1. Identify the risk
  2. Complete a suicide risk screen
  3. Action the risk
  4. Implement support measures and document

Completing a Suicide Risk Screen

Therapists need to complete a suicide risk screen when themes of suicidality are evident during interaction with a client.

This includes if the client presented thoughts of suicide in a passive statement such as:
  • Life isn't worth living
  • It would be easier if I didn't wake up tomorrow
  • I wish I would get hit by a car

This also includes if the client reports thoughts of suicide that have increased in frequency and/or intensity.
The purpose of the suicide risk screen is to determine the
  THOUGHTS / PLAN / INTENT
of suicide specific to this client at this point in time.

Therapists are encouraged to use the suicide risk screener tool to help elicit information. View the risk screening tool at SAK Suicide Risk Screener

Action Following Risk Screening

If a client is identified as a LOW level risk (green)
  1. Complete the suicide risk screen form with client.
  2. Ask they have a safety plan you can help them put in place.
    • If they have a safety plan please review this with the client.
    • If they do not have one, complete a safety plan with the client using any of these options:
    • Ensure the client, yourself and any other relevant supports have a copy of the safety plan and upload to Elara.
  3. Ask the client who in their support team can be contacted to provide them extra support during this difficult time. E.g. they could make an appointment with their GP, mental health clinician, counsellor or other service provider.
  4. Complete a debrief with Team Leader, Clinical Supervisor and/or Clinical Practice Advisor.
  5. DOCUMENT ON ELARA BUT DOES NOT NEED TO BE REPORTED VIA CLINICAL INCIDENT REPORTING.

If a client is identified as MODERATE level risk (yellow)
  1. Complete the suicide risk screener form with client.
  2. Inform the client:
    • That this is a serious situation and that you have an obligation to act to ensure their safety.
    • You will be calling mental health crisis assessment team (psychiatric triage team) as per National 360 procedure.
    • It is your duty of care to make this call regardless of their agreement or consent. It can be helpful to empower the client to call themselves while you are still at the home.
    • CLICK HERE (LINK PAGE 4) for state based contact numbers. Provide a brief handover of the client including name, DOB, known diagnoses. Advise of your role with the client and the client's presenting concerns in relation to their mental state and risk factors you are concerned about. Highlight supports in place and actions taken so far. Explain your recommendations for further mental health assessment.
  3. Ask if they have a safety plan you can help them put in place.
    • If they have a safety plan please review this with the client.
    • If they do not have one, complete a safety plan with the client using any of these options:
    • Ensure the client, yourself and any other relevant supports have a copy of the safety plan and upload to Elara.
  4. Ask the client who in their support network could support them during this time and ask if you can support the client to contact them. Check if a support person could come and be with the person.
  5. Complete a debrief with Team Leader, Clinical Supervisor and/or Clinical Practice Advisor.
  6. DOCUMENT ON ELARA AND TO BE REPORTED AS A CLINICAL INCIDENT.
  7. Update the pre appointment clinical risk tool prior to future clinical activity with client.

If a client is identified as a HIGH level risk (red)

  1. Advise the client that this is a serious situation and that you have an obligation to act to ensure their safety.
  2. Ask they have a safety plan you can help them put in place. If they do, go through this with them.
  3. Contact the mental health crisis assessment team (psychiatric triage) in your local area CLICK HERE. If the mental health crisis assessment team is not available or if the client refuses, contact emergency services.
  4. If safe to do so, remain with the client until emergency support is present.
  5. Call Team Leader when safe to do so (as soon as possible).
  6. Complete CLINICAL INCIDENT form immediately.
  7. Document on Elara.
  8. Update clinical risk tool before any future clinical activity with client.

Mental Health Assessment Team Contact Details

Contact details for local mental health assessment teams Australia wide:

ACT 1800 629 354   FREE: Mental Health Triage Service
NSW 1800 011 511   FREE: Mental Health Line
NT 1800 682 288   FREE: Northern Territory Mental Health Line
QLD 1300 MH CALL (1300 642255)   FREE — 24-hour specialist mental healthcare
SA 13 14 65   FREE: Mental Health Triage Service
TAS 1800 332 388   FREE: Mental Health Service Helpline
VIC Click here for mental health services in your area, or call NURSE-ON-CALL on 1300 60 60 24
WA 1800 676 822   FREE: Mental Health Emergency Response Line

Victoria Regional Contact Details

Contact details for Victorian geographical areas are as per the following website:
http://www.health.vic.gov.au/mentalhealthservices

  Regions Contact Number
VIC METRO Central East & Outer East 1300 721 927
  Dandenong & Middle South 1300 369 012
  Inner SE 1300 363 746
  Inner Urban East 1300 558 862
  Inner West, Mid-West, North-West, Northern 1300 874 243
  North East 1300 859 789
  Peninsula 1300 792 977
  South West 1300 657 259
     
VIC RURAL Barwon 1300 094 187
  Gippsland 1300 363 322
  Glenelg (South Western) 1800 808 284
  Goulburn & Southern 1300 369 005
  Grampians 1300 661 323
  Loddon, Campaspe/Southern Mallee 1300 363 788
  North Eastern Hume 1300 104 211
  Northern Mallee 1300 366 375

Victoria Paediatric / Youth Services

  Regions Contact Number
VIC METRO North West Metro Under 15 years: 1800 445 511
15 years+: 1800 888 320



Home

  1. Identify the risk
  2. Complete a suicide risk screen
  3. Action the risk
  4. Implement support measures and document

Completing a Suicide Risk Screen

Therapists need to complete a suicide risk screen when themes of suicidality are evident during interaction with a client – even when the client is a child or adolescent.

This includes if the client presented thoughts of suicide in a passive statement such as:
  • I wish I wasn’t alive
  • It would be easier if I didn't wake up tomorrow
  • I wish I would get hit by a car
  • My parents won’t even miss me

Consideration for screening suicide risk in children and young people. See below risk factors and warning signs to consider:
  • Changes in mood and behaviour: depressive symptoms, increased withdrawal, low mood, school refusal, sleep patterns, appetite.
  • Family dysfunction or conflict.
  • Increase in talking and thinking about suicide, death or dying.
  • Disruptive behaviour disorders increase risk.
  • Young people may not realise how harmful (lethality) the method of suicide could be.
  • Suicide of others known to them or in the media (contagion effect).
  • Recent bullying.
  • Are exploring their gender or sexuality or identify as LGBTIQ+.
  • Aboriginal and Torres Strait Islander young people are at higher risk.


This also includes if the client reports thoughts of suicide that have increased in frequency and/or intensity.
The purpose of the suicide risk screen is to determine the
  THOUGHTS / PLAN / INTENT
of suicide specific to this client at this point in time.
Therapists are encouraged to use the suicide risk screener tool to help elicit information. View the risk screening tool at SAK Suicide Risk Screener

Therapists are encouraged to adapt their language to meet the client’s individual needs and developmental level.

Action Following Risk Screening

If a client is identified as a LOW level risk (green)
  1. Complete the suicide risk screen form with client.
  2. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like FLASHCARD - SUICIDALITY WITH CHILDREN AND ADOLESCENTS their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care.
  3. Ask if they a safety plan that you can help them put in place.
    1. If they have already safety plan please review this with the client.
    2. If they do not have one, complete a safety plan with the client using any of these options:
      1. Beyond Blue app on phone
      2. Beyond blue web version which can be emailed to therapist
      3. Brown_Stanley Safety Plan Template.pdf
    3. Ensure the client, yourself and any other relevant supports have a copy of the safety plan and upload to Elara.
  4. Follow up with caregiver and stakeholders to ensure the client has additional supports e.g. appointment with GP, CAMHS mental health clinician, psychologist.
  5. Complete a debrief with Team Leader, Clinical Supervisor and/or Clinical Practice Advisor.
  6. Document on Elara using suicide risk screening case note template.
  7. DOCUMENT ON ELARA BUT DOES NOT NEED TO BE REPORTED VIA CLINICAL INCIDENT REPORTING.
  8. In future appointments, continue to monitor the risk and readminister screening if any changes in risk factors occur.

If a client is identified as MODERATE level risk (yellow)
  1. Complete the suicide risk screener form with client.
  2. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care. Aim to immediately involve the caregiver in a discussion before following the next steps.
  3. Ask if they have a safety plan you can help them put in place.
    1. If they have already safety plan please review this with the client.
    2. If they do not have one, complete a safety plan with the client using any of these options:
      1. Beyond Blue app on phone
      2. Beyond blue web version which can be emailed to therapist
      3. Brown_Stanley Safety Plan Template.pdf
    3. Ensure the client, yourself and any other relevant supports have a copy of the safety plan and upload to Elara.
  4. Call the child and adolescent mental health crisis assessment team (CAMHS psychiatric triage team) as per National 360 procedure.
    1. It is your duty of care to make this call regardless of the client’s agreement or consent. It can be helpful to empower the young person to call themselves if appropriate while you are still at the home.
    2. CLICK HERE for state-based contact numbers.
    3. Provide a brief handover of the client including name, DOB, known diagnoses. Advise of your role with the client and the client's presenting concerns in relation to their mental state and risk factors you are concerned about. Highlight supports in place and actions taken so far. Explain your recommendations for further mental health assessment.
  5. Follow up with caregiver/guardian and stakeholders to ensure the client is connected additional supports e.g. appointment with GP, mental health clinician, psychologist and their care team is aware of the risks.
  6. Complete a debrief with Team Leader, Clinical Supervisor and/or Clinical Practice Advisor.
  7. Document on Elara using suicide risk screening template.
  8. TO BE REPORTED AS A CLINICAL INCIDENT.
  9. Determine if actions with Child Protection Services are needed.
    1. If Child Protection is involved, ensure the Child Protection case manager is aware of the current situation. Ensure the child has a suicide prevention support plan in place and on file.
    2. If there are concerns the parent/guardian does not have the capacity to provide adequate safety or protection to the child, then discuss the need to make a Child Protection Services report with clinical supervisor, Team Leader, or paediatric Clinical Practice Advisor.
  10. Prior to next appointment: Therapist to contact CAMHS and request a copy of the suicide risk management plan to ensure a clear plan to follow.
  11. Prior to next appointment: Update Pre-Appointment Risk tool before any future clinical activity with client.
  12. Prior to next appointment: Determine if this is a chronic risk or an acute risk for this client. A chronic risk is a long-term pattern of behaviour with nil changes and a safety plan already in place for this with adequate supports to manage this. Refer to Suicidality Procedure for children and adolescents for further details.

If a client is identified as a HIGH level risk (red)
  1. Complete suicide risk screener form with client.
  2. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care. Aim to immediately involve the caregiver in a discussion before following the next steps.
  3. Advise the client that this is a serious situation and that you have an obligation to act to ensure their safety.
  4. Ask if they a safety plan that you can help them put in place (if safe to do so and the client is able to engage with this).
    1. If they have already safety plan please review this with the client.
    2. If they do not have one, complete a safety plan with the client using any of these options:
      1. Beyond Blue app on phone
      2. Beyond blue web version which can be emailed to therapist
      3. Brown_Stanley Safety Plan Template.pdf
    3. Ensure the client, yourself and any other relevant supports have a copy of the safety plan and upload to Elara.
  5. If the person is at immediate risk of acting on their thoughts of suicide, or they have already harmed themselves and their safety is at immediate risk, call 000 emergency services.
  6. Call the child and adolescent mental health crisis assessment team (CAMHS psychiatric triage team) as per National 360 procedure. Contact crisis mental health number in your local area CLICK HERE If the mental health crisis assessment team is not available or if the client refuses, contact emergency services
    1. It is your duty of care to make this call regardless of the client’s agreement or consent. It can be helpful to empower the young person to call themselves if appropriate while you are still at the home.
    2. CLICK HERE for state-based contact numbers.
    3. Provide a brief handover of the client including name, DOB, known diagnoses. Advise of your role with the client and the client's presenting concerns in relation to their mental state and risk factors you are concerned about. Highlight supports in place and actions taken so far. Explain your recommendations for further mental health assessment.
  7. If safe to do so, the therapist should stay with the child and caregiver until emergency services arrive. Try to engage the client in soothing and distracting activities, or change the environment.
  8. Call Team Leader when safe to do so (as soon as possible).
  9. Document on Elara using suicide risk screening case note.
  10. Complete CLINICAL INCIDENT form as soon as possible.
  11. Determine if actions with Child Protection Services are needed.
    1. If Child Protection is involved, ensure the Child Protection case manager is aware of the current situation. Ensure the child has a suicide prevention support plan in place and on file.
    2. If there are concerns the parent/guardian does not have the capacity to provide adequate safety or protection to the child, then discuss the need to make a Child Protection Services report with clinical supervisor, Team Leader, or paediatric Clinical Practice Advisor.
  12. Prior to next appointment: Therapist to contact CAMHS and request a copy of the suicide risk management plan to ensure a clear plan to follow.
  13. Prior to next appointment: Follow up with caregiver and stakeholders to ensure they have additional supports in place to manage ongoing risk e.g. liaise with behaviour support, appointment with GP, mental health clinician, psychologist.
  14. Prior to next appointment: Update Pre-Appointment Risk tool before any future clinical activity with client.

Appendix 1 – Mental health support line

Lifeline 24-hour line 13 11 14
Lifeline Text Service (available 12pm-midnight daily) Text to: 0477 13 11 14
Suicide Call back Service 1300 659 467
Beyond Blue 24-hour line 1300 224 636
Kids Helpline (if 25 or under) 1800 551 800
Dolly’s dream – 24/7 line 0488 881 033
13 Yarn - support for Aboriginal and Torres Strait Islander people 13 92 76
Qlife – for LBGTIQ+ 1800 184 527
Headspace online counselling Headspace.org.au - 1:1 online chat service
https://headspace.org.au/online-and-phone-support/

Appendix 2 - Child and adolescent mental health service (CAMHS or CYMHS) crisis contact numbers

State CAMHS Crisis Contact Number
Queensland 07 3068 2555
Western Australia 1800 048 636
South Australia 1300 222 647
Tasmania 1800 332 388
New South Whales 1800 048 636
Northern Territory 1800 682 288
Victoria See below for region specific phone numbers

Victoria Regional Contact Details

Contact details for Victorian geographical areas are as per the following website:
http://www3.health.vic.gov.au/mentalhealthservices/child/index.htm

  Region/s Contact Number
VIC METRO North West Metro Under 15 1800 445 511
15+ 1800 888 320
  Inner & Middle South BH: 8552 0555
AH: Glen Eira, south of North Rd 1300 369 012
AH: Port Phillip, Stonnington & Glen Eira, north of North Rd 1300 363 746
  North East metro Business hours (9.00am - 5.00pm, Monday to Friday)
Telephone: (03) 9496 3620
St Vincent's after-hours psychiatric triage:
(BANYULE & NILLUMBIK ONLY)
Telephone: 1300 859 789
(DAREBIN & WHITTLESEA ONLY)
Telephone: 1300 874 243
(YARRA & BOROONDARA ONLY)
Telephone: 1300 558 86

VIC RURAL Barwon 1300 094 187
  Gippsland 1300 363 322
  Glenelg (south western) 1800 808 284
  Goulbourn and Southern 1300 369 005
  Grampians 1300 661 323
  Loddon 1300 363 788
  North Eastern Hume 1300 366 375



Home

Identifying Risk

If a client tells you they have recently self-harmed or you notice a client may have self-injured complete the following screen.

  • Ask the client about the self-injury in a way that is not confronting or challenging e.g. "Sometimes, when people are in a lot of emotional pain, they injure themselves on purpose. Is that how the scars on your arm happened?" Give the client time to respond to this or any questions.
  • Reassure the client that you're there to help & make sure they are safe.
  • Advise the client you are concerned about their safety and have a duty of care to ask some more questions and support them to ensure they are safe.
  • Ask the client to tell you more about the self-harm, was the intent of this to end their life or was this a way of coping with what's being going on?

Explore why the client has self-harmed so you can ensure any problems are dealt with. What led up to the self-injury?

Self-Harm Risk Screening

  1. If the self-harm is related to suicidal thoughts/intention or presents a severe risk to the client's safety:
  2. If the self-harm is not related to suicidal thoughts/intention:
    • Check if medical support for physical injuries is required:
      • If urgent contact 000
      • If non-urgent contact Next of Kin or nominated support to support this action. Support the client to make an appointment with their GP if needed.
    • Review if the self-harm is a known risk for this client. Is this part of a long-term pattern of behaviour or a new behaviour? Is there a behaviour support plan in place?
    • Ask the client who in their support team are aware of their self-harm and advise the client you have a duty of care to liaise with their supports to help them get the support they need.
      • Therapists need to review with supports to establish if the self-harm is a known behaviour and/or if they are aware of the recent episode.
      • If the client's supports are not aware of the self-harm, explain your duty of care and gain consent from the client to let their support team know (including support coordinator, behaviour support practitioner, psychologist, GP, counsellor).
      • If the client has a behaviour support practitioner, liaise with them to understand strategies to support the client.
  3. Provide immediate support to client in the session:
    • Ask about the range of strategies they have tried so far to help with coping.
    • Ask the client how you can be most helpful to them right now.
    • Encourage the client to engage in distraction or self-regulation strategies that work for them.
    • Encourage the client to seek out additional mental health support. Encourage contacting an external mental health support service, talking to trusted family/friends, discussing with GP, psychologist/counsellor. If the client is not linked with mental health supports, gain consent to liaise with their stakeholders and encourage referrals and linkage to mental health supports.
    • If self-harm is a chronic, long-term coping strategy for this client, keep the focus on coping strategies and seeking additional support.
  4. Ask the client if their environment is safe. Encourage them to remove items they have used to self-harm if they are willing to do so.
    • Only do this if there is no risk to therapist.
    • If a risk is present, the therapist must assess if it is safe to remove.
    • If it is not safe to remove, the therapist must contact the Next of Kin or nominated supports to advise and provide additional support to the client.

Next Steps

If after going through these steps, the client is threatening self-injury or they are at risk of further self-injury and do not have support in place to assist with this.
  • Refer for mental health assessment: Advise client of duty of care.
  • Support the client or carer to call their local community mental health crisis assessment service (psychiatric triage).
  • If the client is unwilling to call the CATT team themselves with you supporting, initiate the call yourself.
  • Provide a brief handover of the client including name, DOB, known diagnoses.
  • Advise of your role with the client and the client's presenting concerns in relation to their mental state and risk factors you are concerned about. Highlight supports in place and actions taken so far. Explain your recommendations for further mental health assessment.

Following Contact with Client

  1. The therapist is encouraged to seek support.
    • Clinical support from Mental health CPA to support ongoing clinical intervention.
    • Debrief of incident from Team Leader.
  2. Complete documentation of event
    • If self-harm is suspected but no disclosure or confirmation is made by the client OR the self-harm is a known risk/chronic behaviour:
      • Document on Elara.
      • It DOES NOT REQUIRE clinical incident reporting.
    • If self-harm is witnessed/evidenced and confirmation of event disclosed by client (e.g. evidence of cuts on arm and disclosed by the client):
      • Document on Elara.
      • Complete clinical incident report.

Complete Pre-Assessment Risk Screen PRIOR to any further clinical activity with client


Home
  1. Identify the risk
  2. Complete self-injury risk screening
  3. Action plan to manage the risk
  4. Implement support measures and document
    5.

Part 1: Identifying Risk

If a client tells you they have recently self-injured or you notice a client may have self-injured complete the following screen:

  1. Ask the client about the self-injury in a way that is not confronting or challenging.
    1. Ask the client if they are comfortable with having a conversation about their self-injury. If the client declines, document this and inform them you are concerned and will liaise with their supports. E.g. “Sometimes, when people are in a lot of emotional pain, they injure themselves on purpose. Is that how the scars on your arm happened?”
    2. Give the client time to respond to this or any questions.
  2. Reassure the client that you are there to help and make sure they are safe.
  3. Advise the client you are concerned about their safety and have a duty of care to ask some more questions and support them to ensure they are safe.
  4. Ask the client to tell you more about the self-injury.
    1. Location and method of self-injury
    2. Function of the self-injury: was the intent of this to end their life or was this a way of coping with what’s been going on?
    3. How long have they been using self-injury as a coping strategy? Is this a new behaviour or long-term?
  5. Explore why the client has self-injured so you can ensure any problems are dealt with. What led up to the self-injury?

Where appropriate, ask the client directly in relation to their self-injury. If this is not possible, speak with the person who knows the client best.

Part 2: Self-injury risk screening

  1. If the self-injury is related to suicidal thoughts/intention or presents a severe risk to the client’s safety.
    1. Follow Responding to Suicidality procedure in clinical policy and procedure manual.
  2. If the self-injury is not related to suicidal thoughts/intention:
    1. Check if medical support for physical injuries is required. Any cut which is gaping requires medical attention, as it may need stitches.
      1. If urgent, inform the parent/guardian and contact 000
      2. If non-urgent contact the parent/guardian to support getting medical attention. Recommend the parent/guardian to make an appointment with their GP if needed.
      3. Any burn which is two centimetres or larger in diameter, and any burn on the hands, feet or face requires medical attention.
      4. If the person has harmed themselves by taking an overdose of medication or consuming poison, immediately inform their parent/guardian and call an ambulance, as this is a high lethality method and risk of harm is high.
    2. Review if the self-injury is a known risk for this client. Is this part of a long-term pattern of behaviour or a new behaviour? Is there a behaviour support plan in place?
    3. Ask the client who in their support network are aware of their selfinjury, and advise the client you have a duty of care to liaise with their parent/guardian to help them get the support they need.
      1. Therapists need to review with supports to establish if the self-injury is a known behaviour and/or if they are aware of the recent episode.
      2. If the client’s support network are not aware of the self-injury, explain your duty of care to let their caregiver and support team know (including support coordinator, behaviour support practitioner, psychologist, GP, counsellor). Contact primary giver and child protection case manager if Department of Child Protection is involved. Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care.
      3. If the client has a behaviour support practitioner, liaise with them to understand strategies to support the client.
  3. Provide immediate support to client in the session:
    1. Validate the client’s emotional experiences and express empathy.
    2. Ask about the range of strategies they have tried so far to help with coping.
    3. Ask the client how you can be most helpful to them right now.
    4. Keep in mind that ‘stopping self-injury’ should not be the focus of the conversation. Instead, look at what can be done to make the person’s life more manageable, or their environment less distressing.
    5. Encourage the client to engage in distraction or self-regulation strategies that work for them.
    6. Encourage the client to engage with additional mental health supports appropriate for their age e,g, mental health support numbers or Headspace online counselling. Recommend to their caregiver/guardian to contact external mental health support service, talking to trusted family/friends, discussing with GP, psychologist/counsellor.
    7. If self-injury is a chronic, long-term coping strategy for this client, keep the focus on coping strategies and seeking additional support.
  4. Ask the client if their environment is safe. Encourage them to remove items they have used to self-injure if they are willing to do so. Involve the caregiver/guardian in the process of removing items.
    1. Only do this if there is no risk to therapist.
    2. If a risk is present, the therapist must assess if it is safe to remove.
    3. If it is not safe to remove, the therapist must discuss with the parent/guardian to advise and provide additional support to the client.

Part 3: Action plan

The following visual diagram can be used to understand a client’s risk in relation to their self-injury and assist in formulating an action plan.

High acute risk response (high severity and lethality of behaviour and a new pattern/change in behaviour):

  1. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care. Aim to immediately involve the caregiver in a discussion before following the next steps.
  2. Ask if they a safety plan that you can help them put in place (if safe to do so and the client is able to engage with this).
    1. If they have already safety plan, review this with the client.
    2. If they do not have one, complete a safety plan with the client using any of these options:
      1. Beyond Blue app on phone
      2. Beyond blue web version which can be emailed to therapist
      3. Brown_Stanley Safety Plan Template.pdf
    3. Ensure the client, yourself, parent/caregiver and any other relevant supports have a copy of the safety plan and upload to Elara.
  3. If the person is at immediate risk of severely harming themselves and has the intent and means to act on this, call 000 emergency services.
  4. Refer for mental health assessment: Advise client of duty of care. Call the child and adolescent mental health crisis assessment team (CAMHS psychiatric triage team).
    1. Contact crisis mental health number in your local area CLICK HERE
    2. If the mental health crisis assessment team is not available or if the client refuses, contact emergency services.
    3. Provide a brief handover of the client including name, DOB, known diagnoses. Advise of your role with the client and the client’s presenting concerns in relation to their mental state and risk factors you are concerned about. Highlight supports in place and actions taken so far. Explain your recommendations for further mental health assessment.
  5. If safe to do so, the therapist should stay with the child and caregiver until emergency services arrive or a clear plan is provided by CAMHS. Try to engage the client in soothing and distracting activities, or change the environment.
  6. Call Team Leader when safe to do so (as soon as possible).
  7. Document on Elara using self-injury risk screen template.
  8. Complete CLINICAL INCIDENT form as soon as possible.
  9. Determine if actions with Child Protection Services are needed.
    1. If Child Protection is involved, ensure the Child Protection case manager is aware of the current situation. Ensure the child has a suicide prevention support plan in place and on file.
    2. If there are concerns the parent/guardian does not have the capacity to provide adequate safety or protection to the child, then discuss the need to make a Child Protection Services report with clinical supervisor, Team Leader, or paediatric Clinical Practice Advisor.
  10. Prior to next appointment: Therapist to contact CAMHS and request a copy of the risk management plan to ensure a clear plan to follow.
  11. Prior to next appointment: Recommend BSP and/or psych involvement if not already involved. If BSP/psych involved, contact them to review plan for managing the behaviour.
  12. Prior to next appointment: Follow up with caregiver and stakeholders to ensure they have additional supports in place to manage ongoing risk e.g. liaise with behaviour support, appointment with GP, mental health clinician, psychologist.
  13. Prior to next appointment: Update clinical risk tool before any future clinical activity with client.
  14. The therapist is encouraged to seek support:
    1. Debrief of incident with Team Leader
    2. Request case consultation support from Mental health CPA to support ongoing clinical intervention.

High chronic risk response (high severity and lethality of behaviour and a chronic/long-term behaviour with adequate positive behaviour support and/or mental health supports in place)

  1. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care. Aim to involve the caregiver in a discussion before following the next steps.
  2. Follow the existing care team plan, including behaviour support plan. If there is no behaviour support practitioner involved, recommend PBS involvement and/or psychology supports.
  3. Ask if they a safety plan that you can help them put in place (if safe to do so and the client is able to engage with this).
    1. If they have already safety plan, review this with the client.
    2. If they do not have one, complete a safety plan with the client using any of these options:
      1. Beyond Blue app on phone
      2. Beyond blue web version which can be emailed to therapist
      3. Brown_Stanley Safety Plan Template.pdf
    3. Ensure the client, yourself, parent/caregiver and any other relevant supports have a copy of the safety plan and upload to Elara.
  4. Inform the client’s support network of the recent episode. As a team, discuss whether mental health services referral (CAMHS crisis assessment) is warranted. If the client has a mental health services case manager, handover information of recent episode to them.
  5. Document on Elara using the self-injury risk screen template.
  6. It does not require clinical incident reporting.
  7. Determine if actions with Child Protection Services are needed.
    1. If Child Protection is involved, ensure the Child Protection case manager is aware of the current situation. Ensure the child has a suicide prevention support plan in place and on file.
    2. If there are concerns the parent/guardian does not have the capacity to provide adequate safety or protection to the child, then discuss the need to make a Child Protection Services report with clinical supervisor, Team Leader, or paediatric Clinical Practice Advisor.
  8. Prior to next appointment: Update Pre-Appointment Risk tool before any future clinical activity with client.
  9. The therapist is encouraged to seek support:
    1. Request case consultation support from Mental health CPA to support ongoing clinical intervention.
    2. Debrief of incident with Team Leader.

Low chronic risk response

  1. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care.
  2. Follow the existing care team plan for managing the chronic behaviour, including behaviour support plan. If there is no behaviour support practitioner involved, consider recommending PBS involvement and/or psychology supports.
  3. If they have a safety plan, review this with the client. If they do not have one, complete a safety plan with the client using any of these options.
    1. Beyond Blue app on phone
    2. Beyond blue web version which can be emailed to therapist
    3. Brown_Stanley Safety Plan Template.pdf
  4. Encourage coping strategies with the client.
  5. Ensure the client’s support network is informed of behaviour and this contact with supports is documented.
  6. Complete Documentation of event using self-injury risk screen template.
  7. It DOES NOT REQUIRE clinical incident reporting.
  8. Update Pre-appointment Risk Screen PRIOR to any further clinical activity with client
  9. The therapist is encouraged to seek support:
    1. Discuss in clinical supervision.
    2. Attend mental health mentoring to discuss case and receive clinical support.

Low acute risk response

  1. Let the young person know that you are concerned about them, and will need to let their parent or guardian know (contact primary giver and child protection case manager if Department of Child Protection is involved). Collaborate with the young person on how they would like their caregiver to be informed. If the child asks you not to tell anyone, inform them you have a duty of care.
  2. If they have a safety plan, review this with the client. If they do not have one, complete a safety plan with the client using any of these options.
    1. Beyond Blue app on phone
    2. Beyond blue web version which can be emailed to therapist
    3. Brown_Stanley Safety Plan Template.pdf
  3. Discuss with the client and parent/guardian about referring to mental health supports including psychology supports. If psychology supports already engaged, request consent to liaise and handover this information to them.
  4. Encourage coping strategies with the client.
  5. Ensure the client’s supports are informed of behaviour and this contact with supports is documented. Aim to understand triggers or stressors that may have led up to new behaviour occurring and inform support team about these, recommend additional supports if needed.
  6. Complete Documentation of event using self-injury risk screen template.
  7. It DOES NOT REQUIRE clinical incident reporting.
  8. Update Pre-Appointment Risk Screen PRIOR to any further clinical activity with client.
  9. The therapist is encouraged to seek support:
    1. Discuss in clinical supervision.
    2. Attend mental health mentoring to discuss case and receive clinical support.

Mental Health Assessment Team Contact Details

Contact details for local mental health assessment teams Australia wide:

State CAMHS Crisis Contact Number
Queensland 07 3068 2555
Western Australia 1800 048 636
South Australia 1300 222 647
Tasmania 1800 332 388
New South Whales 1800 048 636
Northern Territory 1800 682 288
Victoria See below for region specific phone numbers

Victoria Regional Contact Details

Contact details for Victorian geographical areas are as per the following website:
http://www3.health.vic.gov.au/mentalhealthservices/child/index.htm

  Region/s Contact Number
VIC METRO North West Metro Under 15 1800 445 511
15+ 1800 888 320
  Inner & Middle South BH: 8552 0555
AH: Glen Eira, south of North Rd 1300 369 012
AH: Port Phillip, Stonnington & Glen Eira, north of North Rd 1300 363 746
  North East metro Business hours (9.00am - 5.00pm, Monday to Friday)
Telephone: (03) 9496 3620
St Vincent's after-hours psychiatric triage:
(BANYULE & NILLUMBIK ONLY)
Telephone: 1300 859 789
(DAREBIN & WHITTLESEA ONLY)
Telephone: 1300 874 243
(YARRA & BOROONDARA ONLY)
Telephone: 1300 558 86

VIC RURAL Barwon 1300 094 187
  Gippsland 1300 363 322
  Glenelg (south western) 1800 808 284
  Goulbourn and Southern 1300 369 005
  Grampians 1300 661 323
  Loddon 1300 363 788
  North Eastern Hume 1300 366 375



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Warning Signs

STAMP can be used to describe behaviours exhibited by a person who is becoming agitated and potentially aggressive and violent.
https://www.youthaodtoolbox.org.au/5-recognising-warning-signs-potential-aggressive-behaviour-violence

S STARING: prolonged glaring
T TONE: sharp, sarcastic, loud, argumentative
A ANXIETY: flushed face, heaving breathing, rapid speech, reaction to pain
M MUTTERING: talking under breath, criticizing staff to self or others, mimicking staff
P PACING: walking around in confined space


Additional warning signs could include:
  • Appearance: Carrying anything that could be used as a weapon, changes in selfcare, evidence of being under the influence of substances.
  • Physical signs: Restless or agitated, pacing, standing up frequently, clenching/grinding of jaw or fists, hostile facial expressions with sustained eye contact, huffing and puffing, rapid movements, aggressive body language, throwing things, face turning pale or red, increased breathing rate.
  • Mood: Angry, irritable, anxious, tense, distressed, difficulty controlling emotions.
  • Speech: Loud, swearing or threatening, slurred. Verbally expressing threats.
  • Worker's reaction: Fear, unease, frustration, anger.

Potential Triggers

  • Temperature changes (especially excessive heat)
  • Noise/over stimulation
  • Staff turnover
  • Hallucinations/psychosis
  • Changes in routine/lack of structure
  • Communication difficulties
  • Perception of being judged and/or disrespected


Antonacci DJ, Manuel C, Davis E. Diagnosis and treatment of aggression in individuals with developmental disabilities. The Psychiatric Quarterly. 2008 Sep;79(3):225-247. DOI: 10.1007/s11126-008-9080-4.

De-escalation Strategies

Things to do Things to avoid
  1. Stay calm, regulate your emotions
  2. Pay attention to your own body language (80-90% of communication is non-verbal)
  3. Listen
  4. Adopt a passive and non- threatening body posture (hands by side with empty palms facing forwards, body at 45-degree angle to the person)
  5. Let the person talk and acknowledge their feelings
  6. Ask open ended questions to maintain dialogue – not excessive questions
  7. Be flexible
  8. Use the space for self-protection (position self-next to exit, don't crowd the person)
  9. Structure the work environment for safety (safety tracker set, remove items that can be used against you)
  10. Make sure other people are out of harm's way –if safe to do so
  • Challenge or threaten the person by tone of voice, eyes, body language
  • Say things to escalate the aggression
  • Yell, even if you are being yelled at
  • Turn your back
  • Rush the person
  • Argue with the person
  • Stay around if the person doesn't want you to
  • Tolerate violence or aggression
  • Try to disarm a person with a weapon



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If a therapist attends an appointment and a client has a behaviour of concern.

If the client has a BSP

  • Review the BSP plan.
  1. If it is a known behaviour and the therapist/client is not injured (****)
    1. Document the behaviour of concern
    2. This does not require a clinical incident report
  2. If it is a known behaviour of concern and the therapist is injured
    1. Document the behaviour of concern
    2. Complete Clinical incident and WH&S form
    3. Request support from TL to review Pre-Appointment Risk screen for future intervention
    4. Communicate with BSP to provide update
    5. Document the behaviour of concern

If the client does not have a BSP

  • If the therapist or another person present at the session was injured or presents as an increased risk of harm (including the participant e.g. absconding, head banging, eating non-food items):
    1. Document in case notes
    2. Complete Clinical incident and WH&S form
    3. Contact stakeholders to inform of incident and recommendations (which may include the need for BSP Assessment/Referral)
    4. Seek support from TL to review Pre-Appointment Risk Form prior to any further clinical contact
  • If no-one was injured:
    1. Document in case notes
    2. Contact stakeholders to inform m of incident and recommendations (which may include the need for BSP Assessment/Referral)
    3. Update the Pre-Visit Risk Assessment Form prior to any further clinical contact
    4. A CLINICAL INCIDENT form is not required


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Abuse can be defined as the "violation of an individual's human or civil rights, through the act or actions of another person or person" (NDIS, 2022). Example of abuse could include:

  • Physical (punching, hitting, slapping etc)
  • Sexual (non-consensual)
  • Psychological or emotional (threatening, harassing or intimidation)
  • Constraints or restrictive practice
  • Financial (wrongful use or restricting use)
  • Systemic (failure to recognise or provide adequate or appropriate services – person’s age, gender, culture, needs or preferences)
  • Neglect is a "failure to provide the necessary care, aid or guidance to dependent adults or children by those responsible for their care" (NDIS, 2022)
  • Physical (inadequate food, shelter, clothes or protection)
  • Passive (withholding or failing to provide necessities of life)
  • Willful deprivation (denying a person assistance)
  • Emotional- (restricting social, intellectual and emotional wellbeing)

If clinicians have concerns regarding abuse and neglect they should always seek assistance from their clinical or team leader for support. As a guide:

If a clinician witnesses or receives firsthand reports of events that could be identified as abuse or neglect:

  1. Attend to any emergency needs (e.g. injuries or seeking emergency assistance)
  2. Contact most appropriate support person to advise of concern/issue
  3. Contact TL to report concern/issue
    1. This may include support to complete a phone call notification via the below links to report the incident
    2. This information does not need to be disclosed to external parties other then the reporting party
    3. Please note that if this relates to a child, the TL and clinician are required to review the child protection policy for specific reporting requirements to their location/state.
  4. Complete case note documentation with all details
  5. Complete clinical incident report
  6. Seek support from TL to complete an updated Pre-Appointment Risk Assessment prior to any further clinician intervention

If a clinician is provided information that is not firsthand of events that could be identified as abuse or neglect :

  1. Document report in case notes
  2. Contact TL to report concern/issue
    1. This may include support to complete a phone call notification via the below links to report the incident
    2. This information does not need to be disclosed to external parties other then the reporting party
    3. Please note that if this relates to a child, the TL and clinician are required to review the child protection policy for specific reporting requirements specifically to their location/state
  3. Seek support from TL to complete an updated Pre-Appointment Risk Assessment prior to any further clinical intervention
  4. THIS DOES NOT NEED TO BE REPORTED VIA CLINICAL INCIDENT FORM

Reporting Contacts

Child Safety:



NDIS Participants:

Aged Care:
  • Contact the aged care provider as soon as possible so they can initiate the reporting process


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National 360's Incident and Near Miss Policy and Procedure outlines that your Team Leader / Manager must be informed of all incidents as soon as they occur. The incident Report form should be completed and submitted within 24 hours of the incident occurring.

Understanding what incidents require reporting:

All therapists are responsible for understanding incident reporting.

Clinical Incident:
Any acts, omissions, events, or circumstances connected with providing support or services to a person with a disability which have, or could have, caused harm to the person receiving services.

Reportable Incident:
A reportable incident is any of the below:
  • The death of a person with a disability
  • Serious injury of a person with a disability
  • Abuse or neglect of a person with a disability
  • Unlawful sexual or physical contact with, or assault of, a person with a disability
  • Sexual misconduct committed against, or in the presence of, a person with a disability, including grooming the person with a disability for sexual activity
  • Use of restrictive practice to a person with a disability where the restrictive practice use is not following an authorisation (however described) of a state or territory concerning the person, or if it is used according to that authorisation but not following a behaviour support plan for the person with disability


WHS Incident:
Means a death, serious injury, illness, dangerous incident or near miss that arises out of the conduct of services, whether or not it is reportable to the relevant workplace health and safety regulator.

Notifiable Incident:
A notifiable incident is when:
  • A person dies
  • A person experiences a serious injury or illness
  • A potentially dangerous incident occurs

What to do when an incident occurs during an appointment:

  • Ensure the client and/or others impacted are safe with all immediate care provided.
  • Acknowledge the impact that the incident had on the client and/or their family.
  • Outline the client’s rights; this includes acknowledgement that their thoughts and opinions will be taken into consideration and that themselves and their advocate (if they have one present) will be kept informed throughout the process.
  • Assure the client and/or their family that the matter will be taken seriously and dealt with in an objective and equitable manner.
  • Advise the client and their advocate (if one is present) that they will be kept informed of progress and any outcomes or follow-up that stem from the investigation.
  • Ensure that the client can provide feedback on National 360’s response to the incident.

What to do after the appointment:

  • Contact your team leader or Manager to complete a debrief and review the requirements for reporting incidents as outlined in the relevant National 360 Policy.


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Get Home Safe

Content for Get Home Safe is coming soon!



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Employee Assistance Program (EAP)

National 360's EAP program is supported by Psychology Melbourne. You can contact Psychology Melbourne for a confidential discussion to get assistance with any issues related to work, finances, relationships, and family.

Phone: 03 9629 1001
Website: www.psychologymelbourne.com.au

Suicide Call Back Service

Anyone thinking about suicide.

Website: suicidecallbackservice.org.au
Phone: 1300 659 467

Lifeline

Anyone having a personal crisis.

Website: www.lifeline.org.au
Phone: 13 11 14

Beyond Blue

Anyone feeling anxious or depressed.

Website: beyondblue.org.au
Phone: 1300 22 46 36

Kids Helpline

Counselling for young people aged 5-25.

Website: kidshelpline.com.au
Phone: 1800 55 1800

MensLine Australia

Men with emotional or relationship concerns.

Website: mensline.org.au
Phone: 1300 78 99 78

Open Arms

Veterans and families councelling.

Website: openarms.gov.au
Phone: 1800 011 046



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Advocacy


Easy Read: Advocacy

Complaints and Feedback


Easy Read: Complaints and Feedback

Privacy and Personal Information


Easy Read: Privacy and Personal Information

What are your Rights?


Easy Read: What are your Rights?

Service Agreements


Easy Read: What is a Service Agreement?

Therapy Plans and Support Planning


Easy Read: Therapy Plans and Support Planning

Withdrawal of Services


Easy Read: Withdrawal of Services

Billing


Easy Read: Billing



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