Date of Initial Issue	26/10/2007
Issue No.	283
PSI Amendments should be read in conjunction with this PSO
Date of Further Amendments

 

Navigating this document:

To go to the beginning of chapter click on the blue links in the CHAPTERS column.  To view the sections covered in each chapter click on the P in the SECTIONS column.  Similarly click on the P in the ANNEXES column to view the list of annexes. Many references within the PSO itself are linked for easy navigation. The  icon on your toolbar above, allows you to move back up, a level at a time.

 

 

 

 

CHAPTER	ANNEXES
1 Roles & Responsibilities	Areas to be covered by a local suicide prevention and self-harm management strategy Annex 1A – Guidance on staff roles Annex 1B – Areas to be covered by local suicide and self-harm management strategy.
3 Pre-Prison And Time At Court	Annex 3A – What to do when you receive a prisoner with an open ACCT Plan Annex 3B – Suicide/self-harm warning form Annex 3C – Example from HMYOI Huntercombe of Information Sharing For Court Staff Annex 3D – Methods of support for at-risk prisoners in court cells
4 Early Period In Prison	Annex 4A – Reception and first night staff Annex 4B – The safer reception environment Annex 4C – Provision of information Annex 4D – Sources of risk information or assistance concerning prisoners Annex 4E – Identifying next of kin Annex 4F – First night Annex 4G – Induction Annex 4H – Drug withdrawal and detoxification Annex 4J – HMP Hull’s First Night Information Sheet Annex 4K - Checklist for Safer Custody before a prisoner is locked up for the first night Annex 4L - Recalled prisoners
6 Specialist Services &  Communication With Staff	Annex 6A – Prevalence of mental and other disorders in male adult, female and juvenile prisoners in England and Wales Annex 6B – Safe management of prisoners withdrawing from drugs/ alcohol Annex 6C – Examples of integrated working between mental health specialist staff and other staff,  including residential staff
7 Peer And Family Support, Samaritans And Telephone Help lines	Annex 7A – Samaritans Annex 7B – Guide to Peer Support Annex 7C – Family Support Annex 7D – Prisoner access to approved telephone helplines
8 Planning & Providing Good Quality Care For At Risk  Prisoners	Annex 8A – Examples of frequencies of observations Annex 8B – Foreign nationals Annex 8C – Description of the care suite in HMP Drake Hall Annex 8D – Ideas for developing use of shared cells Annex 8E – Summary of safer cells evaluation Annex 8F – Summary of care and support available at HMP Woodhill Annex 8G – ACCT (ASSESSMENT CARE IN CUSTODY AND TEAMWORK) PROCEDURES Annex 8H – When the required recording of observations is less frequent than the observations themselves Annex Annex 8N – Template consent form for involving the individual’s relatives or friends in their care Annex 8P – Protecting the individual’s dignity while showering and toileting Annex 8Q – Reducing the level of supervision while still maintaining a high level of safety Annex 8T – Options for maintaining access to activities despite risk attaching to certain items in possession Annex 8U – Ideas for resolving operational difficulties relating to the removal of plastic bags Annex 8V – Communication and Teamwork Annex 8X – Sample Authorisation Form for Constant Supervision Annex 8AA – ‘Supporting the Supporter’ Good Practice Example Annex 8BB – Guidance on establishing and maintaining a team of ACCT Assessors Annex 8DD - Compacts Annex 8EE – Prisoners who present a chronic risk of suicide Annex 8FF – Guidance on what information the case manager should ask for from specialist staff Annex 8GG – Cell-Sharing
9 Management Of At-Risk Prisoners Whose Behaviour Is Particularly Challenging	Annex 9A – Discharge to normal location Annex 9B – Activities that can be provided for at-risk prisoners who present challenging behaviours Annex 9C – Options for providing peer support, where additional safeguards are assessed as required Annex 9D – Key workers (and equivalents) Annex 9E – Example of an incident review sheet used at Glen Parva Annex 9F – Ways of safely managing challenging at-risk prisoners in areas of the prison other than segregation Annex 9G - Reducing the frequency and severity of self-harming behaviour Annex 9H – ‘Sadie’ Annex 9J – Staff support and supervision Annex 9K – Consistency of care – communication Annex 9M – At-risk prisoners with a history of arson Annex 9N – Dirty protests – additional action to be taken for at-risk prisoners Annex 9P – Why do some people behave in this way?
10 Built Environment	Annex 10A – Safer custody cells protocols Annex 10B – Safer furniture purchase agreements Annex 10C – Safer custody accommodation protocol table
11 Equipment	Annex 11A – Cut down
12 Suicide Prevention And Self-Harm Management For Women Prisoners	Annex 12A – Vulnerability factors of women in prison Annex 12B – Examples of good practice in reception/ first night arrangements * (see note) Annex 12C – Good practice examples re: foreign national women prisoners * (see note) Annex 12D – Female Prisoners Welfare Project (FPWP)/ Hibiscus Annex 12E – Detoxification – further guidance Annex 12F – Induction checklist Annex 12G – Good practice examples re: induction Annex 12H – Cell-sharing for women prisoners Annex 12J – Training available for staff working with women prisoners Annex 12K – Mothers in prison Annex 12M – Time out of cell, purposeful activity Annex 12N – Resettlement Annex 12P – Mental and physical health, and medication Annex 12Q – Good practice interventions
13 Actions Following An Incident Of Self-Harm	Annex 13A – Actions following self-harm: emergency procedures Annex 13B – Action upon entering as cell after an incident of self harm
- Suicide Prevention And Self-Harm Management For Young People	Annex YP1 – Suicide Prevention and Self-Harm Management for Young People Annex YP2 – Risk alert procedure Annex YP3 – YJB secure facilities placement policy and protocol Annex YP4 – Self harm Annex YP5 –  Known links between bullying / self-harm / suicide Annex YP6 –  Managing vulnerability Annex YP7 –  Using ‘need2talk’: supporting young offenders Annex YP8 –  Child Protection considerations Annex YP9 –  Multi-disciplinary risk assessment Annex YP10 – Chaplaincy Annex YP11 – Mental health Annex YP12 – Substance misuse Annex YP13 – Time out of cell and in-cell activities Annex YP14 –  Alternatives to self-harm Annex YP15 –  Related documents and relevant links
15 Discharge And Resettlement	Annex 15A – Discharge from custody of at risk prisoners – temporary release Annex 15B - Guidance on what to include in an establishment or area population management strategy about transferring prisoners who are both at-risk and present challenging behaviours.

 

* NOTE   Items marked with an asterisk * are examples of local policies and procedures kindly provided by prison and other establishments.  Please note that they are just that – examples. It is the responsibility of prison establishments making use of such examples to:   1.                   Only utilise policies and procedures that are safe for and appropriate to their particular prisoner/trainee population 2.                   Ensure the policies and procedures are amended to reflect their particular prisoner/trainee population and the ability of their establishment to safely deliver them 3.                   To obtain approval for the policy from appropriate local agencies.  For example, all healthcare policies must be agreed by the PCT (usually the Clinical Governance Committee).  The fact that the Clinical Governance Committee in one PCT has approved a policy for use in one establishment does not automatically mean that it will be approved by a different PCT serving a different establishment.    Where available, contact details of those supplying the examples have been included   Advice on the appropriateness of examples to your establishment can be sought from:   The Area Safer Custody Adviser The Regional CSIP or NIMHE lead

 

 

PSO 2700 - Suicide Prevention and Self-Harm Management

 

EXECUTIVE SUMMARY

 

STATEMENT OF PURPOSE

The National Offender Management Service – including the Prison Service and other providers of custodial care - have a duty of care for all prisoners and staff. This Prison Service Order (PSO) provides instructions on identifying prisoners at risk of suicide and self-harm, and on providing the subsequent care and support for such prisoners, and support for the staff who care for them. This PSO replaces a number of previous instructions, and sets out mandatory requirements. It introduces across the wider estate experience from establishments holding women and young people, with specific approaches for prisoners who regularly self-harm and for at-risk prisoners whose behaviour is particularly challenging. There is considerable emphasis on reducing risk by ensuring all prisoners (whether identified at-risk or not) receive individual support in managing any problems. The PSO incorporates the latest research on both suicidal and self-harming behaviours, including the lessons learned from evaluation of the four-year Safer Locals Programme. It also draws on learning acquired from death in custody investigations.

DESIRED OUTCOME

Reduction in distress and improved quality of life for all who live and work in prisons.   Reduction in the number of incidents of self-inflicted death and self-harm.   Vulnerable individuals are provided with positive care and support that gives them coping mechanisms other than self-harm.   Staff are equipped to carry out this difficult work and provided with support as required.

MANDATORY ACTIONS

Mandatory actions are shown in italics.   Governors and Directors of contracted prisons (referred to as ‘Directors’ throughout the PSO) and the Head of PECS must ensure that all staff involved in the care of prisoners are aware of the contents of this PSO.   Audit and monitoring   Directorate of High Security Prisons, Area Offices and establishments must put in place systems to encourage and enable compliance with the mandatory actions set out in this PSI. Audit will comply with the Audit Compliance and Self-Audit Standard.

RESOURCE IMPLICATIONS

This PSO supersedes the following:   ·             PSO 2700: Suicide Prevention (version that took effect 1 January 2003) ·             PSI 32/2006: Personal Issue Cut-Down Tools ·             PSI 18/2005: Introducing ACCT – the replacement for the F2052SH ·             PSI 42/2003: Guidance on the Insiders Peer Support Scheme ·             PSI 51/2003: Introducing the Suicide Self-Harm Warning Form ·             PSI 52/2002: Introducing the F213SH ·             Suicide Prevention Strategies: Guidance on preventing prisoner suicide and reducing self-harm; the role of Samaritans; and safer custody cell protocols ·             Working with people who harm or injure themselves in prison ·             Good Practice Guide for Peer Support Schemes   Many of the requirements in this PSO are already being undertaken across the estate; implementing the revisions will fill gaps identified by investigations, inspections and audits, and introduce more widely aspects of good practice. Restructuring priorities and profiles, and other changes in the use of local resources, should reflect both any savings (such as from flexible timing of case reviews) and the new resource requirements (such as administrative support) of the revised local safer custody strategy. Establishments will need to ensure their planning arrangements are undertaken in communication with their Area Office (concerning the Area safer custody strategy) and Primary Care Trust (in respect of healthcare).   The Trade Unions have been consulted about the contents of this PSO.

IMPLEMENTATION DATE

To enable establishments to develop and implement their own safer custody strategy in line with the requirements and good practice set out within this PSO and supporting guidance, a six month time period has been allowed prior to the formal implementation completion date of 30 April 2008. However, if a Governor/Director feels they are in a position to declare implementation complete ahead of this date they can do so, subject to the agreement of their Area Manager/Operational Director/ Corporate Operational Director.

 

NOTES

The PSO is supported by comprehensive intranet-based guidance (available on disk for non-Prison Service providers), which staff are urged to draw on. Links are indicated by blue, underlined text.   It is not possible, nor desirable, to be prescriptive about all aspects of suicide prevention and self-harm management, as all establishments vary – not least in prison type (e.g. locals often hold a higher risk population), in the facilities they have, staffing resources, and prisoner population make-up. The supporting guidance offers background information and ideas for good practice, but establishments will have to decide locally which elements will work best for them and how they might go about satisfying the overarching mandatory requirements of policy contained in this PSO.   For the purpose of this Order, ‘self-harm’ is any act where a prisoner deliberately harms themselves irrespective of the method, intent or severity of any injury.   References to ‘prisoners’ include all those - including immigration detainees and those aged under 18 - accommodated in prison establishments, young offender institutions and units for young people (unless otherwise stated).   Where the terms ‘Young Person’ or ‘Young People’ are used in this PSO, they refer to young persons or people under the age of 18 and those who have reached the age of 18, but are held in YJB commissioned places.   References to Directors should (unless otherwise stated) be taken to mean Directors of contracted prisons.   Where Governors are required to seek Area Manager approval, Directors of contracted prisons should seek the same through their Corporate Operational Director.   References to Senior Officers and Principal Officers should be taken to mean equivalent operational first and second line management grades in the contracted sector.    References to SPDRs should for the contracted sector be taken to mean the equivalent staff performance management system.   References to Primary Care Trust (PCT) should for Welsh establishments be taken to mean Local Health Board (LHB).   References to Partnership Agreements with the local PCT/LHB should be taken to mean the corresponding arrangements between contracted prisons and their local PCT/LHB.

 

 

Further advice or information on this PSO or the systems contained within it can be sought from:

 

Samantha Hughes, Ground Floor, Abell House, London ' 020 7217 5778 or,

 

Paul Minos, Ground Floor, Abell House, London ' 020 72171898

 

Advice on matters relating to security issues may be sought from Security Policy Group:

Security Policy Group Advice Line: ' 020 7217 6500

 

 

Director:

CHAPTER 1: ROLES AND RESPONSIBILITIES

 

Link to Standard 60

 

1.1              Introduction

 

1.1.1        The principle of shared responsibility does not mean that individual members of staff are not accountable. All members of staff have clear responsibilities under the ACCT system, but preventing suicide/self-harm is wider than caring for those identified as at-risk. By being supportive to all prisoners, and by taking account of the very different needs of individuals and reflecting diversity and gender quality responsibilities, staff can reduce the levels of distress in their establishment and thereby reduce the number of prisoners who may become a risk-to-self.

 

1.1.2        Examples of what may be expected of managers and other staff in different individual roles, or of different establishments, can be found in Annex 1A.

 

1.2              All members of staff

 

1.2.1        All staff in contact with prisoners must be trained to at least ACCT Foundation level - (see Annex 8G2 – ACCT Training Chart), be aware of the signs of risk summarised in the ACCT Staff Pocket Guide and when caring for at-risk prisoners follow the ACCT procedures set out in Annex 8G.

 

1.2.2        Suicide prevention is the responsibility of all staff. Whenever any member of staff believes a prisoner is at risk of suicide or self-harm they must open an ACCT Plan following the procedures set out in Annex 8G. (Note: Escort staff (contracted or Prison Service) must instead use the Suicide/Self-Harm Warning Form). see Annex 3B

 

1.2.3        Staff have a responsibility to ensure they are aware of which prisoners in their care are on an open ACCT Plan, and what the key requirements of that plan are.

 

1.2.4        It is important that all events relevant to the care of at-risk prisoners are appropriately noted in ACCT Plans and that colleagues are aware of what has happened and what the risks are. All staff (whether healthcare, operational or other) have responsibility for the maintenance of ACCT Plans of prisoners they come into contact with, and a responsibility to share risk information with others caring for the prisoner.

 

1.2.5        At shift change when staff handover prisoners on an open ACCT Plan to colleagues, they must always appropriately brief that member of staff. A record must be maintained to show that the receiving staff have received such a briefing and have checked those prisoners on an open ACCT Plan. It is important that at other handover times receiving staff are made aware of any specific concerns about such prisoners.

 

1.2.6        All staff must know where the emergency response kit(s) are located in the area(s) they work.

 

1.2.7        All staff must know who the First Aid trained staff are in the area(s) they work.

 

1.2.8        All staff hold personal responsibility for learning and taking up training opportunities. All ACCT related training must be reflected in the member of staff’s SPDR.

 

 

1.3       All managers in establishments

 

1.3.1        All Senior Officers, Principal Officers and Operational Managers (F and above), including Governors and Directors, must be trained to at least ACCT Case Manager level.

 

1.3.2        It is the responsibility of all managers to:

 

·                     Promote the compassionate nature of the role of staff in caring for prisoners.

·                     Manage inappropriate behaviour – whether by prisoners, staff or visitors – and to challenge unacceptable attitudes and actions.

·                     Ensure their staff have received (or are to receive) appropriate training as referred to in this PSO.

·                     Support staff caring for at-risk prisoners – for example, by debriefing or assisting to access clinical supervision. This can be reflected in local instructions and managers’ SPDRs. See Annex 1E - Staff Support and Annex 9J – Assessor Support

 

1.3.2    Managers must reflect in each member of staff’s SPDR all duties relating to the care of at-risk prisoners, including any specific additional ACCT responsibilities and functions.

  

1.4       Area Managers, the Director of High Security Prisons and the Head of PECS

 

1.4.1        The Head of PECS must ensure Escort Contractors’ Operating Procedures and training plans are amended to take account of the contents of this Order, particularly in respect of ACCT and improvements in the transfer of risk information, and fully meet the requirements set out herein.

 

1.4.2        Caring for at-risk prisoners can require a level of cross-sector and inter-prison links and communications, and a mix of resources, that are difficult for one establishment to attain alone. Area (or Regional) safer custody strategies can prepare for this and provide for a speedy response when an individual prisoner’s life is at risk, or when wider organisational problems arise. Where they identify a need, Area Managers and/or the Director of High Security Prisons can develop an Area safer custody strategy that reflects the combined needs of the establishments in their Area. To be effective in supporting establishments minimise prisoner distress and provide the optimum level of care for at-risk prisoners, such a strategy needs to reflect all other Area Business Plans/annual strategies and sub-plans/strategies (e.g. prisoner movements, works/built environment or training) and include provision for learning lessons from deaths and incidents of serious self-harm, both nationally and locally, and implementing consequent amendments; for more on learning see PSO 2710 – Follow Up To Deaths In Custody. Further advice is contained in Annex 1C – Area Safer Custody Strategy and Forums.

1.4.3        Area Managers and the Director of High Security Prisons must validate annually the suicide prevention and self-harm management strategy in each of their establishments. This includes ensuring that their establishments’ local policies, procedures, staff profiling and training plans meet the requirements set out in this Order to safely deliver reception screening Section 4.7, internal and external risk information exchange (referred to in Annex IB), and ACCT provision Annex 8G.

 

1.4.4        Area Managers and the Director of High Security Prisons must each appoint an Area Safer Custody Adviser (ASCA). The role of the ASCA is described at Annex 1A

 

1.5        Heads of Headquarters Policy and Training Delivery Groups

 

1.5.1        To be effective, safer custody strategy needs to be reflected across the range of different policies that impact on prisoners. It is important therefore that Heads of Policy Groups ensure that Safer Custody Group is consulted – at the time of drafting – on all Standards, Instructions, Orders and guidance documents that their Group produces.

 

1.5.2        As it is central to prisoner safety that ACCT related training continues to be delivered to all staff working with prisoners - whichever sector they work in - it is essential that contracted prison trainers are able to continue accessing ACCT Training for Trainers courses on the same basis they have since the introduction of ACCT.

 

1.6        Area Safer Custody Advisers (ASCAs)

 

1.6.1        The role of the ASCA - which extends to both public and contracted prisons in their Area - may vary depending on the role assigned to them, or delegated to supporting staff, by the Area Manager. The amount of their time spent working with contracted prisons will be proportional to the number of such establishments in their Area. The ASCA will support their Area Manager in respect of Area policy, Standards and practice, and ensuring compliance by the establishments in their Area. ASCAs are likely to have responsibility for the development and implementation of the Area safer custody strategy and supporting the Governors of that Area in its delivery. They will also usually be responsible for the development, co-ordination and maintenance of an Area Safer Custody Forum Annex 1C.

 

1.6.2        ASCAs must be trained to at least ACCT Assessor level and need to maintain a current knowledge of safer custody good practice including gender specific issues, staff training and policy, including familiarity with the Violence Reduction Strategy (which includes the Cell-Sharing Risk Assessment). Annex 1A

 

1.7       Governors/Directors of contracted prisons

 

1.7.1        Governors and Directors of contracted prisons (hereafter referred to as ‘Directors’) must ensure they have in place a local suicide prevention and self-harm management strategy that fully reflects Annex 1B – Areas to be Covered by Local Suicide Prevention and Self-Harm Management Strategy.

 

1.7.2        Directors of contracted prisons must ensure their Operating Procedures are amended to take account of the contents of this Order.

 

1.7.3        Governors and Directors must ensure they have a fully staffed and functioning Safer Custody Team. See SCT leader (below) and Annex 1D - Safer Custody Team. Governors and Directors will need to ensure their SCT are clear about local policy and their role regarding the recommendation (at 13.2 – Immediate action following incidents of self-harm) regarding investigation of serious incidents of serious incidents of self-harm.

 

1.7.4        Governors and Directors have overall responsibility for the implementation of the suicide prevention and self-harm management strategy for their establishment, and for setting safer custody strategic priorities. They must monitor implementation of local policy and procedures, and review annually; identifying the target for the audit rating for the following year. Particular responsibilities may be delegated to the SCT.

 

1.7.5        Governors and Directors must appoint:

·         A SCT leader (unless they undertake this role themselves). This must be a member of the establishment SMT.

·         At least one Suicide Prevention Co-ordinator (SPC); the decision on whether they are full-time, part-time (and if part-time; how many hours they work) must be based on an assessment by the local Senior Management Team of the level of self-harm risk at the establishment, and agreed with the Area Manager. The decision on the appropriate level of provision, with the reasoning behind it, must be explained in the local strategy, and reconsidered each year. Whilst it is expected that establishments with high risk populations will have at least a full-time SPC, in Category D/open establishments where the risks are low the Area Manager may approve this post being part-time and/or shared with the Violence Reduction Co-ordinator role see PSO 2750: Violence Reduction. It is good practice to appoint a deputy SPC to ensure the role is covered when the SPC is on leave, or faces additional pressures on their time due to a death or serious self-harm incident. See below and Annex 1A for information on the SPC role.

·         ACCT Trainers.

·         Sufficient staff to undertake the administrative support duties needed to meet the volume of safer custody related work at the establishment (see 1.16 below).

And ensure that all ACCT related posts (see below and Annex 8G) are occupied, and that when vacancies occur systems are in place to ensure they are immediately filled. It is also good practice to appoint a Family Contact Officer (not to be confused with the Family Liaison Officer), see 1.18 below.

 

1.7.6        Governors and Directors must seek to influence their establishment’s SLA with their PCT to take account of the requirements of this PSO. Guidance on Partnership Agreement issues that may particularly impact on safer custody can be obtained from the Area Safer Custody Adviser; also see chapter 6.

 

1.7.7        Governors and Directors must publish a local policy statement outlining a multi-disciplinary, multi-agency approach to safer custody - including specific reference to suicide prevention, self-harm management, violence reduction and any other safer custody and safeguarding arrangements at the establishment.

 

1.7.8        Governors and Directors must have in place systems to ensure the quality of ACCT procedures. These must include:

• The daily checks of open ACCT Plans conducted by Unit management (see Unit Managers - below).
• The checks conducted by the Suicide Prevention Co-ordinator (see Annex 1A).
• The weekly check by an ACCT Case Manager trained member of the Senior Management Team (SMT) or member of staff reporting directly to the Governor/Director, of each open ACCT Plan. They must draw deficiencies to the attention of line managers, monitor the response, and record that they have made these checks. The ACCT Pocket Guide for Managers contains guidance on quality checks. SMT support is crucial to the success of ACCT. Care needs to be taken to ensure that this task does not fall on those with least time to meaningfully carry it out, e.g. Duty Governor in establishments where they have large numbers of adjudications to manage.
• The Safer Custody Team checking the quality of a randomly chosen sample of recently closed and excerpts from open ACCT documents at each SCT meeting.
• Ensuring that there is evidence that ACCT Plans are only closed once all the CAREMAP actions have been completed; see the section on closing an ACCT Plan in Annex 8G. It is essential that Governors and Directors lead efforts to ensure that ACCT Plans are not closed before CAREMAPs clearly indicate how the underlying problems have been resolved or reduced, and the prisoner is able to cope with any remaining difficulties.

 

1.8       Safer Custody Team (SCT) leaders

 

1.8.1        The SCT leader will have key responsibility, as directed by the Governor or Director, for the implementation and development of the local suicide prevention and self-harm management strategy Annex 1B and compliance. They will act as the champion for safer custody on the local Senior Management Team.

 

1.8.2        The SCT leader has responsibility for the SCT and its continued development. The SCT leader must ensure SCT meetings review the continuous improvement plan (to deliver long term strategic aims and meet short term objectives) and the local use of self-harm interventions, and undertake an annual review of issues, all as outlined in Annex 1D - Membership, Structure and Functions of the Safer Custody Team

 

1.8.3    The SCT leader must ensure the SCT has meetings every month, or where Area Manager/Director of High Security Prisons agrees a lesser frequency (because the establishment has low levels of self-harm and/or a low risk population) at least every three months. The meetings must be minuted and go to the local SMT, the ASCA, and (edited appropriate to respect any confidentiality issues) onto the local intranet site. For establishments with approval for less frequent meetings, the decision must be explained in both the local and the Area strategy, and reconsidered each year.

 

1.8.4    A deputy team leader, as well as the Suicide Prevention Co-ordinator(s) and Violence Reduction Co-ordinator, can support the SCT leader. However, this must not detract from the SCT leader (with the Governor/Director where different) taking personal responsibility for leading the local safer custody strategy, and must not lead to the delegation of safer custody leadership below SMT level.

 

1.8.5    The SCT Leader must be trained to at least ACCT Case Manager level and must have attended the SCT leader training course. Places on this training course will be available from TDG from 1^st June 2008, and therefore (to give time for all SCT leaders to attend) SCT leaders will be exempt from this training requirement until 1^st December 2009.

 

1.8.6        To provide senior management support for suicide prevention and self-harm management work in the establishment, and maintain the necessary high profile of this work, it is recommended that the SCT leader has line management responsibility for both the SPC (see below) and the Family Contact Officer (see 1.18).

 

1.9       Suicide Prevention Co-ordinators (SPCs)

 

1.9.1    There is no specification about which member of staff can be a SPC. It is recommended that Governors/Directors consider what challenges staff may face as SPC, ensuring they are of sufficient standing and grade to fulfill the role, for example, if they are a uniform grade a minimum of Senior Officer, and often a Principal Officer in high risk establishments, will be needed.

 

1.9.2    SPCs must be trained to at least ACCT Assessor level and must have attended the SPC training course Places on this training course will be available from TDG from 1^st June 2008, and therefore SPCs will be exempt from this training requirement until 1^st December 2009. SPCs also need to undertake regular refresher training in suicide and self-harm prevention, and maintain a contemporary knowledge of safer custody good practice and policy.

 

1.9.3    Advice on the role of the SPC is included at Annex 1A. Where a deputy SPC has been appointed they must be trained to at least ACCT Case Manager level; it is good practice for them to be trained to ACCT Assessor level and attend the SPC training course.

 

1.10     Unit Managers

 

1.10.1  Unit Managers must ensure that all staff on their unit (including night staff) know which prisoners are on an ACCT Plan, what the Trigger box and CAREMAP contents are and what care is required from residential staff. Efforts should be made to do this in a way that reduces the chances of the prisoner being publicly identified to other prisoners as being at risk, for example, through brief verbal handovers at the beginning and end of each shift on all residential and in-patient locations. Among other purposes, these should be used to draw the attention of the new shift to any prisoners newly identified as at-risk, their care/support needs and any significant events relating to at-risk prisoners that have occurred. 

 

1.10.2  Unit Managers (plus Senior Officers where different) on each unit must check observation books and ACCT Plans daily, and record a comment on the quality of the ACCT Plan as well as signing to confirm they have undertaken the checks. They should ensure that:

a)                  Staff follow the ACCT procedures

b)                  The levels of conversations and observations are being maintained to the required standard

c)                  CAREMAP actions are completed by the due date and outcomes recorded

d)                  Healthcare and Mental Health In-Reach Team staff have been informed of all new open ACCT Plans

Where individual staff weaknesses are identified regarding ACCT procedures, or awareness of suicide risk and ability to take required actions, the appropriate improvement objectives must be included in that persons SPDR, and Line Managers must ensure remedial training is arranged and undertaken. This includes encouraging staff to adopt an interactive approach to managing at-risk prisoners, rather than thinking in terms of observation only.

 

1.10.3  Unit Managers must adhere to the local system of post-closure monitoring, and review each closed case at least once after closure of the ACCT Plan (or as stipulated in the record of the closing case review) see the section on closing an ACCT Plan in Annex 8G.

 

1.11     Healthcare Managers

 

1.11.1  Prisoner safety and well-being means that managers need to be trained to ACCT Case Manager level (as they are likely to need to undertake these duties), and all staff in contact with prisoners need to be aware of and trained to ACCT foundation level. Therefore it is important that Healthcare Managers - through their Partnership Board - make every effort to ensure the local training strategy reflects this in respect of all healthcare staff (agency wherever possible and permanent employees, whether existing or new) and mental health in-reach teams. 

 

1.11.2  Healthcare Managers must ensure all healthcare staff (as above) are aware of the importance of sharing risk and care information with staff from other disciplines, are informed that this does not contradict professional guidelines, and do share such information with those managing individual prisoners. Heads of Healthcare will find inclusion of a specific module on information sharing in the induction of healthcare staff new to the establishment helpful in achieving this. See PSI 25/2002 – The Protection and Use of Confidential Health Information in Prisons and Inter-Agency Information Sharing, Annex 8V – Communication and Teamwork, the NHS Code of Confidentiality and ‘Safe and Secure’ - Guidance for healthcare staff on information sharing.

 

1.12     Samaritans Liaison Officers

 

1.12.1  This role may be incorporated into the SPC role in establishments where there is more than one SPC. In other establishments, the SCT leader may nominate a member of staff to undertake the role, with whom the SPC can work in close co-operation.

 

1.13     ACCT Trainers (includes POELT Suicide Prevention Trainers)

 

1.13.1    ACCT Trainers must have attended the ACCT Training for Trainers course and will need to maintain a contemporary knowledge of safer custody good practice and policy.

 

1.13.2    For information about training in delivery of adult education courses see TDG website.

 

1.14     ACCT Assessors

 

1.14.1  ACCT Assessors must be volunteers, selected in accordance with Annex 1A2 - Competences for Assessors and must have successfully completed the training for ACCT Assessors (see Annex 8G – ACCT Training Chart). Grade/role is not important when selecting Assessors (they can be any grade), it is their personal skills that matter; establishments can make good use of all staff available, for example, instructional and probation officers, nurses, chaplain, and psychologists, as well as prison officers. See Annex 8BB – Guidance on Establishing and Maintaining a Team of ACCT Assessors

 

1.15     ACCT Case Managers

 

1.15.1    ACCT Case Managers must be minimum grade of Senior Officer or Nurse Band 5 and have successfully completed the training for ACCT Case Managers (see Annex 8G – ACCT Training Chart).

 

1.15.2    Officers who have passed their substantive Senior Officer JSAC and who are on temporary promotion will require ACCT Case Manager training prior to taking Case Manager duties.  Officers who may have been on temporary promotion to Senior Officer and reverted, cannot act as a Case Manager once temporary promotion ceases.

 

1.16     Safer custody administrative support

 

1.16.1  An effective local safer custody strategy requires that ACCT Assessors, ACCT case managers (who most often are unit managers with many other calls on their time), the SCT Leader, the SPC and the VRC have administrative support. For example, experience has shown that without such support case managers find it difficult to ensure that attendance at ACCT case reviews is truly multi-disciplinary, or that all relevant documentation is available when needed.

 

1.16.2  Equally importantly, staff undertaking safer custody administrative support duties also have a valuable role to play around obtaining and sharing risk information with other agencies (and within the establishment), particularly upon prisoner transfer or discharge (see Chapter 14).

 

1.16.3  The above issues (ensuring timely assessments, full attendance at reviews and meaningful information sharing within the establishment and with other agencies) are fundamental to the safety of prisoners. Ultimately, the SCT leader will need to confirm the job description(s) - and number of hours needed - of staff undertaking safer custody administrative support duties that are most appropriate for that establishment. In deciding this, it will be helpful to consider the results of the assessment made by the local Senior Management Team of the level of self-harm risk at the establishment (see 1.7.5 above).The key elements of the duties are set out in Annex 1A.

 

1.16.4  All staff undertaking safer custody administrative support duties (even if they do not come into regular contact with prisoners) must have a good understanding of ACCT procedures and therefore be trained to at least ACCT case manager level.

 

1.17     Prison Intelligence Officer (PIO)/Police Liaison Officer (PLO)

 

1.17.1  Whilst many of the PIO/PLO duties will be in respect of criminal/security related intelligence and about risk to others, they can also have an important impact on the effectiveness of sharing information about risk of suicide/self-harm with the police.

 

1.17.2  The PIO/PLO must be asked to review annually the local policies and procedures for sharing offender risk-to-self information, including the effectiveness of transferring risk information to the Police National Computer (PNC) and of receiving risk information through the PER and through the PNC.

 

1.17.3  The recommendations of the PIO/PLO following this review must be considered by the next SCT meeting Annex 1D and the response (including any actions taken) noted in the SCT minutes.

 

1.18     Family Contact Officer

 

1.18.1    To encourage the involvement of supportive family members in the care of at-risk prisoners, and to encourage/help prisoners involve those family who can help them (see Case Review section in Annex 8G regarding participants in ACCT case reviews), it is useful for establishments to develop the role of a Family Contact Officer as part of the Safer Custody Team. Examples are included in Annex 7C – Family Support. For support regarding drugs, see the Partners in Reduction Toolkit [Not yet available].

 

1.18.2    The role of the Family Contact Officer is not the same as that of the Family Liaison Officer (who handles issues around deaths in custody). As much of their work is to assist in family input to ACCT CAREMAPs, Family Contact Officers must be trained to at least ACCT Case Manager level.

 

1.18.3    It is for each establishment to develop this role (full or part-time) based on the level of risk of self-harm amongst their population. The Scottish Prison Service (SPS) has been working on this role, and the SPS has provided examples of a Family Contact Officer Job Description – Annex 7C2, a paper on the SPS family initiatives – Annex 7C3 and Keeping in Touch: The Case for Family Support Work in Prison [Not yet available].

 

CHAPTER 2: STAFF-PRISONER RELATIONSHIPS AND THE PRISON CULTURE

 

Link to Standard 60

 

2.1       Prison culture

 

2.1.1        Prisons may build up over many years their own culture, which can determine through custom, attitudes and language, the way in which 'things are done around here'. Sometimes the culture in a prison is not homogenous across all staff, for example, not all staff agree on how prisoners should be treated. Research carried out to evaluate the Safer Locals programme found that the prison culture where suicide prevention was most effective was characterised by: staff felt valued, communication was good, prisoners felt safe, and there were good staff relationships with senior managers, who were approachable and supportive. In contrast, some prisons had a ‘traditional’ or negative culture, where staff relied on overuse of authority, distanced themselves from prisoners, and expressed distrust between uniformed and specialist staff groups. The quality of care for prisoners in these prisons was reduced.

 

2.1.2        Governors and Directors can foster the positive culture where suicide prevention is most effective by such initiatives as joint (cross-grade) training, involving all disciplines in crucial processes (e.g. reception/induction and sentence planning) and multi-disciplinary representation on senior management teams. This may be a long-term process, but it can be reflected in the here and now by making effective the local ‘Teamwork’ aspect of ACCT, i.e. through ensuring cross-grade and multi-disciplinary involvement in care-planning, and through meaningful information sharing.

 

2.1.3        Staff in selected local prisons reported that having a full-time Suicide Prevention Co-ordinator had raised general awareness of the importance of suicide prevention, and had improved the processes in place to support prisoners; hence the emphasis in chapter 1 on all prisons having a Suicide Prevention Co-ordinator.

 

 

2.2       Staff-prisoner relationships

 

2.2.1        Prisoners emphasise the value of having a member of staff listen to them and take their problems seriously. Interviews with suicidal prisoners confirm that staff who take time to help them are greatly appreciated. In particular, several prisoners who had attempted suicide talked about how they wanted staff to talk to them and engage with them, not just to observe them.

This is one of the areas of work that the key worker or personal officer are so important; see Annex 9D – Key workers (and equivalents).

 

2.2.2        The importance of staff attitudes to prisoners who are suicidal or self-harm is also highlighted by the evaluation of the Safer Locals programme. Prisons in which a higher proportion of staff viewed suicide attempts as ‘manipulative’ had higher levels of prisoner distress, linked in turn to higher suicide rates over time.

 

 

2.2.3        It is important that all staff working with prisoners receive training and support in understanding and caring for prisoners and working with them to address problems, including the importance of non-judgemental staff attitudes to prisoners who self-harm, and the use of formal care planning processes (e.g. ACCT) when appropriate. See Annex 8G2 – ACCT Training Chart for training requirements, and Chapter 8: Planning and providing care for prisoners at-risk of suicide and/or self-harm. Annex 1E - Staff Support and Annex 9J – Assessor Support

 

2.2.4        It is good practice for prisons to develop personal officer schemes. These schemes allow prisoners to have an identified officer as a first point of contact; see Annex 9D – Key workers (and equivalents). Developed schemes may see officers involved in a range of sentence planning and more in-depth welfare orientated work which may involve liaison with external agencies and the prisoner’s family. Such schemes clearly have benefits in establishing and developing relationships and could be seen to be at the heart of a healthy prison culture. In Local prisons, though schemes may be difficult to maintain due to the transient nature of the population, they can still contribute to the care of at-risk prisoners, and help to reduce rates of self-harm.

PSO 2300: Resettlement – paragraphs 5.4-5.5

PSO 4950

Regimes Standard KAB 12

 

2.3       Staff supervision and support

 

2.3.1        There is some evidence that establishments that provide good support to staff after an incident of suicide or self-harm experience lower staff stress levels.

 

2.3.2        PSO 8150 - post incident care for staff and PSO 2710 – Follow Up to a Death provides instructions to prisons on providing support to staff after a death in custody, and recommendations have also been produced on what kind of support is likely to be helpful following a self-inflicted death in custody. The local suicide prevention and self-harm management strategy must cross-reference throughout to support mechanisms (local and national) for staff.

 

 

2.3.3        Dealing with suicide attempts, or other serious incidents of self-harm, can be as stressful as dealing with a death. It is therefore also important to consider the needs of staff working with prisoners engaged in ongoing, severe and/or repetitive self-harm.

 

2.3.4        Safer Custody Teams must organise regular (at least annual) consultation with staff working in areas of high self-harm, to identify their support needs and implement appropriate action. Local Care Teams must be involved in this consultation process. Annex 1D - Safer Custody Team

 

2.3.5        All staff working with prisoners who are suicidal or who self-harm must be provided with information on the Staff Care and Welfare Service and/or equivalent services (e.g. Care First), as well as Samaritans.

 

2.3.6        In line with Annex 1B – local strategy, establishments must also have formal support mechanisms for ACCT Assessors that provide for at least quarterly Assessor team meetings formal support mechanisms in place for ACCT Case Managers, and for staff and their managers who supervise prisoners who self-harm. Staff support is further referred to at Annex 1E and Annex 9J

 

 

CHAPTER 3: PRE-PRISON AND TIME AT COURT

 

Link to Standard 60

 

3.1       Introduction

 

3.1.1        It is well established that the early period in custody is a particularly high-risk time for suicide. In recent years about a third of self-inflicted prisoner deaths involved a prisoner in their first month in custody. Lack of consistent care or failure to put the prisoner at ease not only adds to the risk whilst in that agency’s care, but also when they are in the next agency’s care.

 

3.1.2        Ideally, those managing prisoners in early custodial locations should seek to target and commence meaningful care for at-risk prisoners before they have even reached prison or approved premises (or released). The time spent by prisoners in court cells is both a vulnerable time in itself and one that can store up problems for the coming days.

 

3.1.3        Staff awareness of the systems used by other agencies can promote consistency of care. It is good practice for attendance at other agencies’ safer custody meetings to be built into staff career development as part of their performance management Chapter 4. Staff awareness can also be raised by police and court custody officers, prisons reception and first night staff visiting each others’ working environments.

 

3.2       Establishment local cross-agency strategies

 

3.2.1        Establishments must have a local policy for sharing prisoner risk of self-harm information with other agencies, see 1.16 - Safer Custody Administrative Support. To assist prisons staff in developing their local integrated cross-agency strategies – and in understanding how other agencies care for at-risk prisoners – see links to police and courts custody (escorts and Probation) guidance [Not yet available]. To achieve such a cross-agency strategy, establishments will find it helpful to seek Area and Regional advice and support, e.g. from Area and ROMs offices, Health and Social Care in Criminal Justice Programme Leads within the CSIP Regional Development Centres or NIMHE Lead, PECS Area Contract Manager, National Probation Service Chief Officers and Regional Managers Probation and YJB Leads and through Area/Regional PECS Boards and Reducing Re-Offending Action Teams.

 

3.2.2        As part of this strategy it is helpful if establishments provide courts with:

 

(a) Information of use to new prisoners, particularly as reducing prisoner distress related to fears around personal safety is important in reducing suicide risk. See Bristol Booklet [Not yet available] for an example of a prison produced information booklet for prisoners at court.

 

(b) A method (supplemental to the Suicide/Self-harm Warning Form procedures) of directly communicating risk information (from families, staff or others) including contact details - see 3.4.13 (below) and Annex 3C. Also see PSI 25/2002 – The Protection and Use of Confidential Health Information in Prisons and Inter-Agency Information Sharing, the NHS Code of Confidentiality and ‘Safe and Secure’ - Guidance for healthcare staff on information sharing.

 

3.3       Police

 

3.3.1    Police policies may vary across the different Force areas, but in the main should be based on the Police Safer Detention Guidance. The police are also required to use the Prisoner Escort Record (PER) whenever they move a prisoner between locations or transfer them to the care of another agency. Merseyside Police have tested the use of a variation of the Suicide/Self-Harm Warning Form guidance (normally used by court and prisons escorts).

 

3.4       Courts and Escorts Staff

 

3.4.1        Courts custody suites are staffed by the contracted escort companies who also transfer prisoners from the police custody suites to court and from court to prisons. These contracts are managed by the NOMS Prisoner Escort & Custody Services. Management of the actual courts buildings falls to Her Majesty’s Court Service www.hmcourts-service.gov.uk who set out the requirements for courts building in the Court Standards Design Guide [Not yet available].

 

3.4.2        “Escort” staff includes both Prison Service and contracted staff undertaking any prisoner escort duties, and for the purpose of this Order includes staff working in the court custody suites.

 

3.4.3        Guidance on reducing the risk of suicide/self-harm in court is included in Annex 3D and advice that can be advertised at court as available to prisoner families can be found in Courts to Custody [Not yet available], the guide produced by prisoners families and friends.

 

3.4.4        Escort staff must, when taking over responsibility for prisoners, make an immediate check for at-risk status Annex 3B.

 

3.4.5        Escort staff must maintain the PER form they receive with a prisoner (or open one if the prisoner was not already in custody).

PSO 1025 Prisoner escort form

 

3.4.6        Escort staff must not open an ACCT Plan, but where they receive an open an ACCT Plan from an establishment, escort staff must follow instructions on the front and inside front cover, maintain the on-going record and follow the CAREMAP in line with procedures as set out in Annex 8G, also see Annex 3A.

 

3.4.7        Escort staff must open a Suicide/Self-Harm Warning Form whenever they believe a prisoner is at current risk of suicide or self-harm, and complete sections 1 to 6.

Annex 3B.

 

3.4.8        If a prisoner self-harms whilst under escort or at court, escort staff must inform the establishment due to receive the prisoner (once the destination is known) as soon as possible, and record on the PER who they have informed (and when). This is to allow the establishment to prepare for the prisoner’s arrival.

 

3.4.9        As well as noting any incident of self-harm in the PER, if there is a change to the lethality of a prisoner’s method of self-harm whilst under escort or at court, such as a change in the severity of the method to potentially life threatening, escort staff must record details of this on the PER, ensuring it is clearly noticeable, for example in bold or marked by an asterisk.

 

3.4.10    When considering the opening of a Suicide/Self-Harm Warning Form a member of the escort staff must speak to the prisoner. The prisoner must be informed when a Suicide/Self-Harm Warning Form is being opened.

 

3.4.11    Escort staff must detail on-going observations and events on the continuation sheets (Record of Events – box 9 in Part B) of the Prisoner Escort Record (PER).

 

3.4.12    For actions of prison Reception staff upon receipt of an at-risk prisoner see Chapter 4.

 

3.4.13    Systems to encourage other staff at court, e.g. Probation or Court Service, to report risk can be put in place. For an example of an Information Sharing Form for use by for Court Staff; see Annex 3C.

 

3.5       Transfer of risk and care information from Court Custody to Probation Service or Youth Offending Team (YOT)

 

3.5.1    Where an at-risk prisoner released at court is to be under the supervision of the Probation Service/YOT upon discharge, the Offender Manager/YOT worker and also (where the offender is required to reside in Probation Approved Premises) the Approved Premises Manager, must be provided with:

·         either a photocopy of the Suicide/Self-Harm Warning Form, or

·         a photocopy of the final Case Review, CAREMAP, front cover and inside front cover of the ACCT Plan.

Local arrangements – including where (due to lack of photocopying facilities) an alternative system to the above is put in place - must be agreed between escort contractors and the local Probation Area/YOT. These arrangements must also include details of who is to be notified about an at-risk prisoner where there is no representative from the Probation Service or YOT present at court. A model of such an arrangement is available from PECS Contract Managers Link to model agreement [Not yet available]. A record must be maintained to show this has been done. Probation staff have been informed of this arrangement through Probation Circular 35/2006 and YOTs through a YJB document [Not yet available]

Annex 3E - Probation

 

3.6       Transfer of risk and care information from Court Custody where there is no receiving agent

 

3.6.1        Where at-risk prisoners are released either on bail (with no conditions of residence) or with no statutory supervision, it is good practice for escort staff to talk to the individual to see if there are persons in the community likely to be supportive, and whether the prisoner is content for them to be contacted, for example, friends, family, GP, the Community Mental Health Team or the Community Drugs Service. It is recognised that this is very much reliant on the cooperation of the individual at-risk prisoner, and that the level of any sharing of information will depend who is to be contacted, i.e. information shared with the GP will most likely be different to that shared with a friend of the at-risk prisoner.

 

3.6.2        Whilst aimed at prisons discharging an at-risk prisoner, some of the suggestions within the documents in Annex 15D – Suggestions for supporting prisoners at risk from self-harm leaving the establishment where there is no receiving agency may be utilised by escort staff.

 

CHAPTER 4: EARLY PERIOD IN PRISON

 

Link to Standard 60

 

4.1              Introduction

 

4.1.1        Remand and the early period of custody is a time of high risk of suicide and self-harm for the majority of prisoners. It is important to have reception, first night, clinical substance misuse management and induction procedures that provide opportunities to identify and care for those prisoners at heightened risk, and that also provide reassurance to those who – often unknown to staff – may also be at risk.

 

4.1.2        Reception/first night is where prisoners’ fears about what awaits them in an establishment, and about how much support they can expect to solve their individual problems, will be either confirmed or alleviated. It is essential that prisoners pick up a positive message from their reception/first night experience that reflects the wider health of the establishment. Prisoners should feel that the prison environment is responsive and that it is a safe environment in which they will be assisted to cope with the prison experience.

 

4.1.3        While recognising the sometimes intense pressure that reception departments in busy local prisons are under, it is essential that the reception/first night and induction processes should recognise prisoners as individuals. Prisoners are more likely to alert staff or peer supporters to their vulnerability where reception and first night are experienced as a meaningful interaction rather than as processes done to them.

 

4.2              Reception and first night

 

4.2.1        Local policies and procedures must make clear:

a)      That, in addition to security, the guiding principle in management of the reception and first night processes is the duty of care to prisoners.

b)      What are the options available to reception/first night and healthcare staff to keep safe and support those identified at risk of suicide or self-harm upon reception, and how to access any additional care or healthcare, including prescribed management of drug and alcohol withdrawal.

 

See Annex YP1 – Suicide Prevention and Self-Harm Management for Young People and linked annexes for references to young people.

 

4.3              Reception staff

 

4.3.1        Staff in reception should be competent in using ACCT procedures and must be prepared to initiate ACCT procedures themselves, in discussion as necessary with health care staff. See Annex 4A

 

4.3.2        Reception staff should be prioritised for receiving training in Mental Health Awareness and in Substance Misuse.

 

4.4              Prison Reception staff receiving at-risk prisoners

 

4.4.1        When receiving a prisoner with a Suicide/Self-Harm Warning Form, an open ACCT Plan, or a Prisoner Escort Record with the suicide/self-harm warning box ticked, if the reasons for the concern are not clearly documented the Reception Officer should be asking for a verbal handover (i.e. a further explanation).

 

4.4.2        Any difficulties concerning information sharing and Suicide/Self-Harm Warning Form, ACCT or PER procedures in relation to contracted escort or police staff should be forwarded to the Safer Custody Team leader, for discussion at the Safer Custody Team meeting and follow-up with the contractor and/or the appropriate PECS Contract Manager or the establishment Police Liaison Officer.

 

4.4.3        PER, ACCT, Suicide/Self-Harm Warning Form and other documented risk alerts must be entered into the C-NOMIS tag system on the prisoner’s reception into prison.

 

4.5              Receipt of prisoners with a Suicide/Self-Harm Warning Form

 

4.5.1        The receiving Reception Officer must complete section 7 upon receipt of the prisoner. The third (pink) copy of the form must then be retained by the escort staff.

 

4.5.2        The receiving Reception staff must then keep the prisoner safe following local protocols relating to the location, supervision and support of potentially at-risk prisoners pending the reception healthcare screen. It is good practice to ‘fast-track’ an at-risk prisoner to the reception healthcare screen. Whilst it is the practice in many establishments for the decision on whether the risk indicated by the Suicide/Self-Harm Warning Form is current to await the reception healthcare screen, there is no bar to other reception staff opening an ACCT Plan immediately upon reception if they think this necessary.

 

4.5.3        The Suicide/Self-Harm Warning Form will provide one source of information for those completing the reception healthcare screen. Whenever a prisoner arriving in Reception is accompanied by a Suicide/Self-Harm Warning Form, the PER, once seen by the receiving Reception Officer, must be passed with the Suicide/Self-Harm Warning Form to the reception healthcare screener. Once the healthcare screening has been completed the PER can then be returned to that part of Reception other PERs would normally go to at that establishment.

 

4.5.4        Upon receipt of the Suicide/Self-harm Warning Form and the PER the reception healthcare screener must decide, having spoken to the prisoner and considered all other information available, whether to open an ACCT Plan. If the prisoner has self-harmed during the time spent that day (or possibly longer if a new arrestee) under escort supervision, at court, in transit, or while in Police or other custody then the reception healthcare screener must open an ACCT Plan.

 

4.5.5        The top (white) copy of the Suicide/Self-harm Warning Form must then go in the Clinical Record and the remaining (yellow) copy goes in the ACCT Plan if opened. If an ACCT Plan is not opened, the yellow copy must go in the F2052A (history sheet).

 

4.5.6        In establishments with fully functioning C-NOMIS, where there is no F2052A (history sheet) the yellow copy will have to be placed in the core record and a note made in the case notes page.

 

4.5.7        For further information about the Suicide/Self-Harm Warning Form see Annex 3B and ‘Introducing the Suicide/Self-Harm Warning Form – User Handbook for Escort and Court Staff’.

 

4.6              Receipt of prisoners with an open ACCT Plan (or in post-closure phase of ACCT)

 

4.6.1        When receiving a prisoner on an open ACCT Plan receiving staff must immediately check the frequency of conversations and observations requirements, the Triggers box and the CAREMAP, see Annex 3A. The Unit Manager responsible for the prisoner during the first night at the new establishment must ensure arrangements are in place to keep the prisoner safe pending an ACCT Case Review - which must take place within 24 hours of the prisoner’s arrival – and (if one has not already been appointed) appoint a case manager Annex 8G. The Unit Manager will also need to decide whether to arrange an ACCT assessment for the prisoner (if so, to take place within 24 hours of the prisoners arrival), e.g. if the transfer is not part of the CAREPLAN, but made for other reasons not necessarily welcomed by the prisoner.  

 

4.6.2        When receiving a prisoner in the post-closure phase of ACCT (i.e. the ACCT Plan has been closed, but the final post-closure review has not been signed off) the receiving Reception Officer must pass the closed ACCT Plan to the reception healthcare screener, and keep the prisoner safe following local protocols relating to the location, supervision and support of potentially at-risk prisoners pending the reception healthcare screen (see below).

 

4.7              Reception health screen and follow-up care

 

4.7.1        An assessment of possible risk of suicide or self-harm will be made by a member of the healthcare team on the day of reception as part of the health screening procedure for all receptions (including transfers and returns from court) and an ACCT Plan opened if necessary. An ACCT Plan must be opened in every case where the screen is positive for current thoughts of self-harm, wherever the prisoner is located in the prison. Location of an at-risk prisoner in a crisis/intensive support or healthcare bed may be helpful, but is not a substitute for opening an ACCT Plan; see chapter 8 and Annex 8Y

Chapter 6 of PSO 0500 (Reception)

Link to Standard on Health Services for Prisoners                            

 

 

4.7.2        When, in cases where the reception healthcare screener having interviewed a prisoner in the post-closure phase of ACCT (i.e. the ACCT Plan has been closed, but the final post-closure review has not been signed off) has decided not to re-open the ACCT Plan, they must pass the closed ACCT Plan to a Suicide Prevention Co-ordinator for allocating to a Case Manager.

 

4.7.3        Where risk is identified, the care identified as necessary to support that prisoner must be provided, see PSO 3050 – Continuity of Health Care for Prisoners. If local facilities or healthcare arrangements do not immediately provide for the identified need, interim care (the nature of which will depend on the individual prisoners healthcare requirements) will need to be provided. Research has shown the importance of the provision of continuity of care in prison and to reducing the distress of recently arrived at-risk prisoners, and concerns have been raised regarding non-provision of specialist support following reception health screening.

 

4.8              Change of status prisoners, failed appellants and recalled prisoners

 

4.8.1        Reception/first night staff must ensure they talk with prisoners (and maintain a record of this) who have:

(a) Had a change of status (convicted, sentenced, placed on Escape list and/or re-categorised upwards) or

(b) Had a court appeal rejected, or

(c) Had a change in immigration status, or

(d) Been recalled to prison,

keeping in mind the suicide and self-harm risks associated with such prisoners. These prisoners will also be seen by the reception health screener; see PSO 0500 - Reception Chapter 6 and PSI 2006/016 - recalled prisoners

 

4.8.2        Local policies and procedures must make provision for prisoners who have had a change of status or court appeal rejected, or had a change in immigration status, but who have not had to leave the establishment, e.g. been on a video link to court, to undergo the equivalent of a reception screen to assess for risk of suicide or self-harm. PSO 0500 - Reception Chapter 6

 

4.8.3        Where there has been a change of status or the prisoner is a failed appellant or has been recalled, Reception staff must inform the appropriate wing staff, i.e. those who will take responsibility for the prisoner.

 

4.8.4        Local policies and procedures must ensure that - as part of the reception process - checks for previous risk to self are undertaken in respect of all offenders recalled to prison, and that this information is utilised as part of the risk assessment prior to first night ‘lock up’. See ‘Checking for risk in previous custody’ (4.17 below).

 

4.8.5        Reception/first night managers must ensure there are systems in place to make clear which members of staff have responsibility to undertake the above tasks in respect of change of status, failed appellants and recalled prisoners.

 

4.8.6        There is increased risk of suicide and self-harm among prisoners recalled from licences being served in the community. All local prisons must put in place a strategy to respond to the needs of this group of prisoners. Suggestions about what such a strategy would contain can be found at Annex 4L.

PSI 2006/016 - recalled prisoners

PSO 0500 - Reception Chapter 6

 

4.9              Drug/alcohol withdrawal and detoxification

 

4.9.1        There is a significant relationship between drug and/or alcohol withdrawal and suicide, the risk of which may be significantly reduced if people are assessed on reception and provided with effective needs based treatment commenced on the day of reception.

 

 

4.9.2        Reception/first night staff must be made aware of the suicide and self-harm risks associated with prisoners who have drugs and/or alcohol problems, and what options are available to access specialist drugs/alcohol support or healthcare.

            Annex 4H – Drug withdrawal and detoxification

Chapter 11

Link to PSI 46/2005: Prison Drug Treatment and Self-Harm

 

 

4.9.3        All clinical services should be in accordance with PSO 3550 - clinical services (and be developed in line with the Department of Health guidance which is available at: http://www.nta.nhs.uk/areas/criminal_justice/idts_faqs.aspx. It is essential for safety that prescribing for withdrawal symptoms takes place as soon after reception as possible and does not wait until the next day. See 6.3.

 

4.10          Prisoners charged with offences related to violence against a family member and/or homicide

 

4.10.1    Prisoners charged with homicide are a particularly high-risk group, and within this prisoners charged with homicide against a partner or family member are at an exceptionally high risk of suicide. Reception/first night staff must be made aware of the suicide and self-harm risks associated with prisoners who are charged with offences related to violence against a family member and/or homicide. See domestic violence, domestic homicide & homicide/prisoner suicide statistics [Not yet available]. Care of such prisoners will require close monitoring of trigger points, for example during any trial or around key anniversaries. HMCIP has also emphasised the need to give consideration to potential differences in level of risk-to-self between men and women where charges relate to homicide of a violent partner.

 

4.10.2    Establishments must make provision for additional risk assessments and care to keep safe prisoners who have been charged with domestic violence and/or domestic murder/murder of a family member. Such provision must include ensuring a record is maintained to show what action has been undertaken.

 

4.11          Risk of harm to self and others

 

4.11.1    Where the cell sharing assessment process highlights risk of harm to others as well as harm to self, this twin risk must inform decisions about cell allocation.

 

Link to Cell-Sharing Assessment section of PSO 2750 – Violence Reduction

 

 Link to 8.7: Location and Accommodation

 

4.12          Identifying next of kin and supportive persons outside of prison

 

4.12.1    Establishments are required to try to find out who is next of kin to each prisoner (see PSO 0500 - Reception) whilst taking account of peoples willingness to be contacted; see the Victims Charter; PSO 4400. Additionally, to help develop both individual care plans for at-risk prisoners, and individual offender management pathways to reduce re-offending, it is useful to know who outside of the prison – that the prisoner would want and accept support from - the prisoner thinks would be willing to offer help to them. See Annex 4E – Identifying next of kin.

 

4.12.2    Any contacts the offender has in regards to first night or care support should be input into the case notes module on C-NOMIS. These notes should contain any concerns in regards to the welfare of the offender along with next of kin/ contact information.

 

4.13          Phone contact

 

4.13.1    Prisoners must be given the opportunity to make contact with their family or close friends from reception regardless of their ability to pay for use of the phone. See Reception Standard and paragraphs 2.24-2.26 of PSO 4400 (4) Use of Telephones which sets out how to enable pinphone use at reception and arrange payment. However, it must be ensured that prisoners who are subject to restrictions under PSO 4400, Protection from Harassment Act 1997, are not given access to people they are not allowed to contact.

 

4.14          The safer reception environment and violence reduction

 

4.14.1    For local policies and procedures on maintaining the reception environment and reducing fear and the risk of violence/bullying, and providing reassurance, see PSO 2750 – Violence Reduction and PSO 0500 – Reception. These policies should make particular reference to reducing the potential for intimidation of vulnerable and high profile prisoners, and those charged with sex offences.

            Annex 4B – The safer reception environment

 

4.15          Provision of information and diversionary material

 

4.15.1    Establishments must provide prisoners with information and diversionary material (for example television, radio, reading matter) during reception and first night. See Annex 4C and Annex 4J. Reading material must be available in a range of different languages and formats suitable to the population of the establishment.

 

4.15.2    Prisoners must be made aware of the help that is available to them, what ACCT is, and what they should do if they do not feel safe in prison and how they can report incidents Link to PSO 2750.

 

4.16          Checking for risk in previous custody 

 

4.16.1    Local policies and procedures must ensure that as part of the reception process:

·               All new receptions are asked whether they have been in prison before and if so whether they were ever on an ACCT Plan or F2052SH (the system replaced by ACCT)

·               LIDS/C-NOMIS, OASys/ASSET, and the PER are all checked for risk information

·               Any information from the above is utilised as part of the risk assessment prior to first night evening roll check (or for late arrivals before they are locked up for the night).

Until NOMIS is fully operational establishments may find that IT systems (LIDS) do not provide a full record of ACCT Plans or F2052SHs opened during a new prisoner’s previous period in custody. This should not detract from obtaining as clear a picture as possible of the prisoner’s risk history (and the care provided to lessen that risk). OASys and the PER are included as OASys may hold risk of harm information from previous times under Probation care or in prison, and any suicide/self-harm risk warning on the PER may refer to a warning carried over from a prison’s notification of self-harm to their local PNC Bureau.

 

4.16.2    Where a new prisoner has been on an ACCT Plan or F2052SH during a previous period in custody, these must be obtained as soon as possible to help inform care planning decisions by the wing manager responsible for that prisoner. A record must be maintained to show this has been done.

 

Receiving, recording and passing on information about risk from external sources

 

4.17          Other sources of risk information or assistance concerning prisoners

 

4.17.1    Agencies and individuals outside of prison can help with warnings, assessment and referral. Establishments must have in place robust systems for receiving and recording, and passing to the area of the prison where the prisoner resides, information coming into the establishment from families, agencies, Offender Managers/Supervisors and other parties outside the establishment who have a concern for a prisoner who may be at risk of self-harm or suicide.

Annex 4D – Sources of risk information or assistance concerning prisoners Some prisons have set up at-risk hotlines which are dedicated phone numbers for use by family members, friends and prisoners to telephone and inform an establishment that one of its prisoners may be at risk of harm – be it self-harm, harm from others, or harm to others.

 

4.17.2    The C-NOMIS virtual teams concept should be utilised and put into place to enable the sharing of information across agencies. See also 4.12. Where information needs to be shared outside of the establishment; follow procedures set out in Chapter 14 - Discharge and Resettlement.

 

4.17.3    It is also important that where persons outside the prison are supportive of a prisoner identified as at risk, this information is retained in the ACCT Plan (unless there are reasons not to, e.g. a request for confidentiality). This will help better facilitate discussion with the prisoner about who from the community can support their CAREMAP.

 

4.18          First night

 

4.18.1    Establishments must have policies and procedures in place to provide for safer custody during first night.

Annex 4F – First Night

Annex 4K – Checklist for Safer Custody before a prisoner is locked up for the first night

PSO 0500 - Reception

PSO 0550 - prisoner induction

 

4.19          Induction

 

4.19.1    Establishments must have policies and procedures in place to provide for safer custody during induction. These policies and procedures must include ways of ensuring that prisoners who are initially located in the healthcare centre or detoxification unit or segregation access their full induction when they are fit for normal location.

Annex 4G – Induction

 

4.20          Remand

 

4.20.1  Assisting the provision of timely pre-sentence reports by for example, smoothing access of Probation staff, and assisting the timely booking of legal visits, can help move remand prisoners – a high risk of harm group, see research & statistics [Not yet available] - through the system quicker. 10 day target information from BRPG [Not yet available]. Increasing the use of court video linking facilities can also help reduce prisoner distress.

                                                                                                            

CHAPTER 5: POSITIVE REGIMES AND PURPOSEFUL ACTIVITY

 

Link to Standard 60

 

5.1       Introduction

 

5.1.1    Positive regimes are those which enable prisoners to engage in activities which reduce distress and potentially reduce rates of suicide or self-harm, for example through improving mood and increase coping skills and self-esteem. Potentially helpful activities include work, education, structured programmes, art and exercise.

           

5.1.2    It is recognised that prisons vary in the types of activity that can be provided, due to physical environment, resources and population requirements. Prisons therefore need to plan a regime that is realistic and provides for both time out of cell and in-cell occupations. It should also be noted that prisoners who are most vulnerable may be the most difficult to engage in activities initially and will need support and encouragement to do so. The evidence for the importance of purposeful activity is as follows:

 

5.1.3    Independent research has indicated that at prison level, lower rates of self-inflicted deaths over time are associated with higher rates of purposeful activity, even when the type of prison is taken into account.

 

5.1.4    The evaluation of the Safer Locals programme found that vulnerable prisoners were significantly less distressed in those prisons where they had less time in cell, higher levels of employment and offending behaviour programmes, and where association was less frequently cancelled.

 

5.1.5    Interviews with suicidal and self-harming prisoners confirm their view of the importance of having ‘something to do’ as an alternative to self-harm.

 

5.2 Management of Positive Regimes

 

5.2.1    Establishment’s must have in place a system to monitor and review regime provision that reports to a member of the SMT at least quarterly. The aim is to identify any concerns around prisoner distress and wings, units, or categories of prisoner with lower levels of activity than the rest of the prison. This may be undertaken by the local Business Management Unit or equivalent. Indicators in such a risk monitoring system can also include:       

·         The number of times classes or association are cancelled, or (separately) number of times operational difficulties prevented delivery of prisoners to classes or work,

·         The number of prisoners taking part in formal programmes,

·         The number of hours of gym or exercise available, and

·         The number of prisoners with access to in-cell activity.

Where it is determined that the individual needs of prisoners are not being met the Governor or Director must ensure that a remedial action plan is drawn up and acted upon.

 

5.2.2    Unit managers must ensure that when out of cell activity for an at-risk prisoner is cancelled or reduced, and at times when at-risk prisoners are locked up, in-cell activities (not just television) are provided, or record the reason for any non-provision. Activities must be available to all at-risk prisoners regardless of location or status, including those on Segregation or in special accommodation (unless this is not possible for reasons of safety, in which case the reasons and how it is planned to move to a point where the prisoner can undertake in-cell activities, must be recorded in the ACCT Plan). Examples of prisoners’ access to activities to carry out when locked in their cells include the use of activity boxes in several prisons. Resources such as art materials, puzzle books, hobby kits, relaxation tapes are provided in a box on each wing, so that prisoners can select materials to use each day.

 

5.2.3    Any prisoner on an ACCT Plan must have an entry in their CAREMAP outlining how appropriate and suitably risk-assessed in and out of cell activity will be provided, see the section regarding ACCT Case Reviews in Annex 8G. Where there are reasons why the case review consider such an entry in the CAREMAP inappropriate to an individual case, they will need to evidence this in the ACCT Plan.

 

 

CHAPTER 6: SPECIALIST SERVICES AND COMMUNICATION WITH STAFF

 

Link to Standard 60

 

6.1              Introduction

 

6.1.1        There are strong links between self-harm and mental ill health, drugs/alcohol problems, and experience of abuse. Other problems such as bereavement and, especially for women, the loss of children to the care system are common causes of distress to prisoners. All are issues that staff caring for prisoners need to be aware of and watch for; both in terms of the related risks to the prisoner, and around what specialist support is available to help the prisoner. Also, the often repeated findings from PPO investigations into deaths in custody and HMIP reports cannot be emphasised enough, concerning the need for healthcare staff to share risk and basic care information with discipline staff who manage a prisoner. See PSI 25/2002 – The Protection and Use of Confidential Health Information in Prisons and Inter-Agency Information Sharing, Annex 8V – Communication and Teamwork and ‘Safe and Secure’ - Guidance for healthcare staff on information sharing and Guidance on the Management of Drug Using Offenders for Probation, CJITs and CARATs [Not yet available].

 

6.2       Health and mental health services

 

6.2.1        The prison population contains a high proportion of people with one or more psychiatric disorders known to increase the risk of suicide and self-harm.

See Annex 6A for statistics on the prevalence of mental and other disorders among male adult, women and under 18 prisoners

 

6.2.2        Research in prisons shows that the best care for prisoners with mental disorders is provided when mental health services are well integrated into the mainstream prison and prisoner-patients benefit from joined up care provided by mental health specialists, primary mental health staff and prisons staff, including residential officers. HMCIP has also stressed the benefits of mental health workers working with those with lower levels of mental health problems, rather than exclusively with those with severe problems. See the briefing on Quality of Mental Health Provision - Care of at risk Prisoners evaluation. Dual Diagnosis covers a wide range of problems incorporating mental health disorders and substance misuse. The relationship between them is complex and should be regarded in treating either.

 

6.2.3        It is expected that mental health services in prisons should be commissioned and provided in line with ‘Changing the Outlook: a strategy for developing and modernising mental health services in prisons’.  The required standards for all mental health services are set out in the National Service Frameworks for Mental Health in England and Wales.  Women’s prisons must also take account of gender differences as described in Mainstreaming Gender and Women’s Mental Health.  The Offender Mental Health Care Pathways document in England, and the Prison Mental Health Pathway document in Wales (available on request from mentalhealthpolicymailbox@wales.gsi.gov.uk) provides best practice templates to guide providers and commissioners on mental health services for offenders.

 

6.2.4        The quality of the establishment / PCT partnership is crucial to success in developing an effective suicide prevention and self-harm management strategy. PCTs have responsibility to commission prison healthcare services, so have an impact on staffing levels and the priority given in terms of internal staff time, as well as funding external specialist participation. Guidance on Partnership Agreement issues that may particularly impact on safer custody can be obtained from the Area Safer Custody Adviser. Prison and PCT responsibilities are referred to at paragraphs 3.18 and 3.19 of the National Partnership Agreement (January 2007). Paragraph 3.17 deals with dispute resolution: “Where issues cannot be resolved by the Partnership Board they should be referred to the SHA/Area Office.”

 

6.2.5        It is not expected that prisoners in a low category establishment at risk of suicide or self-harm will be automatically be transferred to a higher category establishment. Consideration needs to be given to what access to health and mental health (and other support) can be provided at the current establishment, and the impact of transfer on the prisoner. See Annex 6C for examples of how establishments have developed ‘joined up’ care with mental health specialists working closely with other prison staff.

 

6.3       Drug and Alcohol Services

 

6.3.1        People undergoing withdrawal from drugs and/or alcohol on their arrival to prison (as well as those who have recently undergone withdrawal) are at appreciably higher risk of suicide and self-harm. This risk can be significantly reduced when need is identified at reception, followed by assessment and starting needs based treatment on the night of reception. Also see chapter 4 concerning Reception.

 

6.3.2        To ensure continuity of care, NOMS has in place a comprehensive Drug Strategy, one element being a robust treatment framework. Custodial drug ‘treatment’ extends beyond drug rehabilitation programmes and incorporates: i) clinical services (maintenance prescribing and/or detoxification programmes available in all local/remand prisons and, ii) CARATs (counselling, assessment, referral, advice and throughcare services) provided in all prisons. Harm minimisation is an integral part of the advice CARATs offer and is designed to reduce the harm caused by drugs (including drug-related deaths.)  

 

 

6.3.3        Supporting prisoners to deal with mental health, substance misuse and other problems such as abuse and bereavement can reduce their distress and prevent a suicidal crisis. Where a suicidal crisis has been reached, addressing these associated problems forms a key part of the ACCT CAREMAP. Also see PSI 46/2005 – Prison Drug Treatment & Self-Harm regarding the key actions to be taken to ensure that any tendency to self-harm is taken fully into account during assessment of suitability for drug treatment.

 

6.3.4        All establishments, NHS PCTs and Local Health Boards with publicly funded prisons in their areas must have a strategy in place to provide adult clinical drug and alcohol misuse services, which are in accordance with PSO 3550: Clinical Services and be developed in line with the Department of Health guidance document, Clinical Management of Drug Dependence in the Adult Prison Setting. For prisoners under 18 years old, clinicians’ attention is drawn to Guidance for the detoxification and pharmacological management of substance misuse among young people in custody [Not yet available].

 

6.3.5        Establishments (and their PCTs) that are part of the Integrated Drug Treatment System programme must have a strategy in place to provide clinical drug and alcohol misuse services in line with the Clinical Management of Drug Dependence in the Adult Prison Setting. Building on the existing framework, enhanced support is being made available to drugs users through the Integrated Drug Treatment System (IDTS). IDTS will help to improve the quality and volume of clinical services and psychosocial (CARATs) support for drugs users with an emphasis on the first 28 days in custody.

 

6.3.6        Establishments must have a policy, agreed between the Residential Manager, the Substance Misuse Service Manager and Healthcare Manager, for how prisoners known to be suffering from withdrawal (including alcohol withdrawal) should be managed in order to reduce the associated risk of suicide and/or self-harm. The policy must cover all units where prisoners known to be withdrawing are located, both dedicated units and ordinary wings. This policy should cover aspects of ordinary management by residential staff, training of residential staff and communication between residential and specialist staff. It is not expected to cover clinical aspects of care. The Alcohol Treatment/Interventions Good Practice Guide 2004 contains a reference guide for prison and healthcare staff intending to deliver alcohol treatment interventions. It also offers a treatment framework, a structured model of how to organise the range of problems appropriate to tackling alcohol problems. It should also be linked with the existing drug strategies in each establishment. Also see Annex 6B- Safe management of prisoners withdrawing from drugs/alcohol.

                                                                 

6.4       Prisoners with histories of abuse

 

6.4.1        Many prisoners have an increased risk of suicide or self-harm linked to past physical, emotional and/or sexual abuse. Because of this link, some prisoners disclose that they have been abused to staff (such as ACCT Assessors and others) who are talking with them about their self-harm.

 

6.4.2        To determine the level of need in this area (and resource implications if it appears there is considerable unmet need) it is good practice for Governors and Directors to develop a system to collate over time from ACCT Assessors, and other staff, the number of prisoner who disclose abuse to them. A report based on this information can then be considered by the establishment’s Safer Custody Team, and where this monitoring reveals that disclosures are occurring, Governors and Directors can seek to negotiate with their PCT (and Mental Health Trust) a strategy to support prisoners who disclose that they have been abused. Such a strategy could include the following:

·         How the relevant staff are trained in how to respond to the disclosure. There is a short module in ACCT Assessor training, but if disclosures are very common and/or staff other than Assessors are involved, training for non-Assessors will be beneficial.

·         That the system that provides on-going support to ACCT Assessors is sufficiently robust to deal with this issue.

·         Consideration of options for providing follow-up support and, where appropriate, therapy to prisoners who have disclosed abuse.

·         Account of child protection policy, see Annex YP8 - Child Protection Considerations

·         Account of police involvement where requested.

 

6.4.3        In this area of work account will need to be taken about concerns relating to the possible volume of any unmet need amongst the prisoner population, the resources available to cope with disclosure, and the limited support information currently available on this subject (particularly in respect of the male population).

 

Also see Section 12.1 and Healthcare staff should reference NHS Trust responsibilities regarding women who are abused.

 

6.5              Providers of specialist services and ACCT

 

6.5.1         Where an ACCT Assessment identifies a likely problem with mental illness, substance dependence, abuse, bereavement or other problems causing distress contributing to the suicidal crisis, every effort should be made to refer the prisoner, with their agreement, to an appropriate service. Governors and Directors must ensure that a system is in place to keep ACCT Assessors and Case Managers regularly updated with information about the specialist services that are available in the establishment.

 

6.6       In-Possession medication

 

Issues concerning prisoner safety and in-possession medication, for example, a multi-agency (healthcare and discipline) approach to ACCT case reviews to ensure at-risk prisoners do not have in their possession medication that they might use to kill themselves, and risk assessing prisoners prior to their getting in-possession medication that could be used by them or their cellmate (where known) as a means to suicide, are issues establishments will refer to in their local Partnership Agreement.

 

6.6.1        Establishments’ local searching strategy must be linked to the local in-possession medication policy, and make clear that Discipline staff must inform Healthcare staff when excess medication is found in cell searches. Healthcare staff will then be able to reassess the risk.

 

CHAPTER 7: PEER AND FAMILY SUPPORT, SAMARITANS AND TELEPHONE HELPLINES

 

Link to Standard 60

 

7.1              Introduction

 

7.1.1        Effective peer support can contribute to suicide prevention strategies by helping to create a safe, decent and healthy environment with positive prisoner/prisoner and staff/prisoner relationships, where problems can be voiced and addressed and anxiety alleviated. For this reason there are a number of peer support schemes run specifically by prisoners for prisoners. For further information on peer support including the role of Samaritans and Samaritan-supported Listeners, see the guidance document at Annex 7A and Annex 7B.

 

7.2       Samaritans and Listeners

 

7.2.1        Establishments must make sure that prisoners:

·         Are advised of the existence and availability of Listeners, other peer supporters and Samaritans.

·         Have timely access to Listeners in establishments where these schemes operate (regardless of the prisoners location).

·         Have the facility to contact Samaritans by telephone privately, preferably by means of a direct, dedicated line or pre-programmed cordless phone. This should be at no cost to the prisoner.

·         The same facility must also be made available to Listeners needing to debrief after a call-out, or needing confidential support.

 

7.2.2        It is not appropriate to ask young people under the age of 18 to take on the responsibility of offering confidential emotional support to other young people. Samaritans do not train young people under the age of 18.  A statement [Not yet available] sets out the Samaritans policy on working with young people and the interface between their work and Child Protection Protocols.

 

7.2.3        No prisoner can take on the role of both Listener and Insider. For an explanation of both these peer support schemes see Annex 7B - Guide to Peer Support.

 

7.2.4        When a prisoner, who has been identified as either medium or high risk on the cell sharing risk assessment, requests to see a Listener, staff must make a risk assessment on a case by case basis, considering the specific aspects of risk, to decide whether or not the Listener(s) can offer support to the prisoner. In some cases it may be considered appropriate for two Listeners to be present.  If it is decided that the prisoner should not be given access to a Listener, additional support such as the Samaritans phone must be offered. Also see PSO 2750.

 

7.2.5        The work of Samaritans, and of the Listeners they train and support, is an integral part of NOMS’ safer custody strategy.

 

7.2.6        All members of the Suicide Prevention Team and the Care Team must have copies of the document attached to this PSO at Annex 7A, incorporating ‘The Role of Samaritans and Samaritan-supported Listeners’. The guidance document at Annex 7B must also be made available to all staff.

 

7.2.7        Prisons and Samaritans branches are encouraged to sign an Agreement to Provide Services (APS), which is not legally binding, but expresses intent and clarifies commitment on each side. A model APS is available from Safer Custody Group on request. It is advisable to jointly review the content of the APS each year. For further guidance on setting up an APS, see PSO 4190 Strategy for working with the voluntary and community sector

 

7.2.8        All Listeners, including those located in the Vulnerable Prisoners Unit, must be trained and attend support group meetings together.

 

Understanding confidentiality

 

7.2.9        The principle of total confidentiality is central to the work of Samaritans and this applies equally to their work in prisons, including that of prisoner Listeners.

 

7.2.10    Samaritans allow exceptions to its principle of confidentiality only in the following very specific circumstances:

·         Samaritans and Listeners will not accept a confidence which contravenes the Prevention of Terrorism (Temporary Provisions) Act 1989, since updated to the Terrorism Act 2000, as amended by the Anti-Terrorism, Crime and Security Act 2001

·         Samaritans and Listeners will call for help, without consent, where a contact is attempting to take their own life and has reached a condition where it is clear that they are unable to make their own decision

·         The contact attacks or threatens the Listener

·         The Listener is given information about acts of terrorism or bomb warnings

·         The Listener receives a court order (subpoena) requiring them to divulge the information.

 

7.2.11    Governors and Directors must ensure that all investigators (including police/Coroner’s officers/PPO investigators) looking into the death of a prisoner who want to interview a Listener must do so only in the presence of a Samaritan. It should also be very carefully explained to the investigators, before any interview, that the confidential nature of information shared with a Listener is maintained after death, unless a court subpoenas a Samaritan or Listener.

 

7.2.12    If a Listener is required to attend an inquest, arrangements must be put in place to ensure Samaritans will be available to support the Listener through the hearing. See also PSO 2710 Follow up to deaths in custody

 

7.2.13    Correspondence between prisoners and Samaritans is subject to confidential handling arrangements as set out in PSI 2005/002 Legal and confidential access correspondence and PSO 4400 Prisoner Communications: Prisoners use of telephones.

 

7.2.14    Calls made from prisoners to Samaritans must not be monitored, as set out in PSO 4400 Prisoner Communications: Prisoners use of telephones.

 

Support for Listeners

 

7.2.15    Listeners must be given access to each other and to Samaritans by telephone at no cost to the Listener when they need debriefing and support. Where Listeners schemes are in operation there must be a Samaritans Liaison Officer (see Chapter 1) who can facilitate the provision of support by Samaritans for Listeners. See above regarding support group meetings and debriefing.

 

7.2.16    For information on Listener Support Suites see – Annex 7E

 

Listener transfers

 

7.2.17    Governors need to – wherever possible - ensure that prisoners are put on hold whilst they are training to be a Listener and then, once the prisoner is accepted as a Listener, that they are kept on hold for at least six months. See paragraph 41 of Annex 7A and Annex 1B – Local Strategy.

 

Access to establishments

 

7.2.18    It is essential that staff do everything possible to help Samaritan volunteers make best use of their time and to reduce avoidable delays in entry to the prison.

 

7.2.19    Every effort should be made to facilitate the swift completion of security clearance procedures, the provision of keys and appropriate training.

 

7.2.20    Where circumstances arise which will prevent Samaritans’ entry to the prison, they should be informed as soon as possible.

 

7.3       Other peer support schemes

 

7.3.1    There is an increasing range of Peer Support Schemes where prisoners are trained to offer support and information to other prisoners. They range from a prison wide therapeutic community to individual carers for prisoners with disabilities. The schemes include, Insiders, drug support workers, ‘HOPINS’, Buddies, mental health mentors, CAB advice workers, housing and employment workers, reading tutors and many others. Further information is attached at Annex 7B.

 

7.3.2        Establishments running alternative peer support schemes other than Samaritan-supported Listeners must not use the word ‘Listeners’ in their schemes’ name, as this can lead to serious misunderstanding when prisoners transfer between establishments running different schemes.

 

7.3.3        More generally, adult prisoners can be advised (through induction and locally produced publicity material) how to recognise signs and symptoms of self-harm/suicidal behaviour in fellow prisoners, and encouraged to raise such concerns with a member of staff when they occur. Establishments holding prisoners aged under 18 need to supplement any such advice with clear methods to facilitate them raising any concerns they may have about the well being of other young people.

 

7.4       Insiders

 

7.4.1        The Insiders scheme involves the training of selected prisoner/under 18s volunteers to provide basic information and reassurance to prisoners new to prison shortly after their arrival in prison. The first 24 hours in custody are particularly distressing for many prisoners, particularly those new to the prison system, and the aim of the Insiders scheme is to help reduce the anxiety experienced by prisoners during this vulnerable time.

 

7.4.2        Insiders are not an alternative to Listeners; they offer a different but complementary peer support service. No prisoner can take on the role of both Insider and Listener. It is crucial that Insiders and Listeners understand each other’s role and are able to refer to each other. Further guidance is attached at Annex 7B.

 

7.4.3    Insiders can also work outside at court offering initial information and support to people when they are first remanded or sentenced to custody; see Insiders Guide and Insiders at Court.

 

7.5       Voluntary Organisations

 

7.5.1        There are a wide number of voluntary and community organisations which provide support to prisoners at risk of suicide or self-harm and their families. These outside organisations bring expertise, knowledge and practical support in key areas and can also offer a continuity of services, as these can carry on after a prisoner is released. See link PSO 4190 strategy for working with the voluntary and community sector

 

7.6       Families

 

7.6.1    NOMS recognises that strong support from families and friends can make an enormous difference to prisoners. Families can be vital in helping to support prisoners, particularly those at risk of suicide/self-harm. However, there is often a general lack of understanding amongst families about how to contact the prison if they are worried about someone. Families also express concern that after a visit they often do not know who to tell if they have concerns about a prisoner. Families can provide vital information to prison staff about a prisoner’s well being, particularly if someone is feeling depressed or suicidal.

Annex 7C

PSO 4405 - Assisted Prison Visits

‘Keeping in Touch – the Case for Family Support Work in Prison’ (Prison Reform Trust 2005) [Not yet available] and ‘Reducing Re-Offending: National Action Plan (Home Office 2004)

Intranet: Strategy for Family and Parental Support in Women’s Prisons

Link to Ormiston Children and Families Trust website – ‘Time for Families’

 

Action for Prisoners’ Families

 

7.6.2    Action for Prisoners’ Families (APF) is the national federation of services supporting families of prisoners. APF provides its members with opportunities to participate in a national network that encourages the exchange of knowledge, skills and ideas. This in turn informs both the development of nationally agreed guidelines on good practice in support work with families of prisoners. Further details can be found at http://www.prisonersfamilies.org.uk

 

7.6.3    APF has 110 organisations in full membership and a further 95 supporters. Most of these are either family support groups or prison visitors' centres. A central role of APF is to strengthen the network of prisoners' families' services and help new services to develop. APF has access to a network of organisations who support the families of prisoners.

 

Prisoners’ Families Helpline

 

7.6.4    The Prisoners’ Families Helpline is the freephone National Helpline service (0808 808 2003) co-ordinated by APF. The Helpline provides information and support to anyone with a relative or friend in prison anywhere in England and Wales. The helpline can also advise and assist people who have concerns about someone in prison being at risk of suicide or self-harm. Further details can be found at www.prisonersfamilieshelpline.org.uk

 

7.7       Telephone Help lines

 

7.7.1        Access to telephone help lines is a valuable tool for prisoners. The opportunity to talk to a professional may help reduce distress, thus lowering the risk of suicide or self-harm.

 

7.7.2        It is recommended that each prison offer access to accredited help lines that have offered their services. It is preferable that staff/other prisoners should not be able to overhear a helpline call and that such calls are not subject to time restrictions; though the risk assessment of any such policy needs take account of potential reaction of other prisoners to any reduced use of phones. Also see Annex 7D.

 

7.7.3        Samaritans’ phone number and the phone numbers of all help lines available at an establishment must be displayed by every phone that is provided for prisoners’ use.

 

CHAPTER 8: PLANNING AND PROVIDING CARE FOR PRISONERS AT RISK OF SUICIDE AND/OR SELF HARM

 

Link to Standard 60

 

8.1        Identifying prisoners at risk

 

8.1.1        The training requirements for all staff relating to identifying prisoners at risk and the ACCT process are set out in chapter one and in the chart in Annex 8G See also ACCT Pocket Guide. Also see PSI 46/2005 – Prison Drug Treatment & Self-Harm regarding self-harm risk and assessment of suitability for drug treatment.

 

8.1.2        Requirements relating to the health reception screen can be found in section 4.7.

 

8.2       Actions to take if a prisoner is identified as at-risk (Also see 1.2 – All members of staff)

 

8.2.1        Actions to take if a prisoner is identified as at-risk are set out in Annex 8G which explains the ACCT process. See also ACCT Pocket Guide.

 

8.2.2        The requirements relating to the Suicide/Self-Harm Warning Form (for escort staff) are set out in chapter 3 and at Annex 3B.

 

8.3              Core elements of Care – for all prisoners at risk of suicide or self-harm

 

8.3.1        Core elements of care are the basics that should be reflected in the CAREMAP for all prisoners-at-risk, both those thought to be actively thinking of suicide and those whose self-harm is not thought to be suicidal in intent. These are referred to in the section on the CAREMAP in Annex 8G

 

8.4       Additional care for prisoners who self-harm repeatedly without current suicidal intent

 

8.4.1        Prisoners harm themselves for many reasons, not always with suicidal intent. For many people, self-harm is a way of managing distress, blocking out painful and traumatic memories, alleviating anxiety or dealing with anger. Self-harm may be used as a coping strategy when common means of managing distress (e.g. use of alcohol or drugs, support from family & friends) are not available. Prisoners may also be unclear or ambivalent about their motives for serious self-harm.

 

 

8.4.2        A list of strategies (alternatives to self-harm) that have worked for some people who self-harm is provided below. Staff should customise this for their establishment before using it with prisoners. It is important that the person who self-harms feels they have some choice and control.

 

8.4.3        Wherever possible, a member of staff (ideally the key worker or personal officer) should be tasked with talking regularly with the individual to offer support and help the individual build awareness of the factors that lead to self-harm, explore alternatives and encourage motivation to reduce self-harm. A non-judgemental approach, that recognises that reducing self-harm can be a long-term endeavour, is essential. The aim is to stop the individual from wanting to self-harm. A workbook that can be used to provide structure to these sessions is provided below.

 

8.4.4        The approach to gradually reducing self-harming behaviour must never involve the use of a compact, whereby the prisoner is rewarded for not-self-harming and punished for self-harming.

Annex 8DD – Compacts

 

8.4.5        Establishments must not provide self-harming prisoners with materials to harm themselves more ‘safely’ (e.g. sterilised blades), nor provide encouragement to ‘safer’ self-harm. Staff may wish to discuss with prisoners, particularly those with a long history of self-harm, the use of activities which mimic the sensation or appearance of self-harm without actually causing injury, such as elastic bands, red pens or ice cubes. Any such safe alternatives to self-harm offered to prisoners must be assessed and monitored on an individual basis as part of the ACCT procedures. This is in addition to providing distractions from self-harm (e.g. relaxation tapes, drawing books).

 

 

8.5               Keeping safe: Additional care to keep safe prisoners who are believed to be thinking about or planning suicide

 

8.5.1    For the great majority of people, suicidal crises are short-term and pass quickly, but occasionally this is not the case. Firstly, there are people who experience suicidal crises repeatedly. Secondly, there are those small number of individuals who rationally announce, often soon after reception, that they have no intention of seeing out their sentence. For guidance on how to manage prisoners whose heightened risk of suicide is long-term, see Annex 8EE – Prisoners who present a chronic risk of suicide.

 

8.6               Location and accommodation

 

Location to provide increased interaction, support and activity (Also see Annex 1B - Section on: Accommodation, supervision and support)

 

8.6.1        The type of accommodation required for at-risk prisoners cannot be prescriptive, as much will depend on the facilities available in establishments. Double cells, constant supervision (gated) cells, safer cells, CCTV, open wards, dormitory accommodation, and Listener Support Suites – Annex 7E are examples of facilities that can be used in the care of prisoners.

Chapter 10 – Built environment

Annex 8E – Summary of Safer Cells Evaluation

Annex 8C – Description of a care suite in HMP Drake Hall

 

8.6.2        At-risk prisoners should not be isolated and should be kept in association wherever possible. When deciding on where to locate an at-risk prisoner, consideration needs to be given to:

·         Whether the prisoner should be on a residential unit, healthcare centre or a specialist unit. Crucial considerations include:

o        health and mental health need

o        impact of any detoxification Link to PSI 46/2005 – Prison Drug Treatment & Self-Harm

o        PCT admission policies, as agreed with the Governor in the local SLA

o        levels of healthcare provision on the wing

o        the degree of risk and the level of support (not just supervision) available

o        the level of operational support required in the healthcare centre if the prisoner is considered to be a danger to others

·         How the individual can better be made to feel safe, comfortable and relaxed

·         What opportunities will there be for interaction

·         Whether access to daytime activities in a supportive environment is possible

·         Is provision for conversation at night required

·         Whether when locating at-risk prisoners in adjoining cells there are risks associated with one or both prisoners encouraging self-harm in the other.

 

Cell-sharing for at-risk prisoners

 

(For policy on young, at-risk prisoners sharing a cell/room, see Annex YP1 – Suicide Prevention and Self-Harm Management for Young People)

 

8.6.3        The doubling-up of an at-risk prisoner with a cellmate can help to reduce feelings of loneliness and provide both with someone to talk to. Cellmates can also inform staff if they are particularly worried about their companion.

Annex 8GG – Cell-Sharing

 

8.6.4        When considering where to locate an at-risk prisoner consideration must be given to whether the prisoner will benefit from allocation to shared accommodation. Account must be taken of whether:

o        Shared accommodation is available (this may be particularly relevant in the women’s and young people’s estates where much of the accommodation is single occupancy).

o        The prisoner presents a risk to others see Cell-Sharing Risk Assessment section of PSO 2750 – Violence Reduction

o        Their behaviour is too disturbing to other prisoners

o        Personal space is particularly important to the prisoner and sharing may increase the risk of distress and self-harm

o        There are friends/supportive relatives within the establishment who the case review believe sharing with would benefit the prisoner.

Annex 8D – Ideas for developing shared cells

 

8.6.5        Decisions about whether an at-risk prisoner should share a cell must be recorded in the ACCT Plan.

 

8.6.6        Where an at-risk prisoner is in shared accommodation, the case review must decide how best to ensure staff are aware of which bed the at-risk prisoner is using (e.g. note on the ACCT Plan cover) and record this decision in the ACCT Plan.

 

8.6.7        It is the responsibility of staff - not cellmates or other prisoners - to keep prisoners safe. Cell-sharing or use of Listeners (or other peer supporters) must not be used as an alternative to staff interaction with an at-risk prisoner, including for conversations or observations.

 

8.6.8        When locating an at-risk prisoner in shared accommodation account must be taken of the suitability of the cellmate, and consideration given of the impact on and ability of the cellmate to cope with the individual situation. The F2052A (history sheet) is a suitable place to document such consideration. Support should be offered to cellmates who have agreed to share with a distressed or self-harming prisoner.

Annex 8AA – ‘Supporting the Supporter’ Good Practice example

 

8.6.9        Two prisoners on open ACCT Plans or in the post-closure phase of ACCT, or a combination of each, must not be located together in a double cell, unless a case review team – having considered the care of both prisoners – decides they will both benefit from sharing with each other. Similar consideration needs to be given where staff are aware that prisoners have recently had an ACCT Plan closed.

 

8.6.10    ACCT Plans must make clear whether provision needs to be made for when an at-risk prisoner in shared accommodation is alone in the cell (e.g. if the cellmate is at education, on a visit or at court, or - in establishments with locked spurs and night sanitation arrangements - likely to leave the cell at night). If such provision is decided as necessary, it must be included in the CAREMAP.

 

8.6.11    In allocating accommodation, consideration must be given to how the prisoner can be given access to other people and to activities if they wish during the day, and this must be included in their ACCT Plan. Options include:

·         Sleeping in a residential area but attending day care area

·         Sleeping in healthcare centre (where there is an identified clinical need) but attending residential unit regime activities

·         Providing a cell change to allow for a more supportive mix of prisoners in the residential unit, taking care to try and keep the person-at-risk away from potential bullying situations.

 

8.6.12    If an at-risk prisoner is allocated to a single cell (including a single ‘safer cell’), additional measures must be put in place to compensate for any added risk involved in the individual being alone, and these must be included in their CAREMAP. Options include:

·         Locating the prisoner in a cell that is easier to supervise by staff

·         Increasing the frequency of staff conversations and observations

·         Combining attendance at work, education or day-centre activities during the day with increased levels of staff conversations and observation when the individual is in his/her cell.

 

Use of safer cells

 

8.6.13    When considering where to locate an at-risk prisoner consideration must be given to whether the prisoner will benefit from allocation to a safer cell or other supportive location, e.g. Listener Support Suites – Annex 7E, and such consideration must be evidenced in the ACCT Plan. Account must be taken of whether:

o        Safer accommodation is available, and if not whether risk of an incident of self-harm is increased or decreased by relocating a current occupant

o        The benefits of moving the individual into a safer cell would be outweighed by possible disadvantages, e.g. loss of contact with supportive peers.

 

Segregation, special accommodation, cellular confinement and basic regime

 

8.6.14    A disproportionate number of prisoners who kill themselves do so in Segregation Units, many of them within 24 hours of being located there. See R&D Briefing on SIDs in Segregation [Not yet available]. It is good practice to ensure there are safer cells also in locations other than Segregation Units, so staff are not tempted (for perceived reasons of prisoner safety) to locate at-risk prisoners in the Segregation Unit.

 

8.6.15    Prisoners on an open ACCT Plan or in the post-closure phase of ACCT (i.e. the ACCT Plan has been closed, but the final post-closure review has not been signed off) must not be located in accommodation (such as a Segregation Unit or special accommodation) that reduces their access to social support, other people, activities and stimulation unless, exceptionally, they are such a risk to others that no other suitable location is appropriate and where all other options have been tried or are considered inappropriate. For definitions of segregation and special accommodation see PSO 1700.

 

8.6.16    Location of an at-risk prisoner in the Segregation Unit must be authorised by the Duty Governor, who must record in the ACCT document that this has been done and the reasons it was considered necessary. Link to Initial Segregation Safety Screen

 

8.6.17    A mental health assessment must be undertaken by Healthcare/Mental Health In-Reach staff of all prisoners on an open ACCT (or in the post-closure phase of ACCT) who are placed in a segregation unit or awarded a period of cellular confinement in another part of the establishment. This must take place within 24 hours.

 

8.6.18    Prisoners who are at risk of suicide or self-harm and are found guilty at adjudication should, wherever possible, have sanctions applied that do not consist of cellular confinement. Adjudicators should normally follow local punishment guidelines (or give reasons for departing from them) when deciding on the appropriate punishment for a disciplinary offence, and take account of the prisoner’s mental health, ability to undergo punishment, and the likely impact on them, in which case they will consider an alternative punishment to cellular confinement, see paragraphs 7.6-8, 7.11-12, 9.9 and10.27 of PSO 2000 - Adjudications. A disciplinary charge in relation to an act of self-harm would be exceptional (e.g. intentionally or recklessly setting a fire). Other sanctions such as a reduction in IEP status are separate from the adjudication system.

 

8.6.19    Where prisoners who are at risk of suicide or self-harm are exceptionally located in the segregation unit, or have been located in a segregated setting elsewhere in the establishment, the additional safety mechanisms outlined in PSO 1700 / PSI 2006/17 - segregation special accommodation and body belts must be put in place. In summary, this is:

·         Detailing on the Initial Segregation Safety Screen the reasons for the segregation of an at-risk prisoner

·         ACCT case review at the earliest opportunity and certainly within 24 hours

·         Observations/conversations to take place no less than 5 times per hour at irregular intervals until the Initial Segregation Safety Screen and the Mental Health Assessment take place (or more frequently if stipulated on the ACCT Plan)

·         Accommodation in a safer cell, wherever possible; consideration of use of CCTV. Note that paragraph 7.30 of PSO 2000 – Adjudications requires prisoners undergoing cellular confinement to be accommodated in an ordinary cell set aside for the purpose (this should not be interpreted as disallowing use of a safer cell), and makes clear this need not be in the segregation unit.

 

8.6.20    There must not be a general ban on Listeners visiting the segregation unit. In establishments with Listener schemes, every effort should be made to allow prisoners held in the segregation unit access to Listeners. Any refusal to allow a prisoner in the segregation unit access to a Listener should be documented, e.g. in the ACCT Plan and the Segregation Log/Occurrence book, giving the reason for the refusal, the prisoner’s response to the refusal, and in the Segregation log/occurrence book the prisoner’s current ACCT status. If a prisoner in the segregation unit is refused access to a Listener, he or she should have access to the Samaritans by telephone instead.

 

8.6.21    Family contact is an important aspect of reducing suicide and self-harm, and PSO 2000 – Adjudications in paragraphs 7.21 and 7.24A makes clear that a prisoner punished by forfeiture of privileges (separately from an administrative IEP review), or by stoppage of earnings, must still be able to buy stamps and PIN phone credits (unless the offence related to their abuse) so as to be able to maintain family contact.

 

8.6.22    Staff should be aware that placing an at-risk prisoner on basic regime (especially if this is for a prolonged time) will heighten risk because of the reduced access to support from family and friends involved in the loss of telephone calls and letters.

 

8.6.23    Where available, the use of alternatives such as restorative justice ought to be considered.

Link to Restorative Justice information [Not yet available]

 

8.7      Conversations and observations

 

8.7.1        ‘Conversations’ are supportive interactions when the member of staff talks with the prisoner. ‘Observations’ are checks, appropriate when the prisoner is asleep at night. The term ‘suicide watch’ is unhelpful as it implies a lack of interaction.

Annex 8HH - Conversations and observations

Annex 8G – Section on Conversations and observations

 

8.7.2        Local instructions in respect of staff undertaking conversations and observations of at-risk prisoners must include methods of reducing the impact of night-time observations on the sleep of those being observed and on any cell-mate.

 

Use of CCTV

 

8.7.3        CCTV must not be used as a substitute for face to face observation though it may be used as an additional safeguard.

 

8.7.4        Where, in exceptional circumstances relating to staff safety, CCTV is used as an alternative to face to face observation; this decision must always be made by the ACCT case review team on an individual basis, authorised by the in-charge Governor/Director of the day (who must sign an entry to this effect in the CAREMAP), and must be for the shortest time possible. How efforts will be made to continue to support and interact with the prisoner must be documented in the CAREMAP, and when undertaken recorded in the On-Going Record. Prisoners who remain on Constant Supervision via CCTV for more than 24 hours must be managed with the additional input set out in Chapter 9.

 

8.7.5        A more appropriate use of CCTV-monitoring is as a supplement to staff’s physical presence during frequent, intermittent observation. It may form part of a planned ‘scaling down’ from Constant Supervision. Camera-monitoring might also be used at night, while the prisoner is asleep – perhaps as part of a planned reduction in levels of observation.

 

8.7.6        The decision to locate someone in a cell with overt CCTV should take account of the prisoner’s state of mind and likely reactions – for example, a person of a paranoid tendency might find CCTV monitoring so disturbing that risk is increased.

 

8.7.7        Where CCTV is used, there must be local protocols in place to ensure someone is actually watching the monitor. Prisoners have, in the past, ‘played-up to the camera’ and if there is no one at the other end the results could be fatal. See also Use of overt CCTV in cells. Where a camera is to be switched off, or is not in use, the prisoner must be informed of this.

 

8.7.8        Staff must explain to the prisoner what is happening and that the additional observations are happening because of staff concern for them.

 

8.7.9        Local protocols must set out for how long the tapes will be retained.

 

8.8              Constant Supervision

 

8.8.1        Constant supervision is where a prisoner is supervised by a designated member of staff on a one-to-one basis, remaining within eyesight at all times and within a suitable distance to be able to physically intervene quickly. Detailed requirements and guidance in respect of Constant Supervision - in addition to those relating to the use of observation in general – are set out in Annex 8Y. Also see Annex 8HH - Conversations and observations and Annex 8G – Section on Conversations and observations

 

8.8.2        Constant supervision can only be authorised by a doctor or nurse (in consultation with the Duty Governor) or the Duty Governor (in consultation with a doctor or nurse); must only be for the shortest time possible and how the prisoner will be returned to normal location and/or a lesser level of conversations and observations, must be reflected in the CAREMAP. For more detail see Annex 8Y. For information on Department of Health funding arrangements for constant supervision see the National Partnership Agreement, and for guidance for health staff regarding constant supervision, see Mental Health Observation [Not yet available]. A prisoner considered to be at imminent risk of suicide must not be left alone while this process is carried out.

 

8.8.3        As detailed in Annex 8Y if a prisoner is placed on Constant Supervision during the core working day, the first ACCT case review - chaired whenever possible by the Duty Governor or Head of Healthcare - must take place as soon as is practicable and certainly within four hours (or immediately prior to unlock the following morning in cases where the prisoner is placed under Constant Supervision during the night). For the first 72 hours supervision, an ACCT case review must be held at least once a day (including weekends). Constant supervision beyond 72 hours should only occur in exceptional cases. Where the level of crisis lasts beyond 72 hours, it is for the case review to decide how often future case reviews must be held. Where this is less often than daily, e.g. because awaiting transfer to hospital or outcome of specific event, the reasons for holding less frequent than daily case reviews must be entered in the ACCT Plan. Prisoners who remain on Constant Supervision for 8 days or more must be managed with the additional input set out in Chapter 9.

 

8.8.4        Annex 8Y also contains instructions and further Links in respect of Constant Supervision regarding the CAREMAP; mental health assessment and treatment; staff interaction, regime, activities and visits; showering and toileting; and staffing issues, including a training package [Not yet available].

 

8.9              Removal of items in possession, including removal of normal clothing

 

8.9.1        This section refers to removal of personal items such as normal clothing, shoelaces, belts and other individual items such as razors, lighters, matches, plastic bags, cutlery and other items that a prisoner may use to harm him/herself. Additional instructions regarding removal of normal clothing and issue with alternative clothing are contained further below in 8.10. This section (8.9) does not refer to items of furniture (bed, chair, in-cell sanitation) or bedding. Removal of furniture items (one or more than one) or bedding results in the cell becoming temporary special accommodation, thereby invoking the requirements of PSI 17/2006 / PSO 1700, including that no at-risk prisoner can be placed in special accommodation unless, exceptionally, they are violent or refractory. Alternative solutions will therefore need to be considered by the case review if furniture is used to self-harm, for example, use of cardboard furniture; although this needs to be risk assessed to minimise the risk of fire - see PSI 17/2006. Revised PSO 1700 (due 2008) will clarify policy in respect of removal of a chair (particularly from a safer cell) where it is being used to self-harm. Removal of personal (i.e. non-furniture / bedding items) does not affect the designation of a cell as special or otherwise.

 

8.9.2        Reducing access to the means of suicide or self-harm can (but not always - see 8.9.3 below) form part of the care of people considered to be actively suicidal or at regular risk of self-harm. Hanging (with the ligature attached to a ligature point) is the most frequent method of self-inflicted death for both genders. However deaths, especially among women, also occur as the result of self-strangulation or self-asphyxiation (with the ligature not attached to a point, or placing paper handkerchiefs in mouth and obstructing airflow). Previous methods of self-harm can be a good indicator of likely risk. Cigarette lighters, matches and flammable materials should also be considered for removal where the individual has a history of self-burning, arson or self-harm by smoke inhalation, as should medication, both that belonging to the individual and to a cellmate, and (particularly for women) plastic bags.

 

8.9.3        However, removing personal belongings from a person who is feeling hopeless and depressed (especially items of clothing, belts or shoelaces) can increase feelings of distress and therefore increase the risk of suicide, self-harm or a higher risk method of self-harm. Fear of losing their normal possessions can discourage prisoners from disclosing suicidal feelings. And removal of some items in possession (such as pens) can deprive the individual of access to creative activities which might distract them from their painful feelings. Where possible, prisoners at risk should be allowed to retain their belongings unless it is clearly unsafe to do so.

 

8.9.4        Staff must not remove items from at-risk prisoners as a matter of course. The case review team must decide this having first considered alternative responses (also see duties of case review team in Annex 8G).

 

8.9.5        If it is necessary to remove an item before it is possible to hold a case review (to protect the life of the prisoner), a case review must take place as soon as is practicable and certainly within four hours (or immediately prior to unlock the following morning in cases where items were removed during the night).

 

8.9.6        The reason for removing each item must be documented in the ACCT Plan (for example, perceived risk of suicide, methods used in previous incidents, perceived likelihood of particular items being used to self-harm, failure of alternative methods of helping the prisoner).

 

8.9.7        Items must be removed for the shortest possible times. For example, a high-risk prisoner might have items removed only at night, during lock-up, but be allowed access to most items during the day, when engaged with other people. How the prisoner will access some form of activity also needs to be considered. The item(s) must be returned to the prisoner as soon as the crisis has passed and the case review team has indicated it is safe to do so. This decision must be documented in the ACCT Plan.

Annex 8T – Ideas for maintaining access to activities despite risk attaching to particular items in possession

Annex 8U – Ideas for resolving operational difficulties relating to the removal of plastic bags

 

8.9.8        The prisoner must be informed of the reason why the items have been removed, and again why they have been returned, and these conversations must be documented.

 

8.10          Additional requirements for removal of normal clothing and issue with alternative clothing (previously known as ‘protective’ clothing)

 

8.10.1    This section must be read in conjunction with 8.9 - Removal of items in possession (above). Consultation with prisoners-at-risk shows that removal items of clothing, belts or shoelaces, is particularly likely to result in the individual concerned being singled out and perhaps becoming the butt of jokes from other prisoners. This is of particular concern to younger prisoners. Suggestions for ways of overcoming this stigma made by prisoners included issuing all prisoners in a high risk area (for example, first night accommodation, accommodation where prisoners are withdrawing from drugs/alcohol) with alternative footwear without laces.

 

8.10.2    Decisions to remove all of a prisoner’s normal clothing and issue alternative clothing (e.g. anti-tear or forensic/paper suit) must always be made by the case review team on an individual basis and only when the prisoner’s behaviour is believed to be life threatening. For example, all prisoners placed in special accommodation should retain their normal clothing unless the case review determines otherwise.

 

8.10.3    Alternative clothing must only be used for the shortest possible time. Consideration needs to be given to alternatives, such as locating a prisoner who is considered to be at high risk of suicide and likely to use ligatures from torn clothing, in a safer or constant supervision (gated) cell with high levels of staff observation (and access to some activities).

 

8.10.4    Alternative clothing can be obtained through Enterprise and Supply Service’s Clothing and Equipment Catalogue [Not yet available]. Different alternatives continue to be explored. Previously, tests by Safer Custody Group concluded that an item known as SafeSuit was neither safe nor decent, and may create an excessive build-up of body heat, which could cause agitation in the wearer. Prison Service establishments – if they do need to obtain alternative clothing - must source this from ESS, and are not to purchase the item known as SafeSuit.

 

8.10.5    Where it is necessary to remove a prisoner’s clothes – and options (such as a higher supervision level) have been decided by the case review as insufficient or inappropriate – this should be done, wherever possible, by persuasion and negotiation and not by force. This is particularly important where it is known or suspected that the prisoner has previously been raped or otherwise abused. It should be explained to the prisoner that the use of alternative clothing is a short-term measure to ensure their safety. Where this is not possible and it is considered that there is no other way of preventing the prisoner from taking their own life, then C&R techniques may be used to forcibly undress the prisoner. Should C&R techniques be used, they must be approved by the Duty Governor, the reason why it was necessary to use them must be clearly documented and the minimum amount of force necessary must be used.

Also see PSO 1600 and PSO 1700.

 

8.10.6    A prisoner must be issued with alternative clothing but not forcibly dressed in it. From a common sense perspective, if a prisoner does not want to wear alternative clothing, they can easily take it off themselves.

 

8.10.7    Prisoners must not be left in alternative clothing during any activities that bring them in contact with other prisoners during the day, because of the risk of ridicule and bullying. Normal clothes must be re-issued during these times and increased levels of observation relied upon to reduce suicide risk instead.

See PSI 17/2006, annex D for more information about the use of alternative clothing, including authorisation and reporting requirements

 

8.10.8    Placing an at-risk prisoner in alternative clothing must trigger enhanced care as set out in Chapter 9.

 

8.11          Communication and Teamwork

 

8.11.1    Good care can only be achieved through effective communication and teamwork. See Annex 8V – Communication and Teamwork and PSI 46/2005: Prison Drug Treatment and Self-Harm.

 

CHAPTER 9: MANAGEMENT OF AT-RISK PRISONERS WHOSE BEHAVIOUR IS PARTICULARLY CHALLENGING

 

Link to Standard 60

 

9.1              Introduction

 

9.1.1        This chapter aims to support staff in managing prisoners who display one or both of the following:

·               Prolific, sustained and/or extreme incidents of self-harming behaviour (usually requiring medical intervention)

·               Active suicidal intent – perhaps over a long period and/or from time-to-time being on constant supervision because of their suicidal intent.

 

And who also display one or more of the following characteristics:

·               Present a risk to staff and/or other prisoners

·               Are disruptive of the regime

·               Commit multiple offences against discipline

·               Display repeated and prolonged anti-social behaviour

·               Are on enhanced levels of unlock

Annex 9P – Why do some people behave in this way?

 

9.1.2        Prisoners must be managed in accordance with this (Chapter 9) guidance, including use of enhanced case reviews (9.3) and care planning (9.4) (as well as relevant sections of PSO1600 and PSO 1700), if their behaviour:

·               Has been subject to Constant Supervision for 8 or more days, or

·               Involves fire-setting as a form of self-harm, or

·               Has led staff to use measures of last resort.

 

9.1.3        All the approaches set out in Chapter 8 also apply to challenging at-risk prisoners. However, additional efforts or adaptations may be required to make them work. This Chapter should be read in conjunction with Chapter 8.

 

9.2              Measures of last resort

 

9.2.1    ‘Measures of last resort’ are defined as the prisoner is on an open ACCT Plan and has been:

·               Placed in special accommodation, or

·               Placed in a body belt, or

·               Issued with alternative clothing, or

·               Given medication without consent under common law.

Annex to 9V – Measures of last resort

 

9.2.2    An enhanced case review must be held within 4 hours of the decision to use one of the measures of last resort, or within 4 hours after unlock if the decision is made at night.

 

9.3              Enhanced case review team

 

9.3.1        Individuals who present with a combination of self-harming and very violent behaviour should be managed pro-actively on long-term, multi-disciplinary ACCT care plans by an enhanced case review team. The key mandatory requirements regarding circumstances when enhanced case reviews are initiated are set out in 9.1 and 9.2 above, though there will be other occasions when enhanced case reviews are required or are considered beneficial. 

 

9.3.2        The enhanced case-review team will involve all relevant disciplines and include more specialists and a higher level of operational manager than a typical ACCT case review team. The enhanced case review team must include an Operational F Grade Manager (or above) and where possible the involvement of the following ought to be facilitated: 

·         A member of the mental health team or doctor (where the prisoner is already in receipt of secondary mental health services, wherever possible this should be their mental health care co-ordinator).

·         The manager of the residential, healthcare, special unit or Segregation Unit on which the prisoner is located. If the prisoner has recently moved frequently between healthcare, Segregation Unit and residential wing, representatives with experience of his/her behaviour from all locations should attend the first enhanced case review team meeting

·         An appropriate psychologist. Psychologists, both clinical and forensic, often have valuable expertise in assessing and managing people with personality disorder and/or in behavioural management. Establishments SLA with clinical and forensic psychology services may determine the level of service access.

·         All specialists (e.g. education, Offender Manager/Supervisor) who work with the individual prisoner, including where involved with the prisoner; CARATS, RAPT or Therapeutic Community Therapists

·         Personal officer/key worker.

The appropriate member of the multi-faith Chaplaincy team and a member of the IMB must also be invited to attend. Link to a form for such invitations [Not yet available]. The prisoner – as long as the Case Manager does not have reason to consider this inappropriate, in which case they must document the reason(s) – must also be invited to attend.

 

9.3.3        The prisoner should be involved in case reviews, as far as is practicable. If they seem uninterested or suspicious they may, with perseverance, eventually be persuaded that their opinion is needed and valued. If they feel intimidated, they may need support. Some may find it easier to manage a one-to-one discussion of their problems with a member of staff they trust and who then attends the review with them and helps them put forward their views.  Alternatively, the case review could give consideration to the involvement of a friend of the prisoner (a fellow prisoner) where staff and prisoners agree this is appropriate. However, responsibility should be encouraged, wherever possible, for their own care plan, and as set out in Annex 8G – ACCT Procedures every effort should continue to be made to include in the case review all those who can support the prisoner, including where appropriate, family.

 

9.4              Care-planning and general approach to behaviour management

 

9.4.1        Consistent, integrated care by all staff involved with the prisoner is critical, and the case review will need to ensure care planning enables staff to provide this. As well as setting out the normal planning expected in a CAREMAP, e.g. location, regime, specialist interventions, frequency of conversation and observation, any items not allowed in use, it must also include a named key worker(s), strategies for encouraging pro-social behaviour, and agreed strategies for responding to each individual problem behaviour that the prisoner displays: both those behaviours that involve self-harm and those that involve anti-social behaviour.

 

9.4.2        The care provided must include an active, on-going, persistent attempt to engage the individual and build a positive, on-going relationship with him/her. This is also an opportunity for positive role-modelling. The case review team should identify a particular member (or members) of staff (ideally skilled and experienced mental health nurse or other mental health worker) or a key worker(s) to do this. Annex 9D – Key workers (and equivalents)

 

9.4.3        The provision of adequate support for these members of staff must be built into the ongoing care package for the prisoner. Where mental health professionals are not able to be directly involved in the prisoner’s care, the establishment will need to work with their PCT to determine what local options are available to provide supervision and support to those staff who do take on this role. Annex 1E - Staff Support and Annex 9J – Assessor Support

 

9.4.4        The key worker(s) must discuss with the prisoner (and document in the ACCT Plan):

·         His or her own perception of the reason they self-harm and/or become violent (including precursors and triggers) and

·         Try to gain the commitment of the prisoner to understanding his or her self-harming and/or violent behaviour and reducing it.

Once that commitment is gained, it is useful to review with the prisoner (if necessary, when he or she has calmed down) any acts of self-harm and/or violence that occur, looking for precursors, triggers and ways that the incident could have been prevented.

Annex 9E – Example of an incident review sheet used at Glen Parva

 

9.4.5        The enhanced case review team must decide on the approach staff will take to encourage and reward pro-social behaviours. This might consist solely of role-modelling by staff, the persistent attempt to build a relationship with the prisoner and help him/her become more aware of the causes and impact of his/her behaviour plus praising any signs of pro-social behaviour immediately it has manifested. Or the team may choose to adopt a behaviour modification approach with specific targets and rewards, where it is felt that the prisoner can understand and is likely to respond to this approach.

 

9.4.6        Where a formal behaviour modification approach is taken to reduce the frequency and severity of undesirable behaviours such as violence, it must consist of an individualised programme of clear, achievable targets whereby the prisoner is encouraged and rewarded (see Annex 9G – Reducing the Frequency and Severity of Self-Harming Behaviour for discussion of appropriate approaches). A behaviour modification approach (like self-harm compacts) must not be used in respect of self-harming behaviours. Expectations must take account of the individual’s mental health and be realistic. Targets will typically be more short-term and smaller than those contained within the overall IEPS programme or those on the Segregation Privileges and Review Targets form, with immediate, small rewards for the desired behaviours. Case review teams need to avoid a situation where one or two set-backs result in all rewards and incentives being removed from the prisoner, giving them nothing to lose.

 

9.4.7        All forms of care plan for the prisoner (for example ACCT Plan, Care Programme Approach, offender management plan, anti-bullying plan) must reflect the same consistent approach to encouraging pro-social and positive coping behaviours and responding to problem behaviours.

 

9.4.8        Enhanced case reviews to review progress must be held initially at least weekly (if on constant supervision timings will follow requirements at chapter 8), then less often if agreed by the team, unless behaviour deteriorates, Annex 8G. Decisions on the frequency of reviews must take into account the prisoner’s current mental state, prescribed medications and their effects and assessment of risk. The views of the prisoner must be taken into account wherever possible. At reviews, the notes of the events concerning the prisoner should be reviewed in order to identify ‘what works’ with that prisoner – i.e. what has been tried, what worked and what did not and why, so that a consistent approach to his/her management can be applied.

 

9.5              Location

 

9.5.1        The likelihood of violent incidents by people who are acutely mentally ill and/or suicidal can be reduced when they live in places where they have:

·         Access to privacy (for example a private toilet, washing and shower facilities)

·         Access to open space, fresh air and natural daylight

·         Personal space, including avoidance of overcrowding

·         A homely environment, including access to television, lockers

·         Adequate means of controlling light, temperature, ventilation and noise

·         Access to a room in which they can smoke

·         All areas should look and smell clean.

 

9.5.2        Also important are activities and having someone to talk to and having staff who demonstrated basic respect for everyone – with no racial or other abuse (Source: Royal College of Psychiatrists’ Management of Imminent Violence).

 

9.5.3        Conversely, very restrictive environments, such as those in segregation units, may contribute to the difficulties in managing challenging at-risk prisoners. If relevant to the individual, account of the PSI 9/2007 & 9/2007(W): Smoke Free Legislation also needs taking into account when planning location and care.  

 

9.5.4        Challenging at-risk prisoners should be located in places where:

·         They have access to activities, social support and mental health assessment and care

·          They are supported in understanding and reducing their self-harming behaviours and

  violent behaviours

·         They are kept safe during periods of acute suicidal crisis

·         The staff who care for them are appropriately selected, trained and supported; also see  the High Security Segregation Guide [Not yet available]

·         Communication systems are in place to ensure that the prisoners are managed in a

  consistent manner by staff.

 

9.5.5        Enhanced case review teams must consider, and document in the CAREMAP, whether transfer of the individual to a special therapeutic unit within or outside the establishment or mental hospital would be appropriate and, if so, take steps to facilitate such a transfer. See guidance on the procedure for the transfer of prisoners to and from hospital under sections 47 and 48 of the Mental Health Act (1983) [Not yet available], and Annex 1F [Not yet available]

 

9.6           Regime – access to activities

Annex 9U - Access to activities

 

9.7           Access to social support

 

9.7.1    The requirement for the case review team to consider how to provide access to social support, including peer support, staff support and family contact also applies to those who present challenging behaviours. Annex 9C – Ideas for providing peer support, where additional safeguards are assessed as required

 

9.8           Mental health assessment, engagement and treatment

 

9.8.1        In the case of all challenging at-risk prisoners (i.e. prisoners managed in accordance with Chapter 9 guidance) the case review must determine whether to refer them for a mental health assessment, determine the level of urgency of any such referrals, and ensure (a CAREMAP action) that a request is made to the practitioner to provide subsequent advice to the review team.

 

9.8.2        Where a medication review has taken place, the member of the healthcare team attending the case review must inform the case review, and this (and any actions the case review decide upon as a consequence) must be recorded in the ACCT Plan. It is important that the case review team are aware of this as self-harm or aggression may be related to particular symptoms (e.g. difficulty sleeping, feeling constantly tired, hearing voices, experiencing nightmares) that medication can reduce. In addition, self-harm and aggression may increase when reductions to the dosage of some prescribed or illegally obtained drugs are made.

 

9.8.3        It is particularly important for the care of challenging at-risk prisoners, that health and residential staff involved in their care agree a protocol stating what action residential staff should take should they become aware that a prisoner is not taking their medication (see Chapter 6). See above sections on enhanced case-review team and engagement of mental health staff with the prisoner and for transfer to mental hospital respectively.

 

9.8.4        Staff working with challenging at-risk prisoners with complex disorders (wherever they are located in the establishment) need to receive training in mental health awareness including understanding and managing self-harm and understanding and managing personality disorder.  It is also good practice for such staff to receive training in de-escalating conflict and pro-social modelling. Information about the availability of mental health awareness training can be obtained from the local Training Manager, Area Safer Custody Adviser or Mental Health Lead.

 

9.8.5        The Safer Custody Team Leader working with Training and Healthcare Managers can utilise modules from the ACCT Assessor training package to ensure that these staff receive mental health awareness training. To identify and to manage such prisoners more safely, it is also important that segregation and reception staff and adjudicating governors and adjudicating liaison officers also receive mental health awareness training.

Link to information about Mental Health Awareness training [Not yet available]

Annex 6D – Working with a prisoner who has a severe mental illness [Not yet available]

Annex 6E – Personality (Behavioural) Disorders [Not yet available]

 

9.9       Reducing the frequency and severity of self-harming behaviour

Annex 9G - Reducing the frequency and severity of self-harming behaviour

 

9.10   Reducing the frequency and severity of violent behaviour

Annex 9Q - Reducing the frequency and severity of violent behaviour

 

9.11    Keeping the prisoner safe during periods of acute suicidal risk

Annex 9R - Keeping the prisoner safe during periods of acute suicidal risk

 

9.12    Consistency of care – Communication

 

9.12.1    An essential strategy for managing people with complex, behavioural disorders is for staff to work together in a multi-disciplinary way. Staff of all disciplines and the prisoner need to be clear about what behaviour is expected and what limits are set. Consistency is essential. Additional efforts will be required to do this where prisoners are located throughout the establishment rather than in one Unit. Annex 9K – Consistency of Care – Communication

 

9.13   Administering medication without consent (“Rapid Tranquillisation”)

See Annex 9S - Administering medication without consent (Rapid Tranquillisation) [Not yet available] and Annex 9T - Rapid Tranquilisation [Not yet available] for an example provided by Mental Health Lead, North West Regional Offender Health Team. Also see Offender Health Guidance [Not yet available]

 

9.14   Transfers between establishments

           

9.14.1 PSO 1810 maintaining order in prisons requires each establishment and Area to have a population management strategy which covers the transfer of challenging prisoners and includes instructions on ‘medical/healthcare needs.’ Chapter14 of PSO 2700 covers transfers of at-risk prisoners.

 

9.14.2    Guidance on what should be included in these departure strategies in relation to the needs of at-risk prisoners who also present challenging behaviours is set out in Annex 15D.

 

9.14.3    Establishments where challenging at-risk prisoners are held need to be aware of the appropriate therapeutic units (e.g. NOMS therapeutic communities, DSPD Units, and medium and high secure mental hospitals) to which such prisoners might be referred. This information should be available locally from the NHS, and background information is at Annex 1F - list of therapeutic units [Not yet available]

 

9.15     At-risk prisoners with a history of arson

 

9.15.1  There is a very strong link between charges and convictions of arson and self-harm, particularly prolific self-harm. Women in particular who are charged or convicted of this offence demonstrate some of the highest frequencies of self-harm in the prison estate.

 

9.15.2    Staff should be aware that setting a fire can be both an act of self-harm and a serious breach of discipline. It requires a response on both counts – that is, where discussion with the prisoner demonstrates that the fire-setting was an act of self-harm, ACCT procedures must be followed. A disciplinary response may also be appropriate.

 

9.15.3    A prisoner who has a history of arson as well as self-harm must be managed as set out in this chapter – that is, as a challenging at-risk prisoner who presents challenging behaviours. However, staff should be aware that they may take longer to motivate to try to change. Treatment for any mental disorders and, in particular, management of their medication is particularly important. Annex 9M – At-risk prisoners with a history of arson

 

9.16         Dirty protests

Annex 9N - Dirty protests

 

9.17          Food refusal

 

9.17.1    Refusing a meal, along with refusing medication, can be a warning sign of suicidal intent. Understanding why a prisoner might refuse to eat and/or drink, and managing the amount they eat and/or drink, can be very difficult for prison staff. The Food Refusal Guidance draws together and provides links to current guidelines on food refusal, and offers practical help for those dealing with prisoners who may be refusing food and/or fluids.

 

CHAPTER 10: BUILT ENVIRONMENT

 

Link to Standard 60

 

10.1          Introduction

 

10.1.1    The design of safer cells has several features which can assist staff in the task of managing those at risk from suicide, such as specially designed furniture and fixtures which are manufactured and installed to make the attachment of ligatures very difficult, and access to window bars prevented via specialist approved window design. Safer cells are designed not only to minimise ligature points, but also to create a more normalising environment. They have been found to be more durable, easier to maintain and easier to search.

 

10.1.2    Safer cells cannot deal with the problems underlying a prisoner’s self-harming/suicidal behaviours, and so safer cells can only complement (i.e. not replace) a regime providing individualised and multi-disciplinary care for at-risk prisoners. That said, it is thought that removing or reducing access to means of harm can be an effective way of preventing suicide in some people, especially where suicidal behaviour is an impulsive act in response to particular events or circumstances.

Annex 8E – Summary of Safer Cells Evaluation

 

10.1.3    The basic safer cell specification should not generally be deviated from. If, however, Governors feels that a safer cell could be further enhanced on decency grounds, e.g. curtains at the windows, advice on safety and procurement should be sought from either the ASCA or Safer Custody Group.

 

10.1.4    Staff should not confuse safer cells with special accommodation, and remember that items in possession continue to be allowed for prisoners in safer cells (unless the individual risk assessment requires their temporary removal). See 8.9 – Removal of items in possession.

 

10.1.5    On 4 December 2003, the Prison Service Investment Board (PSIB) confirmed the existing policy, that for new accommodation in existing prison establishments:

 

·         All Cat A, B and local prison establishments would be fitted with 100% safer cells to the full Property Services Group (PSG) specification.

·         Cat C prison establishments would be fitted with 25% safer cells to the full PSG specification.

·         Ready to Use (RTUs), now known as Ready Built Ready to Use (RBRUs), Modular Temporary Units (MTUs), not now used and those still in existence are soon to be decommissioned would not generally be fitted with safer cells to full PSG specification and risks would be managed operationally.

NOTE: The new Temporary Custodial Facilities (TCFs) born out of the capacity build programme will also not generally be fitted with full specification safer cells and the risk will be managed operationally.

 

10.1.6    It was further agreed that, for refurbished accommodation in local prison establishments:

 

·         Consideration should always be given to include safer cell provision in all business cases commissioned by the Estates Planning Committee (EPC) – now the NOMS Property Board. Such provision should be mandatory in high risk areas

·         The PSIB would delegate responsibility to the EPC to decide the final option and therefore the number of safer cells to be provided, on advice from Safer Custody Group, balanced by risk, other priorities and resource availability.

·         Safer cells would be to full PSG specification.

 

10.2          Accommodation of at-risk prisoners

 

10.2.1    Traditionally, safer cells have been located in specialised areas such as First Night, Induction, Healthcare or Stabilisation Units, as directed by research that shows the early period of custody as the time of greatest risk. While this is still the case, it should not preclude the use of safer cell accommodation on normal location - particularly to ensure staff are not tempted (for perceived reasons of prisoner safety) to locate at-risk prisoners in the Segregation Unit because that is where there are safer cells. The exact location should take account of the needs of at-risk prisoners in relation to others on the wing. In establishments with limited numbers of safer cells they should not be located in a main thoroughfare, muster point or in an isolated location. It should be in a discreet position where it can be easily monitored by staff, and supported by an appropriate regime. Safer cells can be used to re-integrate prisoners onto normal location.

 

10.2.2    White Wood furniture is now approved for use in safer cells when all other elements associated with a safer cell (as per Safer Cell Guide – single occupancy [Not yet available]) are addressed at the same time, save for considerations in some specialist locations (e.g. segregation units). The White Wood furniture will also become standard cell furniture. Therefore the normalising aspect of safer custody will be greatly enhanced as safer cells will be significantly less obvious.

 

10.2.3    For safer cell protocols and suggestions for alternatives to the use of special accommodation, see Annex 10C – Safer Custody Accommodation Protocol Table. The design of safer cells is set out in the Safer Cell Guide – single occupancy [Not yet available] and building guidance is found in the Safer Prison Building Requirements Guide [Not yet available]. Advice about safer custody built environment issues can also be obtained from Paul Minos, 3^rd Floor, Fry, 2MS ' 020 7035

4295.

 

10.2.4    Further suggestions for use of safer accommodation are contained in Annex 10A – Safer Custody Cells Protocols and advice concerning procurement is in Annex 10B – Safer Furniture Purchase Arrangements. Details on the procurement of White Wood furniture can be found in the ESS Catalogue and can be ordered through usual ESS procurement.

 

10.2.5    It is for each establishment to take into account any CNA issues around identifying the number of safer cells that will be required to support the risk level posed by their population, along with financial considerations for the implementation of crisis suites and safer cells when planning and making their capital expenditure bids. Each establishment is responsible for ensuring that their safer cells meet required standards and that standard is maintained.

 

10.2.6    For information on Listener Support Suites – Annex 7E

 

CHAPTER 11: EQUIPMENT (Emergency Response Kits, Personal Issue Cut-Down Tools and Specialist Equipment in Healthcare Centres)

 

Link to Standard 60

 

11.1     Introduction

 

11.1.1  It is essential that not only is the necessary equipment available to save lives, but that staff are trained in its use. A variety of staff also need to know how to carry out resuscitation procedures. Managers will find it helpful to link local emergency response procedures with the monitoring of cell call responses.

 

11.2     Emergency Response Kits for residential areas

 

11.2.1    Emergency Response Kits must be available in all residential areas and will include the items specified below. It is good practice to also have Emergency Response Kits in non-residential areas, based on a local risk assessment.

 

11.2.2    The manager of each unit must provide regular checks of the Emergency Response Kit on the unit, and ensure that it is replenished after use (checks should take place at least monthly, and be signed and dated as checked).

 

11.2.3    The manager of each unit must ensure that night staff are aware of the location of emergency equipment.

 

11.2.4    Staff in all residential areas must have ready access to a sealed pack containing the following:

 

1 pair paramedic shears (ligature scissors)

2 CPR face masks, with non-return valve (for resuscitation attempts)^*

2 resuscitation aids with non-return valves

4 pairs rubber gloves (3 medium^** 1 large)

1 spillage kit

2 large ambulance dressing (to stem large bleeds / wounds)

 

The above is a minimum; establishments may wish to also include other items such as an emergency oxygen supply and/or an automated external defibrillator***.

 

11.3     Personal issue cut-down tools

 

11.3.1  Cut-down tools are implements designed to cut ligatures. They are also known as anti-ligature knives. There is not one single piece of equipment that will cut all materials, particularly very thick ligatures such as twisted blankets and towels. Therefore emergency response kits for residential areas must continue to contain the mandatory paramedic shears – see above.

 

11.3.2  This section explains the requirement that all establishments have a local protocol setting out:

 

a)      Arrangements for unified and uniformed staff, and other staff where appropriate, to carry personal issue cut-down tools

b)      The level of flexibility allowed for fully open establishments in recognition of their lower risk populations

c)      How security considerations around cut-down tools will be managed

d)      Who locally will manage the procurement, issue, use and maintenance of cut-down tools and associated instructions on their use

e)      Actions to be taken following use of a cut-down tool.

 

For emergency procedures following an incident of self-harm see Annex 13; for reporting requirements and follow-up care and support in the event of a prisoner ligaturing see Chapter 13 – Actions Following an Incident of Self-Harm; and for further background on cut-down tools see Annex 11 (cut-down).

 

Who carries a cut-down tool

 

11.3.3    All unified and uniformed staff in closed and semi-open establishments must be provided with and carry on duty their own personal issue cut-down tool. It is not sufficient for cut-down tools to be held in a box in the office for ‘grab-and-go’ purposes, nor for staff to collect ‘any’ (i.e. from a store or pool of tools rather than their own locker) cut-down tool upon commencement of duty. Note that open establishments are still required to have Emergency Response Kits (see above) and have a local protocol on cut-down tools appropriate to their risk level (see below).

 

11.3.4    Staff other than unified and uniformed staff may also carry cut-down tools, if it is decided locally to be necessary/ desirable, e.g. CARATS staff who regularly attend residential areas, or healthcare staff. Governors must carry out a risk assessment to decide which other staff, including healthcare staff, must carry their own personal issue cut-down tool.

 

Procurement and training

 

11.3.5    Local procurement arrangements must be in line with national policy. Personal issue cut-down tools must be one of the following: Big Fish (9mm), Pelican or Tuff Kut. Following a trial of various types of cut-down tools, these three tools - and no others - have been confirmed as authorised for purchase as personal issue cut-down tools. These tools can be purchased through the national iProcurement system. Information and contract details can be found in CPU Contract Bulletin ST 117-2008.  Costs of purchasing new cut-down tools and replacement blades will need to be met locally.

 

11.3.6    For the resources available on the intranet to assist staff understanding in how to use cut-down tools see cut-down tools guidance. This material, including a DVD, is also available through Area Safer Custody Advisers.

 

11.3.7    All establishments (including fully open establishments) must have a local protocol on the procurement, issuing, carrying, and use of cut-down tools.

 

11.3.8    Unions must be consulted on the local protocol. Where healthcare staff are included and are employed by a PCT the local Prison/PCT partnership board must also be consulted.

 

11.3.9    The local protocol and the Local Security Strategy must make clear who is responsible for procuring, issuing, storing and managing cut-down tools, as well as any associated instructions on the use of cut-down tools. These may be responsibilities spread across a number of individuals (e.g. Suicide Prevention Coordinator, Head of Security, procurement officer, training manager), or they may be assigned to one nominated person. Local protocols must also make clear who has responsibility in the absence of the nominated person(s).

 

Security considerations

 

11.3.10      Cut-down tools, like any other items that may be used as weapons, need to be thoroughly risk assessed and managed to mitigate the risk of harm they could pose to others. This underlines the importance of robust local protocols to ensure that cut-down tools cannot be misused.

 

11.3.11      Cut -down tools must be stored, marked and used in Accordance with the Accounting and Control Function of the National Security Framework (NSF).

 

11.3.12      The Head of Security must ensure that all staff issued with cut-down tools are compliant with security requirements.

 

11.3.13      The handles of the cut-down tools must be etched or tallied (refer to ‘Tools, Equipment & Materials’ section in the NSF). Etching the blade itself may weaken the blade. Examples of etching are:

 

               The Prison Enterprise code and a serial number (e.g. LEBM1-100)

               The Prison Enterprise code and individual staff’s epaulette number (e.g. LEBM007).

 

11.3.14      Use of cut-down tools must be built into the local security strategy (Tools) for the establishment.

 

11.3.15      Upon issue of a cut-down tool to a member of staff, he/she must sign to confirm that:

 

a)      They have been issued with the cut-down tool and understand how to use it

b)      They agree to carry the tool securely whilst on duty and that they will contact the orderly officer immediately if it cannot be accounted for

c)      They have been informed that checks will be carried out to ensure the security of the tool

d)      They understand that the cut-down tool is for the sole purpose of cutting ligatures and must not be used for any other purpose, as this could reduce its effectiveness in the event of it being required to cut a ligature

e)      They understand what action to take in the event of having used the tool.

 

11.3.16      In the event of a lost cut-down tool, the member of staff must immediately inform the Orderly Officer. The Orderly Officer must then report this to the Duty Governor and activate the Contingency plans for ‘Tool Loss’.

 

11.3.17      Replacement blades must be held securely (e.g. in the security department). They must be accounted for on a daily basis and signed for on a tool check sheet. The replacement of a blade must be recorded.

 

Post-incident actions (also see Chapter 13 – Actions Following an Incident of Self-Harm)

 

11.3.18      Blades must be checked after each usage to determine if they are still fit for purpose and replaced as necessary. If the blade needs to be replaced, this must take place as soon as possible and certainly before the member of staff resumes normal duties.

 

11.3.19      The local protocol must set out in what circumstances the cut-down tool should be bagged and tagged, e.g. in the event that the Police and/or Prisons and Probation Ombudsman are likely to require the tool as evidence.

 

11.3.20      Blades that are no longer fit for purpose must be disposed of into a dedicated ‘sharps box’, which is held in a secured office, and the disposal must be recorded. The disposal of the contents of the ‘sharps box’ must also be recorded.

 

11.4     Specialist equipment to be held in the healthcare centre

 

11.4.1    In addition to the Emergency Response Kits (above), specialised resuscitation equipment for use in responding to incidents of self-harm, including the items specified below, must be available in the HCC (or designated secure area where there is no HCC).

 

Basic equipment to be held in a 'grab bag':

 

Automated external defibrillator (AED)***

Resuscitator bag including valve and mask with oxygen reservoir

3 x masks (various sizes)

4 x Oropharyngeal (Guedal) airways

4 x Nasopharyngeal airways

Vitalograph portable suction device

Oxygen with non-re-breather mask

Pen torch

Pulse Oximeter

Sphygmomanometer (portable)

Stethoscope

2 x Asherman chest seals

2 x CAT Tourniquet

2 x large Israeli Trauma Wound dressings

Shears

 

‘Second line’ equipment (i.e. not necessarily held in a ‘grab bag’):

 

Blood pressure device

Rigid collars

Long Board and Head Immobilisation Device

Selection of Cannulae (for those trained to gain venous access)

Normal Saline or Lactated Ringers Solution

Drugs (Epinephrine, Atropine, Glucagon, Naloxone, Salbutamol (inhaler or IV injection), Diazepam emulsion injection) – for those authorised in their use.

 

11.4.2    Offender Health have advised regarding basic ‘second line’ equipment that it is for local determination in consultation with the local PCT and pharmacist responsible for providing services to the establishment, and in line with NHS clinical best practice, depending upon the type of prison, the population being served, as well as proximity to hospital the equipment should be held in a ‘grab bag’ to decide what this should be. Offender Health similarly advise that the same local determination applies concerning whether the Sphygmomanometer (portable) is contained in the grab bag or not.

 

11.4.3    Both the quantities of emergency equipment held in an establishment, and the training of staff in using it, need to take account that at times healthcare workers may not have the luxury of rapid transportation of the casualty due to Ambulance Service response times or simply that at times it takes an ambulance quite a time to gain entry to an establishment and arrive at a convenient location near an incident. This may be especially true during the night period. Staff will need to be prepared to stabilise patients that otherwise would have been identified for rapid transportation if an ambulance had been available, and consider how best to use fluid therapy in patients who have suffered severe blood loss pre-hospital. Regarding the reconfiguration of NHS Ambulance Trusts, see the letter issued by Richard Bradshaw and Michael Spurr on 28^th September 2006 [Not yet available] which requires Governors to ensure that a protocol exists at each establishment to facilitate the immediate access to both the prison and individual prisoner when emergency ambulance services are requested.

 

Training

 

11.4.4    Governors and Directors must ensure their establishment has developed a local training plan for discipline staff to be trained in the use of equipment held in the emergency response kits, including refresher training. This can of course – and would be good practice to – include other staff who come into contact with prisoners. Establishments can also augment this with the use of office wall first aid posters (e.g. of the human body).

 

11.4.5    Governors and Directors must ensure their establishment has developed a local training plan for discipline staff to be trained in delivering emergency first aid and resuscitation procedures, including refresher training.

 

11.4.6    Training plans relating to emergency care and resuscitation procedures should be linked to local protocols on contingency plans (e.g. role of orderly officer, how to raise the alarm, role of first person on the scene). See First Aid – Health & Safety: First on Scene Guidance [Not yet available] and Annex 13a - Action Following Self-Harm: Emergency Procedures and to PSO 1400 Such training plans also need to cross reference to local POELT, training for healthcare staff, and local emergency response teams where these exist.

 

11.4.7    Sufficient health care staff must have training in the use of the specialist equipment held in the healthcare centre to ensure it can be used to full effect in an emergency. It is for local management, most likely the Healthcare Manager and Training Manager at each establishment, to determine the numbers of staff that require this training, basing their local arrangements on existing skills of staff, staff turnover, levels of risk in the establishment and shift patterns. Dependent on risk/need and availability of healthcare staff at all hours, this training plan can also include a number of Discipline Officers.

 

CHAPTER 12: SUICIDE PREVENTION AND SELF-HARM MANAGEMENT FOR WOMEN PRISONERS

 

Link to Standard 60

 

12.1                Introduction

 

12.1.1          PSO 2700 is written for all prisoners – male, female, young, old, of every ethnicity. But, given the particular vulnerabilities and needs of women prisoners, there are some areas of suicide prevention and self-harm management that require a gender-specific approach (e.g. regarding homicide of a violent partner, see 4.10). NOMS does not seek to provide favoured treatment for women prisoners, but recognises that treating men and women prisoners with uniformity does not necessarily amount to equality, nor to the best level of care.  There are a number of documents explaining the gender equality duty:

Link Understanding Your Duty [Not yet available]

Link to Doing Your Duty [Not yet available]

Link to Public Sector Duties [Not yet available]

Link to Equality Act 2006

 

12.1.2          As all staff working in women’s establishments will be aware, many women prisoners enter custody already struggling to cope with a wide range of difficult issues. These issues, which include drug misuse, a history of abuse, mental health problems and family background problems, have all been identified as significant risk factors for suicide and self-harm.

Annex 12A – Vulnerability factors of women in prison

 

12.1.3          In recent years, the rate of self-inflicted deaths among women prisoners (i.e. the number of deaths expressed as a proportion of the total population of women prisoners) has been higher than that for male prisoners, and statistics show that women in prison self-harm at a rate over 20 times that of men in prison.

 

12.1.4          This Chapter and links provides additional guidance with respect to women prisoners. It needs to be read in conjunction with the rest of the PSO and related guidance.

 

12.2                Reception/ first night

 

12.2.1          It is well established that the early period in custody is a particularly high-risk time for suicide. Of the women who take their own lives in prisons, around a third has been there less than a week. Policy and guidance can be found at: Chapter 4 and Annex 4K – Checklist for Safer Custody before a prisoner is locked up for the first night and Annex 12B as well as PSO 0500 Reception

 

12.3                Foreign national women prisoners

 

12.3.1          Women prisons hold a high proportion of prisoners who are foreign nationals (i.e. not having the right of abode in the UK): at the beginning of 2004, some 20% of the women in prison were foreign nationals (compared to 11% in the male estate). This highlights the importance of women’s establishments having information about reception and first night processes in languages appropriate to the prison’s population.

 

12.3.2          Women foreign national prisoners may also be more vulnerable: they are more likely to have feelings of isolation and difficulties in communication. They are also more likely to be experiencing custody for the first time. They may be experiencing feelings of shame that they have let down not only themselves and their families, but their community and culture too. For others it is the distance from family support and a sense of hopelessness. For some, cultural norms may mean a reluctance to complain or seek help and staff need to be alert to this. All this means:

·         Carrying out a needs analysis to identify which languages your population speaks

·         Providing reception packs and/or language tapes in those languages

·         Assisting all women on reception to make contact with families to let them know where they are – this applies equally to women from overseas.

PSO 4630 Immigration and Foreign Nationals

Annex 12C – Good practice examples re: foreign national women prisoners

Annex 12D – Female Prisoner Welfare Project/ Hibiscus

Annex 8B – Foreign Nationals

When considering asking other prisoners with relevant language skills to act as translators, take account of those prisoners’ own needs and concerns. Care needs to be taken to ensure that what is being asked of them does not add to their personal burden or cause distress. 

 

12.4                Women withdrawing from drugs and/or alcohol on arrival to prison

 

12.4.1          Women undergoing withdrawal from drugs and/or alcohol on their arrival to prison (as well as those who have recently undergone withdrawal) are at appreciably higher risk of suicide and self-harm. One of the key learning points from investigations into deaths in custody is that a substantial proportion of women who have died in recent years were undergoing detoxification (or had recently undergone detoxification) at the time of their death. See Section 6.3 and the Best Practice Guidance by W&YPG [Not yet available] sent to governors in Jan 2007, which makes clear that wherever a woman undergoing withdrawal is located, the healthcare must meet the same criteria as if she was located in a substance misuse or healthcare unit, i.e. unrestricted observation and a nurse based on the unit 24 hours a day.

 

12.5                Induction

Annex 12F – Induction Checklist

Annex 12G – Good practice examples re: induction

 

12.6        Training available for staff working with women prisoners

Annex 12J – Training available for staff working with women prisoners

 

12.7        Mothers in prison

When discussing maintaining links with children, account needs to be taken that not all prisoners may have told their families that they are in prison. Also see. Annex 12K – Mothers in prison. Guidance on maternity blues, post natal depression, post natal psychosis and resources for mothers and helpers are in Annex 12L [Not yet available] and good practice guidelines for Managing Women who have experienced Miscarriage, Termination of pregnancy, Stillbirth or Neonatal death can be linked to at Women & Young People’s Group Good Practice Guidelines (August 2006) [Not yet available]. Account of increased risks relating to last visits with children, i.e. while in custody many women face having their children go into care or be adopted.  This can be a traumatic experience both for the woman and children and the staff supporting her. 

 

12.8        Resettlement

Annex 12N – Resettlement

 

12.9        Interventions for self-harm

               Annex 12Q – Good practice interventions

 

CHAPTER 13: ACTIONS FOLLOWING AN INCIDENT OF SELF-HARM

 

Link to Standard 60

 

13.1          Introduction

 

13.1.1 People harm themselves for many different reasons. Research [Not yet available] shows that the reasons prisoners harm themselves fall mainly into 3 main groups. They self-harm as a way:

·         Of coping with painful feelings or thoughts (perhaps of previous abuse) and not dying;

·         To escape their problems either by dying or by blotting out their problems for a time; and

·         Of achieving a goal, such as a move away from a unit where they are fearful of others.

The great majority of self-harm in prisons is not done with suicidal intent.

 

13.1.2 In studies in Australian [Not yet available] and Scottish [Not yet available] prisons, prisoners who reported that they had been trying to kill themselves were more likely than others who self-harmed to use highly lethal methods such as hanging. But a significant minority of those reporting that they self harmed in order to achieve a goal also used methods that would have resulted in death if intervention had not been immediately provided. Furthermore, a history of self-harm (of all types) greatly increases the risk that someone will kill themselves in the future. Self-harm, whether suicidal in intent or not, is a sign that something is wrong.

 

13.1.3    All acts of self-harm or statements of intent to self-harm must always be taken seriously no matter

what the perceived reason for the self-harm is. Attitudes that see some people who self-harm as “genuine” and others as “manipulative” are dangerous and should not be tolerated by managers. Where the self-harm is goal-oriented, the prisoner should be helped to find a more constructive way to meet their underlying need.

 

13.2          Immediate action following incidents of self-harm or attempted suicide

 

13.2.1    For initial action following self-harm see Annex 13B - Flow Chart on actions upon entering a cell and Annex 13C - Flow Chart on actions upon discovering a hanging.

 

13.2.2    For actions following a death in custody see PSO 2710 follow up to deaths in custody, chapter 2 of which also refers to initial actions upon entering a cell.

 

13.2.3    Emergency first aid procedures are described in Annex 13A and instructions concerning the contents of emergency response kits, personal issue cut-down tools and the specialist resuscitation to be held in healthcare centres are set out in chapter 11.

 

13.2.4    Where the individual who has self-harmed is still conscious, it is vital that the member of staff who is first on the scene – having ensured help is on its way - talk to the individual in a calm and empathic way, without judging them. The nature of the harm may not reflect the seriousness of the distress. It is important to talk to the prisoner to find out if they are feeling suicidal. It is never appropriate to scold someone for self-harming or to ignore them. It is important that staff, including POELTs, know how to supportively respond to a prisoner who has self-harmed.

Link to self-harm guidance section on ‘Responding to an Incident’ and ‘training’ [Not yet available]

 

13.3          Follow-up actions and care for prisoners who have self-harmed

 

13.3.1    In the event of any incident of self-harm staff must (where there is not one open already) open an ACCT Plan. This must be done no matter what the reason for the self-harm. Opening an ACCT means that the individual will be interviewed by an ACCT Assessor who will talk with them about what led up to the incident, what they were trying to achieve and why and how they think further self-harm could be avoided or reduced in the future. The care plan for someone whose self-harm was not suicidal in intent will be different from one who is determinedly suicidal, but they still require care. Annex 8G – ACCT Procedures and Annex 13D – Self-Harm Management.

 

13.3.2    Where an ACCT Plan is already open and the prisoner self-harms, unless the CAREMAP states otherwise, the Case Manager must be informed about the incident and an ACCT case review must be held as soon as possible (i.e. within two hours, or twelve hours if the incident occurs at night). See below if the prisoner is taken to hospital. Regardless of when the case review is to be held, the ACCT Plan must be referred to straight away and the incident noted. In this case, the immediate case review is the forum in which the issues surrounding the incident of self-harm will be explored. See Chapter 8 - Planning and Providing Good Quality Care for Prisoners Identified as At Risk of Suicide and/or Self-Harm.

 

13.3.3    After consultation with the prisoner, the nominated next of kin must be notified, unless:

·         There is a clinical reason not to, or;

·         If aged 18 and over, the prisoner does not consent (when asked, the prisoners response must be noted in the ACCT Plan), also see the Victims Charter; PSO 4400 concerning next of kin, or;

·         The prisoner’s CAREMAP indicates otherwise (for example, in the case of a prisoner who repetitively self-harms).

 

13.3.4    For young persons (under 18s) the Safeguard Manager must be consulted about the appropriateness of informing the parents/carer/next of kin about the opening of the ACCT Plan, and about whether to make an external referral to Social Services for advice, support or assessment.

Annex YP1 – Suicide Prevention and Self-Harm Management for Young People

 

13.3.5    Where appropriate, after suicide attempts or medically serious incidents of self-harm consideration should be given to allowing the prisoner themselves the opportunity to notify the next of kin by a phone call and/or an extra exceptional visit.

 

13.3.6    If the prisoner is taken to hospital, the ACCT Plan must travel with them. Staff on bed watch should include any pertinent observations in the on-going record in the ACCT Plan, including any information provided by specialist services at the hospital, for example, the deliberate self-harm team. A case review will still take place as required above to decide what, if any, action is required by the establishment at that time. Once it is known when the prisoner is to be discharged from hospital, a case review must be held in time to prepare an updated CAREMAP for his/her return to the establishment. Where possible this should involve appropriate specialist input (in person, in writing or by telephone) from hospital staff.

 

13.4          Investigating serious incidents of self-harm

 

13.4.1    It is strongly recommended that following incidents of serious self-harm an investigation is carried out into the circumstances of the incident (‘serious incidents’ are defined as those that mean the prisoner involved required resuscitation and/or transfer to an outside hospital as a result of their harming themselves). As each individual incident will differ in level of severity, Governors/Directors will need to judge when such investigations are appropriate. Cases where the injury was life threatening, the person required hospitalisation and it is likely that they will be sustain permanent injuries as a result of the self-harm incident, are examples of where Governors/Directors are likely to consider an investigation into the incident to be imperative. Wherever possible the family ought to be included in such investigations. Care needs to be taken to retain required documentation. For references to investigations and learning, see Annex 1D regarding both the Safer Custody Continuous Improvement Plan, and the Safer Custody Team Annual Review.

 

13.4.2    Further instructions and advice on investigating incidents of serious self-harm (and other relevant incidents where serious harm results) will be issued by Safer Custody Group in the next few months.

 

13.5          Reporting requirements

 

13.5.1    All incidents of self-harm must be reported on incident report forms and an F213SH self-harm form must be completed. Noose/ ligature making must also be reported on the F213SH even if no injury has occurred, but anorexia, bulimia nervosa and food refusals should not be reported using the F213SH.

 

13.5.2    Care is required to complete the form properly as this information is used both locally and nationally to be able to better understand where, when and why incidents occur and to obtain early warnings of any changing trends.

 

13.5.3    The F213SH has two pages; the front of the second page is a carbon copy of the first page, and records the details of the incident. The reverse of the second page has a section for healthcare to complete. The bottom copy must be inserted into the prisoner’s clinical record and the top copy must be forwarded to security for inputting on the Incident Reporting System (IRS). Note: the F213SH is for NOMS incident reporting purposes and should not be confused with ‘Health only’  medical in confidence forms.

 

13.5.4    All incidents of self-harm must be reported to National Operations Unit (NOU) through the IRS. See Chapter 2 of PSO 1400, Reporting of Incidents. All serious incidents (where resuscitation and or transfer to outside hospital as the result of self-harm have been required) must also be reported to NOU by telephone. Staff must fill in prisoner involvement screens. SCG may contact establishments for further details on a prisoner’s condition and prognosis if required.

 

13.6          Post-incident support for staff and other prisoners

 

13.6.1    Dealing with suicide attempts, or other serious incidents of self-harm, can be as stressful as dealing with a death. The Safer Custody Team and Care Team should work closely on an agreed strategy to support staff and prisoners following a death in custody, and also following an incident of serious self-harm, particularly those resulting in a life threatening injury where the person required hospitalisation and it is likely that they will be sustain permanent injuries as a result of the self-harm incident.

 

13.6.2    Support for staff involved in an incident of serious self-harm must be offered in every case, and should be based on Chapter 5 of PSO 2710 - follow up to deaths in custody and PSO 8150 - post incident care for staff Link to Staff Welfare Contacts. This should also relate to support for staff in connection with any investigations into serious incidents of self-harm. The Staff Care and Welfare Service (SCWS, tel: 0845 6072034) can arrange a referral to a completely independent practitioner, such as a counsellor or psychologist, should a member of staff need more specialised, professional help than SCWS can provide itself. Some establishments also use Care First, which gives staff, or their families, access to a 24 hour hotline to a counsellor – privately, discreetly and confidentially.

 

13.6.3    Witnessing a suicide attempt or incident of self-harm is a traumatic experience for prisoners too. Special attention should be paid to prisoners who were in the vicinity of the incident (for example, cellmates) and prisoners who are related to or are particular friends of the individual who self-harmed. It is good practice for them to be seen individually and support offered over the subsequent days and weeks. Similarly, where it is known that a prisoner who has seriously self-harmed has relatives or particularly close friends in another establishment, that establishment will need informing so that staff can – where appropriate - break the news to them.

 

13.6.4    Where a prisoner is already at risk of suicide or self-harm (that is on an open ACCT Plan) being aware that another prisoner has tried to kill themselves or self-harm usually raises the risk, by making self-harm and suicide seem more acceptable and familiar. Prisoners on an open ACCT Plan should be interviewed and, where any concerns are raised, their care reviewed. Therefore, establishments need to follow their local procedures concerning how and when.

 

13.6.5    Where appropriate, after serious incidents of self-harm consideration should be given to allowing other prisoners the opportunity to contact friends/family by a phone call and/or exceptional visit. The prisoner should also be offered the services of a Listener or Samaritans. See Chapter 7: Peer and family support, Samaritans and telephone helplines.

 

13.7          Contingency planning

 

13.7.1    Local contingency plans or emergency orders must include the following in respect of an incident of self-harm, or when there is concern that a prisoner is at risk:

 

a)      Ensuring speedy access to a suicidal prisoner by (a) health care staff and (b) external paramedics for transfer to outside hospital

 

b)      Escorting prisoners to hospital who have cut their wrists and cannot be put into mechanical restraints see Incident Management Manual – PSO 1400 (restricted status)

 

c)      Staff entering multi-occupancy cells 

 

d)      Requesting/authorising an ambulance to attend.

CHAPTER 14: SUICIDE PREVENTION AND SELF-HARM MANAGEMENT FOR YOUNG PEOPLE

 

Link to Standard 60

 

14.1     Introduction

 

14.1.1  The aim of this chapter is to provide a reference point for staff working with young people at-risk of suicide/self-harm. Development of specific policy is in response to requirements from the specific legislative framework and child protection procedures that apply to children, and in recognition of the specific needs of this age group. Where appropriate, references are made to relevant legislation and procedures.

 

14.1.2  This chapter applies to both young men and women. Separate guidance has been developed for women prisoners, and should be referred to alongside this guidance in relation to young women, see Chapter 12. The drafting of specific guidance for young women was considered, but decided against due to there being a limited body of evidence to draw from owing to the relatively low numbers of young women in prison custody.

 

14.1.3  Studies of investigation reports into adult self-inflicted deaths and of adults who have attempted suicide, show that most have a long history of disrupted family relationships, painful and abusive experiences and other problems. Research suggests that adult prisoners who kill themselves today may have long custodial histories, often beginning as children/ young people. In this light, efforts to support and care for young people is a form of early intervention and prevention of adult deaths.

 

14.2     Further information

 

14.2.1  Suicide prevention and self-harm management is an essential component of establishments’ safeguards strategy and requires both strategic and operational integration with violence reduction (anti-bullying) and child protection workstreams. For further contextual and more detailed background information, see Annex YP1 – Suicide Prevention and Self-Harm Management for Young People which includes references to:

 

Annex YP2 - Risk Alert Procedure

Annex YP3 - Youth Justice Board Secure Facilities Placement Policy and Protocol

Annex YP4 - Self-Harm

Annex YP5 - Known Links Between Bullying/ Self-Harm/ Suicide

Annex YP6 - Managing Vulnerability

Annex YP7 - Using ‘Need2talk’: Supporting Young Offenders

Annex YP8 - Child Protection Considerations

 

14.3     Definition of Young People

 

14.3.1  NOMS no longer uses the term ’Juvenile’ to describe under 18s. PSO 4950 refers to and defines “child/children as those under the age of 18”, “young person / people as those under the age of 18 together with those who have reached 18 and continue to be accommodated in the Young People’s Estate.” PSO 4950 relates to those unconvicted and convicted unsentenced young people under 18 years of age, and also young people who have been sentenced to a Detention and Training Order (DTO) or who are sentenced under Section 91 (or 90) of the Powers of Criminal Courts (Sentencing) Act 2000 under 18 years of age. However, this also includes young people over 18 years of age who have been sentenced to a DTO and placed by the Youth Justice Board, despite being 18 and 19 years of age.

 

14.4     Multi-disciplinary risk assessment

See Annex YP9 – Multi-disciplinary risk assessment

 

14.5     Chaplaincy and Young People

 

14.5.1  For guidance on the role the multi-faith Chaplaincy team can play, see Annex YP10. For information on training available, see Annex 12J.

 

14.6     Mental health

Annex YP11 – Mental health

 

14.7     Substance misuse

 

14.7.1  The Youth Justice Board’s National Specification for Substance Misuse was launched in November 2004 and is being implemented in all prisons holding young men and women. This Service has replaced the Adult CARAT Service. The Specification is based on Health Advisory Service Guidance, ‘The Substance of Young People’s Needs’ (2001) and will be delivered in line with the ‘Ten key principles for working with young people.’ These principles were developed by the Standing Conference on Drug Abuse (SCODA) in accordance with the Children Act 1989 and the UN convention on the rights of the Child. For more detail see Annex YP12 – Substance misuse.

 

14.8     Time out of cell and in-cell activities

Annex YP13 – Time out of cell and in-cell activities

 

14.9     Alternatives to Self-Harm

 

14.9.1  Some young people who have self-harmed have suggested possible alternatives when they have the urge to self-harm. Annex YP14 – Alternatives to self-harm.

 

14.10  Related documents and relevant links

Annex YP15 – Related documents and relevant links

 

 

CHAPTER 15: DISCHARGE AND RESETTLEMENT

 

Link to Standard 60

 

15.1     Introduction

 

15.1.1  Whether transferring to another prison, being moved into the custody of another agency, or being released, the safety and well being of prisoners requires that any existing support and care plans are maintained in the new environment. A released prisoner will be at increased risk of suicide or self harm as a result of any unplanned reduction in the level of support which had previously been available in a prison context. See statistics & research on deaths in first year after leaving prison [Not yet available]

 

15.1.2  Similarly, risk is increased by failure to adequately inform those taking over responsibility for prisoners on transfer to another place of custody about levels of risk, likely triggers of increased risk, and existing care plans, all of which enables continuation of care.

 

15.1.3  Guidance on inter-agency information sharing is contained in PSI 2002/025 - The protection and use of confidential health information in prisons and Annex 8V – Communication and Teamwork, plus the NHS Code of Confidentiality and ‘Safe and Secure’ - Guidance for healthcare staff on information sharing.

 

15.1.4  Instructions on the transfer of risk and care planning information are also contained in PSO 1025 The Prisoner Escort Form, PSO 2300 - Resettlement and PSO 3050 - Continuity of healthcare for prisoners. The reason for prisoners leaving establishments (release, transfer to hospital, police custody, Immigration Service custody, Probation approved accommodation or to another prison), should not detract from ensuring that all available (and appropriate) risk and care planning information is provided to:

·         those who can assist in their on-going/future care; and/or

·         who will take over responsibility for them; or

·         those who store data to assist in care in the event of future likely contact.

 

15.2     Preparation for release

 

15.2.1  Where a prisoner has an offender supervisor, that person must be involved in case reviews.

 

15.2.2  The Offender Supervisor must communicate at the earliest opportunity (and certainly before release) with the Offender Manager to ensure they are aware of the prisoner’s history of risk to self and others, and that the offender’s sentence plan includes appropriate interventions to address long-term problems such as repetitive self-harm, which can be expected to remain a problem after release.

 

15.2.3  It is good practice for staff working closely with challenging prisoners to attend MAPPA reviews before release, so that those people supervising the offender after release are fully informed about risk and about management strategies that have been tried within the prison setting.

 

15.2.4  Information concerning continuity of treatment, preparation for release and the transfer Health/Mental Health information to appropriate external agencies, is contained in PSO 3050 – Continuity of Health Care for Prisoners.

 

15.3     Discharge from custody of at-risk prisoners – Preparing post-release care

 

15.3.1  The aim is to ensure discharged at-risk prisoners receive comparable support to the support they received in the establishment. Staff from agencies (and others) that will be involved in the care of the prisoner post-release should be invited to input to the Case Reviews prior to discharge. The pre-release CAREMAP should include action to link the prisoner to external organisations that provide support after release, e.g. Probation, Youth Offending Team (YOT), Social Services Department, housing, education/employment, family, healthcare, drugs treatment teams and mental health services. The CAREMAP should also reflect the provision of information to the prisoner about how to obtain support from outside organisations such as Samaritans.

 

15.3.2  If closure of the ACCT Plan is because the prisoner is being discharged from custody the Case Manager must update the CAREMAP to reflect the care they will require in the community. Annex 15D – Suggestions for supporting prisoners at risk from self-harm leaving the establishment where there is no receiving agency. Where notice of discharge allows it (i.e. 24 or more hours notice) the Case Manager must involve Offender Supervisor/YOT (if the prisoner is to be under their supervision) and resettlement staff in at least the final Case Review. If notice of discharge is less than 24 hours the final case review must still take place, but it is recognised attendance may be limited to who is available, for example, Orderly Officer or Reception Manager. It is good practice to involve Offender Managers/YOT staff as early as possible in updating the CAREMAP to reflect planned support in the community. Local protocols will explain Probation and resettlement staff requirements in respect of this. For relevant offenders the Offender Manager in the community should be actively involved in planning for release. The Case Review needs to keep in mind that BIA Detention Centres also use ACCT, therefore the ACCT Plan will transfer with the individual and the CAREMAP will be continued (see 15.12.3 & 15.8).

 

15.4     Provision of information for prisoners leaving custody

 

15.4.1  Whilst support for a prisoner once they leave the establishment should have been prepared as part of the pre-release care planning process, it is still desirable for discharging establishments to have in place wider systems for the provision of supportive information. Many prisoners may not have post release care plans, e.g. because they have not been identified as at risk or their drugs or health workers have had problems arranging post-prison care. Decisions about personalising this information has to remain at the discretion of each establishment, i.e. whether such provision is based on each individual’s known need/likely risk, or whether – due to sheer numbers – the same package of information is provided to some or all who are discharged from the establishment, with an explanation of what it is for.

 

15.4.2  Supportive information takes two forms:

(i)      warnings about danger e.g. about the strength and dangers of drugs outside of prison, or implications of not taking medication, and

ii)   where to obtain help and support relevant to their individual need, e.g. where to obtain health care, or how to contact support groups, see support groups information [Not yet available], or provision of telephone helpline numbers. See chapter 7.

 

15.5     Care of at-risk prisoners leaving the establishment

 

15.5.1  Prisons will have (see Internal and External Information Flows section of Annex 1B) local protocols for the care of at-risk prisoners leaving custody. Amongst the suggestions to help with this are Annex 15A - Temporary Release and Annex 15B - Transferring Prisoners who are Both At-Risk and Present Challenging Behaviours.

 

Link to the Resettlement PSO with specific links to: Healthcare provision in the community; family; alternative support mechanisms; employment

 

15.6     Transfers, court movements and other external movements of at-risk prisoners

(Additional instructions regarding transfer of risk information to Borders and Immigration Agency establishments – Immigration Detention Centres - is set out further below)

 

15.6.1  Where a prisoner on an open ACCT Plan is leaving the establishment (i.e. moving to another place of custody such as court or prison, not final discharge):
wThe ACCT Plan must accompany them
wDischarging reception staff must make receiving escort staff aware that the prisoner is on an open ACCT
wThis must be recorded on the Prisoner Escort Record (PER), the bottom copy of which is retained by the establishment

 

15.6.2  ACCT Plans must not be closed (or where already closed and in the post-closure phase of ACCT, the prisoner must not have the final post-closure review) within the 72 hours before a known transfer.

 

15.6.3  Where a prisoner in the post-closure phase of ACCT (i.e. the ACCT Plan has been closed, but the final post-closure review has not been signed off) is leaving the establishment (i.e. moving to another place of custody such as court or prison, not final discharge):
wThe closed ACCT Plan must accompany them Link to Eastern Area post-closure form [Not yet available]
wDischarging reception staff must make receiving escort staff aware that the prisoner has a recently closed ACCT Plan
wThis must be recorded on the Prisoner Escort Record (PER), the bottom copy of which is retained by the establishment
ANNEX 15C – Suggestions for Determining Who (Amongst Departing Prisoners) is in the Post-Closure Phase of ACCT

This does not mean that staff, if they consider the movement, e.g. a return to court, a potential trigger, can not re-open the ACCT Plan.

 

15.6.4  Where a prisoner has had an ACCT Plan fully closed in the last month (i.e. the ACCT Plan has had the final post-closure review signed off within the last 30 days) and is transferring to another prison establishment, the closed ACCT Plan must accompany them.

15.6.5  Escort staff must ensure they are aware of the contents and maintain the ACCT Plan. Escort staff must make receiving reception staff at the other end of the journey aware that the prisoner is on an open ACCT Plan.

 

15.6.6  The ACCT Plan must be readily visible to the escort staff; it must not be put in the sealed pouch with the prisoner’s clinical record. If the prisoner is taken to hospital, the ACCT Plan must travel with them. Staff on bed watch must include any pertinent observations in the Ongoing record, including any information provided by specialist services at the hospital, for example the deliberate self-harm team.

 

15.6.7  Discharging staff must complete the PER accurately PSO 1025 - The Prisoner Escort Form. Receiving staff (whether prison, contracted escort or other agencies) must also be notified by way of a verbal briefing when an at-risk prisoner is to be handed over into their care. Any significant information on the PER must be highlighted as part of these procedures.

 

15.6.8  Escort staff must, when taking over responsibility for prisoners, make an immediate check for ACCT status, checking observation requirements and the content of CAREMAPs. They must document relevant observations, contacts, events, changes in mood, behaviour or circumstances in the PER and in the ACCT ongoing record.

 

15.6.9  Where prisoners appear at court whilst on an open ACCT Plan and are released on bail, but remain within the care of a criminal justice agency, then court escort staff must pass the risk information to that agency.

 

15.6.10Where prisoners appear at court whilst on an open ACCT Plan and are released – whether to the care of another criminal justice agency or not - the ACCT Plan must be returned to the ‘sending’ prison for filing in his/her core F2050.

 

15.6.11For advice on the management of Non-Compliant and/or Violent Prisoners on Transfer refer to PSO 1810 - maintaining order in prisons

 

15.7     Further instructions regarding transfers of at-risk prisoners to other establishments

 

15.7.1  All establishments must accept a prisoner on an open ACCT Plan. Transfer may form an integral part of their CAREMAP, for example locating the prisoner closer to home, and may be an appropriate tool to support a prisoner at heightened risk.

 

15.7.2  The intention to transfer a prisoner on an open ACCT Plan (or in the post-closure phase of ACCT) must be discussed with the receiving establishment, a record must be retained in the sending establishment to show this has been done (as well a record made in the ACCT Plan), and relevant information must be conveyed either with or ahead of the prisoner. For an example of a form for Advance Notice of Transfer on Open ACCT, see Annex 15E. It is good practice to invite staff from the receiving establishment to attend a Case Review prior to any transfer of a prolific self-harmer.

 

15.7.3  The proposed transfer, and issues arising from it, must be discussed at a case review with the prisoner (in the case of Category ‘A’ and ‘E’ list prisoners additional discretion about transfer arrangements must be maintained).

 

15.7.4  The prisoner should be given information about the regime and facilities of the new establishment, helped to prepare, and subject to security considerations, given the opportunity to contact family and friends prior to the transfer.

 

15.7.5  The F2052A (history sheet) must be used in addition to the PER to record that an open ACCT Plan is in existence when transferring prisoners.

 

15.8     Transfer of at-risk prisoners to Borders and Immigration Agency

 

15.8.1  Where an at-risk prisoner/immigration detainee is transferred to an immigration centre The ACCT Plan will travel with them (see 15.12.3).

 

15.9     Transfer of at-risk prisoners to Probation Service

 

15.9.1  Currently the care of at-risk prisoners released to Probation involves Probation Service input to care planning (see 15.2 & 15.3) and the transfer of risk information and care plans (see 15.12.1). However, it is good practice for establishments and the Offender Supervisors working there to develop improved local methods of continuous care for prisoners moving from prison to Probation.

 

15.9.2  Some prisoners are required on release to reside in the first instance in Probation Approved Premises. To assist members of the local Safer Custody Team to understand what happens in approved premises, see Probation Circular 40/2004 and ACCT pilot in approved premises [Not yet available] and Probation Circular 35/2006. Court escort and Probation systems to communicate risk from court cells to Probation may also be of interest, see chapter 3.

 

15.10   Transfer of at-risk prisoners to secure hospital

Link to ‘Guidelines on the transfer of prisoners to and from hospital under Sections 47 and 48 of the Mental Health Act 1983 (on the Offender Health website)

 

15.11               Transfer of at-risk prisoners to Police custody

 

15.11.1            There are occasions when police take into custody people who may already be in prison, and  who could be on a care or support plan having been identified as a suicide or self-harm risk. Some examples are:

·         When a prisoner is lodged overnight in police cells due to the distance of the court from any prison (not to be confused with a ‘lock-out’), and they are due back in that court the following morning.

·         When a prisoner is released to police custody (sometimes referred to as a police production) because of outstanding elements of an investigation or new charges.

·         When a prisoner is arrested on release from prison (known as a re-arrest).

 

15.11.2            It is possible that police custody staff will temporarily have in their custody an at-risk prisoner and it is important that discharging prison staff ensure the police have information about how to maintain the care/support plan that is already in place.

 

15.11.3            To assist police custody staff and those non-police staff who pass prisoners to the police, information on current systems in use in prisons and YOIs, and on what police custody staff need to look for if an at-risk prisoner comes into their custody suite is outlined in guidance to police on receiving ACCT [Not yet available] and Appendix 10 of Police Detention Guidance [Not yet available]

 

15.11.4            Where an at-risk prisoner is to be transferred or discharged to police custody, the receiving authority must be provided with their ACCT Plan (or a copy) so that this can be passed to the relevant police custodial staff. If the original ACCT Plan is passed over a copy must be kept in the sending establishment, with a record to show where the original ACCT Plan has gone.

 

15.12               Discharge from custody – Transfer of risk information

 

Transfer of risk information to Probation Service or YOT

 

15.12.1            If the at-risk prisoner is to be under the supervision of the Probation Service/YOT upon discharge, a photocopy of the final Case Review, CAREMAP, front cover and inside front cover of the ACCT Plan must be provided to their Offender Manager/YOT worker or approved premises manager in accordance with local protocols. Ideally this should be provided at least 48 hours before and not later than same day of transfer. A record must be made in the retained ACCT Plan to show this has been done. This is in addition to any requirements in respect of updating Risk of Harm information on OASys/ASSET. Probation staff have been informed of this arrangement through Probation Circular 35/2006 and YOTs through a YJB document [Not yet available]

 

Probation care of offenders who self-harm and recalls to prison

 

15.12.2            Offender Managers will be using the above information to inform the care planning process for offenders who are at risk of suicide or self-harm on return to the community. Additional guidance for Probation staff in managing self-harm/suicide risk can be found in Probation Circular 35/2006

 

Transfer of risk information to Borders and Immigration Agency

 

15.12.3            Where an at-risk prisoner is reaching the completion of his/her sentence and is to be deported from the UK, the Borders and Immigration Agency (BIA) Criminal Casework Team must be informed about the risk in advance of BIA taking responsibility for the escort/custody of that person. This is to ensure that appropriate arrangements can be made for the person's care during their escort from prison and thereafter during their custody at an Immigration Service Removal Centre or to the point of departure from the UK. Calls should be made to 020 8604 0763. This number is for this purpose only and should not be used as a general BIA enquiry line. When such an at-risk prisoner (or an at-risk immigration detainee) is discharged, the receiving authority must be provided with their ACCT Plan (BIA also use a version of ACCT and the Plan will be continued as appropriate at the Detention Centre). The ACCT Plan must travel with the staff escorting the at-risk prisoner/immigration detainee to a Detention Centre. A photocopy of the final ACCT Plan must be retained by the discharging prison and placed in the core F2050 with a record to show where the original ACCT Plan has gone.

 

15.12.4            Similarly to above, where a prisoner/immigration detainee in the post-closure phase of ACCT (i.e. the ACCT Plan has been closed, but the final post-closure review has not been signed off) is being moved to a BIA establishment:
wThe closed ACCT Plan must accompany them (a copy is retained by the prison)
wDispatching reception staff must make receiving escort staff aware that the prisoner has a recently closed ACCT Plan

wOnce BIA start to use the Prisoner Escort Record (PER) (estimated start date is 2008), the above must be recorded on the PER, the bottom copy of which is retained by the establishment

 

Transfer of risk information to Police upon discharge

 

15.12.5            The police can be informed through the Police National Computer (PNC) of any history of self-harm by the prisoner during their recent period in custody. This information allows the police to better care for and support any previous at-risk prisoner who returns to their custody. Direct inputting to the PNC is not currently available to prisons, but a prisons/police transfer of risk information protocol [Not yet available] has been agreed with the Association of Chief Police Officers (ACPO).

 

15.12.6            Establishments must ensure their local PNC Bureau is able to update the PNC by (i) consulting LIDS prior to discharge and (ii) informing the local PNC Bureau of any history of self-harm by the prisoner during this period in custody.

 

15.12.7            For PNC warning marker purposes ‘suicide risk’ refers to any self-harm incident where the prisoner involved required resuscitation and/or transfer to an outside hospital. ‘Self-harm risk’ refers to any act other than the above where a prisoner deliberately harms themselves irrespective of the method, intent or severity of any injury. Advice about and forms for the transfer of information to the police can be found on the Guide to transferring risk information to the PNC.

 

15.13              Departures from Custody where there is no receiving agent  

 

15.13.1            Where prisoners are released either on bail (with no conditions of residence) or with no statutory supervision, prison staff will need to talk to the individual to see who is supportive in the community and whether the prisoner is content for them to be contacted.

Annex 15D – Suggestions for supporting prisoners at risk from self-harm leaving the establishment where there is no receiving agency