{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Preventing Suicide by Hanging and Strangulation Policy

1. Purpose

The purpose of this policy is to provide clear guidance on preventing suicide by hanging or strangulation within our domiciliary care service. This policy ensures that our organisation takes proactive measures to identify, assess, and reduce risks associated with suicide while supporting service users’ mental health and wellbeing.

Our home care service is committed to:

• Identifying individuals at risk and implementing appropriate support strategies.
• Training staff to recognise warning signs and respond effectively.
• Reducing environmental risks that may contribute to suicide by hanging or strangulation.
• Providing crisis intervention and emergency response procedures.
• Ensuring multi-agency collaboration, safeguarding service users, and following Care Inspectorate Wales (CIW) regulations.

This policy must be read and implemented in accordance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Social Services and Well-being (Wales) Act 2014, the Mental Capacity Act 2005, the Human Rights Act 1998, the Equality Act 2010, the Wales Safeguarding Procedures and current Welsh Government and NICE guidance relating to suicide prevention and self-harm. It also takes account of Understanding: the Suicide Prevention and Self-harm Strategy for Wales and its delivery plan.

2. Scope

This policy applies to:

• All staff, including care workers, supervisors, and managers, who support service users.
• Service users who may be at risk of suicide or self-harm.
• Families and external professionals, including mental health teams, social workers, and emergency services.

It covers:

• Recognising suicide risk factors and warning signs.
• Risk assessment and safety planning.
• Environmental risk reduction.
• Emergency response and crisis intervention.
• Staff training and multi-agency working.

3. Identifying Suicide Risk Factors and Warning Signs

3.1 Understanding Risk Factors

Suicide risk is complex and may be influenced by multiple factors, including:

• Mental health conditions such as depression, anxiety, PTSD, schizophrenia, or bipolar disorder.
• Previous suicide attempts or a history of self-harm.
• Substance misuse (alcohol, drugs, or prescription medication abuse).
• Significant life events, including bereavement, abuse, trauma, or relationship breakdowns.
• Social isolation or lack of support networks.
• Chronic illness, disability, or pain that affects quality of life.

3.2 Recognising Warning Signs

Staff must be trained to identify early warning signs of suicidal thoughts, including:

• Expressing feelings of hopelessness, worthlessness, or being a burden.
• Talking about death or suicide (e.g., “I can’t go on,” “There’s no point”).
• Sudden changes in behaviour, such as withdrawal, agitation, or recklessness.
• Giving away personal belongings or preparing a will.
• Unusual preoccupation with methods of suicide, including talking about hanging or ligatures.

Where a service user displays a warning sign, discloses thoughts of suicide or self-harm, or where a member of staff has another reasonable concern about the person’s safety, the member of staff must take the concern seriously, remain calm, listen without judgement and establish whether there is an immediate danger. The member of staff must follow section 6 where there is an immediate or life-threatening risk. In all other cases, the member of staff must promptly notify the Registered Manager or delegated senior person, record the concern factually and obtain or facilitate appropriate advice from the person’s GP, mental health team, NHS 111 Wales or another relevant healthcare professional in accordance with the person’s personal plan.

4. Risk Assessment and Safety Planning

4.1 Assessment and Management of Suicide and Self-harm Concerns

The service provider must assess risks to the individual’s well-being as part of the provider assessment and must record within the individual’s personal plan the steps required to manage identified risks. The assessment must be completed by a person who has the skills, knowledge, competence and training required for the assessment being undertaken.

Domiciliary care staff must not make a clinical diagnosis, undertake a specialist mental health assessment or determine a person’s clinical level of suicide risk unless they are professionally qualified and authorised to do so. Staff must obtain advice or assessment from an appropriate healthcare or mental health professional where suicide or self-harm concerns are identified.

The service must not use a risk assessment tool, checklist or global classification such as ‘low’, ‘moderate’ or ‘high’ as the sole means of predicting future suicide or self-harm, deciding whether professional help is required, determining access to treatment or deciding whether the person is safe to be left alone.

The assessment and resulting personal plan must, so far as relevant, record:

• the individual’s own account of their thoughts, wishes, feelings and immediate concerns;
• any current thoughts of suicide or self-harm, disclosed plans, access to means and recent acts or preparations;
• relevant previous incidents and changes in presentation or circumstances;
• protective factors, strengths, relationships and coping strategies identified by the individual;
• the advice received from healthcare or mental health professionals;
• the actions required of staff, including escalation and emergency arrangements;
• any agreed measures relating to the individual’s environment;
• how the individual will be involved in decisions and supported to understand the plan; and
• when the assessment and personal plan must be reviewed.

Where there is an immediate danger to life, an attempt in progress, a recent attempt requiring urgent treatment, or a clear and imminent intention to act, staff must call 999 and follow section 6. The Registered Manager or delegated senior person must also be notified without delay.

4.2 Individual Safety Plans

For service users identified as at risk, a Safety Plan must be developed, which includes:

• A list of coping strategies for managing distress.
• Emergency contact details of crisis services, support networks, and family members.
• Agreed environmental safety measures, including reducing access to ligature points.
• Regular welfare checks by staff or family members.

The safety plan must form part of, or be clearly cross-referenced within, the individual’s personal plan. It must be prepared with the individual and, where applicable and appropriate, the placing authority, commissioner and representative. The individual must be given a copy in an accessible language and format unless there is a documented lawful reason for not doing so.

The safety plan must clearly state who is responsible for each action. Family members or other informal carers must not be assigned monitoring or safety responsibilities without their knowledge and agreement. Welfare visits or telephone checks must not be treated as a substitute for calling emergency services where an immediate danger exists.

The safety plan and associated risk assessment must be reviewed whenever there is a significant change, a new disclosure, an incident, an attempt, a change in professional advice or evidence that the current plan is not maintaining the person’s safety. It must also be reviewed as part of the statutory review of the individual’s personal plan.

The safety plan must be reviewed in accordance with the review arrangements above and whenever the individual’s personal plan is reviewed.

4.3 Consent, Mental Capacity and Best-interests Decisions

Staff must presume that an adult has mental capacity unless it is established otherwise in accordance with the Mental Capacity Act 2005. A diagnosis, suicidal thoughts, self-harm, distress or an unwise decision does not, by itself, establish that the person lacks capacity.

Where there is reason to doubt the individual’s capacity to make a specific decision concerning safety measures, disclosure of information, access to property or proposed changes to their home, an appropriate decision-specific capacity assessment must be arranged and recorded.

Any act or decision made for an adult who lacks capacity must be in the person’s best interests, must be the least restrictive available option and must have an identified lawful basis. Staff must consult relevant persons and professionals as required by the Mental Capacity Act 2005.

No item may be removed, property altered, access restricted or monitoring arrangement imposed solely because staff believe it would be safer. The person’s consent or other lawful authority must first be established, except where immediate and proportionate action is necessary to preserve life or prevent serious and imminent harm.

5. Environmental Risk Reduction

5.1 Individualised Environmental and Ligature-risk Assessment

An environmental or ligature-risk assessment must only be undertaken where there is an identified and recorded reason connected with the individual’s assessed needs, current presentation, professional advice or previous history. It must not be applied as a blanket assessment to every person receiving domiciliary support.

The assessment must be proportionate to the identified risk and must be completed with the involvement of the individual. Where appropriate and lawful, it should also involve the individual’s representative, landlord or property owner, service commissioner and relevant healthcare or mental health professional.

The assessment must consider:

• the particular item, fixture or area giving rise to concern;
• the likelihood and potential seriousness of harm;
• the person’s views, preferences, privacy, dignity and right to use their own home;
• the person’s capacity to make the relevant decision;
• professional advice and any agreed clinical or safety plan;
• the effect of the proposed measure on the person and other occupants;
• whether the measure is lawful, necessary and proportionate; and
• whether a less restrictive alternative is available.

Staff must not remove, confiscate, conceal, secure or dispose of the individual’s belongings, alter the fabric or fittings of the home, or install specialist equipment without the individual’s valid consent or another clearly recorded lawful authority. Permission from the landlord or property owner must also be obtained where an alteration to the property is proposed.

Any agreed environmental measure must be recorded in the individual’s personal plan, including who authorised it, who is responsible for implementing it, how it will be monitored and when it will be reviewed. Specialist fittings such as load-release or reduced-ligature equipment must only be introduced following competent assessment and advice; they must not be presented as eliminating all risk.

The purchase, possession or ordinary use of a cord, belt, rope, tie or other everyday item must not automatically be treated as evidence of suicidal intent. Staff must report the matter promptly where the surrounding circumstances create a reasonable concern about the individual’s immediate safety, and must follow the escalation arrangements in sections 4 and 6.

5.2 Supporting Independent Living While Ensuring Safety

We balance safety with personal choice and dignity by:

• Encouraging open conversations about mental health and self-harm prevention.
• Involving service users in decision-making about their environment.
• Supporting service users to maintain personal autonomy while keeping them safe.

Any restriction, environmental control or reduction in access to personal belongings must be based on an individual assessment, must be necessary and proportionate to the identified risk, must use the least restrictive available option and must be supported by consent or other lawful authority. The reason, decision-maker, duration and review arrangements must be recorded in the individual’s personal plan.

6. Emergency Response and Crisis Intervention

6.1 Responding to an Immediate or Life-threatening Situation

Where a service user has attempted hanging or strangulation, has a ligature in place, is unconscious, is not breathing normally, has sustained an injury requiring urgent treatment, or presents an immediate danger to themselves or another person, staff must:

1. Call 999 immediately, request an ambulance and clearly state that the incident involves suspected hanging, strangulation, ligature use, self-harm or immediate suicide risk. Staff must follow the emergency call handler’s instructions.
2. Assess the immediate safety of the scene. Staff must not place themselves or another person in serious danger. Where there is a threat, weapon, violence, unsafe structure or another serious hazard, staff must withdraw to a safe position and request police assistance through 999.
3. Where it is safe to do so, release or remove the source of constriction and support the person’s body to prevent a fall. Staff must use only the equipment and techniques for which they have been trained and must follow the emergency call handler’s instructions.
4. Check responsiveness and breathing and provide first aid, including cardiopulmonary resuscitation where required, within the member of staff’s training and competence. An automated external defibrillator must be used where available and indicated.
5. Do not leave the person alone unless remaining would place the member of staff or another person in danger. Provide calm reassurance, maintain privacy so far as is compatible with safety and await emergency services.
6. Do not promise confidentiality. Explain that relevant information must be shared with those who need it to protect the person’s life and safety.
7. Notify the Registered Manager or delegated senior person as soon as it is safe to do so. The manager must ensure that the person’s representative, commissioner, healthcare professionals, safeguarding authority, police and CIW are informed where legally required and appropriate.
8. After immediate life-saving action has been taken, preserve the scene and relevant items as far as reasonably practicable. Do not unnecessarily move, clean, discard or alter items that may be required by the police, coroner, safeguarding authority or CIW.
9. Make a complete, factual and contemporaneous record of the event, observations, times, emergency instructions, first aid provided, persons contacted, decisions made and the outcome.

6.2 Post-incident Action, Review and Support

Following any suicide attempt, suspected attempt, ligature incident, episode of serious self-harm or emergency intervention, the Registered Manager or delegated senior person must ensure that:

• the individual receives appropriate medical and mental health assessment and follow-up;
• any discharge instructions, professional recommendations and changes to treatment are obtained, recorded and communicated to staff who need the information;
• the provider assessment, risk assessment, personal plan and safety plan are reviewed without delay and revised where necessary;
• the individual is involved in the review and is given information in a language and format they can understand;
• the individual’s representative, commissioner and relevant professionals are involved where appropriate and lawful;
• any safeguarding referral required by the Social Services and Well-being (Wales) Act 2014 and the Wales Safeguarding Procedures is made without delay;
• any statutory notification required under regulations 60 or 84 and the relevant schedules to the Regulations is submitted to CIW or another authority without delay;
• the provider considers whether the duty of candour applies and acts openly and transparently with the individual and their representative;
• staff involved are offered appropriate welfare support and supervision; and
• the incident is reviewed through the provider’s governance and quality-assurance arrangements to identify learning, required action and whether similar risks exist elsewhere in the service.

6.3 Statutory Notifications

The Registered Manager must immediately inform the Responsible Individual of any death, serious injury, suicide attempt, ligature incident, safeguarding concern or other significant event that may meet a statutory notification threshold.

The service provider and Responsible Individual must determine whether notification is required under regulations 60 or 84 and Schedules 3 or 4 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended. Where notification is required, it must be made to CIW or the other specified authority without delay and within any prescribed timescale.

A record must be retained of:

• the event;
• the regulatory provision considered;
• the decision whether or not to notify;
• the reasons for that decision;
• the person who made the decision;
• the date and time of any notification; and
• any reference number, acknowledgement or follow-up correspondence.

A safeguarding referral, police report, commissioner notification or internal incident report does not replace a required CIW notification.

7. Multi-Agency Collaboration in Suicide Prevention

Effective suicide prevention requires collaborative working with:

• GPs and mental health teams for psychiatric assessments and ongoing therapy.
• Crisis intervention services for immediate support.
• Social workers and safeguarding teams to ensure protective interventions.
• Charities and support groups (e.g., Samaritans, Mind Cymru) to provide additional emotional support.

Where information gives the service provider reasonable cause to suspect that an adult or child is at risk of abuse, neglect or other harm within the applicable statutory safeguarding criteria, staff must take immediate action to protect the person and must report the concern in accordance with the organisation’s safeguarding policy, the Wales Safeguarding Procedures and local safeguarding arrangements.

Suicidal thoughts or self-harm do not automatically constitute abuse or neglect; however, a safeguarding referral must be considered where there is suspected abuse, neglect, exploitation, coercion, improper treatment, self-neglect within applicable local arrangements, or an inability to protect the person from identified harm. The decision and reasons must be recorded. Immediate danger must always be dealt with through the emergency arrangements in section 6.

7.1 Information Sharing and Confidentiality

Information concerning suicide or self-harm must be handled confidentially and shared only with persons who have a legitimate need to know. Consent should ordinarily be sought before information is shared.

Information may be shared without consent where this is necessary and proportionate to protect the individual or another person from death or serious harm, to comply with a legal obligation, to support a safeguarding enquiry, or for another lawful purpose. Only information relevant to that purpose must be disclosed.

Staff must never promise absolute confidentiality where suicide, self-harm or serious danger is disclosed. The individual should be told what information will be shared, with whom and why, unless doing so would increase the danger or prejudice a police or safeguarding investigation.

The service must record the information shared, the recipient, the lawful reason, whether consent was obtained and, where consent was not obtained, the reasons for proceeding without it.

8. Staff Training, Competence and Responsibilities

The service provider must identify training requirements according to each member of staff’s role, the needs of individuals using the service and the organisation’s statement of purpose. Before being expected to respond independently to suicide, self-harm or ligature-related concerns, relevant staff must receive training and have their competence assessed in relation to:

• recognising and responding to indicators of suicide and self-harm;
• listening and communicating in a calm, compassionate and non-judgemental manner;
• the limits of the domiciliary care worker’s role and the requirement to obtain professional advice;
• immediate escalation, calling 999 and following emergency call-handler instructions;
• first aid and cardiopulmonary resuscitation appropriate to their role;
• individualised risk assessment, personal plans and safety plans;
• mental capacity, consent, best-interests decision-making and least-restrictive practice;
• safeguarding and the Wales Safeguarding Procedures;
• confidentiality and lawful information sharing;
• incident recording, evidence preservation and statutory notifications;
• lone-working and personal safety arrangements; and
• the organisation’s relevant policies and escalation contacts.

Training must be refreshed at intervals determined by legislation, recognised training requirements, changes in guidance, individual learning needs and the service’s training-needs analysis. The provider must retain records of attendance, content, competence assessment, refresher dates and any additional support required.

Staff must work within their training and competence. They must not undertake specialist clinical suicide-risk assessment, remove or alter property without authority, or agree changes to professional treatment plans unless qualified and authorised to do so.

8.1 Management Responsibilities

The Registered Manager is responsible for ensuring that:

• staff can access this policy and understand the emergency escalation procedure;
• current local emergency, crisis, safeguarding and out-of-hours contact details are available to staff;
• only competent persons undertake provider and risk assessments;
• personal plans and safety plans are accurate, accessible and reviewed following any relevant change or incident;
• staffing and visit arrangements are sufficient to deliver the actions specified in the personal plan;
• incidents, safeguarding matters, professional referrals and statutory notifications are properly recorded and followed up;
• staff receive supervision and support following a serious event; and
• learning from incidents is reported to the Responsible Individual and incorporated into quality monitoring and service improvement.

The Responsible Individual is responsible for maintaining effective oversight of the service, monitoring compliance and ensuring that notifications required under regulation 84 are made.

9. Related Policies

This policy should be read alongside:

• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).
• Mental Capacity, Best-interests Decision-making and Lawful Restrictions Policy (DCW39).
• Risk Management and Assessment Policy (DCW18).
• Confidentiality and Data Protection (GDPR) Policy (DCW34).

• Admissions and Commencement of Service Policy.
• Personal Planning and Review Policy.
• Incident and Accident Reporting Policy.
• First Aid and Medical Emergencies Policy.
• Duty of Candour Policy.
• CIW and Statutory Notifications Policy.
• Lone-working Policy.
• Information Sharing and Record-keeping Policy.
• Whistleblowing Policy.
• Staff Training, Supervision and Development Policy.
• Consent and Best-interests Decision-making Policy.

10. Policy Monitoring and Review

The Registered Manager must review this policy at least annually and sooner where there is:

• a change in legislation, statutory guidance, NICE guidance, Welsh Government strategy or CIW requirements;
• a suicide, suspected suicide, attempted suicide, serious self-harm incident or ligature-related event involving a person using the service;
• a safeguarding enquiry, complaint, coroner’s matter, CIW finding or enforcement action relevant to the policy;
• evidence that staff have not understood or followed the procedure; or
• learning from an audit, investigation, professional review or quality-of-care review.

The Responsible Individual must maintain oversight of implementation through the service’s quality monitoring arrangements. Audits must include, where applicable, the quality of risk assessments and personal plans, evidence of individual involvement, timeliness of escalation and referrals, incident recording, safeguarding decisions, CIW notifications, staff competence and completion of remedial actions.

---

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.