Prison Service Order 2700

Suicide Prevention and Self-Harm Management

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.

CHAPTERS	CLICK ON TICK TO VIEW CHAPTER SECTIONS / ANNEXES
	SECTIONS	ANNEXES
Executive Summary
1. Roles & Responsibilities	P	P
2. Staff-Prisoner Relationships and The Prison Culture	P	n/a
3. Pre-Prison and Time at Court	P	P
4. Early Period In Prison	P	P
5. Positive Regimes And Purposeful Activity	P	n/a
6. Specialist Services and communication with staff	P	P
7. Peer And Family Support, Samaritans And Telephone Help lines	P	P
8. Planning & Providing Care For Prisoners At Risk of Suicide/Self harm	P	P
9. Management Of At-Risk Prisoners Whose Behaviour Is Particularly Challenging	P	P
10. Built Environment	P	P
11. Equipment	P	P
12. Suicide Prevention And Self-Harm Management For Women Prisoners	P	P
13. Actions Following An Incident Of Self-Harm	P	P
14. Suicide Prevention and Self Harm Management For Young People
15. Discharge And Resettlement	P	P

CHAPTER	SECTIONS AND SUBHEADINGS
1 Roles & Responsibilities	1.1 Introduction 1.2 All members of staff 1.3 All Managers in Establishments 1.4 Area Managers, the Director of High Security Prisons and the Head of PECS 1.5 Heads of Headquarters Policy and Training Delivery Groups 1.6 Area Safer Custody Advisers 1.7 Governors/ Directors of contracted-out establishments 1.8 Safer Custody Team (SCT) Leaders 1.9 Suicide Prevention Coordinators (SPCs) 1.10 Unit Managers 1.11 Health Care Managers 1.12 Samaritan Liaison Officers 1.13 ACCT Trainers (inc POELT Suicide Prevention Trainers) 1.14 ACCT Assessors 1.15 ACCT Case Managers 1.16 Safer Custody Administrative Officer 1.17 Prison Intelligence Officer (PIO) / Police Liaison Officer (PLO) 1.18 Family Contact Officer
2 Staff-Prisoner Relationships And The Prison Culture	2.1 Prison culture 2.2 Staff-prisoner relationships 2.3 Staff supervision and support
3 Pre-Prison And Time At Court	3.1 Introduction 3.2 Establishment local cross-agency strategies 3.3 Police 3.4 Courts and Escort Staff 3.5 Transfer of risk information to Probation Service or Youth Offending Team 3.6 Transfer of risk and care information from Court Custody where there is no receiving agent
4 Early Period In Prison	4.1 Introduction 4.2 Reception and first night 4.3 Reception staff 4.4 Prison Reception staff receiving at-risk prisoners 4.5 Receipt of prisoners with a Suicide/Self-Harm Warning Form 4.6 Receipt of prisoners with an open ACCT plan 4.7 Reception health screen and follow-up care 4.8 Change of status, failed appellants and recalled prisoners 4.9 Drug/alcohol withdrawal and detoxification 4.10 Prisoners charged with offences related to violence against a family member and/or homicide 4.11 Risk of harm to self and others 4.12 Identifying next of kin and supportive persons outside of prison 4.13 Phone contact and help lines 4.14 The safer reception environment and violence reduction 4.15 Provision of information and diversionary material 4.16 Checking for risk in previous custody 4.17 Other sources of risk information or assistance concerning prisoners 4.18 First night 4.19 Induction 4.20 Remands
5 Positive Regimes And Purposeful Activity	5.1 Introduction 5.2 Management of positive regimes
6 Specialist Services & Communication With Staff	6.1 Introduction 6.2 Health and mental health services 6.3 Drug and alcohol services 6.4 Prisoners with histories of abuse 6.5 Providers of specialist services and ACCT 6.6 In-possession medication
7 Peer And Family Support, Samaritans And Telephone Help lines	7.1 Introduction 7.2 Samaritans and Listeners 7.3 Other peer support schemes 7.4 Insiders 7.5 Voluntary organisations 7.6 Families 7.7 Telephone help lines
8 Planning & Providing Care For At Risk Prisoners	8.1 Identifying prisoners at risk 8.2 Actions to take if a prisoner is identified as at-risk 8.3 Core care – for all prisoners at risk of suicide or self-harm 8.4 Additional care for prisoners who self-harm repeatedly without current suicidal intent 8.5 Keeping safe: Additional care to keep safe prisoners who are believed to be thinking about or planning suicide 8.6 Location and accommodation 8.7 Conversations and observations 8.8 Constant Supervision 8.9 Removal of items in possession 8.10 Additional requirements for removal of normal clothing and issue with alternative clothing 8.11 Communication and teamwork
9 Management Of At-Risk Prisoners Whose Behaviour Is Particularly Challenging	9.1 Introduction 9.2 Measures of last resort 9.3 Enhanced case review team 9.4 Care-planning and general approach to behaviour management 9.5 Location 9.6 Regime – access to activities 9.7 Access to social support 9.8 Mental health assessment, engagement and treatment 9.9 Reducing the frequency and severity of self-harming behaviour 9.10 Reducing the frequency and severity of violent behaviour 9.11 Keeping the prisoner safe during periods of acute suicidal risk 9.12 Consistency of care – communication 9.13 Administering medication without consent (“Rapid Tranquillisation”) 9.14 Transfers between establishments 9.15 At-risk prisoners with a history of arson 9.16 Dirty protests 9.17 Food refusal
10 Built Environment	10.1 Introduction 10.2 Accommodation of at-risk prisoners
11 Equipment	11.1 Introduction 11.2 Emergency Response Kits for residential areas 11.3 Personal issue cut-down tools 11.4 Specialist equipment to be held in the healthcare centre
12 Suicide Prevention And Self-Harm Management For Women Prisoners	12.1 Introduction 12.2 Reception/ first night 12.3 Foreign national women prisoners 12.4 Women withdrawing from drugs and/or alcohol on arrival to prison 12.5 Induction 12.6 Training available for staff working with women prisoners 12.7 Mothers in prison 12.8 Resettlement 12.9 Interventions for self harm
13 Actions Following An Incident Of Self-Harm	13.1 Introduction 13.2 Immediate action following incidents of self-harm or attempted suicide 13.3 Follow-up actions and care for prisoners who have self-harmed 13.4 Investigating serious incidents of self-harm 13.5 Reporting requirements 13.6 Post-incident support for staff and other prisoners 13.7 Contingency planning
14 Suicide prevention and self-harm management for young people	14.1 Introduction 14.2 Further information 14.3 Definition of Young People 14.4 Multi-disciplinary risk assessment 14.5 Chaplaincy and Young People 14.6 Mental health 14.7 Substance misuse 14.8 Time out of cell and in-cell activities 14.9 Alternatives to Self-Harm 14.10 Related documents and relevant links
15 Discharge And Resettlement	15.1 Introduction 15.2 Preparation for release 15.3 Discharge from custody of at-risk prisoners – Preparing post-release care 15.4 Provision of information for prisoners leaving custody 15.5 Care of at-risk prisoners leaving the establishment 15.6 Transfers, court movements and other external movements of at-risk prisoners 15.7 Further instructions regarding transfers of at-risk prisoners to other establishments 15.8 Transfer of at-risk prisoners to Borders and Immigration Agency 15.9 Transfer of at-risk prisoners to Probation Service 15.10 Transfer of at-risk prisoners to secure hospital 15.11 Transfer of at-risk prisoners to Police custody 15.12 Discharge from custody – Transfer of risk information

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: