Queen Mary: Advice and Counselling Service - WhatDoTheyKnow

Advice and Counselling Service

Policy on Students at Risk

. [email protected]

Abstract Includes our definition of risk, criteria we use to assess risk to self or others, how risk is

identified, recorded and managed so that self-harm, suicide and harm to others of minimized, and also sets out the procedures we follow when a student using ACS is thought

to be at risk


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www.welfare.qmul.ac.uk 1


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Policy on Students at Risk

Table of Contents

1.Definition of Risk…………………………………………………………….….…2

2. Assessment of Risk…………………………………………………………....…2

2.1 Suicide

2.2 Self Harm

2.3 Harm from others including Domestic Violence

2.4 Harm to others

2.5 Factors known to decrease risk or suicide or self-harm

3. Duty of Care………………………………………………………..……...………4

4. Training and supervision of counselling staff .……….…………….…..….4

5. DPA, Confidentiality & Liaising with academic departments…….…...…4

6. Risk reduction strategies…………………………………………….…...….…6

6.1 Access to the Service

6.2 Role of Reception in identifying vulnerable students

6.3 Referrals within the service

6.4 Managing waiting lists

6.5 GP registration

7. Procedures ……………………………………………………………..…………8

7.1 Initial assessment & recording

7.2 On-going assessment & recording

7.3 Procedure for Students at Risk

8. Monitoring students at risk……………………………………………………10

9. Psychiatric referral .……………………………………………..………….….10

10. Referral to the Mental Health Co-ordinator ……………………….…...….10

11. Supporting the University ………………………………………………...…11

11.1 Guidelines on supporting Students in Distress

11.2 Staff Consultation

11.3 Staff Training

11.4 Supporting Peer Support Initiatives

APPENDIX……………………………………....……………………………….……11


Risk levels for monitoring and recording

1. Definition of Risk

Most definitions have the concept of ‘assessment’ meaning to make a judgement, weigh

up, consider facts or to use ones prior knowledge to inform the likelihood or how

probable something will be and ‘risk’ meaning an adverse future event through exposure

to danger, a hazard or miss-hap. The third component centres around ‘magnitude’ or

‘significance’ meaning how serious or bad the event or situation is likely to be should it

happen. It is most often used in the following ways.

Suicide risk

Self harm – cutting, burning, punching, scratching, picking, swallowing or

inserting objects into body, serious eating disorders, extreme over-exercise

Harm to others (violence)

Harm from others – emotional, sexual, physical abuse, intimidation, domestic

violence

Risky behaviours (alcohol, drugs, sex, criminal )

Academic risk

2. Assessment of Risk

Factors known to increase risk of:

2.1 Suicide

Gender (male) Age (19-35)

Social status (unemployed / single, socially isolated, social class I & V)

Alcohol/drug usage (used as coping mechanism)

Mental health (strong association with depression, schizophrenia, poor impulse

control, low self-esteem)

Change in medication

Apparent recovery from depression (strong enough to attempt suicide)

Physical health problems (chronic pain, debilitating illness)

Past behaviours (previous attempt biggest predictor- 10% go on to complete)

Past experiences (family history, sexual abuse, personal history- recent rejection

or failure, life-stress)

Family members or close friend committed suicide

A clear plan of intent, low risk of being found, intent was communicated, suicide

note, violent methodology, aim was to die

Current behaviours (withdrawal, self neglect, insomnia, lethargy)


Self-harm (may use self-harm to prevent suicide attempt)

Religious beliefs (of a better after life)

2.2 Self-harm

Gender (females 4:1)

Age (13-24)

Social status (single)

Alcohol/drug usage (not a strong association but can influence type of self-harm)

Mental health (depression, low self-esteem, unhappiness, anxiety, impulsivity)

Disordered eating behaviours (especially bulimia)

Past behaviours (previous history increases risk)

Past experiences (recent separation / rejection / bullying / abuse)

2.3 Harm from others including Domestic Violence

Gender (females)

Age (19-45)

Social status (single from family – married DV)

Alcohol/drug usage (strong usage as coping strategy)

Mental health (depression, anxiety, shame, guilt, hopelessness)

Past behaviours (perpetrators history of violence and/or intimidation)

Past experiences (pattern of poor relationship, victim mentality)

2.4 Harm to others

Gender (males)

Age (19-45)

Social status (single, divorced)

Alcohol/drug usage (strong association)

Mental health (depression, anger, personality issues)

Past behaviours (perpetrators of violence, forensic or criminal history)

Past experiences (pattern of poor relationships, abuse, poor impulse control

Rationale or motivation

Risk is often increased following a specific (critical) event or incident, such as,

bereavement, loss, attack, victim of crime, re-activation of past traumatic memory,

stressful event

2.5 Factors known to decrease risk or suicide or self-harm:

Reasons for living – a sense of the ‘future’


Good social support network – community involvement (religion)

Good and/or stable intimate and/or family relationships

Believing things can and will change

High self-esteem

Good coping / problem solving skills

Therapy / help /counselling /advice

Limited access to risk increaser

People knowing

Meaningful occupation

Religious beliefs (suicide / self-harm is wrong is a sin)

Exercise

Debriefing following an incident (such as offering a University or department

sessions)

Using clinical skills and experience counsellors will assess risk according to the factors

highlighted above.

3. Duty of Care

As employees of the University we operate our service in the context of the University’s

Duty of Care. In legal terms the University and therefore the counselling service has to

demonstrate that it has taken “reasonable steps to prevent” suicide. In order to satisfy

ourselves that we are fully compliant with the duty of care we need to follow good

practice as defined by BACP. It is generally recognised that a person who is determined

to end their life will do so despite the best efforts of counselling and medical

professionals to prevent this. However, we are working largely with young people,

people who are primarily here to learn, those who may be far from home, some who are

away from family for the first time. It is understood that the institution should accept that

it has a role in providing emotional and practical support to its students. It is generally

agreed that although we practice within professional ethical frameworks for good

practice around confidentiality, we are also accountable for our actions (or lack of them)

to the student’s family, the institution, the legal system.

4. Training and supervision of counselling staff

The counselling service employs professional counsellors and therapists who are well

trained and experienced. In addition to this, staff are given training in the services policy

and procedure, which includes clarification about what is considered to constitute risk

and how, as a team we work with students who may be at risk.


All counsellors attend regular clinical supervision where they will discuss issues around

good practice regarding working with issues of risk, and in particular where they will

explore ethical dilemmas around specific clients who may be at risk. Through this

process, counsellors ensure that their judgment about a specific case is sound and that

the actions they have taken, or are about to take, are in line with what is generally

accepted as good practice, as well as being within the agreed procedures of the

Counselling Service.

Supervisors sign an agreement with the service by which they agree to inform the

counsellor’s line manager, should they have serious concerns about the practice of their

supervisee. Therefore, if a supervisor considers this to be the case around how a

counsellor assesses, or works with issues around risk, they should inform the line

manager.

5. DPA, Confidentiality & Liaising with academic departments

The Counselling Service works within various legal frameworks including the Data

Protection Act, Disability Discrimination Act, Children Act and Freedom of Information

Act. It also operates according to BACP Ethical Framework and in line with requirements

of Queen Mary as an institution.

Before counselling begins, students are asked to sign a form to say that they have been

given information regarding the keeping, storing and access to counselling notes.

Anything discussed during a counselling session remains confidential to the service, i.e.

it may be discussed with other members of the Advice and Counselling team but not

anyone else. If a tutor, parent, friend or partner contacts us to ask if the student has

seen a counsellor we will not disclose this information. They should be advised to ask

the student themselves.

Similarly details regarding what was discussed during sessions will not be disclosed to

anyone outside the service. There are of course some exceptions to this as follows:-

If the student is considered to be at risk of harm to themselves or others (see

policy on ‘Students at risk’)

If the student disclosed details pertaining to their involvement in issues

around child abuse, treason or terrorism

If the student requests that we pass on information to a third party and gives

their explicit consent to do so (e.g. for the purposes of mitigating

circumstances)

If the counsellor wishes to discuss the case in supervision, in which case

identifying details should be omitted/disguised


Breaking confidentiality when a student is considered to be at risk will be for the

purposes of ensuring that the student gets the appropriate and timely support they need.

Breaks in confidentiality are usually to another professional e.g. GP, Psychiatrist, A&E

staff. It may also involve a close relative or friend of the student if their help is needed to

accompany them to their GP or A&E. If the need arises for confidentiality to be broken

all attempts will be made to discuss this with the student beforehand.

When liaising with staff, confidentiality will be safeguarded at all times unless the student

has given their explicit consent to do otherwise. This would normally happen for the

purposes of writing Confirmation of Attendance form, or talking to the department about

a student’s difficulties regarding their academic programme. Staff who contact the

service for consultation regarding their concern about a specific student are usually

asked not to identify the student to the counsellor. If this does happen, and the student is

known to be a current or past counselling client, this will not be disclosed to the staff

member.

6. Risk reduction strategies

6.1 Access to the Service

The counselling service sees students who are referred via a number of routes. Most

students self-refer, but on some occasions we are contacted by a tutor or another

person involved in their pastoral care whilst at university, and sometimes by a GP or

friend or housemate. If they have a student with them who needs to be seen quickly, we

will try to see them on the same day, or a soon as possible after that. Or if it’s clear from

the description given that the student is in need of urgent medical or psychological

treatment, we would normally talk them through the Distressed Students procedure

The Counselling Service can be contacted in a variety of ways:-

Visit on the Mile End campus, ground floor of the Geography Building. Reception

open Monday to Friday, 9:30 to 4:00pm

Telephone on +44 (0)20 7882 8717 (voice mail available)

Fax on +44 (0)20 7882 7013

Email –via our website, make an email enquiry:

http://www.admin.qmul.ac.uk/welfare/contact/index.html

6.2 Role of the front line team in identifying vulnerable students

http://www.dds.qmul.ac.uk/documents/146407.pdf


The receptionist counter is often the first point of entry into the service for students at

risk. Although receptionists are not expected to be expertly skilled in assessing risk,

there may be obvious things which raise concern (see below), when a student may need

something other than a regular counselling appointment. This might happen during the

course of a phone call from a student, a parent, or tutor, or when the student arrives in

person to request help. Examples of things which may raise concern include:-

the student is obviously distressed, tearful, angry, anxious, etc

their personal hygiene and appearance show signs of self neglect

their behaviour is bizarre, inappropriate, aggressive or disruptive

their speech is slurred, disjointed or difficult to make sense of

This kind of presentation may have already alerted someone else who is contacting the

service because they are worried about a student. In either case the receptionist should,

whenever possible discuss the situation with the Senior Counsellor. S/he will then

decide on a course of action in line with the Distressed Students procedure. If contact is

by the student themselves, a member of the counselling team would normally take them

into a consulting room and assess as soon as possible. If it is considered that the

student is at serious and immediate danger, the Crisis Checklist will be used.

In the absence if the Senior Counsellor, the receptionist will enlist the support of the

Head of Service or another member of staff, preferably one of the counsellors, who will

make a judgment about what needs to be done.

6.3 Referrals within the service

Students sometimes make an appointment with an advisor when they actually need

counselling because they do not understand the difference in the 2 aspects of the

Advice & Counselling Service. Sometimes students who are seeing a Welfare Advisor

appropriately, also show signs of emotional, psychological distress. These students

should be encouraged to access the Counselling Service for an assessment

appointment. It is often helpful if the welfare adviser can talk to the counselling colleague

about your concerns before they see the student.

If it is felt that the student may be at risk – see above, advisers should discuss with the

senior adviser and if the situation is urgent enlist support from a colleague and follow the

Crisis Checklist

6.4 Managing waiting lists

http://www.dds.qmul.ac.uk/documents/146407.pdf

Crisis%20checklist%20-%20latest%20version%20OCT%202015.doc

Crisis%20checklist%20-%20latest%20version%20OCT%202015.doc


At certain times of the year it can become necessary to hold a waiting list of those who

have been assessed and are awaiting counselling. Those at level 1 or 2 risk will have

been given various support options at assessment – see 7.3. Risk to self and academic

risk are recorded in their records and those most at risk are given priority when

appointments become available.

6.5 GP registration

All students are encouraged to register with a local GP. It is our policy that unless there

are exceptional circumstances (defined once raised with the senior counsellor), the

counselling service cannot undertake regular counselling without medical support. If

during the course of the preliminary interview it becomes clear that the student is not

registered, the counsellor should take the opportunity to inform the student of the service

policy. The student would be invited back for a follow up session but would need to have

the details of their GP by then. The purpose of medical support is specifically for those

students who are at risk and are liable to suicidal actions.

7. Procedures

7.1 Initial assessment & recording

All students entering the counselling service, whether for counselling, CBT, group

therapy, psychiatric appointment or referral elsewhere, will usually be seen firstly by a

counsellor. During the initial appointment the counsellor will use the CORE evaluation

scores as well as their clinical skills, training and experience to make an assessment

regarding factors which may indicate risk. This will include type and level of risk (see

appendix). This is recorded on the assessment sheet using a coding system. The

procedures for what actions to take for differing levels of risk should then be followed

(see below ‘Procedure for Students at Risk’). Areas of uncertainty should be discussed

with the Senior Counsellor, the Head of Advice and Counselling or a counselling

colleague.

7.2 On-going assessment & recording

The service recognises that risk assessment does not just apply to the first appointment

but needs to be on-going. If there are indicators of risk recorded during the first

appointment, this needs to be followed up during subsequent appointments and any

changes and action taken also recorded. Similarly, if there is no indication of risk during

the initial appointment, counsellors will continue to be vigilant during subsequent

sessions so that they can pick up any new factors which indicate risk. The procedures


for what actions to take for differing levels of risk should then be followed (see below

‘Procedure for Students at Risk’). Areas of uncertainty should be discussed with the

Senior Counsellor, the Head of Advice and Counselling or a counselling colleague.

7.3 Procedure for Students at Risk

Level 1

Some indications of low level of risk, thoughts but no plan or intent, which can be

contained within the counselling relationship and does not require urgent intervention by

another professional body, and does not justify a break of confidentiality.

Action:

Provide information about sources of support outside the counselling service, eg

relevant helplines, support groups

If there is a clear mental health difficulty, make a referral to the MHC

If you are not sure about this, make an appointment to see one of our

psychiatrists

Inform about our same day system in case the student needs to see someone

between weekly appointment

Record in the client’s notes, factors which indicate risk, type and level of risk and

actions taken

Level 2

Definite indications of risk are evident, may have suicidal or violent thoughts, may have

some thoughts about how they would do it, but no immediate intention to follow these.

The client cannot be safely contained within the counselling relationship alone and

needs intervention by another professional. May justify breaking confidentiality,

preferable with the client’s consent.

Action:

Make a plan with the student about what to do next.

Encourage the student to see their GP, or arrange this yourself, preferably the

same day. If there is doubt about the student’s ability to explain what they need

help with, use the GP form.

If the GP is not contactable, send the student to the NHS Walk-In-Centre at The

Royal London Hospital, Whitechapel. (it may be helpful to suggest that the

student contacts a friend or relative to accompany them).

Ask the student or the GP to let you know the outcome of the appointment.


Inform the student about our drop-in system in case they need to see someone

between weekly appointments

If the student is already being seen by a psychiatrist make contact and let them

know the situation, if not, it may be helpful to make a referral to the MHC

Record in the client’s notes, factors which indicate risk, type and level of risk and

actions taken

Place their file in the ‘AT Risk’ section of the counselling filing system

Inform reception and enter their name in the ‘students to look out for’ book, with

instruction about how reception should respond if the student appears between

appointments

Inform Senior Counsellor or Head of Service as soon as possible

Level 3

Definite indications of risk are evident and the risk is serious and needing immediate

intervention by another professional.

Action: FOLLOW THE CRISIS CHECKLIST see appendix.

8. Monitoring students at risk

Files holding notes on counselling appointments for students at level 2 or 3 risk are kept

in a specific section of our record system called the ‘At Risk’ section. This is so that they

are easily accessible should the student turn up unexpectedly, and it also alerts staff to

them being currently concerning. The ‘At Risk’ files are reviewed every week and

discussed at a counsellor’s clinical meeting when a decision is made as to whether they

need to remain in this section or not.

Students who are mentally unwell and causing concern, usually because they are

actively putting themselves or others at risk, are discussed once a month in a meeting

between ACS Head of Service, Senior Counsellor, Consultant Psychiatrist and the

Mental Health Co-ordinator. This is to share information and ensure a consistent

approach.

9. Psychiatric referral

The psychiatrists employed by the Advice and Counselling Service should be used as

back-up when working with students at risk at Level 1 or 2. If counsellors are concerned

about a client’s mental health and feel they need a psychiatric assessment, they will

write an email to the psychiatrists and book an appointment in their diary. Referral

emails to psychiatrists need to provide specific information as set out in the templates


we use as a service i.e. giving a clear indication about what is being requested by the

counsellor and how this fits with their counselling contract.

The Advice and Counselling Service Psychiatrists can be used when second opinion is

needed. Clients can usually be offered an appointment much faster than if they were

referred to an NHS psychiatrist via their GP. In this way, any treatment required can be

put in place quickly, with minimum disruption to their studies.

Psychiatrists here however, will not normally carry case load of long term clients or act

as an alternative to NHS services for students who need on-going psychiatric support.

Assessment may identify the need for specialist treatment or for medication, both of

which would be arranged via their student’s GP.

10. Referral to the Mental Health Co-ordinator

If there are clear indications that a student is experiencing mental health difficulties,

(whether this has been diagnosed or not) they may be entitled to support and

‘reasonable adjustments’ under the Equality Act. A referral should be made to the MHC

using the email template and procedure agreed by the service.

ACS share their confidentiality policy with the MHC which allows them to discuss and

agree support plans for students at risk. Liaising with the MHC can also be useful when

working with students whose functioning is impaired and who need assistance in

communicating with their academic department, NHS services and other third parties

outside of the Advice and Counselling Service.

11. Supporting the university

10.1 Guidelines on supporting Students in Distress

Written by ACS and DDS, - A step by step guide available on our website for members

of staff who come into contact with students in distress is available to download. This will

help staff assess how urgent a situation is, what action they need to take and provides

contact details of internal and external sources of support.

For a link to the Students in Distress Guide and more information about Queen Mary's

Mental Health Coordinator see: Disability and Dyslexia - Mental Health

10.2 Staff consultation

The Advice and Counselling Service offers consultation to any member of staff regarding

students who cause concern and who may be at risk. If staff contact the service by

http://www.dds.qmul.ac.uk/mentalhealth/index.html


phone, email, or in person their concern will be dealt with by one of the Head of Advice

and Counselling Service or one of her deputies. Each situation is different so we try to

tailor the advice we give according to the specifics and to support staff to take whatever

action is necessary to avoid personal or academic risk to the student concerned or to

others involved.

10.3 Staff training

ACS staff run two different kinds of training, the first, which is a pre-requisite for

attending the second is aimed at helping academic staff to develop their skills for

supporting students. This is bookable via through the Centre for Academic and

Professional Development.

The second training is focussed on Mental Health Awareness and is run in collaboration

with the QM Mental Health Coordinator. These enable staff to develop their

understanding of mental health conditions and an opportunity to learn skills for

identifying students who are unwell and responding to them appropriately, and in line

with the Students in Distress guidelines

The workshops are highly flexible and can be tailored to the needs of any department or

service within the college. Please contact Rebekah Shaw in the Advice and Counselling

Service to discuss your needs: [email protected]

10.4 Supporting Peer Support Initiatives

Each year we provide training to students who are volunteering as PASS mentors. This

is aimed at helping them to develop skills for responding to student mentees who are

struggling with personal, emotional, mental health difficulties, including what to do if you

think someone may be at risk of self-harm or suicide.

From time to time we are asked to get involved in a range of student led initiatives and

campaigns and we are happy to act in an advisory role as well as participating directly

and promoting them on our website.

Updated: February 2016

Review Date: February 2018

Staff Member Responsible for Review: Terry Patterson

mailto:[email protected]

http://www.qmul.ac.uk/undergraduate/schools/wp/qmul-students/index.html


Appendix Risk levels for monitoring and recording

Risk level Suicide

1

Some indications of low level of risk, thoughts but no plan or intent, can be contained within the counselling relationship and does not require urgent intervention by another professional body, and does not justify a break of confidentiality.

2

Definite indications of risk are evident, may have suicidal or violent thoughts, may have some thoughts about how they would do it, but no immediate intention to follow these. Client cannot be safely contained within the counselling relationship alone and needs intervention by another professional. May justify breaking confidentiality, preferable with the client’s consent.

3

Definite indications of risk are evident and the risk is serious and needing immediate intervention by another professional – use Mental Health Crisis Checklist

Risk level Self-harm

1

Has self-harmed previously, (more than 3 months ago). Has some insight into why they did this and feels it’s unlikely they will do so again

2

Has self-harmed recently, within the last few weeks. May or may not have insight into why. Sees this as a viable coping strategy which they use when feelings become unmanageable

3

Is currently self-harming, including serious self-neglect and/or high risk behaviours. Cannot see other ways of coping and may lead to serious injury or death

Risk level Academic

1

Missed some assignment deadlines, discussed with academic department and made arrangements to resolve this and unlikely to prevent progress

2

Missed a significant number of deadlines, or not attended an exam, not yet discussed with academic department, poor attendance


3

Has had significant academic difficulties, missed assignments, had previous resits, failed exams, interrupting studies and is at real risk of being deregistered

Documents

Queen Mary: Advice and Counselling Service - WhatDoTheyKnow