Background The Sue Ryder Online Community is an online peer support service where people affected by terminal illness or bereavement exchange messages and support each other. The site is moderated to keep it safe and supportive. Because of the difficult subject matter, individuals may occasionally post about suicidal thoughts and feelings, and it is necessary to have a robust process for responding.

Aims To ensure that individuals considered at risk are supported and signposted to appropriate services, and that our approach is consistent.

Methods A decision flow chart helps moderators assess the level of risk and gives an easy-to-follow process. Template responses and lists of signposting resources are used by moderators to support individuals and encourage them to seek specialist help – these are adapted and personalised in each case. Issues where an individual is considered at-risk are escalated to senior health and social care staff. Following assessment, in a very high-risk case, we consider, on a risk-based approach whether to break confidentiality and contact emergency services. These methods are in line with the best practice guidelines from the National Suicide Prevention Alliance.

Results In 2016/17, five issues required escalation, equivalent to 0.1% of posts. One of these individuals later confirmed they had got support from family members and the Samaritans.

Moderator Feedback ‘This process makes me feel much more confident. I know that if I spot something worrisome, I don’t need to panic – it’s a simple process, and I won’t be dealing with it on my own.’

Conclusion The safeguarding process appears effective, but we will be able to draw more conclusions in future, when there have been a greater number of issues escalated. We will review the process annually and review individual cases after three months.