Background
The death of a child is an incredibly emotional time and it is common for parents to express their distress in a variety of ways. Often parents can make statements like “I can’t imagine life without her”, or “my life will end when his does”. This can be challenging for family and staff to hear. While this can be part of the normal grief response, when does it cross the threshold of risk to the parent themselves, and how do we assess and manage this risk? 

Methods
Using a case study example, we draw on the literature around grief, bereavement and self-harm in mental health and social work contexts. The findings in the literature will then be integrated with our clinical experience to describe our approach to risk assessment and principles of risk management for vulnerable families.

Lessons learned
Through this discussion, we identify the need for consistent and transparent risk assessments, and specialist management. In so doing, we recognise the opportunity for standardisation of this aspect of care within specialist paediatric palliative care service provision and question our current practices – are they safe enough?