WHO NEEDS TO SEE THIS BULLETIN?
Audit, Assurance & Compliance, HMIP and PPO have recently highlighted that there is inconsistency and confusion amongst some staff about what constitutes constant supervision. The aim of this bulletin is to highlight the key principles of constant supervision and includes prompts for improved practise.
When considering applying Constant Supervision you are strongly advised to refer to PSO 2700, chapter 8 and annex
8Y and joint Prison Service and Offender Health Guidance entitled Mental Health Observation, including Constant
Supervision: Good Practise Guidelines for Healthcare Staff Working in Prisons.
What is Constant Supervision?
Constant supervision is used in response to an immediate and life threatening risk of suicide or self harm. It is carried out on a one to one basis and is designed to allow the supervising member of staff to:
- Raise the Alarm in the event of self harm or attempted suicide occurring
- Intervene in line with the Constant Supervision Intervention Plan
- Provide the individual with active and ongoing interaction and encouragement to reduce the level of risk
- Maintain accurate records for the period of supervision
Constant Supervision Intervention Plans
Constant Supervision Intervention Plans provide the authority for staff to approach a prisoner, under constant supervision, who is engaged in potentially life threatening self harm or attempted suicide. It details what the supervising member of staff needs to do if the individual starts to self harm, and includes raising the alarm, expectations in regard to entering cells, the use of force to prevent self harm and the provision of PPE for staff. The plan will also reflect how staff gain access to the cell during night state. Each intervention plan will differ dependent on the individual circumstances presented by the prisoner.
! Learning Point
Constant supervision is an intensive and intrusive method of managing someone at risk of suicide or life threatening self harm. Constant supervision when coupled with methods of last resort, such as Special Accommodation,
Alternative Clothing or Physical Restraints can increase feelings of worthlessness and hopelessness and therefore increase the risks of suicide or self harm. Where such management strategies are adopted they should be authorised at the appropriate levels, recorded in the CARE MAP and be introduced for the shortest possible time. Accurate record keeping in these circumstances is exceptionally important.
This ‘quick time’ learning bulletin is the Third in a series of new publications from NOMS Safer Custody and Offender Policy Group. The aim of the bulletin is to highlight key learning points which may be useful to all establishments in helping them to identify potential safer custody risks and take remedial action where it is needed.

Combining Different Levels of Supervision and Observations
Constant Supervision can be utilised at different times of the day with a single person, for example as part of a supervision reduction strategy a prisoner might be subject to reduced levels of observation when they are engaged in activities, but be subject to constant supervision during periods where they are alone in a cell, (patrol state, night time). Such decisions would be taken by the Case Review.
What’s the Difference between Constant Supervision and Camera Supervision?
Constant Supervision requires there to be personal interaction and encouragement with the prisoner by a member of staff. This cannot be achieved through camera surveillance alone. PSO 2700 prevents the use of CCTV alone to conduct constant supervision, except in the most exceptional circumstances where there is a clear danger to the individual member of staff.
How long should Constant Supervision be maintained?
Constant supervision is a response to an immediate suicidal crisis and therefore is intended to be in place for the shortest time possible. An acute suicidal crisis is often temporary and one aim of the case review is to reduce the level of supervision required progressively, substitut ing alternative supports, as the prisoner’s condition improves.
Once commenced how can Constant Supervision be reduced?
Inevitably there is a degree of risk taking in deciding to reduce such high levels of supervision and timing is crucial, particularly in relation to trigger factors such as anniversaries, court appearances and transfers. Reductions in supervision can be staged to ensure the prisoner remains supported and is gradually encouraged to take more responsibility for themselves. Combining levels of supervision with activities and mental health and physical healthcare support is essential. Involving families, where appropriate, can also be an important motivator and encouragement for individuals.
How can I support staff carrying out Constant Supervision?
Constant supervision of an actively suicidal or self-harming prisoner is a very demanding role for the supervising member of staff. Governors must consider how best to support those carrying out constant supervision taking into account:
- The length of each supervision and rotation arrangements
- The need for comfort breaks, debriefing and ongoing support
- Training requirements (regardless of whether they are NOMS or PCT staff)
- The impact supervision may have on staff wellbeing.
! Learning Point
OSRR have previously produced a Constant Supervision Training DVD and accompanying script. They are suitable for anyone undertaking Constant Supervision. The DVD should be available from your local SPC.
The purpose of this learning bulletin is to prevent a recurrence of such events. Are any of these issues relevant to where you work? What action may be needed to improve how you deliver safer custody to prisoners in your establishment?
If you have identified learning points which may assist other establishments in delivering safer custody please contact us at [ scoplearning@noms.gsi.gov.uk
]. Any resulting learning bulletins will be anonymous.
This ‘quick time’ learning bulletin is the Third in a series of new publications from NOMS Safer Custody and Offender Policy Group. The aim of the bulletin is to highlight key learning points which may be useful to all establishments in helping them to identify potential safer custody risks and take remedial action where it is needed.