National recommendations - College of Policing, July 2024

The IOPC recommends that the College of Policing review and update its guidance on Suicide and Bereavement Response as part of its ongoing work to review APP on mental health. This review should:

• Ensure that any national strategies and academic work signposted in APP remain relevant and do not conflict with the current policing position on mental health.
• Ensure that where any relevant documents are signposted that links have been checked and updated where relevant.
• Amend conflicting language used within the ‘After a suicide attempt’ section around attending and managing a scene of a hanging.

This follows two IOPC investigations where officers attended separate incidents where members of the public had taken their own lives by hanging.

The IOPC has specific concerns in the Suicide and Bereavement Response APP on the conflicting content under ‘After a suicide attempt’. It currently states, “where there are signs of life, cut and loosen the ligature” but it also states, “consider the use of CPR – where a person is found hanging consideration should be given to the possibility that the person may be in cardiac arrest”. As someone in cardiac arrest could be showing no signs of life, it is unclear when officers should be cutting a ligature and performing CPR.  

It appears the use of CPR has been added into this section of APP following our investigation into 2018/109205 where officers cut a man hanging from a fence but did not perform CPR. However, this has now created some confusion which is evident in a recent investigation, 2023/188862. In this case, attending officers assumed a man hanging from a tree was dead and did not cut the ligature or perform CPR as they believed the man should remain in situ before a crime officer attended. Following attendance from the ambulance service, they cut the man down and performed CPR leading to the man being resuscitated. He sadly passed away a few days later.

In addition, the IOPC has concerns around the overall standard of the APP on Suicide and Bereavement Response. There are currently references to national strategies and academic work which dates back 15 years, some of which have broken links.  This includes the World Health Organisation (WHO’s) 2009 and 2012 guidance around “preventing suicide” which uses out of date terminology and does not represent Mental Health in policing today. As awareness and research of Mental Health has advanced over the past 15 years, the IOPC believes the APP needs to include up to date terminology and research which reflects the current climate.

The IOPC recognises the College of Policing has commenced a review of their Mental Health APP in February 2024 and has chosen to issue this recommendation to ensure that this matter is addressed as part of this review.

Accepted

The College of Policing is currently undertaking a full review of the Mental Health APP (Approved Professional Practice).

This is a formal review process that covers the guidance on suicide and bereavement response and will be subject to a full consultation process.

The review will ensure that any signposting to academic work or national strategies is relevant and appropriate and used effectively in support of the content within the APP.

The review process will encompass all of the existing content, including any current links to ensure these are relevant, appropriate and updated where required. Old links that are no longer relevant or working will be removed and/or updated.

Part of the review will focus specifically on the language and advice provided to front line policing, when an officer attends the scene of a suicide/attempt suicide to ensure there is more clarity on actions to undertake and to ensure any conflicting/unclear language is removed/updated as appropriate.

The IOPC recommends the College of Policing and the National Police Chiefs’ Council (NPCC) work together to produce clear guidance on preservation of life at the scene of a hanging where death has not been confirmed. This should include guidance on how to manage the weight of someone hanging.

This follows three IOPC cases where officers attended separate incidents where members of the public had taken their own lives by hanging. involving officers at the scene of a hanging

The current Suicide and Bereavement Response APP guidance is unclear on how officers should be cutting down a ligature which was evident in case 2022/176800. Officers found a man hanging from a staircase who initially felt warm to touch. The officers knew they needed to remove the ligature but were unsure how to manage the man’s weight. The APP does not provide guidance around supporting the weight of a person who is found hanging or who should be undertaking this is, i.e., the police service, ambulance service or the fire service.

It appears the use of CPR has been added into APP following 2018/109205 where officers cut a man hanging from a fence but did not perform CRP. However, this has now created some confusion which is evident in a recent case, 2023/188862. In this case, attending officers assumed a man hanging from a tree was dead and did not cut the ligature of perform CPR as it was believed he should remain in situ before a crime officer attended. Following attendance from the ambulance service, they cut the man down and performed CPR leading to the man being resuscitated. He sadly passed away a few days later.

The IOPC has been notified that the College of Policing is setting up working group early 2024 to discuss how emergency services can manage hangings. The IOPC supports the creation of this group and believes the issues raised in this recommendation should be a topic of discussion.

Accepted

The College of Policing along with the NPCC have already started this work through regular meetings with the National Fire Chiefs’ Council and plan to integrate this work into the APP content during the APP review process.
The updated guidance will be provided within the APP content and will provide further clarity and advice for frontline policing when attending incidents to ensure the focus is on preservation of life.