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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Preventing Suicide by Hanging and Strangulation Policy

1. Purpose

The purpose of this policy is to set out how {{org_field_name}} will prevent, identify, assess, manage and respond to risks of suicide, attempted suicide, self-harm, hanging and strangulation for people using our domiciliary care service in England.

This policy is intended to support safe, person-centred, lawful and proportionate care in a community setting. It explains how staff must work with service users, families, advocates, commissioners, safeguarding agencies, GPs, community mental health services, crisis teams, emergency services and other professionals to reduce risk while respecting the person’s rights, choices, dignity and independence.

This policy supports compliance with the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in particular Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance), Regulation 18 (Staffing), Regulation 19 (Fit and proper persons employed) and Regulation 20 (Duty of candour). It also supports compliance with the Care Act 2014, the Mental Capacity Act 2005, the Health and Safety at Work etc. Act 1974, and CQC registration and notification requirements.

{{org_field_name}} recognises that suicide prevention in domiciliary care requires timely risk recognition, clear escalation, robust recording, effective information-sharing, lawful consent practice, safeguarding action where indicated, and learning after incidents and near misses.

2. Scope

This policy applies to all staff engaged by {{org_field_name}} in connection with the regulated activity, including directors, the nominated individual, the registered manager, deputies, coordinators, care workers, senior care workers, agency staff, temporary staff, bank staff and any person working on behalf of the service.

This policy applies to all service users receiving domiciliary care or support from {{org_field_name}}, particularly where there is a known, suspected or emerging risk of suicide, self-harm, hanging or strangulation.

Because care is delivered in people’s own homes and in the community, this policy also applies to risks identified during assessment, care planning, reviews, welfare checks, visits, medication support, moving and handling support, personal care, companionship, overnight or waking services, telephone welfare contact, and any contact with family members or other professionals connected to the person’s care.

This policy covers:

• initial assessment before or at the start of the service;
• risk assessment and review;
• care planning and safety planning;
• consent and mental capacity;
• safeguarding and escalation;
• environmental and situational risk reduction in a domiciliary care context;
• emergency response;
• incident reporting, notifications and duty of candour;
• staff training, supervision and governance.

3. Legal and Regulatory Framework

This policy must be read alongside the following legislation, regulations and guidance, as amended from time to time:

• Health and Social Care Act 2008.
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including:
  • Regulation 9: Person-centred care;
  • Regulation 11: Need for consent;
  • Regulation 12: Safe care and treatment;
  • Regulation 13: Safeguarding service users from abuse and improper treatment;
  • Regulation 16: Receiving and acting on complaints;
  • Regulation 17: Good governance;
  • Regulation 18: Staffing;
  • Regulation 19: Fit and proper persons employed;
  • Regulation 20: Duty of candour.
• Care Quality Commission (Registration) Regulations 2009, including:
  • Regulation 16: Notification of death of a service user;
  • Regulation 18: Notification of other incidents.
• Care Act 2014, including safeguarding duties and cooperation with local authority safeguarding processes.
• Mental Capacity Act 2005 and the Mental Capacity Act Code of Practice.
• Health and Safety at Work etc. Act 1974.
• Any current national suicide prevention strategy, safeguarding guidance, local safeguarding adults board procedures, and local NHS crisis pathway arrangements applicable to the area in which care is delivered.

For the avoidance of doubt, this policy applies within a domiciliary care setting. Where a person requires assessment, treatment or detention under mental health legislation, {{org_field_name}} will not attempt to replace statutory mental health services, but will escalate concerns promptly to the appropriate emergency, crisis, safeguarding and clinical services.

4. Risk Assessment and Early Identification of Suicide Risk

{{org_field_name}} will carry out a documented suicide and self-harm risk assessment where risk is known, suspected or newly identified. This assessment must be completed:

• before or at the commencement of the service where relevant information is known;
• at the point of any new concern, disclosure, warning sign or incident;
• following discharge from hospital, attendance at A&E, crisis team involvement, bereavement, major life event or significant deterioration in mental state;
• after any missed visit, failed welfare contact, refusal of entry, unexplained disengagement or sudden change in presentation;
• at each formal care plan review; and
• whenever staff identify a change in risk during a visit or contact.

The risk assessment must consider, where relevant:

• current suicidal thoughts, plans, intent, means and opportunity;
• previous suicide attempts, self-harm, ligature use, hanging or strangulation behaviour;
• recent losses, trauma, abuse, domestic abuse, exploitation, isolation, financial stress, housing instability or substance misuse;
• mental health history, current symptoms, medication issues, relapse indicators and professional involvement;
• physical health issues, pain, sleep disturbance and delirium or cognitive impairment;
• protective factors, including family support, faith, pets, therapeutic relationships, future plans, reasons for living and willingness to accept help;
• environmental and situational risks within the home and local community;
• the person’s communication needs, culture, language, neurodiversity and any reasonable adjustments required.

Risk assessments must be person-centred and, wherever possible, completed with the service user and with their consent. Where the person may lack capacity in relation to relevant decisions, staff must act in accordance with the Mental Capacity Act 2005 and record how capacity and best-interest decision-making have been considered.

Any high-risk presentation, credible suicidal intent, recent attempt, access to means with intent, inability to maintain immediate safety, or concern that the person is at imminent risk must be escalated immediately in line with Section 6 of this policy.

5. Consent, Mental Capacity and Best-Interest Decisions

{{org_field_name}} will presume that service users have capacity to make their own decisions unless there is reason to believe otherwise. Staff must support service users to make decisions wherever possible and must provide information in a way the person can understand.

Where there is concern that a person may lack capacity in relation to a specific decision linked to risk management, care delivery, information-sharing or emergency intervention, staff must follow the Mental Capacity Act 2005 and the Mental Capacity Act Code of Practice. Capacity assessments must be decision-specific and time-specific.

If a person with capacity makes a decision that appears unwise, this does not by itself mean that the person lacks capacity. However, staff must still assess and document the risks, offer support, consider safeguarding and escalate concerns where there is a risk of serious harm.

Where a person lacks capacity in relation to a relevant decision, any action taken by {{org_field_name}} must be the least restrictive option and must be in the person’s best interests. Staff must involve lawful representatives, attorneys, deputies, advocates and relevant professionals where appropriate.

All capacity assessments, best-interest decisions and consent discussions must be clearly recorded.

6. Preventative Environmental Controls and Safety Measures

In domiciliary care, {{org_field_name}} recognises that the service user’s home is not a controlled clinical environment. Staff must therefore take a proportionate, lawful and person-centred approach to reducing risks associated with hanging, strangulation and self-harm.

Where risk is identified, the service will consider and document, in partnership with the service user and others involved in their care where appropriate:

• whether there are identifiable ligature points or readily accessible items that increase risk;
• whether the person consents to specific steps to reduce access to means;
• whether family members, informal carers, landlords, housing providers or other professionals should be involved to support environmental risk reduction;
• whether additional welfare checks, increased visit frequency, double-up visits, telephone checks, waking night support or urgent review of the package of care are required;
• whether the current package of domiciliary care remains safe and sufficient to meet the person’s needs.

Examples of proportionate risk reduction measures may include:

• safe storage or supervised access to medicines, cords, belts, ropes, sharp items or other identified means where agreed and lawful;
• changes to visit timing or frequency;
• enhanced observation during high-risk periods within the limits of the commissioned service;
• prompt referral for urgent mental health review or safeguarding intervention;
• immediate escalation where the risk cannot be safely managed within domiciliary care.

Staff must not place themselves at unreasonable risk and must not attempt environmental interventions that are unsafe, unlawful, outside their competence or contrary to the service user’s legal rights without proper authority.

7. Domiciliary Care Setting: Limits of Control and Need for Escalation

Because {{org_field_name}} provides care in people’s own homes, the service cannot always control the physical environment, remove all potential means of self-harm, or provide continuous observation unless this forms part of an agreed and resourced care package.

Where identified risks cannot be safely managed within the scope of domiciliary care, {{org_field_name}} will escalate concerns promptly to the relevant commissioner, local authority, NHS professional, crisis service, emergency service or safeguarding team, and will review whether the package of care remains appropriate and safe.

The service will not accept or continue a package of care where known risks cannot be managed safely, lawfully and competently within the service model, staffing arrangements and commissioned support available. Any such concern must be escalated to the registered manager immediately and documented clearly.

8. Emergency Response and Crisis Intervention

If a staff member believes a service user is at imminent risk of suicide or serious self-harm, the staff member must take immediate action within the limits of their role, training and personal safety. This includes:

• calling 999 without delay where there is an immediate threat to life, an attempt in progress, an unresponsive person, or urgent need for ambulance or police attendance;
• giving first aid or CPR only if it is safe to do so and the staff member is trained and able;
• following lone worker and emergency procedures;
• informing the office, on-call manager or registered manager as soon as possible;
• seeking urgent support from the person’s GP, NHS 111, local crisis team, community mental health team or other clinician, where appropriate and without delaying emergency action;
• contacting family, carers or lawful representatives where appropriate, necessary and in line with confidentiality, consent and best interests.

Where staff cannot gain access and there is a credible welfare concern, the service must follow its welfare concern / no response procedure, which may include attempts to contact the person, next of kin, emergency contacts, key safe holders, commissioners, housing staff or emergency services, depending on the urgency and known risk.

Following any emergency, the manager must ensure:

• the incident is fully documented;
• the care plan and risk assessment are reviewed immediately;
• safeguarding referral is made where required;
• consideration is given to Duty of Candour obligations;
• consideration is given to CQC notification requirements;
• staff receive debrief and support;
• lessons learned are recorded and acted upon.

9. Staff Training and Responsibilities

{{org_field_name}} will ensure that staff receive training, supervision and support appropriate to their role so that they can identify and respond to suicide and self-harm risk safely and lawfully.

Training must include, as appropriate to role:

• recognising warning signs of suicide, self-harm, hanging and strangulation risk;
• professional curiosity and trauma-informed practice;
• communication skills for responding to distress and disclosure;
• dynamic risk assessment during home visits;
• safeguarding adults procedures;
• consent, mental capacity and best-interest decision-making;
• emergency response, first aid and CPR arrangements relevant to role;
• record keeping, information sharing and escalation;
• lone working and personal safety;
• post-incident reporting, duty of candour and learning.

Managers are responsible for ensuring:

• staff competence is checked before lone working;
• concerns are escalated without delay;
• supervision addresses risk issues and staff wellbeing;
• staffing levels and skills are sufficient to respond to identified risk;
• recruitment, induction and ongoing suitability checks are robust;
• training compliance is monitored and gaps are acted on.

All staff are responsible for recognising concerns, acting promptly, recording accurately, escalating appropriately and working within the limits of their competence.

10. Communication, Information-Sharing and Safeguarding Procedures

{{org_field_name}} will promote a culture in which service users, families and staff can raise concerns early and without stigma.

Where there is concern that a service user is experiencing, or is at risk of, abuse or neglect, including self-neglect, domestic abuse, coercion, exploitation or circumstances that materially increase suicide risk, staff must follow the safeguarding adults procedure without delay.

A safeguarding referral must be considered where the service user:

• has needs for care and support;
• is experiencing, or is at risk of, abuse or neglect; and
• as a result of those needs may be unable to protect themselves.

Information must be shared on a need-to-know basis, in line with confidentiality, data protection, consent and best interests. Lack of consent will not prevent information-sharing where there is a lawful basis to protect the person or others from serious harm.

Records must clearly show:

• the concern identified;
• what the service user said or did;
• any mental capacity considerations;
• what advice was taken;
• who was informed;
• what action was taken and why;
• the outcome and any follow-up actions.

Where the service user is at significant risk, managers must consider urgent liaison with the local authority safeguarding team, GP, crisis team, community mental health team, ambulance service, police, commissioner and family or lawful representative as appropriate.

11. Duty of Candour and CQC Notifications

{{org_field_name}} will act in an open and transparent way with service users and, where appropriate, with people lawfully acting on their behalf, in accordance with the statutory Duty of Candour.

Following any notifiable safety incident, the registered manager or delegated senior manager must consider without delay whether Duty of Candour applies and, where it does, must ensure that the relevant person is informed in a timely, truthful and compassionate manner, offered an apology, told what is known at the time, kept updated, and provided with a written record in line with organisational procedures.

The service must also consider whether a notification to CQC is required. This includes, where applicable, notification of:

• the death of a person using the service where the death occurred while a regulated activity was being provided or may have resulted from the regulated activity or how it was provided;
• serious injury;
• abuse or allegations of abuse;
• incidents reported to or involving the police;
• other incidents required under the Care Quality Commission (Registration) Regulations 2009.

A clear record must be kept of:

• the incident;
• whether Duty of Candour was considered and applied;
• whether a CQC notification was required and submitted;
• whether safeguarding and commissioner notifications were made;
• what communication took place with the service user, family or relevant person.

12. Compliance Monitoring, Audit and Learning

{{org_field_name}} will maintain effective governance arrangements to monitor compliance with this policy and to improve practice.

Governance activity must include:

• audit of risk assessments, care plans and reviews for people at risk;
• audit of incident reports, safeguarding referrals, complaints and near misses;
• review of whether escalation and emergency response times were appropriate;
• review of whether staffing, supervision and training were sufficient;
• review of whether records were complete, contemporaneous and accurate;
• review of whether Duty of Candour and CQC notification duties were considered and met;
• identification of themes, patterns and lessons learned across incidents;
• action planning, assignment of responsibilities and follow-up on completion.

The registered manager will ensure that serious incidents and significant near misses are reviewed promptly and that findings are used to improve policy, care planning, staff support and service delivery.

13. Policy Review and Updates

This policy will be reviewed at least annually and sooner where required, including following:

• a death, attempted suicide, serious self-harm incident or significant near miss;
• a safeguarding adult review, serious incident review or coroner’s learning relevant to the service;
• changes in legislation, regulation, statutory guidance or CQC guidance;
• changes to local safeguarding or crisis pathway arrangements;
• complaints, audits, inspections or staff feedback identifying a need for revision.

14. Conclusion

{{org_field_name}} is committed to reducing the risk of suicide, self-harm, hanging and strangulation through safe, person-centred and lawful domiciliary care. By combining early identification, robust risk assessment, appropriate escalation, safeguarding action, competent staffing, effective governance and learning from incidents, the service aims to protect people’s safety, dignity, rights and wellbeing in line with current legislation and CQC requirements.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.