay in secure care and reviewed throughout. Visits take place within the secure unit and, although policies vary across establishments, visits are generally flexible and permitted out with school or programme times. There are restrictions on what can be brought into the secure unit during visits for safety reasons, with information on prohibited items shared on admission and displayed throughout units. Secure unit staff can be involved in the supervision of contact and procedures for managing this should be established. Phone and letter contact can also be made with those agreed on contact lists.

Family work and family support

Family members should where possible and appropriate be involved throughout a child or young person’s time in secure care. Where they intend to reside with their family on return to the community, work with parents/carers should be included as part of the Child’s Plan (Scottish Government, 2011). This is an important role of the Lead Professional and can involve third sector organisations, with families often involved as part of interventions in the secure unit.

Families may face numerous difficulties when a child enters secure care, during their period of detention and during transitions. Malloch (2013) identified necessary support and gaps in provision, recommending:

• Clear information be made available about the secure unit, where possible prior to admission, and throughout the child or young person’s time in secure care
• Support should be provided including practical help to visit the centre, this is crucial as children and young people will often be placed outwith their home area (Gough, 2016)
• The provision of independent family support, including support to siblings
• Increased involvement of families in care planning and support, particularly post-release