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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 ensure that {{org_field_name}} takes proactive, compassionate, and evidence-based steps to prevent the risk of suicide by hanging or strangulation among service users. This policy reflects our commitment to safeguarding vulnerable individuals, promoting mental well-being, and ensuring a safe environment while delivering person-centred care.

Our approach prioritises prevention through robust risk assessments, staff training, environmental safety measures, and effective care planning. This policy aligns with CQC Regulation 12 (Safe Care and Treatment)​, Regulation 13 (Safeguarding Service Users from Abuse and Improper Treatment)​, and the Mental Capacity Act 2005, ensuring service users receive safe, respectful, and dignified support.

2. Scope

This policy applies to all staff, agency workers, contractors, and volunteers working within {{org_field_name}}. It covers the identification, prevention, and management of suicide risks, with a specific focus on hanging and strangulation.

It applies to all service users, including those with a known history of self-harm, suicidal ideation, or mental health conditions that may increase vulnerability. This policy ensures that all staff are equipped to identify risks early, respond effectively, and create safe, supportive environments for service users.

3. Our Commitment to Suicide Prevention

3.1 Understanding Suicide Risk

{{org_field_name}} recognises that suicide is a complex and sensitive issue, often linked to mental health challenges, life stressors, or feelings of isolation. Hanging and strangulation are among the most common methods of suicide, making it essential to adopt a proactive, preventative approach.

We adopt a compassionate, non-judgemental approach, understanding that suicidal thoughts are often a cry for help rather than a desire for life to end. Our goal is to create an environment where service users feel safe, valued, and supported in expressing their emotions and accessing the help they need.

3.2 Person-Centred Approach

{{org_field_name}} is committed to providing person-centred, safe and proportionate support. Suicide and self-harm risk must be assessed and managed in the context of the individual person, their circumstances, known history, current presentation, strengths, protective factors, communication needs, wishes and preferences.

This includes:

• completing an individual risk assessment when suicide, self-harm, hanging or strangulation risk is identified and reviewing it whenever there is a material change in the person’s circumstances, presentation or level of risk;
• developing and reviewing a personalised support and risk-management plan with the person wherever practicable;
• clearly recording identified risks, protective factors, warning signs, agreed interventions, escalation arrangements and the action staff must take in an emergency;
• ensuring information is communicated to staff who need it in order to provide safe care and support;
• supporting timely access to the person’s GP, community mental health team, crisis service, emergency services or other appropriate health professionals according to the level and immediacy of risk; and
• taking account of the person’s communication needs and making reasonable adjustments where required.

The person must be involved in decisions about their care and support to the greatest extent possible. Consent must be sought and recorded where required. Family members, carers, advocates and relevant health or social care professionals will be involved where the person consents, where they have lawful authority to act for the person, or where information may lawfully be shared without consent because this is necessary and proportionate to protect the person or another person from serious harm.

Where the person is unable to make a specific decision because they lack mental capacity, staff must act in accordance with the Mental Capacity Act 2005, including its statutory principles, and any decision made on the person’s behalf must be in their best interests and be the least restrictive available option.

4. Risk Assessment and Monitoring

4.1 Identifying Risks

All service users undergo a comprehensive risk assessment during their initial assessment and care planning process. This assessment identifies:

• Any history of self-harm or suicide attempts.
• Current mental health conditions, including depression, anxiety, or psychosis.
• Environmental and situational triggers that may increase risk.
• Protective factors, such as social support and coping strategies.

Staff conduct regular reviews of risk assessments, particularly after significant life events, changes in mental health status, or following any incidents of self-harm.

4.2 Continuous Monitoring

Monitoring is a continuous process, with staff trained to observe for early warning signs of distress, such as:

• Social withdrawal or isolation.
• Expressions of hopelessness or worthlessness.
• Changes in behaviour, mood, or personal hygiene.
• Increased agitation, anxiety, or restlessness.

Staff document and report concerns promptly, ensuring timely interventions and support.

5. Environmental Safety Measures

5.1 Identifying and Managing Environmental and Ligature Risks

In supported living, the person ordinarily lives in their own home and the accommodation arrangements are separate from the provision of regulated personal care. {{org_field_name}} will therefore manage environmental and ligature risks within the limits of its legal responsibilities and authority and will not assume ownership or unrestricted control of a person’s home or possessions.

Where an individual assessment identifies a foreseeable risk of hanging, strangulation or ligature-related harm, staff must consider relevant features of the environment, including potential ligature anchor points and materials that may reasonably present a risk to that particular person.

The assessment must consider, where relevant:

• bedrooms, bathrooms, toilets and other areas where the person may have greater privacy;
• doors, windows, rails, handles, hooks, pipes, furniture and fittings;
• cords, cables and other potential ligature materials;
• equipment or adaptations used by the person;
• changes, damage or deterioration that may introduce additional risk;
• the person’s own possessions where these are relevant to an identified risk; and
• the level of staff support, engagement or observation required by the person’s individual risk-management plan.

Any proposed environmental alteration must be discussed with the person and, where applicable, the landlord, housing provider, property owner or other person responsible for the premises.

Potential risks must be managed through the least restrictive reasonable measures available. Blanket removal of personal possessions or blanket environmental restrictions must not be used simply because a person has a history of self-harm, suicidal thoughts or mental ill-health.

Where an environmental risk cannot immediately be removed, the risk assessment must record the interim controls required to keep the person safe and the person responsible for taking further action.

Environmental and ligature risks must be reviewed when there is a material change in the person’s needs or circumstances, following an incident or near miss, where a new hazard is identified, or where existing controls are no longer effective.

5.2 Environmental Controls and Individual Safety Measures

Where a person’s individual assessment identifies that environmental controls are necessary to manage a material risk of hanging or strangulation, {{org_field_name}} will work with the person and, where appropriate, their lawful representative, relevant professionals and the housing provider or landlord to identify proportionate measures.

Measures may include environmental modification, increased staff engagement or observation, changes to support arrangements, management of identified high-risk items, or referral for specialist clinical assessment.

Any measure adopted must:

• address an identified and documented risk;
• be necessary and proportionate to that risk;
• be specific to the individual rather than imposed as a blanket restriction;
• interfere as little as reasonably possible with the person’s privacy, dignity, independence and ordinary use of their home;
• take account of the person’s consent and mental capacity;
• be clearly recorded in the person’s risk assessment and support plan;
• identify when and how the measure will be reviewed; and
• be removed or reduced when it is no longer necessary.

The use of anti-ligature or reduced-ligature fixtures must not be automatic. Where such an alteration is considered necessary, responsibility and authority for making changes to the property must first be established and any required agreement from the person, landlord, housing provider or property owner obtained.

5.3 Consent, Restrictive Practice and Deprivation of Liberty

Care and support must be provided with the consent of the relevant person in accordance with Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A diagnosis of mental illness, learning disability, autism, previous self-harm or suicidal thoughts does not by itself establish that a person lacks mental capacity.

Where there is reason to doubt a person’s ability to make a particular decision about a proposed safety measure, their capacity must be assessed in accordance with the Mental Capacity Act 2005. Capacity is decision-specific and time-specific.

Where the person lacks capacity to make the relevant decision, any action taken on their behalf must:

• be made in their best interests in accordance with the Mental Capacity Act 2005;
• take account of the person’s wishes, feelings, beliefs and values;
• involve relevant people as required by the Mental Capacity Act 2005;
• be necessary and proportionate; and
• represent the least restrictive practicable option.

Restrictions must not be imposed solely for organisational convenience.

Potentially restrictive measures may include, depending upon the circumstances, removal or control of personal items, continuous or enhanced observation, preventing access to areas of the person’s home or community, restricting movement, or other measures intended to prevent self-harm.

Any such measure must be individually risk assessed, authorised through the appropriate decision-making process, recorded and reviewed.

Staff must immediately escalate to the Registered Manager any arrangement which may amount to a deprivation of liberty.

For a person living in supported living or another community setting, the Deprivation of Liberty Safeguards applicable to care homes and hospitals must not be treated as the legal authorisation mechanism. Where a person lacking capacity may be deprived of their liberty in a supported living setting, appropriate legal advice and authorisation through the Court of Protection must be sought where required.

6. Staff Training and Competency

{{org_field_name}} will ensure that staff have the competence, skills, knowledge, experience, training, supervision and support necessary to recognise and respond safely to risks of suicide, self-harm, hanging and strangulation within the responsibilities of their role.

Training and competency requirements will be determined according to staff responsibilities and the needs of the people supported and will include, where relevant:

• recognising indicators of deteriorating mental health, suicidal thoughts and self-harm risk;
• responding appropriately and compassionately where a person communicates suicidal thoughts or intent;
• understanding individual risk assessments and safety or risk-management plans;
• recognising environmental and ligature risks relevant to the people being supported;
• responding to an actual or suspected hanging or strangulation emergency;
• summoning emergency assistance and providing first aid or cardiopulmonary resuscitation within the employee’s training and competence;
• safeguarding responsibilities and escalation procedures;
• incident reporting, recording and CQC notification requirements relevant to the employee’s role;
• consent, mental capacity, best-interests decision-making and restrictive practice;
• recognising when restrictions may require further legal authorisation;
• confidentiality and lawful information-sharing; and
• duty of candour responsibilities relevant to the employee’s role.

Staff must receive learning disability and autism training appropriate to their role in accordance with the statutory requirements applying to CQC-registered providers and the current Oliver McGowan Code of Practice on statutory learning disability and autism training.

Training must be provided at induction where appropriate and refreshed or updated at intervals determined by legislation, statutory guidance, the provider’s training-needs analysis, identified risks, changes in practice or learning following incidents.

The Registered Manager must ensure that staff competency is monitored through appropriate supervision, observation, assessment, appraisal and review. Staff must not undertake tasks for which they have not received the necessary training or have not demonstrated appropriate competence.

Mental capacity assessments must be undertaken by an appropriate person in accordance with the Mental Capacity Act 2005. Staff involved in supporting the person must understand their responsibilities under the Act and must escalate concerns regarding capacity or restrictive practice to the appropriate manager.

7. Responding to Suicide Risk

7.1 Immediate Response

Where staff believe that a person is at immediate risk of suicide, serious self-harm, hanging or strangulation, the person’s immediate safety takes priority.

Staff must:

• remain with the person where it is safe and reasonably practicable to do so and must not leave a person who is assessed as presenting an immediate risk without appropriate support;
• call 999 where there is an immediate threat to life, an actual or suspected hanging or strangulation incident, serious injury, loss of consciousness, breathing difficulty or another medical emergency;
• provide emergency first aid or cardiopulmonary resuscitation within the limits of their training and competence and follow instructions given by the emergency services;
• where an active ligature is present, take immediate action within their training and competence to relieve the pressure or remove the ligature where this can be done without exposing the person, staff member or another person to unreasonable danger;
• remove or secure an immediately accessible item presenting a clear and immediate risk where this is necessary and proportionate and can be done safely;
• obtain additional staff assistance where available without delaying emergency action;
• provide calm, respectful and non-judgemental reassurance;
• notify the Registered Manager or senior person on duty as soon as emergency action permits; and
• make a complete and contemporaneous record of the incident, action taken, persons contacted and subsequent outcome.

Following an actual or suspected hanging or strangulation incident, staff must not assume that a person is medically well merely because there are no obvious external injuries. Emergency or urgent clinical assessment must be obtained according to the person’s presentation and the advice of emergency or healthcare professionals.

7.2 Crisis Intervention and Support

Following an incident or expression of suicidal thoughts, staff provide compassionate, non-judgemental support. This includes:

• Conducting a detailed risk assessment and updating the support plan.
• Offering emotional support and signposting to mental health services.
• Engaging with the individual’s family, GP, or mental health team, where appropriate.

8. Safeguarding, Incident Reporting, External Notifications and Duty of Candour

8.1 Internal Reporting

Any suicide attempt, suspected suicide attempt, hanging or strangulation incident, serious self-harm, significant increase in suicide risk, near miss or other serious safety concern must be reported internally without delay in accordance with {{org_field_name}}’s incident-reporting and escalation procedures.

Staff must:

• take immediate action required to protect life and prevent further harm;
• inform the Registered Manager, senior person on duty or other designated manager as soon as practicable;
• make an accurate, factual and contemporaneous record;
• preserve relevant evidence where an incident may require investigation, police involvement or safeguarding enquiries, so far as this does not compromise emergency care;
• ensure relevant risk assessments and support plans are reviewed following the incident; and
• cooperate with any internal or external investigation.

Internal reporting arrangements include:

1. verbal notification to the Registered Manager, Safeguarding Lead or senior person on duty;
2. email to the Registered Manager at {{org_field_registered_manager_email}}, where appropriate;
3. telephone contact through {{org_field_phone_no}};
4. use of the out-of-hours contact arrangements at {{out_of_hours}} where required; and
5. completion of the provider’s prescribed incident-reporting record or electronic reporting system.

Reporting an incident internally does not replace any statutory requirement to notify an external authority.

8.2 Safeguarding

Suicidal thoughts, self-harm or suicide risk must not automatically be categorised as an adult safeguarding concern solely because those circumstances exist.

A safeguarding referral or concern must be raised where there is reasonable cause to suspect that the statutory safeguarding criteria are met, including where the person may be experiencing or at risk of abuse or neglect and, because of their care and support needs, is unable to protect themselves from the abuse or neglect or the risk of it.

Examples may include circumstances involving:

• abuse or neglect by another person;
• organisational abuse or neglect;
• acts or omissions by staff or others which have caused harm or placed the person at risk of harm;
• inappropriate restraint or restrictive practice;
• exploitation, coercion or domestic abuse; or
• another circumstance meeting the applicable safeguarding threshold.

Where the threshold may be met, staff must immediately follow {{org_field_name}}’s Safeguarding Adults from Abuse and Improper Treatment Policy and make or escalate the appropriate referral to the relevant local authority adult safeguarding service.

8.3 Notifications to the Care Quality Commission

The Registered Person must ensure that CQC is notified of events where notification is required by the Care Quality Commission (Registration) Regulations 2009.

This includes, where applicable:

• a death which must be notified under Regulation 16 of the Care Quality Commission (Registration) Regulations 2009; and
• an injury, allegation of abuse, police-reportable incident or other event falling within Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Notifications required by Regulations 16 and 18 must be made to CQC without delay and using the notification method or form required by CQC.

A suicide attempt, expression of suicidal thoughts or self-harm incident is not automatically a CQC notification merely because it occurred. The Registered Manager must consider the facts against the statutory notification criteria and document the decision where appropriate.

Where a service user dies by suspected suicide and the circumstances meet Regulation 16, the death must be notified to CQC without delay. Other relevant statutory notifications, referrals and reporting duties must also be considered according to the circumstances.

8.4 Police, Coroner, Safeguarding and Other Agencies

Emergency services must be contacted where required to protect life or respond to an immediate emergency.

The Registered Manager must determine whether notification, referral or cooperation is required with other organisations, which may include:

• the police;
• the local authority adult safeguarding service;
• the person’s GP or relevant mental health service;
• commissioners or placing authorities where contractually or legally required;
• the coroner following a death, in accordance with the applicable legal process; and
• any other statutory body requiring notification.

8.5 Duty of Candour

{{org_field_name}} will act in an open and transparent way with people receiving care and support.

Where an incident meets the statutory definition of a notifiable safety incident under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Registered Person will comply with the statutory duty of candour.

This will include, as applicable:

• notifying the relevant person as soon as reasonably practicable;
• providing a truthful account of the facts known at that time;
• explaining what further enquiries or investigations will be undertaken;
• providing reasonable support;
• giving an appropriate apology;
• maintaining a secure written record of the notification; and
• providing the required written follow-up.

Duty of candour requirements are separate from CQC statutory notification requirements. Compliance with one requirement must not be treated as compliance with the other.

8.6 Post-Incident Review and Learning

Following a serious incident, the Registered Manager will ensure an appropriate review or investigation is undertaken.

The review must consider, where relevant:

• the person’s risk assessment and support plan;
• whether known risks were appropriately identified and managed;
• environmental or ligature risks;
• staffing, training and communication;
• compliance with agreed support arrangements;
• whether safeguarding, CQC notification or duty of candour requirements were met;
• whether referrals or professional support were obtained appropriately;
• contributory factors;
• lessons learned; and
• actions required to reduce the likelihood of recurrence.

Actions arising from reviews must be allocated, recorded, monitored and completed. Relevant learning must be shared with staff and incorporated into risk assessments, support plans, procedures and training where appropriate.

9. Supporting Service Users and Staff

Suicide prevention requires a compassionate, whole-team approach. {{org_field_name}} ensures that both service users and staff receive appropriate support:

• For Service Users: Emotional support, mental health referrals, and regular check-ins.
• For Staff: Debriefing sessions, counselling, and reflective practice to promote resilience and learning.

We promote open dialogue about mental health, reducing stigma and encouraging service users and staff to seek help when needed.

10. Collaborative Working

Effective suicide prevention relies on collaborative working. {{org_field_name}} works closely with:

• GPs and mental health services to ensure timely interventions.
• Families and advocates, respecting service users’ wishes and confidentiality.
• Local safeguarding boards and crisis teams.

We ensure that service users have access to mental health resources, including crisis lines and counselling services.

11. Related Policies

This policy must be read alongside the following policies and procedures, where applicable:

• Safeguarding Adults from Abuse and Improper Treatment Policy (SL13);
• Risk Management and Assessment Policy (SL18);
• Health and Safety at Work Policy (SL16);
• Mental Capacity Act, Best Interests and Deprivation of Liberty Policy (SL39), including the arrangements applicable to community and supported living settings;
• Staff Supervision, Training and Development Policy (SL27);
• Consent to Care and Treatment Policy;
• Incident, Accident and Near-Miss Reporting Policy;
• Duty of Candour Policy;
• Emergency and First Aid Procedures;
• Information Governance, Confidentiality and Information-Sharing Policy; and
• any applicable Positive Behaviour Support or Restrictive Practice Policy.

Where a related policy refers to the Deprivation of Liberty Safeguards, staff must recognise that the statutory DoLS scheme for hospitals and care homes must not be used as the authorisation mechanism for a deprivation of liberty in supported living. Potential deprivation of liberty in a supported living or other community setting must be escalated for the appropriate legal process.

12. Monitoring and Continuous Improvement

{{org_field_name}} will operate effective governance systems to assess, monitor and improve compliance with this policy and the safety of the service.

The Registered Manager will ensure that appropriate monitoring includes:

• audits of individual suicide, self-harm and ligature risk assessments;
• audits of support plans and recorded risk-management measures;
• review of serious incidents, near misses and patterns or trends;
• monitoring of environmental or ligature risks identified in relation to individual service users;
• checking that agreed actions arising from incidents and investigations have been completed;
• checking that safeguarding referrals have been made where required;
• checking that statutory notifications to CQC have been made correctly and without delay where required;
• checking compliance with the statutory duty of candour where applicable;
• monitoring staff training, competency, supervision and refresher requirements;
• reviewing whether restrictive measures remain necessary, proportionate and the least restrictive practicable option; and
• obtaining and considering relevant feedback from people using the service, staff and other appropriate persons.

Records of audits, reviews, decisions and resulting actions must be accurate, complete, contemporaneous and securely maintained.

Where monitoring identifies a shortfall, the Registered Manager must ensure that corrective action is identified, allocated to a responsible person, given an appropriate completion date and monitored until completed.

Learning from incidents, safeguarding enquiries, complaints, investigations and audit findings must be used to improve risk assessments, support planning, staff training, procedures and service delivery.

13. Policy Review

This policy will be formally reviewed at least annually and sooner where necessary.

An earlier review must be undertaken where relevant following:

• a change in legislation or statutory requirements;
• a material change in CQC regulations or statutory guidance;
• a serious incident, suicide, suicide attempt, hanging or strangulation incident or significant near miss which identifies a policy or procedural issue;
• safeguarding findings relevant to this policy;
• regulatory, coroner, commissioner or other external recommendations;
• significant learning from audits, complaints or investigations;
• identification of a new or emerging risk; or
• evidence that existing procedures are not operating effectively.

The Registered Manager or other person authorised by {{org_field_name}} will be responsible for ensuring amendments are approved, communicated to relevant staff and incorporated into training and practice where required.

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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}}
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