HMP LINCOLN

SUICIDE & SELF-HARM PREVENTION

POLICY

November 2012

Governor: Peter Wright

Review Date: August 2013

Deputy Director of Custody: Andrew Cross

1

Safer Prisons Strategy Policy Document

CONTENTS

Chapter Page Subject

1. 4. Executive Summary - Statement of Purpose and Policy

Statement

2. 5. Introduction

3. 6. Local Aims and Objectives

4. 9. Key Roles & Responsibilities

5. 16. Information Sharing

6. 17. Management of Violence

7. 20. Suicide Prevention

8. 30. Constant Supervision

9. 37. Enhanced Case Management

10. 40. Food & Fluid Refusal

11. 45. Palliative Care

12. 48. Actions Following a Death in Custody

13. 54. Family Liaison & Engaging with the Family (FLO)

14. 58. Complex Behaviour

15. 66. Learning


STATEMENT OF PURPOSE

This document replaces local policies for Suicide & Self Harm Prevention, Violence Reduction and Death in Custody. Instructions are taken from PSI 2011/64 which replaces PSO 2700, 2750 and 2710.

1. To contribute to Prison Service principles, aims and objectives.

2.To identify, manage and support prisoners who are at risk of harm to self, others and from others.

3. Reduce incidents of self- harm and deaths in custody.

4. Manage and reduce violence, deal effectively with perpetrators and support victims.

5. Support effective multi-disciplinary case management and share information to reduce incidents of harm.

6. Ensure staff, prisoners and visitors affected by incidents of self-harm are supported appropriately.

7. Ensure appropriate responses and investigations to incidents, which promote learning to prevent future occurrences and improve local delivery of safer custody services.

8. To ensure that a death in custody is dealt with in a sensitive, constructive and open way.

SAFER CUSTODY POLICY STATEMENT

HMP Lincoln is committed to identifying, managing and supporting prisoners who are at riskof harm to themselves, others and from others in order to reduce incidents of self harm anddeaths in custody.

We believe that everybody has the right to live and work in a safe environment free fromabuse, harm or oppression.

Any form of violence or anti-social behaviour will be managed in accordance with our

Violence Reduction Strategy in order to actively promote a safe and decent environment forstaff, prisoners and visitors. We will adopt a multi-disciplinary approach to risk managementwithin the establishment by ensuring that staff have the necessary knowledge, skills andconfidence to consistently challenge this type of behaviour immediately and fittingly.

Staff will be alert to the needs of those prisoners who find it difficult to cope and help themreduce those feelings as much as possible by providing care, treatment and continuoussupport suitable to the needs of the individual.

We will ensure that any staff, prisoners or visitors who may be affected by incidents of self-harm are supported and will provide appropriate responses to such examples which promotelearning to prevent future occurrences and improve the local delivery of safer custodyservices.

Peter Wright

GOVERNOR

2. INTRODUCTION

The prevention of acts of self-harm and suicide is everyone’s responsibility.

This policy takes its authority from PSI 64/2011 and staff should familiarise themselves with the Instruction. This document will be revised and updated in response to instructions and guidance issued from Headquarters, or developments in policy at local level.

Caring for those at risk is a shared responsibility. This does not mean that staff are not accountable. We care for prisoners and we believe that:

  • Suicide is not inevitable

Most suicidal people are ambivalent about suicide and want to be helped right to the end. We should attempt wherever possible to restore hope rather than confirm despair.

  • Change is always possible

Even where the individual faces enormous odds, things can improve. We shouldalways assume that change for the better is possible. There is no room for valuejudgements on whether another person’s life is no longer worthwhile.

  • Awareness of suicide can significantly reduce the risk

Most people who think about suicide leave some clue of their intention and areprepared to talk openly about it given the opportunity. The greater the awarenessand sensitivity of all those in contact with those at risk, the more chance of averting a crisis.

  • The suicidal person must consent to the help which is offered

We should not aim to coerce or simply mount surveillance but to set up a supportive relationship, which allows the suicidal person to cope. People in despair are usually willing to accept various levels of care if presented in the right way. If deprived of control there is a risk they may not disclose their suicidal feelings and they will see this as the only way of gaining control.

  • Positive listening alleviates despair

Talking about suicidal feelings has enormous therapeutic value. Positive listening, which reaches out empathically and accepts the suicidal person without judgement, is the most effective way of reducing despair.

  • Some suicides will still occur despite excellent care

Suicide is ultimately a matter of choice. We can usually influence that choice and should always seek to intervene. However, there will always be some who do not seek or respond to help. Not all suicides are preventable.

  • The need to support staff

Where suicides do occur, staff who have acted with due care and have done their best to help the prisoner should be fully supported. The causes of suicide are complex and cannot be attributed simply to the actions or omissions of any particular individual.

3. LOCAL AIMS AND OBJECTIVES

Prisoners who pose a risk to themselves, to others and/or from others are identified.

The safety, care and well being of all prisoners at HMP Lincoln are everyone’s concern. We understand there may be times when prisoners feel especially isolated, depressed and uncared for. At these times thoughts of suicide and self-harm may occur.

HMP Lincoln will support its prisoners at these times in the following manner:

1. HMP Lincoln will work together to create a safe and caring environment,where distress is minimised and those who are distressed are able to ask forhelp. To identify individual need and offer individualised care and supportbefore, during and after a crisis.

2. We will take a “whole prison” approach, which makes everyone responsiblefor prisoners at risk of suicide or self-harm.

3. By operating an effective Violence Reduction Strategy, coupled with staff training, HMP Lincoln will create a safe and supportive environment, whichhelps prisoners cope with custody, and enables those at risk to be identified.

4. We will provide a “Listeners Scheme” from Samaritan trained prisoners,available 24 hrs a day, to help those in need, through periods of crisis (an upto date list will be kept in each wing office. Listeners will be identifiedby a notice on his cell door, a ‘Listeners’ badge and/or a green polo shirt bearing the HMP Lincoln ‘Listeners’ logo.

This will not replace or undermine good staff/prisoner relationships.

5. We will provide 24hr direct telephone access to the Samaritans available onrequest by way of a dedicated Samaritan handset.

6. Visitors will be provided with information that outlines the procedures in placefor the identification, assessment and management of prisoners at risk ofharm to self, others and/or from others.

7. Staff at HMP Lincoln who receive information from concerned familymembers or observe changes in a prisoner’s behaviour which indicates achange in the risk they pose to themselves, to others and/or from others, willcommunicate their concerns immediately to the prisoners Wing Manager, Safer Custody Manager, Oscar or the Night Orderly Officer and consider openingan ACCT document and recording these actions in the relevant areas i.e. Observation book, PNOMIS, SIR, Incident Report, IRS and the ACCTdocument itself.

8. Where appropriate, HMP Lincoln will encourage family engagement inmanaging and reducing the risk of prisoners who harm themselves and/orothers. All reasonable steps will be taken to obtain all relevant informationregarding prisoner safety and this information will be recorded, shared andacted upon within the prison and between service providers or agencies.

9. We will make every effort to encourage the prisoner-in-crisis to fullyparticipate in the process, where it is safe to do so. Where this is not possiblewe will record the reasons in the appropriate documentation e.g. ACCTdocument.

10. All prisoners will be screened by a member of healthcare staff on reception orwithin 24 hours and be given the opportunity to see the Doctor at the earliestopportunity. Where mental illness is suspected we will refer to the MentalHealth team for assessment of mental state.

11. HMP Lincoln’s Prisoner Induction Programme will include information onSuicide and Self-Harm Prevention and Violence Reduction within the SaferCustody package, including how to access help which includes the Listenersand the Insiders scheme.

12. All prisoners, on reception onto a wing, will have their Cell Sharing RiskAssessment confirmed and be allocated a personal officer who will: -

  • Endeavour to encourage supportive and trusting relationships within theprison community
  • Assist in relieving fears of new prisoners and help them to settle
  • Provide help in coping with problems
  • Fully explain the prison’s regime and routines
  • Offer guidance in maintaining home and community ties and begin toprepare prisoners for release
  • Identify themselves as the primary source of contact for help andguidance

13. All staff at HMP Lincoln will consider the use of NOMS contracted translationservices when dealing with prisoners whose first language is not English andin particular, when conducting assessments of risk or during the riskmanagement process.

14. HMP Lincoln will provide Constant Supervision Cells (on A1) and E1 where prisonerswho are identified as being at high risk of self-harm may be located andsupported. Listener suites are available on A2, C2 & E2 landings.

15. HMP Lincolnalso hasa Constant Supervision Cell within the Segregation unit for those prisoners who may also pose a risk to others or who’s behaviour is considered to be so disruptive that their location warrants being placed in segregation. The use of this cell will always be subject to an approved algorithm.

16. Staff at HMP Lincoln will make themselves aware that the preservation oflife is the first priority when managing at-risk prisoners. Justifiable decisionson when to enter a cell where life is endangered, particularly at night, musttake account of the need to preserve life and should be documented in wingobservation books, PNOMIS and ACCT documents where one is open.

17. It is the responsibility of all staff at HMP Lincoln to make themselves awareof the location of emergency response equipment for the area that they aredesignated to work and those staff issued with ‘Cut Down’ tools, (Fish knives), must carry these at all times when they are on duty within the Establishment.

18. All prisoners located in the Constant Supervision Cells willhave a case review at least once every 24 hrs for the first 72 hours. Whenoccupied, the Orderly Officer or Night Orderly Officer will visit at least onceduring their tour of duty.

19. We will ensure that any prisoner who witnesses or is affected by anotherprisoners self-harm is given appropriate support.

20. We will ensure that any prisoner who is a victim of violence is provided withthe appropriate level of support according to the hurt or injury they suffer. Thevictim will be informed of the outcome of actions taken as a result of theviolence.

21. HMP Lincoln will have in place a Suicide and Self-Harm Prevention Team,which will meet Monthly. The chair of the Suicide Prevention Team will be amember of the Senior Management Team.

22. In the event of any death of a prisoner at HMP Lincoln, all open Acctdocuments, and those in Post Closure, will be reviewed within 24hrs. Contingency plans will be activated.

23. Staff at HMP Lincoln will have regard to equality considerations and willensure that all services are delivered fairly and appropriately. Regard will begiven to the protected characteristics defined in the Equality Act 2010, whichare age, disability, gender reassignment, marriage and civil partnership,pregnancy and maternity, race (including nationality), religion or belief, sex orsexual orientation.

4. KEY ROLES and RESPONSIBILITIES

(All Key Roles MUST be identified on the individual’s SPDR)

Governor

The Governor is responsible at HMP Lincoln for the implementation of the Self Harm & Suicide Strategy the Governor will monitor implementation of this policy by ensuring:

  • A Fully compliant Safer Prisons Strategy is in place, in accordance with PSI 64/2011, which must be reviewed annually;
  • Identify the target for the audit rating for the following year, delegating responsibilities as appropriate.
  • A local policy statement outlining a multi disciplinary, multi agency approach to safer custody & influence the establishments SLA with the PCT
  • Daily Checks of open ACCT by unit managers
  • Weekly checks by the Duty Governor - Deficiencies must be brought to theattention of the line managers, the response must be monitored and a record of checks must be maintained;
  • Random periodic checks by the Safer Custody Manager
  • A named Safer Custody Manager with Officer & Administration support
  • A Safer Custody Team leader, (Head of Residential), who takes responsibility for leading the safer prisons strategy.

Prison Service Operational Manager ’F’ or above, or a suitable competent Manager.

A competent Manager is, a manager who The Governor has authorised as having the appropriate authority to make the relevant decisions regarding the level of supervision of a prisoner at risk of self-harm or suicide.

The relevant Manager will:

  • Support staff in the management of prisoners at risk.
  • Attend constant observation review boards and enhanced review boards.

The Duty Governor

The Duty Governor will:

  • Check all open ACCT documents once a week and audit the quality of ACCT entries and draw deficiencies to the attention of line managers, monitor response, and record that they have made these checks in the ACCT document.
  • Will check observation books daily to ensure entries indicating risk of suicideand self-harm are promptly and appropriately actioned, and ensure that staff follow ACCT procedures

Safer Prisons Team Leader – Head of Residence

  • Has overall responsibility for the implementation, evaluation and co-ordination of the Safer Prisons Strategy.
  • Responsible for ensuring that the Safer Prisons Strategy is compliant withStandards Audit and national policy guidelines.
  • Is responsible for convening, circulating an agenda and chairing Safer Prisons Meetings in accordance with the Safer Prisons Strategy.
  • Annually agrees a Service Level Agreement with the local Samaritans.
  • Ensures that the Safer Prisons Team reviews the continuous improvement plan for HMP Lincoln.

Safer Custody Manager

  • Must be trained to at least ACCT Assessor level.
  • Take a primary role for the implementation, co-ordination and evaluation of our establishment’s Safer Prisons Strategy. The hours of this MUST be based on risk assessment carried out by the SMT and agreed with the Area Manager. The job will involve making contributions to the prevention of suicide and the reduction of self-injury within establishment.
  • Will work towards ensuring the establishment’s full compliance with bothLocal and National policy and, through the support of the Safer Prisons Team Leader, will take responsibility for disseminating good practice. The SC Manager will also develop their role with regular refresher training and by keeping a contemporary knowledge of good practices & the PSI.

Duties/tasks:

  • the day-to-day co-ordination and effective implementation and delivery of the Safer Prisons Strategy in the establishment.
  • Co-ordinate with Wing Senior Officers and Healthcare team to ensure an effective and responsive ACCT process.
  • ensuring that all prison standards relevant to the Prevention of Suicide and reduction of self-harm are known and published.
  • in consultation with the Safer Prisons Team, devise and implement strategies to promote good practice in suicide prevention within the establishment.
  • Achieve and maintain a high standard of service using appropriate managementand monitoring systems in order to evaluate the service.
  • Assist and support staff through contributing to the assessment of prisoners whoare in an acute phase of suicide ideation or persistent self-injury but not assuming responsibility for the management of the care.
  • Support the Safer Prisons trainers in the delivery of authorised training in safer custody and mental health.
  • Co-ordinate the establishment response to make suicide everyone’s responsibility by advocating the use of support services available within theestablishment and ensure that information regarding this is kept up to date for Case managers and Assessors.
  • Positive promotion of good work that is done in the area of suicide prevention by the establishment. This will be achieved through liaison and network with other prison establishments and organisations.

The Safer Custody Administrative Support Officer

  • The Safer Custody Administrative Support Officer must have a good understanding of Safer Custody procedures and will be trained to a minimum of ACCT case manager level.
  • They will provide administrative support to the Safer Custody Manager which will include the collection and recording of relevant data in accordance with Prison Service rules, to maximum efficiency and in accordance with Prison Service objectives and principles.
  • Maintain an up-to-date list of all ACCT assessors and publish an ACCT assessor rota at least once per month.
  • Maintain an up-to-date list of prisoner Listeners and publish a rota at least once per month.
  • Act as a liaison point for Safer Custody correspondence.
  • Liaise daily with OCA to ensure that all relevant parties are made aware of any prisoners on an open ACCT, or ones in Post Closure are identified.
  • Maintain the Z drive folder for open and Post Closure ACCT’s ensuring that the Safer Custody Manager or Duty Governor is made aware if reviews are out of time.
  • Provide administrative assistance in relation to Samaritan Listener training.

All Managers