HMP FORD
Suicide Prevention & Self Harm Management
Local Policy
Approved by …………………………………
Regional Custodial Manager
………………………………….
Governor
Published:
March 2010
To be reviewed:
February 2011
TABLE OF CONTENTS
Page
Policy Statement
3
Safer Custody Team
4
The Care of Offenders at Risk of Self-Harm or Suicide
5
Terms of Reference
6
Standing Agenda Items for Safer Custody Meetings
7
Chapter 1 - Statement of Management Responsibilities
8
Chapter 2 – Samaritans and Listeners
18
Chapter 3 – Early Period in Custody
20
Chapter 4 – ACCT Planning &Providing Care for Offenders “At Risk”
21
Chapter 5 – Discharge & Resettlement of “At Risk” Offenders
35
Chapter 6 – Self Harm Injury Interventions & Actions
39
Chapter 7 – Post Incident Support
43
List of Annexes
1
ACCT assessors
44
2
Offender Consent form
45
3
Personal Issue Cut Down Scissors
46
4
Personal Issue Cut Down Scissors – safe System of Work
47
5
PSO Follow up to a Death in Custody
48
6
CAREMAP – Sources of Support for Offenders ‘At-Risk’
49
7
Safer Custody Team Leader – Job Description
50
8
Safer Custody Team Co-ordinator – Job Description
51
9
ACCT Co-ordinator Audit Check list
52
10
ACCT Register
53
11
Custody Continuous improvement plan 2008/09
54
12
Risk Assessment for SAFER CUSTODY CO-ORDINATOR and Safer Custody
57
Administration support hours
13
Standard Letter to contact family /close friend
61
14
Authorisation Form for Constant Supervision & PSO 2700 Annex 8Y
62
15
United Kingdom Borders Authority fax number and form
68
2
HM PRISON FORD
POLICY STATEMENT
CARING FOR THE SUICIDAL
The prison service has a duty of care for all offenders. We aim particularly to identify and
to provide special care for those in distress and so reduce the risk of self-harm and self
inflicted deaths. We aim to provide a service of a high standard and quality.
Primary Care
1.
2.
3.
4.
5.
6.
7.
8.
Create a safe, humane and positive environment for offenders and staff.
Give positive support to enable offenders to settle quickly into the regime.
Encourage supportive and trusting relationships at Ford.
Provide support and help to offenders to cope with their problems.
Provide facilities for offenders to contact staff, listeners and Samaritans.
Receive counselling when required.
Encourage offenders to form and maintain home and community ties.
Prepare offenders for their release.
Special Care
An offender who feels like harming or killing himself is in crisis. We aim to identify and
resolve this crisis by:
1.
2.
3.
4.
5.
Making every effort to recognise times of suicidal crisis.
Treating those people with compassion and understanding.
Preserving their individual dignity.
Allowing offenders to express their feelings and encourage positive choices.
Protecting the suicidal from harming themselves or others.
Community Care
Offenders and staff will share our accepted responsibility to be aware and support those in
distress.
1.
2.
3.
4.
Providing staff with suitable training and support.
Encourage offenders to take a share of the responsibility for others.
Working in partnership with the offender’s families, voluntary agencies, in particular
the Samaritans.
Ensuring good communication and co-operation between all disciplines and agencies
that work with offenders.
To be reviewed November 2010
HMP FORD
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SAFER CUSTODY TEAM
The team will reflect a multi-disciplinary approach to the prevention of suicide and selfharm management. There is a monthly meeting. Members of the team are from the
following departments:
Team Leader – Operational Manager
Safer Custody Co-ordinator
Safer Custody/ACCT trainers
Violence Reduction Co-ordinator
Establishment Drug Co-ordinator
Chaplain
Offender Management
IMB
Samaritans
Listeners
Healthcare
Anti-Bullying Representative (offender)
Residential Principal Officer
CARATs
Safer Custody administration Support
Race Equality Officer
Security/Operations Senior Officer
Reception Manager
Segregation Unit/Adjudication Liaison Officer
4
THE CARE OF OFFENDERS AT RISK OF
SELF-HARM OR SUICIDE
The care of offenders who are at risk of suicide and self-harm is one of the Prison
Service’s most vital tasks. The care of offenders is one of our core values and as such,
the responsibility of successful implementation is a multi-disciplinary one.
The Suicide Prevention and Self Harm Management Policy of HMP Ford are based on
PSO 2700 Suicide Prevention and Self-Harm Management. The policy document is based
on the Prison Service duty of care for all offenders and staff. It provides us with
instructions on identifying offenders at risk of suicide and self-harm and on providing the
subsequent care and support for such offenders and support for the staff who care for
them.
The Suicide Prevention and self harm management Policy is underpinned by the need for
good information and communication between prison staff and all other internal and
external agencies.
What is most important is the need for everyone to recognise the unique environment and
human situations that offenders find themselves in whilst in prison. It is also imperative
that it is recognised that all offenders are vulnerable and may behave differently in a
custodial situation.
The Suicide Prevention and Self Harm Management Policy is led by a governor grade,
supported by the Safer Custody Co-ordinator and the Suicide Prevention Team. The SPT
has responsibility for formulating strategy and developing Suicide Prevention and self
harm management Policy.
This development will include learning lessons from
experiences, improved awareness, improved training, and the development of a caring
attitude within HMP Ford. This policy is dependent on individual effort and awareness, the
close liaison between staff, offenders, the listeners, the Samaritans, Chaplaincy,
Healthcare Centre, and all other relevant departments. The multi-disciplinary nature of this
type of work cannot be over-stated. The Governor has ultimate responsibility and this may
lead staff to believe that they do not have responsibility for the care of the suicidal. It is,
however, the responsibility of everyone to understand how they can contribute to providing
a safe, decent, and healthy environment for all who live and work here.
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TERMS OF REFERENCE
The Safer Custody Team will meet every month and on behalf of the Governor be responsible
for:
1.
The development and implementation of local policy and procedures, in accordance
with national policy.
2.
Developing statements of local policy and procedural instructions for the Governor to
issue to staff, offenders, or visitors.
3.
Keeping local policy and procedure under review, taking account of information and
guidance disseminated by Headquarters, Area Safer Custody Team meetings or
shared by other establishments.
4.
Work pro-actively by further developing good practice in the prevention of suicide and
self-harm management.
5.
Carrying out an annual review covering the establishment’s policy, procedures and
numbers of self-harm incidents and in respect of self inflicted deaths the finds,
recommendations and the action taken to implement those findings. The report should
highlight both successes and areas of concern, also setting objectives for the following
year.
6.
To oversee suicide prevention and self-harm management self-audit procedures and
ensure implementation of any continuous improvement plans.
7.
Monitoring the level and nature of self-harm and reviewing individual incidents where
appropriate.
8.
Monitoring the implementation of local procedures, in particular the ACCT document.
9.
Ensuring the staff of HMP Ford are trained in the use of the ACCT document and in the
operation of the review system concerning offenders identified as being at risk of selfharm.
10.
Identifying training needs of both staff and offenders, and monitoring the delivery of
training.
11.
Ensuring that all staff have access to advice and support in their day-to-day work with
offenders at risk of suicide and self-harm and following serious incidents.
12.
Ensuring effective communication and co-operation between all staff disciplines,
outside agencies, offenders and offenders’ families.
13.
Maintaining staff and offender awareness.
14.
Consulting and informing offenders about matters relating to suicide and self-harm and
encouraging their involvement in the support of other offenders.
15.
Supporting the Listener Scheme and ensuring it is operating as agreed with the
Samaritans.
16.
To ensure provision of post-incident support for staff and offenders.
6
STANDING AGENDA ITEMS FOR SAFER CUSTODY TEAM MEETINGS
1. Violence Reduction Report
2. Safer Custody Co-ordinator’s Report
3. Anti Bullying Report - Safer Custody Performance indicators
(a) Statistics
4. Samaritans Report
5. Listeners Report
6. Healthcare Report – Self-harm Incident Report
7. Training
8. Review of ACCT Plan’s
9. Learning from Deaths in Custody
10. Learning from Near Misses
11. Continuous Improvement Plan
12. Policy Review
13. Any Other Business
Date of next meeting:
7
Chapter 1
STATEMENT OF MANAGEMENT RESPONSIBILITIES
Introduction
The principle of shared responsibility does not mean that staff are not accountable. All
members of staff have clear responsibilities under the ACCT document.
Regional Custodial Manager
It is the Regional Custodial Manager’s responsibility to ensure that Governors at each
establishment in their area implement the policy and continuous improvement plans which
have been made in the light of investigation reports following deaths in custody and after
suicide prevention and self harm management audits.
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 Prison
service Order 2700 .
Receive reports submitted by the Governor on particular incidents of self-harm and
consider with the Governor the need for follow-up action or further investigation.
Liaise with Headquarters as necessary to share good practice and identify areas for further
research or policy development.
The Governor
The Governor will have overall responsibility for the implementation of Suicide Prevention
and Self Harm Management policies within their establishment. Particular responsibilities
may be delegated to the Suicide Prevention Team (SPT).
The Governor must:
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Ensure they have in place local suicide prevention and self-harm management
strategy that fully reflects Annex 1B – PSO 2700 Areas to be covered by Local
Suicide Prevention and Self-Harm Management Strategy.
Ensure they have a fully staffed and functioning Safer Custody Team at Ford.
The Governor will need to ensure their SCT are clear about local policy and their
role regarding the recommendation regarding investigation of serious incidents
of serious incidents of self-harm.
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.
The Governor must appoint:
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A SCT leader, who is an Operational Manager and is a member of the SMT at
Ford.
At least one Safer Custody Co-ordinator; the risk assessment (annex 12) details
how the decision was made on how many hours were allocated to this task at
HMP Ford .
ACCT Trainers to facilitate the training of staff at HMP Ford.
Sufficient staff to undertake the administrative support duties needed to meet
the volume of safer custody related work at the establishment.(annex 12)
and ensure that all ACCT related posts are occupied, and that when vacancies
occur systems are in place to ensure they are immediately filled.
The Governor will seek to influence their establishment’s SLA with the local PCT to take
account of the requirements of PSO 2700.
A local policy statement will be published 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.
The Governor must have in place systems to ensure the quality of ACCT procedures.
These systems include:
 The daily checks of open ACCT Plans conducted by Wing management.
 The checks conducted by the Safer Custody Co-ordinator.
 The daily check by an ACCT Case Manager trained member of the Senior
Management Team (SMT), 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 duty governor carries out this task on a daily basis
 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.
 The Safer Custody Team Leader and his deputy or in their absence the Safer
Custody Co-ordinator ensure that any ‘open’ ACCT plans are checked on a daily
basis and this will be noted on the ‘on going’ record sheet
Additionally, where possible, the Governor should:
Investigate individual incidents of self-harm which give rise to particular concern and
submit a short report to the Area Manager. This should include all incidents where
resuscitation was necessary and/or the person was transferred to outside hospital.
Appoint a Samaritan Liaison Officer.
The governor has overall responsibility of overseeing and monitoring the effectiveness of
all elements of the suicide prevention and self harm management policy through the
scheduled operational SMT meeting. In practice this function has been delegated to the
Safer Custody Team leader
9
Safer Custody Team Leaders
The SCT leader will have key responsibility, as directed by the Governor, for the
implementation and development of the local suicide prevention and self-harm
management strategy and compliance. They will act as the champion for safer custody on
the local Senior Management Team.
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.
The SCT leader will ensure the SCT has meetings every month. The meetings will be
minuted,(edited appropriate to respect any confidentiality issues) onto the local intranet
site.
A deputy team leader, who is the Safer Custody Co-ordinator(s) and the Violence
Reduction Co-ordinator, support the SCT leader. The SCT leader takes personal
responsibility for leading the local safer custody strategy, and reports to the SMT on a
monthly basis
The SCT Leader is trained to ACCT Case Manager Level and must have attended the
SCT leader training course by 2010
Safer Custody Co-ordinators
The role of the Safer Custody Co-ordinator is to co-ordinate the response to suicide
prevention and self-harm management issues, and ensures the resulting strategy and
procedures are reflected in all practices across HMP Ford. The SCC will provide advice
and assistance on current initiatives and their introduction at establishment level. The SCC
will monitor compliance at HMP Ford with safer custody strategies and the quality of
management ACCT checks, and highlight good and deficient practices in procedures used
at Ford. The hours allocated to this task are detailed in the risk assessment (annex 12)
SAFER CUSTODY CO-ORDINATORs will:
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10
Co-ordinate the effective implementation and day-to-day delivery of the suicide
prevention and self-harm management policies in the establishment.
Where possible support Case Managers at ACCT case reviews.
Promote the Suicide Prevention and Self-Harm Management and Violence
Reduction Standards.
Monitor and evaluate safer custody procedures.
Compile monthly statistical reports.
Use accumulated monthly data to issue an annual report. This report can also
give an overview of the suicide prevention and self-harm management initiatives
implemented at the establishment and commend staff where appropriate.
Assist and support staff.
Undertake the role of Samaritan Liaison Officer.
Support the ACCT Trainers.
Attend SCT meetings and promote the development of local management
strategies.
Co-ordinate establishment initiatives and further the notion that suicide
prevention is everyone’s responsibility
Promote establishment good practice.
Support the offender induction programme.
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Provide support to other establishments as directed by the Regional Custodial
Manager.
Be responsible for ensuring that an Assessor Rota is published on a monthly
basis and is distributed to all areas in Ford
Provide a monthly report which will include:
A review of all self-harm incidents during the previous calendar month;
Identified learning points that could improve management arrangements relating
to self-harm cases;
Identifying any 24 hour assessment not completed on time (listing location and
offender number);
Identifying any case reviews not completed on time (listing location and prison
number);
Undertake a quality check of all open and closed ACCT documentation. This includes
checking (preferably on a weekly basis) the quality of management ACCT checks, and
feeding back to the Governor and/or Safer Custody Team any identified concerns
Ensure the Samaritans telephone number and publicity material are appropriately
displayed.
ACCT Trainers
Develop a training strategy in agreement with the Governor to provide, where possible,
refresher ACCT and suicide prevention training for all staff in their establishment working
with offenders.
Ensure that all staff who has direct contact with offenders have received ACCT Foundation
training.
Maintain a contemporary knowledge of safer custody good practice and policy.
ACCT Assessors
ACCT assessors are volunteers and will be located throughout the prison, within
Residential Units and in the Health Care Centre. A multi-disciplinary team with members
from a wide range of disciplines/backgrounds will make up the ACCT assessor team
Assessors will complete the task of assessing the needs and level of risk of identified
offenders within the framework of their existing work detail. The team will work on a rota
basis, the rota to be managed by the Safer Custody Co-ordinator and displayed on the ‘ Z
Drive’ under the Safer Custody file on the computer. Communications will also have an up
to date list.
Assessors will:
 Be approached to interview an offender who has been identified as being at risk of
suicide or deliberate self harm, mental illness or actual self-harm.
 Agree arrangements with the Wing Manager to interview the person-at-risk, wherever
possible at a time that will facilitate the first case review taking place immediately after
the assessment
 Respond to the distressed offender and explore the issues to enable a care plan to be
formulated, helping the offender over the crisis he is currently in.
11
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Participate in the first case review wherever possible, along with the offender and the
Case Manager or, where this is not possible, pass the assessment information on to
the Wing Manager
Establish good working relationships, communicate formally and informally with other
colleagues where appropriate and as the needs of the offender dictate at the time.
Support for ACCT Assessors
There is a scheduled formal quarterly team meeting to provide support and update
information for our ACCT assessors.
Supervision for the assessors will be given by the Clinical Manager of the Healthcare
Department at Ford.
Frequencies and types of support
As often as required, assessors are able to access support through the Staff Care Team
as frequently as needed. It is also possible for line managers to refer assessors to
Employee Services if required. Samaritans are always available 24 hours a day if needed.
THEY ARE A NATIONAL SERVICE FOR EVERYONE
Informal – this usually takes the form of peer support. Colleagues can be and are a great
source of support for some.
Formal – a more structured form of support would be more appropriate for someone
experiencing ongoing stress/difficulties relating to work.
The SCC will meet with the ACCT assessors on an informal and regular basis, if the SCC
has any concerns then a further meeting will be arranged and the Clinical Manager of
Healthcare will attend that meeting.
Assessors are invited to attend the monthly Safer Custody Meeting.
Residential Managers/Orderly Officers
The following specific responsibilities for Orderly Officer are in addition to those designated
to all staff.
 It is the responsibility of the Duty Governor, Orderly Officer and Night Orderly Officer to
check and sign all open ACCT forms as part of their daily duties.
 The Orderly officer is also required to check the ‘At risk hotline’ [see the
communication section].
 When an ACCT is opened, speak to the offender and initiating member of staff, refer to
Healthcare and other relevant staff and check ACCT for any relevant information.
Ensure a photograph of the offender is attached to the ACCT document.
 Ensure the assessment and first case review takes place within 24 hours. The care
review team will consist of the Case Manager, Assessor (first case review only) and
other members as appropriate. It is likely to include a member of Healthcare, and the
Safer Custody Co-ordinator.
 Check observation books daily to ensure entries indicating risk of suicide or self-harm
are promptly and appropriately actioned ensuring that Healthcare staff have been
informed of all new open ACCT documents. Check open ACCT documents daily and
document in the ACCT plan. Ensure that entries demonstrate meaningful interaction
with the offender and advise staff accordingly.
 Decide how to manage the offender on the residential wing and document reasons on
the Immediate Action plan on page 4 of the ACCT.
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Contact the duty assessor to arrange an assessment at the earliest opportunity and at
least within the 24 hour time boundary
Ensure a case review is held within 24 hours and document a summary of the review
and agreed support plan on page 7 of ACCT.
Consult other departments and agencies as much as possible in drawing up the care
map.
Ensure all staff coming on duty and other relevant staff are aware of open ACCT
documents and of the care map’s contents, trigger points and that handovers take
place and are documented in the ACCT.
Ensure the care map is implemented and the daily supervision and support record is
maintained.
Ensure further case reviews are held as necessary and arranged to the individual’s
particular needs, i.e. trigger points and completion of care map
Consult Healthcare staff if the offender deteriorates and requires medical assessment,
documenting the reasons in the daily supervision and support record. Refer
immediately to Healthcare centre if self-harm occurs or risk appears acute.
Co-ordinated team decision to close the ACCT at a case review when the offender is
coping satisfactorily. Agree aftercare or follow-up requirements. Document reasons
for closure and any aftercare plans in the report of the case review. Only close the
document when the Caremap is completed.
Provide Caremap Support Plan copy to the offender and advice of other support
networks.
Record closure on the front cover of ACCT and on the F2052A (history sheet) with
details of follow-up support and the aftercare plan (eg. Offender to remain in shared
accommodation for a specified period).
Ensure the aftercare plan is implemented.
Arrange post closure interview within seven days to ensure Offender is still coping
ensure that, where available, offenders on an open ACCT have been offered the
opportunity to talk to a listener and/or Samaritan.
Night Orderly Officers must:
13
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Advise night patrols of the location of all offenders on open ACCTs and of the
appropriate level of supervision, as indicated by the ACCT document.

Check the ‘At Risk Hot line number’ in the detail office and sign the book detailing
any calls and the action that has been taken.
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Supervise and support night staff in their supervision and care of offenders with
open ACCT.

Night orderly officers are also responsible for quality checking the ACCT document
and endorsing the document with a legible signature.

Ensure that anything of significance is reported on the ACCT and that the
Residential Wing Manager is briefed (by the day Orderly Officer if necessary) when
coming on duty in the morning.
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Ensure an ACCT is opened if a new concern is raised and ensure that it is either
passed to the Wing Manager on handover, or that Healthcare staff are immediately
contacted in an emergency.

Ensure that night patrols are aware of the location of emergency equipment and
relevant emergency instructions and protocols.
Refer to the Manager’s ACCT pocket guide book for further reference
Residential staff must:
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When coming on duty make an immediate check of open ACCTs, checking the
observation /conversation requirements and content of support plans for each one
carefully.
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In case of emergency contact the Communication room via UHF radio or telephone
on 2222. State the assistance required.

In the event of self harm an F213sh must be completed a copy to be retained in the
ACCT document and the original taken to healthcare
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When concerned about an offender, speak to the offender where possible and open
an ACCT by completing the front cover and page 3. Pass the form to the wing
manager or Oscar if no wing manager available (unless opened by a member of the
Healthcare team, who will refer direct to the HCC). A Case manager will be
appointed if necessary.

Record that an ACCT has been opened, or that the offender has self-harmed or
attempted suicide, in the wing observation book and in the offender’s F2052A
(history sheet), giving reasons.
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Provide help and support to offenders in accordance with the agreed care map
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Be alert to, and document in, the ACCT any change in mood or behaviour. This
includes failure to collect prescribed medication (as informed by Healthcare staff)
and any information provided by visiting staff and subsequent follow-up action.

Report any further observations and contacts with the offender on the daily
supervision and support record and bring them to the attention of the Unit Manager.
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Ensure all ACCT entries are legible, dated and timed. Print name and sign next to
all entries.
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Provide a full handover to colleagues when going off duty, ensuring that they are
aware of the current situation of all offenders on open ACCTs, and document this
handover in the ACCT
Reception/Discharge staff must:
14
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Staff should note that it is now a requirement to indicate both a current risk of suicide or
self-harm and any known past risk in the PER document. The identification of suicide/ self
harm risk is one of the prime purposes of the PER. It is now however only a requirement
that an ACCT is opened if there is a current risk. In order to assist in highlighting any
suicide/self-harm risks, there is now an indicator section on the front cover of the PER This
enables staff to complete a tick box if risk paperwork is present and covers both HMPS,
Police and Escort Contractors individual formats.
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Verbally brief escort staff or staff from other agencies, when handing over an
offender subject to an open ACCT.
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When discharging offenders, endorse the ACCT prior to despatch.
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If the offender is to be released on any form of ROTL, reception staff must ensure
that they read the last case review which will state the conditions that the offender is
to be released upon.
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The ACCT document will be retained in reception, the ‘On Going’ record will be
noted that the offender has been released on ROTL and record comments prior to
the offender being released.
The Duty Communication OSG
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On being told that an ACCT plan has been opened, will provide the next sequential
number from the ‘central register’ held in the Communications room.
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Will inform all those listed on the ACCT central register actions list.
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Up date LIDS entry
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Alert staff by completing details on the ACCT alerts boards, situated in the
communications room and the main gate area.
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Make themselves aware of the ‘ On Duty ACCT Assessor’ as per the ACCT Rota
and also of available trained First Aid staff
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The Communications Officer must inform NOU (National Operations Unit) by
telephone of any self-harm incident that requires external medical attention or
resuscitation.
Doctor’s Responsibilities in Relation to Outpatients
Doctors must:
Raise an ACCT if concerned about possible risk of self-harm following contact with an
offender.
Healthcare Officers/Nurses Responsibilities in Relation to Outpatients
Healthcare Officers/Nurses must:
 Raise ACCT if concerned about an offender following reception screening or any
other contact, complete Concern and Keep Safe Form. Ensure that a current
photograph is attached to the ACCT plan.
15
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Record the raising of an ACCT in the IMR (whether or not referred) and in the
F2050A, together with any advice given or assessment of the offender. Inform the
Doctor.
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Provide ongoing advice and support to wing staff as necessary in the management
of at risk offenders. Provide contributions as necessary to the ‘Daily Supervision
and Support Record’ in the ACCT. Inform residential staff of any failure to collect
prescribed medication, recording this in the ‘Daily Supervision and Support Record’
in the ACCT and attend case reviews as requested.
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Record closure of form in the IMR
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In many cases, an individual will be receiving special care on the residential wing as
a result of being considered at risk and will be in receipt of some form of mental
healthcare. In these cases, the CAREMAP should be considered to be the means
whereby care on the residential unit is planned and delivered.
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Healthcare Managers should ensure that procedures are in place to allow Wing
Managers and members of Assessor Teams to access relevant, risk pertinent
information about offenders for whom they are caring.
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Healthcare staff are responsible for carrying out mental health assessments and
providing appropriate care, where the individual at risk has mental health problems,
is self harming and/or is at high risk.
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Where an individual is in receipt of mental healthcare, it is essential that the
provider of that care contributes to the ACCT case reviews. If attendance is not
possible, contribution can be via telephone or letter.
All members of staff
All staff in contact with offenders must be trained to at least ACCT Foundation level, be
aware of the signs of risk summarised in the ACCT Staff Pocket Guide and when caring
for at-risk offenders follow the ACCT procedures set out in the local Suicide Prevention
and Self Harm Management policy.
Staff have a responsibility to ensure they are aware of which offenders in their care are on
an open ACCT Plan, and what the key requirements of that plan are.
It is important that all events relevant to the care of at-risk offenders 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 offenders they come into contact with, and a responsibility
to share risk information with others caring for the offender.
At shift change when staff handover offenders 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 offenders on
an open ACCT Plan and risk factors such as trigger points and any issues in the Caremap.
All staff must know where the emergency response kit(s) are located in the area(s) they
work as per the published list on locations of emergency response kit(s). The training
department has a training plan to ensure all disciplined staff receive the appropriate
training in the use of this equipment, including refresher training.
All staff must know who the First Aid trained staff are in the area(s) they work as per
published notices
All staff holds personal responsibility for learning and taking up training opportunities. All
ACCT related training must be reflected in the member of staff’s SPDR.
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Any member of staff may become aware of an offender’s particular concerns. An ACCT
must be opened by any member of staff who is concerned that an offender may be at risk
of self injury or suicide.
All managers in establishments
All Senior Officers, Principal Officers and Operational Managers (F and above), including
Governors, must be trained to at least ACCT Case Manager level.
It is the responsibility of all managers to:
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Promote the compassionate nature of the role of staff in caring for offenders.
Manage inappropriate behaviour – whether by offenders, 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 PSO 2700.
Support staff caring for at-risk offenders – for example, by debriefing or
assisting to access clinical supervision. This can be reflected in local
instructions and managers’ SPDRs.
Managers must reflect in each member of staff’s SPDR all duties relating to the care of
At- risk offenders, including any specific additional ACCT responsibilities and functions.
Safer Custody administrative support
An effective local safer custody strategy requires that ACCT Assessors, ACCT case
Managers (who most often are wing managers with many other calls on their time), the
SCT Leader, the SAFER CUSTODY CO-ORDINATOR, and the VRC have administrative
support.
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 offender transfer or discharge.
All staff undertaking safer custody administrative support duties (even if they do not
come into regular contact with offenders) must have a good understanding of ACCT
procedures and therefore be trained to at least ACCT case manager level. The risk
assessment for this post determines the allocated hours (annex 12)
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Chapter 2
Samaritans / Listeners
We are committed to working in partnership with the Samaritans and support the use of
Listeners in providing support to at-risk offenders. This work follows traditional values
that are adopted by the Samaritans and supported by the Prison Service.
The Samaritans will provide regular, in confidence, support to Listeners.
All offenders will be provided with 24-hour access to the Samaritans. The Samaritans will
listen to any offender who is in distress or going through a crisis and is in greater than
usual risk of self-harm or suicide. They hope that by listening and offering support the
offender will gain insight and a sense of proportion to see his own way forward from his
immediate situation. Central to the work of Samaritans is its very strict principle of
confidentiality, which applies equally in prison work. Consequently, the details of any
conversation between a Samaritan and an Offender will remain totally confidential. It is
therefore important that staff and offenders should be aware that;
Phone calls to Samaritans should not be monitored or overheard
Visits should take place out of the hearing of staff, though they may remain close at
hand in case assistance is required
Letters to and from Samaritans should not be read by any other person
Mobile phones are located in both wing offices. These phones should be booked out
and back in again after use. They are available 24 hours a day. The chargers for these
phones must be kept in the wing offices and the mobile phones must be charged in the
wing office, and returned to the storage box once charged.
Samaritans have scheduled visits to Ford each Wednesday evening. Every assistance
should be given to ensure that they are valued as an organisation as the support they
provide is invaluable. The Samaritans will always attend the establishment during or after
a crisis, they are there to support the listeners, attend the Safer Custody Team meetings
wherever possible.
The Samaritans are to be given every assistance possible so that they are able to make
the best use of their time. In addition to this they will train and support our Listeners and
are available to staff, offenders and families alike.
They can be contacted on:
08457 909090 (National)
Use of the Listeners suite
The Listener suite is located on D lower adjacent to the staircase. It is for use when a
listener and/or member of staff feel that an offender would benefit from the private facilities
the suite offers.
Following an incident of self harm, an offender who may have witnessed the incident may
also benefit from time with a Listener in the suite.
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Listener Scheme
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The Listener scheme is a system whereby selected offenders are trained and supported by
Samaritans, using their same guidelines to listen in complete confidence to their fellow
offenders who may be in crisis, feel suicidal or who need a confidential sympathetic ear.
When an offender requests a Listener, local arrangements must be followed to allow prompt
access to Listeners.
If an offender requests a Listener during a patrol state, staff must contact Oscar 1 immediately,
so that arrangements can be made to facilitate the movement of a Listener to the offender who
has made the request.
Our Listeners run a rota, which is widely available. The Listeners appearing on a set day
should always be called upon first, to call a Listener out of sync because it is convenient to do
so, may result in that individual listener being unnecessarily overburdened.
They may also need to discuss a caller with one another for example a particularly disturbing
callout, or safety concerns, or feel the need to contact the Samaritans, these requests must be
taken seriously and implemented without delay.
Staff should log these movements within the observation books, both sending and receiving
areas. (Initial request, time of arrival of Listener, termination of callout).
The listeners can be contacted on call by the ‘ Listener Pager Scheme’ 07654 386 130
If you have any concerns or queries about the Listeners / the scheme itself, please contact
****************** Samaritan liaison officer for HMP Ford.
Listeners are available 24 hours a day
Samaritans and Listeners will encourage ‘callers’ to give permission, so that they may inform
the staff of any risks
Listeners will encourage callers to speak with Samaritans if permission to alert staff is not given
We must facilitate a Samaritans phone immediately if a Listener requests it. (Be alert to the
possible heightened risk to an offender if this is the case)
Take care to maintain and protect the credibility of the confidential role of the Listener. Staff
should not expect or request a Listener to breach confidentiality
A Listener will be dismissed from the scheme if he breaks confidentiality
A Listener will be dismissed from the scheme if he misuses it for his own or another offender’s
purpose
Any suspicion in regards to involvement with the drug culture will result in suspension
A listener may take time off from the scheme (for example; personal difficulties), however, he
may still attend the weekly offloading sessions (Wednesday evening), but will not be active in
any other way
It is a requirement that Listeners attend the Wednesday evening offloading/support meetings
An up to date list of Listeners and rota will be held in the Communications Room and on
residential units.
Listeners must have access to each other at all reasonable times and it may be necessary for
them to be located together during the patrol state
Staff must make discreet observations throughout any callout, to observe that all is well. It is
the responsibility of staff on duty to ensure that regular checks are made whilst the session is
underway, be it day or night.
Most callouts are of a relatively short duration, but those which go on for any time should alert
staff to consider that the problem could be of a more serious nature, staff should be alert to
this, be vigilant and ensure that at the end of the call they speak to the offender and make their
own judgement
Chapter 3
Early Period in Custody at HMP Ford
The quality of the reception process and first night experience is crucial in helping
offenders settle into Ford prisons regime.
This is particularly important to at-risk offenders as the experience should aim to
demonstrate concern / support towards them and help them improve their wellbeing.
Our aim is to reassure offenders that they are in a safe environment that respects
individuals and treats all with dignity.
Health Screen Assessment on Arrival
HMP Ford does not have a full time Healthcare Centre. A Healthcare nurse will interview
all new offenders coming into the prison. Interviews in reception will identify the needs of
offenders in the following areas:
 Risk of suicide or self harm (using standard screening procedures)
 First time in custody
 Drug and/or alcohol issues
 Domestic issues
 Where at-risk indicators are identified, or if staff are in any doubt whatsoever, an
ACCT plan will be raised in reception in every case.
Reception Procedure
Additionally the duty reception officer, as part of the reception process, will also assess
offenders in reception in relation to self harm concerns, mood, and responsiveness.
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They will check the ACCT status of all offenders being received and discharged
to/from Ford.
All other accompanying documentation will be checked for any indications of current
or historical sell-harm.
On or before handing an offender over who are subject to “at risk” procedures, the
reception staff will notify the residential staff and instruct that this is noted in the
wings observation book. A comment will be put in the ACCT plan prior to the
offender being located on A/B wing.
Any new reception who appears to be ‘at risk’ of suicide or self harm whilst in transit
to HMP Ford will have a suicide and self harm warning form raised. On arrival at
reception, the escort staff will brief the receiving officer who will sign the warning
form and pass the documentation to the Healthcare screening staff or the Orderly
Officer. In the event that no healthcare staff are on duty, there will then be an
assessment of the level of risk of suicide/self harm. If the offender screens positive
in reception an ACCT document must be opened.
Where there has been a change of status or the offender 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 offender. This is to be recorded in the wing
observation book.
Chapter 4
ACCT Planning & Providing Care for Offenders “At Risk “
Offenders with a change of Status
Reception/first night staff must ensure they talk with offenders (and maintain a
record of this) who have:
(a) Had a court appeal rejected, or
(b) Had a change in immigration status, or been recalled to prison,
Keeping in mind the suicide and self-harm risks associated with such offenders. These
offenders will also be seen by the reception health screener; see PSO 0500 - Reception
Chapter 6 and PSI 2006/016 – recalled offenders.
Offenders Charged with Offences Related to Violence against a Family Member
and/or Homicide
Offenders charged with homicide are a particularly high-risk group, and within this
offenders charged with homicide against a partner or family member are at an
exceptionally high risk of suicide. This would have been assessed whilst they were at their
previous prisons earlier in their sentence. Reception staff must ensure they check all
documentation and assess the offender’s current status. If there are any concerns then the
Orderly Officer must be contacted who in conjunction with the Duty Governor will carry out
a risk assessment on the offender; this must be recorded and passed onto the wing staff.
The reception staff must make an entry on the offender’s history sheet stating that they
have spoken to the offender and no concerns have been raised, comments made by the
offender should also be recorded.
Recognised or Suspected Drug / alcohol Withdrawal Issues
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Ford’s Healthcare and CARAT’s services offer support for substance misusers
All offenders are immediately seen on reception by healthcare staff and if needed
within 24 hours by the duty doctor
Those identified as showing withdrawal symptoms and/or are taking prescribed
substitute drugs as part of a chemical detoxification will be transferred to a prison
where more suitable regimes and primary support is available.
The link between drug / alcohol withdrawal, detoxification, mental health and suicide and
self harm is significant. Staff must:
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Be alert to indicators such as refusal to take medication and sharp mood swings
Report any such signs to healthcare, residential staff and CARAT’s team
In cases where the level of risk is considered high and constant, or high levels of
observations are needed then the duty governor will make arrangements to move
the offender to a prison where more appropriate care and treatment is available.
Induction Period
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During the Induction process the offender will be asked to provide with next of kin
details. This is to be recorded on the history sheet.
The Induction period will also be used as an opportunity to assess offenders for
suicidal and self harm tendencies or behaviour and to offer help to alleviate
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anxieties. All offenders will undergo a structured Induction programme, and will be
given an Induction booklet.
Refer to the local Induction policy.
Cell Sharing Risk Assessment – Category ‘D’ Open conditions
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Such assessments are not required for category ‘D’ offenders held in “open”
conditions see PSO 2750
Offenders received at Ford are liable to be allocated shared accommodation.
Reception staff are to look through the last Cell Sharing Risk Assessment. If the risk
is medium or high then the Orderly Officer and duty governor will be informed and
decide what action to take. HMP Ford is not in a position to take ‘high’ risk offenders
and they may be transferred to a more suitable location. The reception Senior
officer will carry out a ‘First Night Interview & Room Sharing Risk Assessment’.
Further risks or needs can be identified using this document and the appropriate
action taken with regards to allocation of a room.
For new offenders considered at risk of suicide / self harm their location will be
determined after consulting the ACCT plan.
Family Links – Phone Contact
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The need to make phone contact with family or a close friend can be a major cause
of distress for new arrivals. Offenders will be offered the opportunity for staff to
telephone their family / next of kin – informing them they are safe and well. This will
be done by the Induction staff.
Offenders will also be given the opportunity to have access to emergency pin credit
allocated by the Reception Senior Officer.
Any offender “at risk” or considered by staff to need direct conversation with their
family will be allowed to do so – irrespective of their ability to pay for the call
However it must be ensured that offenders 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.
First Night
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Offenders will be allocated on to B wing.
Have access to the next day’s start of the Induction programme.
Names and locations of new arrivals are noted in the wing office and night staff are
made aware of them.
All offenders are greeted and spoken to on arrival onto B wing by a member of the
wing staff.
Additionally they are seen by a responsible offender “induction orderly” on their
arrival
During the evening period there is a drop in centre, the “FOCUS” group is run by
responsible offenders. This is a peer support group and all offenders have access
to this service up until 20:00 hours. This provides advice and support on all aspect
of the establishment.
New receptions are also given an induction into the assistance and support by the
Listeners and also the Violence Reduction Representatives.
Details of the “FOCUS” group and Ford’s listeners are also detailed in the
information booklet issued to all new receptions at HMP Ford.
Communication of Information
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The protocol is designed to ensure all external and partnership agencies are informed as
to which offenders are at risk of self harm and what nature of what the self harm is likely to
be. The sharing of this information will hopefully ensure the offender receives the help and
support they require in prison and when released. The main vehicle for the sharing of this
information is OASYS.
Offenders on the Offender Management Model
It is the responsibility of the Prison Offender Supervisor to ensure the Offender Manager is
kept fully briefed concerning any information indicating that the offender may be at risk of
self harm. This information should be conveyed to the Offender Manager by email and the
offender contact sheet to be marked to evidence this has been done. Additionally an Ad
Hoc RFI should be completed to ensure whoever updates the OASYS has this information.
The contact sheet should evidence that a conversation has taken place with the OM to
ensure whoever needs to know that the offender has a history of self harm or suicidal
intent has been informed.
If the at-risk offender is to be under the supervision of an Offender Manager/probation
Service / approved premises manager upon discharge then a photocopy of the final case
Review, CAREMAP, front cover and inside cover of the ACCT plan must be provided.
Ideally this should be provided by the offender’s offender supervisor at least 48 hours
before and no later than the same day of transfer. He/she must make a record of this and
retain it within the ACCT plan.
This requirement is in addition to updating risk of harm information on OASys.
Offenders not on the Offender Management Model
The Prison Offender Supervisor will ensure the OASYS is updated to include information
indicating there is a risk of self harm and the nature of what the self harm is likely to entail.
Again an AD Hoc RFI can be used to ensure this information is available to the OASYS
officer should the offender be due to be released.
Offender Escort Record
The PER is the key vehicle for ensuring that information about the risks posed by
offenders on external movement from prisons or transferred within the criminal justice
system is always available to those responsible for their custody. It is a standard form
agreed with and used by all agencies involved in the movement of offenders. The form
highlights the risks posed by and the vulnerability of offenders on external movement
provides assurance that the risks and weaknesses have been identified and
communicated to those who are responsible for the offender and provides a record of
events during an offender’s movement.
Outside Calls
It is important to offender safety that systems are in place to allow for the speedy receipt
and transfer of risk information to those who can use it to keep the offender immediately
safe and to develop the offenders care plan.
External calls are routed to the relevant department and if this is outside the Core day then
they go to the communications room where they are recorded in the observation book and
passed onto the relevant parties as soon as possible. In the case of At-Risk information
coming into the prison then this would be passed directly to the Orderly Officer who would
take the appropriate action/s
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Dedicated At Risk Hot Line
At HMP Ford we have a dedicated “Hot line” for families and friends to call if they have any
information on an offender who may be “At risk”. The telephone is located in the detail
office. It is checked on a regular basis by the duty Orderly Officer. It is an answer phone
service and also gives alert by a ‘beep’. When a message is received the concerns raised
will be passed to the appropriate person and the action taken noted on the Orderly Officer
check list.
Telephone number is 0800 389 2246 this number is displayed in the visiting hall, around
the establishment and on all offenders identification cards.
ACCT Documents
The ACCT document will travel with an at- risk offender who is escorted outside of the
establishment. The ACCT must be readily available to the escorting staff: it must not be
put into a sealed pouch with the IMR or Offenders Core Record. The 2052A [ History
Sheet] must be used in addition to the PER record that an open ACCT is in existence
when transferring offenders.
Observation Books
Staff should record in the Observation Book any information from internal or outside
parties with reference to an At Risk offender. All handovers of offenders on ACCTs should
also be documented in the Observation Book.
ACCT LOG
The Communication officer is required to fill out the ACCT log in Comms informing staff
from multi- disciplinary areas within the establishment that an ACCT has been opened.
Names of those who have been informed will be detailed in the log with a time and date.
Prison Intelligence Officer (PIO)/Police Liaison Officer (PLO)
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.
The PIO/PLO will review annually the local policies and procedures for sharing
Offender’s 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.
The PIO/PLO will inform the establishment of any risk of harm for relevant offenders.
This will be discussed during the Monthly Security Meeting which the Safer Custody
Team leader attends.
The recommendations of the PIO/PLO following this review must be considered by the
next SCT meeting and the response (including any actions taken) noted in the SCT
minutes
Risk information should also be shared with the police through the P.N.C. bureau this will
be completed by the collator in the Security department. Where an at – risk offender is
being deported or removed from the UK copies of the risk pertinent information, including
CAREMAP must be provided to the receiving authority. The case manager will be
responsible for passing this information on to the United Kingdom Borders Authority via
fax on 02088181327) annex 15
Transfers of Offenders
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The OCA department at Ford will liaise with all relevant parties’ reference the transfer of
an offender on an ACCT. The information will include risks and any other relevant factor.
Information which is not ‘medical in confidence’, must be shared to ensure that the most
appropriate care is offered to offenders who are in need of support.
Discharge from custody – Transfer of Risk Information
When handing over an at-risk offender to the Borders and Immigration Agency (BIA) the
criminal casework team must be informed about the risk in advance of BIA taking over
responsibility for that individual. The SAFER CUSTODY CO-ORDINATOR will carry out
this task.
On arrival and on handing over the offender they must be provided with the ACCT plan. A
copy of the ACCT plan must be taken and retained by us at Ford.
Similarly if the offender is in post-closure phase of ACCT then the BIA officers must be
made aware and the ACCT document must accompany them on escort. Again a copy
must be retained by us at Ford.
The PER form must be endorsed to prove these actions have been completed.
Prior to discharge the PNC bureau is informed by our PLO/PIO of history of self-harm
whilst at HMP Ford.
ACCT
(ASSESSMENT, CARE IN CUSTODY AND TEAM WORK)
PROCEDURE DOCUMENT
An ACCT document can be opened by any member of staff who is concerned that
an offender is at risk of suicide and/or self harm
The ACCT is a process whereby staff work together to provide individual care to offenders
who are in distress in order to
 Help diffuse a potentially suicidal crisis.
 Help offenders with long term needs, such as a pattern of repetitive self injury.
 To better manage and reduce their stress.
 To offer support through difficult and distressing times
 Help to reduce the risk of actual deliberate self harm.
Initiating an ACCT document
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All offenders identified as being ‘at risk’ of suicide, self injury or distress will have an
ACCT plan opened by the member of staff who identifies the risk.
The initiating member of staff should speak to the offender and complete the
Concern and Keep Safe Form on page 3. Describing what the concerns are and
summarise recent events, behaviour or information received.
If it is believed that a suicide attempt to be imminent, or if the individual is acutely
distressed, take action and do not leave the person alone.
In an emergency contact Communications via UHF radio or by dialling 2222. Report
clearly and in a concise manner which assistance is required e.g. Ambulance,
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healthcare.
Line managers will support and advise any member of staff in the completion of
Page 3 of the ACCT Plan.
The person opening the ACCT Plan will contact the Communications room for an
ACCT Plan log number and provide details for the central register. Communications
will notify relevant departments within the establishment that an ACCT plan has
been opened.
The ACCT plan must be passed to the Residential SO (or Orderly Officer if no wing
Manager is on duty.)
Unit Manager/ Orderly Officer Immediate Continuous improvement plan
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Speak with the initiating member of staff and the offender.
Speak with healthcare staff and other staff who may have relevant information.
Check other records, the main F2050, wing history sheets, observation book, etc.
Complete the Immediate Continuous improvement plan
The purpose of the Immediate Continuous improvement plan is to consider an
appropriate environment and regime required to support the person at risk prior to
the first case review. The Case Manager/ Orderly officer should decide the following
after consulting the location of the offender for any potential conflict. Location of the
offender, type of accommodation, level of supervision, other immediate
interventions.
If 24 hour care is required, a transfer to another establishment with Healthcare inpatient accommodation may be appropriate with the option of transferring back to
HMP Ford at a later date. The decision must be recorded in the ACCT Plan. A copy
of the ACCT plan must also be retained by the establishment.
 The manager will arrange for a trained Assessor to interview the offender within 24
hours to make an assessment. Following the assessment the Case Manager will
chair a multi disciplinary case review.
 The Case Manager will record all details required on the Immediate Continuous
improvement plan to keep the offender safe.
 The Case Manager must check that details of the offender placed on ACCT Plan
are:
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Entered in the ACCT Plan register that is held in the Communications room
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That L.I.D.S is updated by the Communications room
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A photograph of the offender is obtained and attached to the inside cover of
the ACCT Plan.
 It should be remembered that the ACCT Plan itself contains guidance within the
document that all staff should follow.
 This section of the procedural document outlines how staff may provide appropriate
support and review arrangements whilst at risk offenders are located at HMP Ford.
 Checks if a previous ACCT Plan has been closed within the last 2 months, if so
collect the old ACCT Plan from Records Office. Check the document and record
any relevant information in the open ACCT plan
Assessment
The Residential S/O/ Case Manager will arrange for a trained ACCT Assessor to interview
the offender within 24 hours to make an assessment. The ACCT rota is displayed on the
‘Z drive’ under the Safer custody folder. Communications also hold a copy.
 A trained assessor will interview the offender within the first 24 hours of the ACCT
Plan being opened. Part of their role will be to carry out an assessment of risk of
harm (this is a multi-disciplinary decision not solely the assessors) and to contribute
to a Multi-disciplinary case review. Consideration will be given to mental health
issues. The assessor will be responsible for gathering risk pertinent information in
their own interviewing style. Areas of discussion will focus around, perceived
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problems causing distress, acts of recent self harm or historical self harm or suicide
attempts, current thoughts relating to self harm or suicide attempts, reasons for
living and coping resources and any other concerns. Bullying, drug and alcohol
misuse will also be explored.
Action Following Assessment
 An initial case review must take place after the assessment and within 24hrs of
opening the ACCT Plan. Further reviews are required as and when indicated by the
care map and the needs of the offender at risk.
 The Residential SO (Case Manager) must chair the review and it should be
attended where practicable by members of the following agencies, but only when
they have been involved or have input to the offenders care plan:
The Residential SO (Case Manager)
Residential Officer who is familiar with the offender
Probation
Chaplain
Healthcare
The offender
The ACCT Assessor (usually the first review only)
CARAT’s,
Offender Supervisor (should attend all reviews where possible.)
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This first case review must take place immediately .This identifies an
appropriate support plan that addresses the underlying needs and support of
the offender.
Record a summary of the reviews [include any views of the offender].
Record the frequency of observations and conversations and adjust as
necessary on the front cover.
The idea is to help diffuse a crisis and address problems, referral’s can be
made and any trigger points at this stage should be added to the inside
cover of the ACCT document. These may be considered as part of each
case review. Refer to the ACCT document reference ideas to diffuse a crisis.
Reviews should take place in a quite and calm room – no interruptions
It is good practice to use first names and have the same Case Manager
present where possible.
The Caremap
 An effective care map engages the offender at risk, and a copy must be offered to
the offender and the ACCT document noted accordingly. It is beneficial if the
offender co- operates and agrees with the care map and is given a copy.
 The care map should clearly identify who should do what, by when. The offender
will sign his care map to agree the actions that have been documented. If an
offender refuses to sign his Caremap the Case Manager should sign to say that the
offender has refused to sign and his reasons why. Such a refusal does not
invalidate the care map. To identify problems start from the person at risk’s
perspective, describe the problems: don’t prescribe solutions.
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The care map must be reviewed, updated and put into action.
Ideas for developing a care map:
 Allocate officers to liaise with the offender.
 Try to keep the offender occupied by offering the opportunity to work, associate, or
pursue other activities such as TV, radio or books.
 Consider the listener scheme, prison visitors, family or friends, the offender may be
willing for you to contact them or you could facilitate phone calls, visits, or letters.
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Look to identifying ways of rewarding positive coping by the offender.
Consider a room change to allow for a more supportive ‘mix’ of offenders in the
accommodation and take care to try and keep the offender away from potential
bullies/bullying situations. Consider the benefit of locating the offender in a room
where it is easier for staff to monitor/supervise.
In exceptional circumstances offenders identified as single room occupancy can be
located in shared accommodation if this is identified as crucial to the offender’s care
and welfare. In these situations staff must ensure that the roommate is informed of
any security/welfare issues, is prepared to share a room with the individual and is
supported by staff.
Ensure the Offender is offered a shared room unless otherwise authorised to do so
by a Medical Officer. Identify if in-room hobbies and/or access to library books could
be of assistance.
Liaise with specialist departments to provide support (e.g. Probation, Chaplaincy]
Identify how reviews can be best completed to provide on-going support to the
offender (formalise and record these in the ACCT Plan so that expectations are
clearly identified). Spending time listening to the offender and exploring ideas that
he believes could help resolve the situation will often have the greatest rewards.
Referring to Healthcare, carats, or other interventions available within the
establishment. Further support can be found within the ‘Establishment Intervention
Directory’ which is held on the ‘Z drive’.
Effective Case Reviews
 involves the person at risk
 Has the same case manager present , wherever possible
 Is carried out in a quite and calm location with no interruptions by phone or any
other party.
 Case reviews will be held at appropriate intervals as agreed by the review team.
Each review must be multi-disciplinary. Only relevant people need attend e.g.
education, PEI, chaplain, workplace supervisor, IMB etc. The case manager will be
responsible for notifying members of staff attendance. This can be done via email or
verbally.
 Where a key member of staff is making a written or telephone report, it must advise
how the at-risk person is receiving help/ treatment and how it has affected their risk
or need. A copy of this information should be kept within the ACCT document.
 The case review will also identify the level of conversations and observations
required e.g. once per shift period (Morning, afternoon and evening duty period)
and twice during the night, or more or less frequent as appropriate, e.g. once per
day, once per week. It is expected that the level of documented conversations and
observations will reduce as the offender is supported through his difficulties.
 The agreed level of conversations and observations must be documented on the
Care map and stated within the case review.
 A copy of the Care map should always be given to the offender so he can refer to
action points and support if needed.
Managing the Offender
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The Residential S/O must brief staff informing them who is on an ACCT Plan
and their location. This information is also relayed to staff on the morning
briefing by the Orderly Officer. It is the responsibility of the Residential wing
officer to make themselves aware of who in their charge is on an ACCT
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document and handover and brief their colleagues taking over duty.
Staff should check the offender when they take over the roll which they are
accountable for and record this in the Wing Observation book.
All staff should record any involvement with the offender on the ACCT Plan.
This record demonstrates how we have cared for the offender and explains the
reasons for actions taken. It is imperative that the ‘Observations and
Conversations as per the front cover are adhered to.
All entries should be meaningful depicting the offender’s mood and behaviour.
Often people who feel very low or self harm find it hard to say how they feel
and may be hard to engage in conversation. Open questions can be useful to
engage the offender at this time.
Everyday language must be used and not jargon.
Staff must be sensitive to the offenders needs when carrying out observations
during the night state, if there is any doubt about the well being of the offender
then a response must be sought.
Residential SO’s/ Case Manager
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All reviews are completed on time (the Residential S/O/ Case Manager should
check the ACCT Plan) to identify if a review is required at the beginning of the
morning shift.
The roll board accurately identifies the location of those offenders on a ACCT
Plan
That staff on duty are aware of those offenders on an ACCT Plan and
understand any needs or requirements of the care map and any trigger points.
They monitor and maintain compliance with the entries required in the ACCT
Plan as outlined above;
They are satisfied that the ACCT Plan has a register number, has a photograph
attached to the information sheet, and the location of the offender on the front
cover is accurate.
The ACCT plan should be checked daily by the Residential S/O. Quality
checking is to ensure the frequency of observations/ conversations are adhered
to. The checks must also ensure that meaningful entries and legible signatures
by staff are recorded.
Closing the ACCT Plan
An ACCT Plan can only be closed following a case review. The decision to close the
ACCT plan must be a multi disciplinary one and will only happen if all parties agree.
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Usually the ACCT document may only be closed once all the issues have been
resolved on the Care map.
It is not acceptable to close an ACCT Plan just to facilitate a transfer.(must not be
closed within 72 hours of transfer)
Have the issues raised when the ACCT Plan was opened been addressed? [seek
evidence to support this]
Has the offender come to terms with his moment of crisis and established support
strategies that allow him to cope more effectively?
Is there evidence that the self-harm has stopped?
Is the offender taking responsibility for managing his time in custody? He would
normally be expected to be taking part in a range of activities without being
encouraged by wing staff.
Are reports from staff that have come into contact with the offender positive?
The offender should understand how to seek help if he starts to slip into crisis again
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once removed from the ACCT Plan.
Any ongoing support must be recorded in the ACCT Plan. It should also be copied
into the wing history sheet and summarized in the wing observation book so that it
can be referred to after closure of the ACCT Plan.
The Case Manager must then complete the closure section on the front of the
ACCT Plan
The Residential S/O / Case Manager will notify communications informing them of
the ACCT document closure. The Communications officer will notify all relevant
departments and ensure lids is updated signifying closure of the document.
Post Closure Review
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 The ACCT is to remain in the Wing Office until the post closure review is completed.
 At the Post Closure review discuss:
 How the individual is now feeling
 How they are now managing with the problems that led to their distress.
 Whether they can see alternative ways of dealing with similar problems should they
arise in the future?
 The offender would be expected to articulate how his time in prison will be spent for
the next few weeks and to understand how he can seek and support.
The closed form must then be given to the Safer Custody Co-ordinator who will conduct a
final Quality check and then ensure that the ACCT plan is filed the in the offender’s core
record
Management Checks
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The Duty Governor will inspect and endorse each open ACCT Plan on a daily basis.
The Orderly Officer will inspect and endorse each open ACCT plan on a daily basis.
The Residential Senior officer will inspect and endorse each open ACCT plan on a
daily basis.
The management checks will involve identifying any outstanding issues in the Care
map, ensuring the frequency and quality of ‘Observations and Conversations’ are
being carried out. A legible signature and printed name is to be endorsed.
A full Standards Audit will be carried out in line with the agreed self-audit timetable.
The Head of Safer Custody will conduct a System and Quality check monthly and
report to the Senior Management Team.
Constant Supervision
Constant Supervision can only be authorised by a doctor or nurse in consultation with the
Duty Governor. If an offender is placed on constant supervision at Ford he will be
transferred to another establishment who have the relevant facilities to deal with the
offender as soon as practicable.
In the interim the offender will be supervised by a designated member of staff on a one-toone basis, remaining within eyesight at all times and within a suitable distance to be able
to physically intervene quickly. It is better to think of constant supervision as providing
one-to-one interactive support rather than as “watching”.
A case review must be held within 4 hours of the Offender being placed on constant
supervision or if during the night state immediately prior to unlock the following morning,
this should be chaired by the Duty Governor or head of healthcare.
In exceptional cases where this level of crisis lasts beyond 24 hours, further case reviews
must be held at least three times during the establishment’s core working day. Acute
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suicidal crisis is usually temporary and the aim of the case reviews should be to reduce the
level of supervision progressively as the offender’s condition improves. The temporary
nature of this level of supervision must be reflected in the support plan.
Where the offender attends a case review, the supervising member of staff must also
attend. Where possible staff who have undertaken Constant Supervision should attend
any case review concerning that offender that occurs during their shift. Refer to annex 14
Staff members carrying out Constant Supervisions may be of any professional background
or grade. The key point is that they need to be considered competent to provide the level
and quality of support designated in the CAREMAP. Where possible, staff carrying out the
observation should know the offender.
Staff will undertake Constant Supervision for periods of no longer than 4 hours, this allows
time for the observer to build a rapport with the offender without losing focus. At the end of
each observation shift ideally the member of staff should have a break. The Orderly Officer
of the day will ensure that the Constant Supervision is staffed according to these
guidelines; the duty governor will carry out management checks to ensure compliance.
The member of staff conducting the Constant Supervision must make written reports on
the offender’s progress, and provide a verbal and written report at shift handovers. All
relevant information must be recorded in the ACCT Plan.
Use of Shared/Supervised Accommodation
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When an ACCT Plan is raised on an offender it is essential that the decision on
the most appropriate location be made on the basis of the individual’s needs
and not on available accommodation.
 All offenders subject to an open ACCT Plan will normally be located in shared
accommodation. If left on their own, at risk offenders must be seen by staff at
intervals no longer than 30 minutes or as support plan in ACCT Plan indicates.
At risk offenders should be located in rooms, which facilitate good supervision.
These rooms should not be marked so as to stigmatize the occupant.
 Whilst it is recommended that offenders on ACCT Plan should not normally be
located together, the decision whether to do so or not will be taken as part of
the continuous improvement plan.
 On no account should a offender subject to a ACCT Plan be located in the
cells without a case conference being attended by the Duty Governor and/or
Head of Residence. If the Head of Residence is not on duty the Residential
Manager I/C should attend.
For further information on Constant Supervision refer to PSO 2700 Chapter 8.8
and annex 8Y Referral can be made to the local policy document held on the
Intranet.
Managing an Offender on an ACCT Document in the Cells
Offenders on open or post-closure phase ACCT plan should only be located in the cells in
exceptional circumstances.
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In all cases of exceptional circumstances, should the requirement be for the offender to
be placed in the cells the Orderly Officer, Duty Governor and Case Manager should be
consulted.
The offender must remain on intermittent watch until the healthcare representative has
signed the algorithm.
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A case review must be held on the same day or within 24 hours of the offender being
located in the cells
A case review must be held prior to an offender leaving the cells and returning to
normal location. The offender’s Case Manager should attend the case review.
The ACCT document should depict reasons why the offender was placed in the cells
and endorsed by the Orderly Officer or Duty Governor.
Removal of In Possession Items
Personal items including shoelaces and belts will not normally be removed from at risk
offenders held at HMP Ford unless a Case Review determines it appropriate.
Decisions to remove any items (and their subsequent return) are made by the case review
team and the reasons must be recorded on the “ongoing record sheet”
It is possible to remove items before the case review – but the decision must then be
considered on a case review to be held within 4 hours and the offender then informed of
the reason
Removal of Normal Clothing and Issue with Alternative Clothing
Decisions to remove all of an offender’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 offender’s behaviour is believed to be life threatening.
For example, all offenders placed in special accommodation should retain their normal
clothing unless the case review determines otherwise.
Alternative clothing must only be used for the shortest possible time. Consideration needs
to be given to alternatives, such as locating an offender 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).
In-Possession medication
HMP Ford’s local searching strategy refers to in – possession medication, this makes it
clear to staff that they must inform Healthcare staff when excess medication is found on
room searches. Healthcare staff will then be able to reassess the risk this posses to the
offender
The issues surrounding in–possession medication are discussed at the local Partnership
meeting with the PCT
Management of At-Risk Offenders whose Behaviour is Particularly Challenging
In such critical circumstances it must be recognised that as an open prison this
establishment does not have the necessary facilities or staff resources to keep such
individuals safe from harm. The following are some examples of behaviour that HMP Ford
would deem “high risk”
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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:
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Present a risk to staff and/or other offenders
Are disruptive of the regime
Commit multiple offences against discipline
Display repeated and prolonged anti-social behaviour
Are on enhanced levels of unlock
The Segregation unit at HMP Ford is only used to hold offenders prior to their transfer, if
an offender was “At-Risk” and the risk assessment stated that he was to no longer stay in
“Open” conditions he would be placed in the segregation unit and a review would take
place. A transfer to “closed” conditions would be arranged and the offender would only
stay in the segregation unit for a short period. If at risk of self harm/suicide an ACCT plan
will be opened and the offender will be observed as per the ACCT plan recommendations.
Information relating to the offender would be given to the receiving establishment, the
ACCT plan would be noted accordingly.
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Chapter 5
Discharge and Resettlement of “At-Risk” Offenders
Offenders on Escort
If an offender self-harms whilst in custody during the core day period and requires to be
taken to outside hospital he will be as a minimum be accompanied by an officer, the
offender will be on licence. If the offender’s category has changed (risk assessment states
no longer suitable to be a category ‘D’ offender) the offender must be escorted in a secure
manner, refer to local LSS for details on ‘Secure Escorts’
If an offender self-harms during ‘night state’ and requires attention at outside hospital then
the Night Orderly Officer (NOO) must contact the duty governor who will carry out an initial
risk assessment and instruct the NOO accordingly. As a minimum the offender will be
accompanied by a member of staff, this would be on licence.
The ACCT Plan will travel with an at-risk offender when he is escorted outside the
establishment. The ACCT Plan must be readily visible to the escort staff; it must not be
put in the sealed pouch with the IMR.
Prior to discharge to court or escort the ACCT Plan must be checked and any details
recorded on the PER form. Part of the brief to staff must include reference to the ACCT
Plan and any concerns handed over to the escort staff.
When an offender is out on a bed watch, staff must continue to complete the ACCT Plan
and enter all relevant details in the observation pages.
Offenders on ROTL
ACCT instructions refer to the need to keep offenders safe after release including any
Temporary release. An open ACCT Plan on any at-risk offender still serving a sentence
will remain open for the periods they are on temporary release in the community.
Prior to any period of temporary release a case review will take place, 24 hours prior to the
day of ROTL. At this review the forthcoming ROTL will be discussed and reporting
instructions if applicable will be discussed, the CAREMAP will be updated accordingly.
The ACCT Case Manager for the at-risk individual, will act as the person (or nominate
someone) to receive and note in the ACCT Plan updates from outside participants in the
individual’s care (as agreed in the ACCT CAREMAP), or any ad-hoc information as it is
received. In addition, they will ensure that the ACCT Plan is available to Reception staff on
each occasion that the offender goes on ROTL, the ACCT document will be retained by
reception until the offender returns to prison, and the reception staff will make relevant
entries in the ACCT plan.
Concerns from outside agencies whilst on ROTL
If an offender is on ROTL and concerns are raised from outside agencies, such as nursing
staff, friends or family or the offender himself then an ACCT document is required to be
opened. The Governor will carry out an initial risk assessment and instruct the Orderly
Officer accordingly.
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An ACCT assessor in consultation with medical staff should assess the offender when
practical. The ACCT process is to be followed. It is required for support purposes that in
these extreme circumstances that as a minimum the offender will be accompanied by a
member of staff whilst returning to the establishment.
Discharge and Resettlement of “At Risk” Offenders
Whether transferring to another prison, handing over to other custodial agencies, or being
released, we are required to ensure that existing support and care maps are maintained in
the new environment.
Such individuals 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 at HMP
Ford. Risk is increased by failure to adequately inform those taking over responsibility for
offenders on transfer to another place of custody about levels of risk, likely triggers of
increased risk, and existing care maps, to enable support to continue
Preparing Post Release Care
If the offender concerned is to be imminently released into the supervision of an Offender
Manager or other agency, then a final case review should be arranged via the ACCT case
Manager.
The relevant external personnel must be invited to participate, preferably by attending the
Prison or by contributing in some other way.
The offender’s Offender Supervisor must be involved in case reviews and is required to
communicate (before release) with the external Offender Manager or other supervising
agencies to ensure they are aware of the individual’s history of risk.
Such information should be given to those supervising the offender post-release during
MAPPA reviews
The final case review, the CAREMAP should be updated to reflect the care they will
require in the community and the information (a copy) forwarded on to the department
responsible for his care i.e. Offender Manager, rehabilitation unit etc.
The risk information should also be shared with the police through the P.N.C. bureau
this will be completed by the collator in the Security department.
Where an at – risk offender is being deported or removed from the UK copies of the risk
pertinent information, including the CAREMAP must be provided to the receiving authority.
The case manager will be responsible for passing this information on to the United
Kingdom Borders Authority via fax on 02088181327. (annex 15)
Discharge from Custody of At-Risk Offenders – Preparing Post-Release Care
The aim is to ensure discharged at-risk offenders receive comparable support to the
support they received at HMP Ford. Staff from agencies (and others) that will be involved
in the care of the offender post-release should be invited to input to the Case Reviews
prior to discharge. The pre-release CAREMAP should include action to link the offender to
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external organisations that provide support after release, e.g. Probation, 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 offender about how to obtain support from outside organisations such as
Samaritans.
Care of “At-Risk” Offenders Leaving HMP Ford on External Movements.
Where an offender 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): The ACCT Plan
must accompany them
Discharging reception staff must make receiving escort staff aware that the offender is on
an open ACCT
This must be recorded on the Offender Escort Record (PER), the bottom copy of which is
retained by the establishment
ACCT Plans must not be closed (or where already closed and in the post-closure phase of
ACCT, the offender must not have the final post-closure review) within the 72 hours before
a known transfer.
Where an offender 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): The closed ACCT Plan must accompany them
Discharging reception staff must make receiving escort staff aware that the offender has a
recently closed ACCT Plan.
Further Instructions Regarding Transfers of “At-Risk” Offenders to Other
Establishments
The intention to transfer an offender 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
offender. The ACCT plan will be photocopied and retained in the establishment; the
SAFER CUSTODY CO-ORDINATOR will be responsible for this and will also retain the
copied plan. The SAFER CUSTODY CO-ORDINATOR will keep a register of all offenders
transferred that meet these criteria.
The offender 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.
The F2052A (history sheet) must be used in addition to the PER to record that an open
ACCT Plan is in existence when transferring offenders.
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Transfer of “At-Risk” Offenders to Borders and Immigration Agency or Police
Where an at-risk offender/immigration detainee is transferred to an immigration centre The
ACCT Plan will travel with them. The immigration service use a document identical to
ACCT called ACDT
Where transferred or discharged to police custody the ACCT plan or a copy must be
passed over. If the original is handed over then a copy must be kept at HMP Ford with a
record to show where the original has gone.
Departures from Custody Where There Is No Receiving Agent
Where offenders 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 offender is content for them to be contacted.
Transfers
An open ACCT Plan does not preclude an offender from being transferred. The intention to
transfer an offender on an open ACCT Plan must be discussed with the receiving
establishment, and relevant information must be conveyed either with or ahead of the
offender.
The OCA department at Ford will liaise with all relevant parties The proposed transfer, and
issues arising from it, must be discussed at a case review with the offender although the
open ACCT Plan does not preclude the transfer, staff should be aware that a transfer may
cause the offender further distress, therefore increasing the likelihood of self-harm or
suicide. Such concerns need to be documented and managed through the individual care
map.
Additionally, a transfer may form part of the care planning process and may be in the best
interests of the offender
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Chapter 6
Self Harm Injury Interventions & Actions
Immediate Action Following Incidents of Self-Harm or Attempted Suicide
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Where the offender has self-harmed, this must be documented in the ACCT
document. The entry must be highlighted and details given of the circumstances,
e.g. method used, what the offender said. A F213SH is to be completed. The
offender is to receive medical treatment. The F213SH is to be given to healthcare
and a copy retained in the ACCT plan. A case review must be carried out.
Any incidents of Self Harm, however minor must have an ACCT Plan opened.
If an offender has self-harmed by cutting his wrists and cannot be put into
mechanical restraints for escort (should they be deemed necessary) consult the
Duty Governor for instructions regarding additional security arrangements.
Preservation of life in this instance will be the overriding consideration.
In the case of actual self-harm all incidents must also be recorded on F213SH
and the IMS (Incident Management System). Top copy to be forwarded to
Security for recording on IMS. Bottom copy to be filed in IMR.
Reporting Requirements on discovery of an act of Self Harm
All cases
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Summon help and request emergency medical assistance and first aid equipment.
The need for an ambulance will be decided by the individual who is first on scene or
any member of healthcare staff.
The Communications Room should be contacted immediately. This can be
requested via UHF radio or dialling 2222.
Enter the room as soon as possible, following the local strategy for safely doing so.
Give concise report on handover to Healthcare staff.
The Communications Officer will contact the emergency services and inform the
Duty Governor and Orderly Officer.
The Communications Officer must inform NOU (National Operations Unit) by
telephone of any self-harm incident that requires external medical attention or
resuscitation. In the absence of the Communications officer the Assist Orderly
officer will carry out relevant work. [Nights only].
The emergency services vehicle will then enter the establishment in accordance
with the Gate protocol for such an event. It is a requirement in all cases of self
harm that the offender is accompanied by a member of staff to the hospital. The
minimum requirement is one officer.
The ACCT Plan must accompany the offender to hospital. If on MSL a member of
staff will accompany the offender to outside hospital and an officer will be called in
to attend the establishment.
If the stay in hospital is to be extended then a further risk assessment will be carried
out.
The Safer Custody Team Leader [Denyse Benson] is to be informed of any
incidents of self harm.
If a serious self harm incident occurs during night patrol state and the offender is required
to attend outside hospital the following protocol will be adhered too.
An ACCT plan is to be opened as soon as possible, and will be sent to the hospital in
order that the member of staff can maintain it. Staff are also reminded that all paperwork
must be completed as soon as possible, ACCT Forms, incident reports, F213SH. The
observation book is required to be endorsed detailing the incident.
Action Following Self-Harm: Emergency Procedures
Hanging
Support the body to reduce constriction. Staff should be aware of the potential for injury to
them selves from such a process, and should consider utilising any alternative methods of
support, such as items of cell furniture (see manual handling guidelines).
Cut the offender down.
Cut and then release the ligature immediately the offender has been cut down, preserving
the knot if possible
Place the offender on his back on a flat, solid surface.
Check for signs of life, i.e. breathing, pulse, any movement of the body.
If not breathing and / or no pulse is present, clear airway and attempt resuscitation, using a
mask with non-return valve, unless rigor mortis of the limbs has clearly set in. (Rigor
mortis is a face condition of extreme stiffness affecting the arms and legs after death,
making it virtually impossible to bend the wrists, elbows, or knees).
If conscious/revived, place in recovery position.
Cutting
Check for level of consciousness and breathing or bleeding.
If not breathing and/or no pulse is present, clear airway and attempt resuscitation using a
face mask with non-return valve.
If conscious/revived, priority is to reduce bleeding.
Use rubber gloves and follow universal infection control procedures.
Apply direct pressure over wound using sterile dressing.
Raising injured limb may also reduce blood loss.
Overdose/poisoning
Do not try to make offender vomit.
Encourage offender to drink water or milk if corrosive substance taken.
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If not breathing, clear airway and attempt resuscitation using a face mask with non-return
valve.
Look for clues and ask what substance taken.
Keep any containers/bottles and surplus tablets.
Self-harm by fire
If necessary, and if safe to do so, douse fire before approaching casualty, with reference to
local fire safety training.
Avoid inhaling fire fumes.
Remove casualty from proximity of fire.
Lay casualty on the ground to prevent flame from attacking face and head.
If necessary to smother flame, tightly wrap casualty in blanket/sheet or similar.
If casualty is not breathing and /or no pulse is present, clear airway and attempt
resuscitation using a face mask with non-return valve.
Douse burnt areas with copious amounts of water and keep wet.
Jumping from a dangerous height
Likely multiple injuries. Skeletal or internal (this may not be instantly evident).
Control major bleeding, but do not move the patient.
Use rubber gloves and follow universal infection control procedures.
If not breathing, clear airway and attempt resuscitation using a face mask with non-return
valve.
Do not move casualty in case of spinal / major bone injury.
Swallowed foreign body
Provide nil by mouth in case of need for surgery.
Monitor bowel movements for any items passed.
Emergency Equipment
Paramedic Shears – personal issue to staff
All unified staff are issued with a ligature cut down tool called ‘Paramedic Shears’. These
shears are personal issue and will be engraved with a Ford Security Code.
All staff issued with “Paramedic Shears” will be given instruction on the use of the
Paramedic shears and given a compact to sign prior to their shears being issued to them.
The Paramedic Shears must be worn at all times when on duty, BUT must not be removed
from the establishment.
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Emergency Response Cut Down Kits for Residential areas
The Manager of each unit must ensure that night staff are aware of the location of
emergency equipment
Emergency Response Cut Down Kits will be available in all residential areas and the
Segregation unit and will include the items specified below. They are bright orange in
colour and placed within the wing offices on Residential and the office within the
Segregation Unit.
The kits are sealed with uniquely numbered seals and must remain sealed unless used. A
monthly check of the kits will be carried out by the Health and Safety Representative or the
Health and Safety Orderly. The Health and Safety department will be responsible for
maintaining the record of checks which is displayed on the reverse of the kits.
In the event of the kit being used a notice displayed on the front of the box gives guidance
of who to contact with regards to re stocking and resealing the kits. The Health& Safety
Team will restock the items, Paul Comerford/ Adam Parish.
The Health & Safety Team will be informed electronically by a system on the computer as
to when the equipment expires within the box.
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 (1 medium, 3 large)
1 spillage kit [Bio- Hazard Clean up pack.
2 x no 4 large ambulance dressings (to stem large bleeds/wounds)
In the Healthcare Centre (back pack)
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 and health care staff should have training in its use:
1 Resuscitator bag and mask
3 masks (various sizes)
4 guedal airways (sizes 1, 2, 3, 4)
1 suction (hand portable)
1 pen torch
1 sphygmomanometer (portable)
1 stethoscope
41
Chapter 7
Post Incident Support
The Safer Custody Team and Care Team should work closely to support staff and
offenders following a death in custody and also following a serious incident of self harm.
Support for staff involved in an incident should be offered in every case. See PSO 2710
Chapter 5 (Follow up to Deaths in Custody) and PSO 8150 (Post Incident Care for Staff).
Witnessing a suicide attempt or incident of self harm is a traumatic experience for
offenders too.
Where necessary, offenders should be seen individually and support
should be offered over the subsequent days and weeks.
The following support is available:
Employee Support
Ford Prisons ‘Staff Care Team’
Samaritans Support
Chaplaincy Team
Peer support
The Samaritans should be contacted as soon as possible by the prison following a serious
self harm incident or self inflicted death. Telephone: 08457 909090 they will be willing to
offer support to staff and offenders alike. The Samaritan phone located on each
Residential Unit can also be used for both staff and offenders. A confidential service and
the phone can be used in private.
The skills and experience of the Chaplaincy Department should be considered in providing
support for both offenders and staff. A Memorial Service may be held, to which the family
of the deceased, staff and offenders should be invited.
Any offender who may be particularly affected by the death should be offered support.
Staff should be alert to the possibility of heightened vulnerability and particular attention
should be given to those currently on an open ACCT Plan.
NB:
IN THE EVENT OF A DEATH IN CUSTODY ALL OFFENDERS ON ACCT
PLANS MUST BE REVIEWED
Our Listeners should be given free access to associate amongst offenders within the area
where the death has occurred. We must facilitate any contact with the Samaritans as
requested by them. We must be alert to their needs (they may be grieving themselves)
and ensure that they are fully supported throughout.
Ensure that the Listeners are informed as much as possible as to what has happened / is
happening, so that they are prepared for the fall out from other offenders.
Take time to quietly review all the events, a member of staff who is off duty, but was
closely involved with the offender should be notified. A written statement to offenders to
defuse rumour and myth may be useful. Staff of all grades and disciplines should be
informed about the facts of the death. Particular care should be shown to the room mate/s,
close friends of the offender.
42
NOTE: During the event and early aftermath, consider the room mate/s feelings and needs
their location at this time and the availability of a Listener/Samaritan/Chaplain is of
paramount importance. Offer a change of location.
If an offender, closely connected to the deceased wishes to meet with the family we should
endeavour to facilitate this. The Family Liaison Officer [Jackie Jefcut] will facilitate this.
Post Traumatic Stress counselling and/or Bereavement counselling is to be offered.
Consider special visits, phone calls, letters, and canteen.
Room mate is to be given the opportunity to return to the original room, if appropriate.
The Care Team will establish contact and offer support with those members of staff
involved. A Critical Incident Debrief will be arranged by Staff Care and Welfare Service
and if necessary, personal counselling, if appropriate can be implemented.
This support is available up to and beyond the inquest, to help prevent and relieve the
symptoms of Post Traumatic Stress, which may be as a consequence of the incident.
Additional support for offenders is available from Healthcare staff, Duty Governor, Wing
staff, Independent Monitoring Board, Safer Custody Officer and Personal Officer.
Following an attempted or successful self inflicted death the Duty Care Team Member is to
be contacted via pager number 07659 18 9997, you will speak to a real person, or
alternatively through the Communications Room. They will need to know the names of
offenders and staff involved.
Support for Offenders Family

Nominate a member of staff to act as continuing personal link between the family and
the Establishment. This should be the Family Liaison Officer ***********. It is
advisable in the absence of Fords Family Liaison Officer that the FLO at Lewes is
contacted for guidance alternatively a senior member of staff, with a second person
nominated to cover in their absence.

It is vital to establish a rapport and trust with the family, to maintain consistency and
to keep them informed of events and to offer practical assistance.

A letter of sympathy from the Governor may be appropriate.

Invite the family to the prison, they may wish to visit the scene and meet staff and
offenders who knew their loved one.

Offer further support through the organisation INQUEST.

In appropriate cases, financial assistance with funeral expenses may be offered.

Ensure that the handing over of any monies or personal effects is managed with care
and sensitivity. (Some thing made in Education/Workshops may be appropriate to
offer).
If an offender has made a serious self harm attempt, a special visit may be
appropriate.

Support mechanisms available to staff (Chaplaincy/Samaritans) should be considered
43
ACCT Assessors
Annex 1
************
******************
**************
*************
************************
****************
*****************
******************
************
********************
*****************************
All RMN’s are also qualified to facilitate an assessment if they have completed the ACCT
assessors’ course.
44
CONSENT FORM
Annex 2
Agreement to the attendance at a review of a relative/friend/Listener/interpreter
Name:
Number:
I wish for the following ………………………………………. To be present at my ACCT Plan review
Signed:
Print:
Date:
Witnessed by:
Signed:
Print:
Position:
Date:
45
Annex 3
HMP FORD
PERSONAL ISSUE CUT-DOWN SCISSORS
There will be a personal issue of cut-down tools for all unified grades. This will allow 24
hour per day access to the cut-down tools.
The following procedure will apply:
1. Cut-down tools will be signed for on issue.
2. They will be Security marked with the epaulette number of each member of staff.
3. The Security department will manage the procurement, issue, and use of cut-down
tools and associated instructions on their use.
Actions Post Incident:
The cut-down scissors must be bagged and tagged following use on any occasion.
The Security department will dispose of any cut down scissors that are no longer fit for
purpose, following HMP Ford’s Tool Disposal Policy.
Upon issue of a cut-down tool to a member of staff, they 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 understand that the cut-down tool is for the sole purpose of cutting
ligatures and must not be used for any other purposes, as this could reduce
its effectiveness in the event of it being required to cut a ligature.
(d)
They understand what action to take in the event of having used the tool.
(e)
They understand that if they lose the tool they must inform the Orderly
Officer.
(f)
Under no circumstances must the cut down tools be taken outside of the
establishment and are only to be carried while on duty.
*****************
Operations Principal Officer
Annex 4
46
Safe System of Work Number 2.5
HMP FORD
PERSONAL ISSUE CUT-DOWN SCISSORS
There will be a personal issue of cut-down tools for all unified grades. This will allow 24
hour per day access to the cut-down tools.
The following procedure will apply:
1. Cut-down tools will be signed for on issue.
4. They will be Security marked with the epaulette number of each member of staff.
5. The Security department will manage the procurement, issue and use of cut-down
tools and associated instructions on their use.
Actions Post Incident:
The cut-down scissors must be bagged and tagged following use on any occasion.
The Security department will dispose of any cut down scissors that are no longer fit for
purpose, following HMP Ford’s Tool Disposal Policy.
Upon issue of a cut-down tool to a member of staff, they 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 understand that the cut-down tool is for the sole purpose of cutting
ligatures and must not be used for any other purposes, as this could reduce
its effectiveness in the event of it being required to cut a ligature.
(d)
They understand what action to take in the event of having used the tool.
(e)
They understand that if they lose the tool they must inform the Orderly
Officer.
(f)
Under no circumstances must the cut down tools be taken outside of the
establishment and are only to be carried whist on duty.
(g)
Lone workers please familiarise yourself with Risk Assessment number 1.7
Re. Cut Down Tools and ensure they comply with the requirements set out in
the above.
**************
………………………
Head of Operations
47
*************** ………………..
Operations Manager
Annex 5
The Prison Service Order: Follow Up To Deaths in Custody
Chapter Two: Immediate action on discovering of apparent death.
Overview
This chapter describes the actions to be taken immediately by staff on the discovery of an
offender who appears to have died.
Key Procedures
The following procedures are to be followed on the discovery of an apparent death.
Initial Action
 Summon help and request emergency medical assistance and first aid equipment.
 Enter the cell if safe to do so. Staff can do so alone. If the cell is entered as soon
as the discovery is made staff may be able to take immediate action to help an
offender’s life (see paragraph 5 below).
 If a ligature has been used, support the offender, cut the ligature whilst preserving
the knot if possible and place the offender’s body onto his/her back on a flat, solid
surface (e.g. the floor or a solid based bed without the mattress).
 Check for signs of life, i.e. breathing pulse, any movement of the body.
 If the offender is not breathing, staff should attempt resuscitation unless rigor mortis
of the limbs has clearly set in. (Rigor mortis is a condition of extreme stiffness
affecting the legs and arms after death, making it virtually impossible to bend the
wrists, elbows or knees.)
 Only a medical officer (or if at outside hospital, a Doctor there) can certify the
offender dead.
Post-incident action





After the offender has been taken to outside hospital for medical attention or has
been pronounced dead and the body removed, the room must then be sealed,
leaving everything in it untouched, to await the arrival of the police (and the SIO)
who will wish to examine it to make an assessment of whether there are any
suspicious circumstances.
It is essential that all relevant evidence is preserved. Where any letters have been
written which are pending in outgoing post, the next of kin should be informed and
asked how thy wish them to be dealt with. The Coroner’s office should be advised
of their existence since they may contain evidence germane to the Coroner’s
inquiry.
A record must be kept of the names of all those entering the scene including those
offenders located in adjacent cells.
Where possible, arrange for a chaplain or other minister of religion of the
appropriate denomination to administer last rites.
Ensure staff are aware of the care team and counselling available
Annex 6
48
CAREMAP- Sources of Support for Offenders ‘At Risk’.
The following are ideas and support services that are available to offenders at HMP Ford
who are at-risk:























49
The Safer Custody Leader – develops and maintains systems and procedures
promoting a safe custodial environment for offenders.
The Safer Custody Coordinator and A.C.C.T. assessors –dedicated trained staff
able to support vulnerable offenders and liaise with the Safer Custody Leader on
areas of concern.
Listener Service – a confidential service available 24 hours a day.
Dedicated Telephone Samaritan Link – available 24 hours a day to offenders in
distress and in need of support. Also available to Listeners in seeking advice or
support.
Prison Visitors – a befriending service for isolated offenders.
Direct Telephone Hotline – a confidential service for offenders and members of the
public who may have concerns about people in our care.
Community Mental Health In Reach Team – providing support and through-care for
offenders with mental health needs.
Counselling (abuse/bereavement etc).
Community Psychiatric Nurse.
Doctor (medical intervention).
Infectious disease advisors.
Smoking cessation work.
Referrals to medical specialists
CARATS workers – for help with detoxification, drug and alcohol issues.
CBDT support testing.
Access to NA/AA.
Listeners Suites – for offenders needing one-to-one support in a safe, relaxed and
private setting.
Chaplaincy team – Support for offenders and staff of all faiths.
Advice Centre – expert advice and practical help available for offenders with
housing, employment, financial issues etc.
Family support–help with visits or phone calls home.
Offender Management Unit – links with external post release support.
Psychology & Programmes – help with problem solving and some provision for
individual work.
Gym – Fit for life course, recreational activities – helping to build self confidence.
Annex 7
SAFER CUSTODY TEAM LEADER – JOB DESCRIPTION.
Grade: Operational Manager
Purpose: To manage the strategy through the Safer Custody/Suicide Prevention Team on
behalf of the Governor.
Accountable: To the Governor.
Responsibilities:














50
To coordinate the Safer Custody Team.
To chair regular meetings, at least quarterly
To develop the local suicide and self-harm management strategy in accordance
with Prison Service Standards and to ensure it forms part of the agreed
establishment service level agreement between the Governor and the Area
Manager.
To manage the Safer Custody Co-ordinator.
To ensure that the team is represented at area meetings and other related events.
To ensure effective feedback to the establishments Senior Management Team
through the scheduled SMT performance meetings.
To ensure that Suicide/self-harm gets priority in the establishment.
To foster and maintain good working relationships with the Samaritans and other
agencies.
To ensure monitoring and quality control of the A.C.C.T. procedures in accordance
with the Prison Service Orders.
To ensure that all instances of self-harm are monitored and reviewed.
To ensure that staff are adequately supported in managing offenders at risk.
To act as the main point of contact between this establishment and others on
matters concerning suicide prevention/self-harm management.
To ensure that minutes are sent to Area Safer Custody Advisor, Senior
Management Team and published on the local Intranet.
To ensure an annual self audit of suicide prevention/self-harm is conducted and the
continuous improvement plan is implanted.
Annex 8
SAFER CUSTODY TEAM COORDINATOR – JOB DESCRIPTION
Grade: Officer.
Purpose: To assist the Safer Custody Team Leader in managing the strategy.
Accountable: Safer Custody Team Leader.
Responsibilities:












When on duty to regularly check the A.C.C.T. central register and to confirm that
the LIDS list corresponds.
To carry out random checks of A.C.C.T. documents and refer any deficiencies to
the safer custody team leader or the duty Governor for actions.
To check A.C.C.T. documents have a photograph inside the cover.
Ensure CAREMAPS are of good quality and actions carried out, reporting any
deficiencies.
To manage the Samaritans/Listeners scheme.
Attend Safer Custody team meetings.
Help update Fords Safer Custody Strategic Policy documents.
Randomly check that immediate continuous improvement plans, case assessment
interviews and reviews happen within the laid down time boundaries.
Randomly check that A.C.C.T plans have been closed off properly and that post
closure reviews have taken place, reporting any deficiencies.
Ensure that case managers have informed /involved Offender manager/supervisors
and any other appropriate external agencies if an ‘ at risk ‘ offender is to be
released and is the subject of a current A.C.C.T. plan.
Ensure incidents of self-harm have been reported as required.
When on duty to give induction talk on suicide prevention/self harm management to
new staff.

Samaritans/Listeners scheme.
Responsibilities:
 To regularly meet with and support our offenders Listeners.
 To ensure regular Listener group meetings take place.
 To oversee the system and assist in selecting suitable Listener candidates.
 To organise training for Listeners.
 To conduct our bi-annual bullying survey report and compile a quality report.
 To attend Safer Custody Team meetings.
 To assist the SCT Leader as required.
 To liaise between this prison and our Samaritans Support services.
 To maintain and update all of our safer custody information boards.
 To look after and regularly check our Listeners suites.
 To display Samaritans telephone contact number as required.
 To maintain and display a current list of Listeners together with their photographs.
51
Annex 9
A.C.C.T CO-ORDINATOR’S CHECK LIST AUDIT
DATE OF CHECK
NAME (PRINT)
SIGNATURE
A FRONT COVER
Yes
1. Are, frequency of staff conversations/observations noted?
2. Has date of next Case Review been entered?
B INSIDE FRONT COVER
3. Is photo attached?
4. Are trigger/warning signs entered?
5. Has offender signed agreement to share information?
6. Has it been signed by the officer?
C CONCERN AND KEEP SAFE FORM (PAGE 3)
7. Has it been signed and dated?
8. Have the concerns been completed satisfactorily?
D IMMEDIATE CONTINUOUS IMPROVEMENT PLAN (PAGE 4)
9. Has it been signed and dated?
10. Have actions been completed satisfactorily and recorded as having been completed?
11. Have the four tasks been completed before going off duty?
12. Has it been completed within the 12/24hours time limit? (check dates on Page 3 and 10)
E ASSESSMENT INTERVIEW (PAGE 7-9)
13.Was it completed within the 24 hour time limit?(check dates on page 3 and 4)
14. Was the assessment signed and dated?
F ACTION FOLLOWING ASSESSMENT (PAGE 10)
15. Was the first review completed within the 24 hours time limit?
16. Has next review date been set and relevant departments invited to attend?
G CAREMAP (PAGE 13-14)
17. Have issues been identified and goals set?
18. Have particular people /departments been made responsible for the action and date set?
19. Has the Case Manager signed the CAREMAP?
20. Has offender signed and been given a copy of the CAREMAP? (speak to the offender if
possible)
21. Have actions been completed on time?
H CASE REVIEWS (PAGE 15 ONWARDS)
22. Was it carried out on the day stated on the front cover?
23. Was it chaired by appointed Case Manager?
24. If frequency of observations has changed are they noted on front cover?
25. Have any changed plans been updated on the CAREMAP?
26. Has it been signed and dated?
27. Has next review been set and noted on the front cover?
I ONGOING RECORD (PAGE 21 ONWARDS)
28. Do the frequency of observations and conversations correspond with the front cover?
29. Do the entries relate to good interactions with the offender and are signed and dated?
30. Are the handovers to/from night staff recorded?
52
No
Annex 10
ACCT REGISTER AND CHECKLIST INFORMATION
Log Number
Name
Number
Date ACCT opened
Time
Location
Date ACCT closed
OPEN
Inform
Duty
Governor
Orderly
Officer
Duty ACCT
Assessor
IMB
Duty
Chaplain
Work place
Supervisors
Health care
CARATS
Security/PIO
OMU
Name
Samaritans
(serious self harm
08457 909090
CLOSED
Date & Time
Inform
Duty
Governor
Orderly
Officer
Duty ACCT
Assessor
IMB
Duty
Chaplain
Work place
Supervisors
Health care
CARATS
Security/PIO
OMU
Name
Samaritans
(serious self harm
08457 909090
incident)
incident)
Lids
Opened
Alert board
Opened
Gate
Informed
Lids
Closed
Alert board
Closed
Gate
Informed
Checklist Opened By:
Checklist Closed by;
Name
Name
Signature
Signature
Audit Check
Name
53
Time
Signature
Grade & Date
Date & Time
Annex 11
HMP FORD SAFER CUSTODY
CONTINUOUS IMPROVEMENT
ACTION
Policy Document
High self harm
methodology
Substance impact on
self harm
MH impact on self harm
TIMESCALE
Annual review/
Update when needed
Monthly
LEAD
Safer Custody Manager
Monthly
Safer Custody Manager
CARATS Team DSM
Head Of Health Care
Monthly
Safer Custody Manager
MANAGEMENT
When new information received from Safer
Custody Group to be added to document
Monitor all acts of self harm and produce
monthly report
Monitor referrals to Drug Team and compare
to ACCT register
Number of MH referrals made monthly to be
reported to Safer Custody Manager to
compare to ACCT register.
Maintain accurate records of all ACCT and
anti-bullying to analyse at monthly Safer
custody team meeting
Produce monthly stats for discussion Safer
custody team meeting. Target areas of
concern.
Links between self harm
and bullying
Monthly
Violence Reduction cocoordinator
Bullying issues

In possession
medication

Drug use

Mobile phones

Debt or
transfer
Monthly
Violence Reduction cocoordinator
Monitor all incidents of
violence. (Threats,
assaults, fights, damage
to property, weapons)
Immigration
Monthly
Violence Reduction cocoordinator
Produce monthly stats for discussion at Safer
Custody team meeting. Target areas of
concern.
Monthly
Diversity Manager
Produce monthly information to be discussed
OUTCOME
Cross reference where appropriate and
discuss
Cross reference where appropriate and
discuss
Discuss at meeting
Discuss at meeting
Discuss at meeting
Discuss at meeting Dreat
ACTION
status/deportation
Staff / offender
relations
Raising the profile
of Safer Custody
Common offender
problems identified
through ACCT
documents
Actions following DIC
Learning from Serious
incidents and
disseminating results
Procedures to share risk
information with other
agencies
Interventions available
for those at
risk
.
55
TIMESCALE
LEAD
MANAGEMENT
at Safer Custody Team meeting
Discuss the issue of staff/ offender relations.
Identifying problem areas, liaison with
training, line managers to address need and
seek solutions.
Reporting information to the meeting where
possible.
Discuss ideas and put into practice ways to
raise the profile of Safer Custody.
Monthly
Safer Custody Manager
Training Manager
Line Managers
Monthly
Monthly
Safer Custody Manager/
Safer Custody Team
SMT
Safer Custody Manager
Annual Review
Safer Custody Manager
Annual Review
Safer Custody manager
Annual Review
Head of Safer Custody
Monitor sharing of risk protocols and review
annually
Monthly
Safer Custody Manager
All wings to be issued with interventions for
those at risk
Produce monthly information to be discussed
at Safer Custody Team meeting
Produce monthly information when available to
be discussed at Safer Custody Team meeting
Produce monthly information when available to
be discussed at Safer Custody Team meeting
OUTCOME
.
See monthly report.
DISCUSS AT MEETING
See monthly minutes
See monthly minutes

Offending behaviour courses

Listeners

Counselling via Healthcare

Mental Health

Cognitive Behaviour Therapy.

Assessment referral
Further sources of help available at
HMP FORD can be found in the local
policy document. Applications can be
made to the Oast House, Carats, and
referrals from healthcare, personal
officer referrals, wing managers.
ACTION
Sharing information and
good practice
TIMESCALE
LEAD
July 09
Safer Custody manager
MANAGEMENT
To build relationships with other open
establishments and share good practice
OUTCOME
To attend Stanford hill on the 1st July 09
FLO SAFER CUSTODY CO-ORDINATOR
& **************.
To attend Elmley on the 23rd July 09 to
consult in the new audit procedure.
56
Annex 12
Risk Assessment Record
HMP Ford
Section / Department Assessor
Date
Safer Custody Co-ordinator
*******************
November 2009
Brief Description of Task / Process / Area
To establish the correct amount hours profiled into the Safer Custody Co-ordinators
(SAFER CUSTODY CO-ORDINATOR) working week at HMP Ford.
To maintain a safe environment.
To comply with PSO 2700
To comply with the local Suicide Prevention and Self-Harm Management policy
SAFER CUSTODY CO-ORDINATOR to follow guidance on the role as per annex 1A of
PSO 2700 (attached to risk assessment.
Considerations
The following information was considered during the risk assessment:
 Previous open ACCT documentation(16 ACCT plans opened since January 2009)
 Previous IMS reports
 Review of ACCT Register and Violence Reduction log
 Previous SIR’s relating to Self Harm and Violence Reduction
 Role of SAFER CUSTODY CO-ORDINATOR at HMP Ford
 Amount of time for meetings, internal and external
 Training needs of SAFER CUSTODY CO-ORDINATOR
 Promoting staff and offender awareness
 ‘Open’ prison environment
 Agency liaisons
 Samaritans Liaisons Officer time
 Change in criteria for ‘Open’ prisons
 Audit results
 Reception processes
Recommendations
Having considered all the above information and discussed the work load with the SAFER
CUSTODY CO-ORDINATOR and the SMT it has been decided that HMP Ford would
require 12 hours per week to ensure that all mandatory requirements of PSO 2700 are
met.
Safer Custody Administration support is required (see risk assessment for Safer Custody
Administration)
Author of Assessment
******************
Signed by ***********************
Date
Regional Custodial Manager Signature
Date
Next Assessment Date
November 2010
58
Risk Assessment Record
HMP Ford
Section / Department -
Safer Custody Administration Support
Assessor
******************
Date
July 2009
Brief Description of Task / Process / Area
To establish the correct amount hours required for the Safer Custody Administration
support at HMP Ford.
To maintain a safe environment.
To comply with PSO 2700
To comply with the local Suicide Prevention and Self-Harm Management policy
Safer Custody Administration support to follow guidance on the role as per annex 1A of
PSO 2700 (attached to risk assessment).
Considerations
The following information was considered during the risk assessment:
 Previous open ACCT documentation (16 ACCT plans opened since January 2009)
 Previous IMS reports
 Review of ACCT Register and Violence Reduction log
 Previous SIR’s relating to Self Harm and Violence Reduction
 Role of SAFER CUSTODY CO-ORDINATOR at HMP Ford
 Amount of time for meetings.
 Training needs of Safer Custody Administration Officer
 Promoting staff and offender awareness
 ‘Open’ prison environment
 Agency liaisons
 Audit results
 ACCT Assessor support
 Administration support required for Safer Custody Team
 PSO 270
Recommendations
Having considered all the above information and discussed the work load with the SAFER
CUSTODY CO-ORDINATOR and the SMT it has been decided that HMP Ford would
require 4 hours per week to ensure that all mandatory requirements of PSO 2700 are met
59
Signed by **********************
Date
Regional Custodial Manager Signature
Date
Next Assessment Date
60
July 2010
Annex 13
Letter to contact family /close friend
Consent Form for Involving the Individual’s Relatives or Friends in Their Care
(To be considered only where relatives or friends are supportive of the individual.)
I agree that staff can contact my relative/friend ……………………………………… in order to let
them know that I am experiencing problems just now and, if my relative/friend wishes it, to talk to
them about how I am and what is being done to help me. *
Offender’s signature …………………………………….. PRINT NAME ……………………..
Date ……………………………
Member of staff’s signature ……………………………….PRINT NAME ………………………
Date …………………………………..
For adults (18years and over), where permission is withheld, relative/friends should not be
contacted.
61
Annex 14
AUTHORISATION FORM FOR CONSTANT SUPERVISION
Offender name/ No ……………………………………………………..
Date and time constant supervision commenced
…………….. Date
…………….. Time
If constant supervision commenced overnight, names of persons authorising:
…………………… Name of Doctor/Senior Nurse ……..………….Name of Duty Governor
If constant supervision commenced during the working day, names of persons attending
multi-disciplinary case review which authorised the constant supervision:
………………………….
Unit Manager (Chair)
………………………….
Duty Governor
………………………….
Member of Safer Custody Team
………………………….
Officer supervising the offender
………………………….
Doctor or Senior Nurse (Registered Mental Nurse if possible)
………………………….
Offender
Note: The Duty Governor and Doctor or Senior Nurse must be involved in any decision to place an
offender on Constant Supervision. During the night this may be by telephone. During the day a
case review must be held at which the Duty Governor and Doctor (or Senior Nurse) is present.
Why has the offender been placed on constant supervision?
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CONSTANT SUPERVISION
1. These requirements relating to the use of Constant Supervision are additional to those relating
to the use of observation in general. This section should be read in conjunction with PSO 2700,
chapter 8 and [Annex 8HH - Conversations and observations].
2. Constant supervision is a temporary arrangement (see below - Reducing the level of
observation and engagement).
3. Constant supervision is where an offender 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. It is required when it is believed that the offender could, at any time,
make an attempt to kill themselves. It is better to think of constant supervision as providing
one-to-one interactive support rather than as “watching”.
[Link to Annex 8S – The importance of interaction and not just ‘watching’] [Not yet available]
4. NHS Guidelines also refer to level of Constant Supervision described as: ‘Within arm’s length.’
It is for individual case reviews to decide if levels of risk are such that this intense level of constant
supervision is required.
Reducing the level of observation and engagement
5. Acute suicidal crisis may be temporary and one aim of the case reviews should be to reduce the
level of supervision progressively, substituting alternative supports, as the offender’s condition
improves. This will involve some degree of risk-taking as it involves the offender being allowed to
gradually take more responsibility for him/herself. Constant supervision must only be for the
shortest time possible and how the offender will be returned to normal location and/or a lesser level
of conversations and observations must be reflected in the CAREMAP.
[Link to Annex 8Q – Reducing the level of supervision while still maintaining a high level of safety,
including examples from establishments]
6. Where the offender is still on Constant Supervision beyond a week, this may be a sign of lack of
confidence and fear of blame in staff and/or a particularly challenging and difficult-to-manage
offender, perhaps with multiple behavioural and mental health problems. Offenders who remain on
Constant Supervisions for 8 days or more must be managed with the additional input set out in
Chapter 9: Managing at-risk offenders whose behaviour is particularly challenging.
Process for placing an offender on Constant Supervision
7. 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). Local instructions on this
will need to take account of each establishment’s arrangements for communication with their
healthcare provider during out-of-hours. Those staff instigating the Constant Supervision must
record clearly the reasons why this level of observation is required. [Link to Annex 8X – Sample
Authorisation Form]
8. Where Governors and PCTs are concerned that a high number of offender/patients are being
placed on Constant Supervision, they should consider implementing, in consultation with their
mental health provider, a process involving a risk assessment and multi-disciplinary review that will
inform the recommendation to the Duty Governor that an offender should be placed on Constant
Supervision. The review should consider alternative arrangements for supervision such as location
in a care suite, treatment in healthcare or use of a less frequent level of observation on ordinary
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location. An offender considered to be at imminent risk of suicide must not be left alone while this
process is carried out.
[Link to Annex 8K – Factors to be considered in developing a risk assessment] [Not yet available]
[Link to annex 8L – Example of an Establishment Protocol for placing an offender on Constant
Supervision] [Not yet available]
First ACCT Case Review
9. If a offender is placed on Constant Supervision during the core working day, the first ACCT
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 the offender is placed under
Constant Supervision during the night). This case review should consist of properly interested
persons (for example, the offender, orderly officer and/or unit/case manager, mental health nurse
or other health professional if available, and the SAFER CUSTODY CO-ORDINATOR if on duty).
This case review must be chaired whenever possible by a member of the SMT; preferably the Duty
Governor or Head of Healthcare, or a manager nominated by them if neither is available. All other
staff involved in the offender’s daily care should be invited as appropriate, including (where
available) those who have been/will be carrying out the observations.
10. The manager chairing the first review must ensure that the offender is informed about the level
of their supervision (taking account any need to not give information that assists the offender
decide when a suicide attempt is likely to be unobserved) and the reasons why they are being
observed, how long this may be maintained and what else may happen (for example, case
reviews). If the offender is not able to absorb this information at this point, the CAREMAP must
include steps to share this information with him/her at the earliest possible opportunity.
11. Sometimes (for example overnight) it will not be possible to convene a well attended case
review team. In such cases the Orderly Officer, in consultation with the on-call Doctor/ other
healthcare professional will make an interim decision by telephone, pending a case review at the
earliest possible convenience the next day. Local instructions on this will need to take account of
each establishment’s arrangements for communication with their healthcare provider during out-ofhours.
12. For the first 72 hours’ supervision, an ACCT case review must be held at least every day
(including weekends). These may be more frequent if the risk assessment of the individual
indicates this would be helpful. The ACCT case review team will review the reasons for the
Constant Supervision and sign to record their view that these are still current, if this is the case.
Subsequent ACCT Case Reviews
13. 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 case reviews must be entered in
the ACCT Plan.
Offenders who remain on Constant Supervisions for 8 days or more will be managed with the
additional input set out in [Chapter 9].
14. Subsequent ACCT case reviews during the core day Monday to Friday ought to be attended by
a minimum of three staff and (subject to local agreements with the healthcare provider) include a
mental health professional and residential staff. Subsequent ACCT case reviews that take place at
weekends or during evening duty and at night should be attended by a minimum of two staff and
include a member of the healthcare team (if possible mental health-trained) and residential staff.
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15. The case reviews must be formally written up in the offender’s ACCT plan, using the
designated pages for records of case reviews.
16 In the event of an incident of self-harm, the ACCT process should be followed – that is, a review
should be called immediately unless the CAREMAP specifies otherwise.
Mental health assessment and treatment
17. Where the offender is not already under the care of secondary care mental health services,
being placed on Constant Supervision must trigger an urgent referral for mental health assessment
and, if appropriate, provision of care. PCTs/establishments should agree with their mental health
service provider protocols for urgent referrals based upon clinical need. In establishments without
in-house mental health in-reach services (e.g. lower category establishments), these providers will
be community mental health or crisis services.
18. Where the offender is already under the care of secondary mental health services, the relevant
mental health professional must be called and asked to make an urgent visit, to engage
therapeutically with the offender, contribute to case reviews and advise on the individual’s care.
19. The Initial Segregation Safety Screen (OT014) is not sufficient to meet this requirement for a
mental health assessment and treatment.
20. It is good practice for a named mental health nurse or doctor to assess the mental health and
trigger problems of the offender on a daily basis.
Staff interaction, regime, activities and visits
21. Staff must be able to gain access to the offender swiftly in the event of an incident and also to
have access for conversation, both by day and by night. This means that staffing levels on an area
where a offender on Constant Supervision is held will need to allow for immediate unlock, staff
conducting the supervision must either be C&R trained or able to call support from staff who are,
and must hold a cell key or be able to obtain immediate support from staff who do. Where high
security considerations make this impossible, the establishment must have an alternative strategy.
22. The member of staff engaged in supervision must actively engage with the offender,
encourage him/ her to talk and participate in activities with him/her where appropriate. Talking,
playing games, and escorting the offender on walks (subject to risk assessment) should all be
considered. Sitting outside the offender’s room reading a book - unless aloud to the offender with
the offenders agreement - does not meet this requirement. Research has shown that, while staff
may believe that this is a way of giving the person being observed space and privacy, the people
being observed experience this behaviour as controlling. Account will also need to be taken where
the case review has concerns about interaction, due to the risk of violence posed by an offender.
23. The CAREMAP must contain plans for how the individual-at-risk is to engage in purposeful
activity and how contact with family, friends, staff and other offenders will take place. Access to
exercise, religious worship, work, education, library, association periods, domestic and legal visits
and support from CARATS, IMB, Probation, Foreign National Officer and other staff, can all
contribute positively to the individual’s recovery and should be encouraged. An offender on
Constant Supervision must be allowed to continue to practice his/her religion.
24. The CAREMAP must state which in-cell activities, such as books, CD player, television, radio,
art materials, will be made available to the offender. See section 8.10 below re: access to items in
possession. It is good practice when considering this to utilise a list of all activities available in the
establishment so that no options are overlooked.
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25. Where the person under Constant Supervision is on remand, their solicitor must be informed of
the situation (again with the individual’s permission) in order to enable speedy representation to be
made to the court.
26 Where the person under Constant Supervision is under 18 it is a requirement of the Children
Act that their legal guardian be informed. The Safeguard Manager must be consulted about the
appropriateness of informing the parents/carer/next of kin or relevant Children and Families
Services Department and about whether to make an external referral to Social Services for advice,
support or assessment.
27. Special attention should be paid to reducing the impact of night time observations on the
sleep of the person under Constant Supervision. See 8.8.5.
[Link to Annex 8M – Access to a Positive Regime for Offenders on Constant Supervision] [Not yet
available]
[Link to Annex 8N – Template Consent Form for involving the individual’s relatives or friends in
their care]
Showering and toileting
28.
Decisions about how to handle shower and toileting arrangements must be taken by the
review team and must include ways of preserving the offender’s dignity as much as is consistent
with safety. [Link to Annex 8P – Protecting the offender’s dignity while showering and toileting] If
supervising staff are of a different gender to the offender, they must be aware of whom to contact if
the offender wants to use washing/toilet facilities.
Staffing issues
29. Regarding the constant supervision of a Young Person (under 18), there is a requirement
for supervising staff to have enhanced CRB clearance. Best practice would strongly suggest that
staff supervising at this critical time should also have child protection training.
30. Where the Constant Supervision has been authorised (or jointly authorised) by a doctor or
senior nurse for mental health reasons, specific observation tasks are ideally undertaken by
registered nurses. Where this is not possible, then a registered nurse should provide overall
oversight of the conduct of the constant supervision, delegating the supervision as necessary and
appropriate to other competent persons (e.g. HCO, officer or Healthcare Assistant) but retaining
overall responsibility for ensuring that the constant supervision is carried out appropriately. He or
she should provide information and support, as necessary, to the staff actually carrying out the
supervision.
31 Staff members carrying out Constant Supervisions may be of any professional background or
grade. The key point is that they need to be considered competent to provide the level and quality
of support designated in the CAREMAP. They should, where possible:
 have completed the relevant training for observers and be deemed competent to carry out the
observation. [Link to training package] [Not yet available]
 have good interpersonal and report writing skills and be able to convey to the person-at-risk that
they are valued
 be C&R trained or able to access immediate support from staff that are
 be able to speak English (or other – see 31 below) well enough to allow effective communication
with the offender
32. If the offender is a foreign national and has difficulty with English, managers should make
every effort to detail as observers staff who have language skills that allow some communication.
[Link to Annex 8B – Foreign Nationals] This is often difficult to achieve; it may be that the agency
66
providing nurses can assist (subject to ensuring such agency staff have all the sensitivity and
competencies to undertake constant supervision). Picture cards are another useful tool when faced
with language barriers.
33. Ideally staff should undertake Constant Supervision for periods of not longer than 2 hours. This
allows time for the observer to build a rapport without losing focus. At the end of each observation
period, the member of staff should, again ideally, have a break (not different work) from Constant
Supervision of at least 2 hours.
34. Where possible, staff carrying out the observation should know the offender.
35. Where possible, a small number of staff should be rotated as observers so that there is some
continuity of care.
36. The member of staff conducting the Constant Supervision must make written reports on the
offender’s progress, and provide a verbal and written report at shift handovers. All relevant
information must be recorded in the ACCT Plan. Where the offender attends a case review (see
8.4.5), the supervising member of staff must also attend. Where possible staff who have
undertaken Constant Supervision should attend any case review concerning that offender that
occurs during their shift.
37 It is important that excellent communication between staff is maintained by, for example, a group
briefing of all staff to be involved in constantly supervising an individual at the beginning of each
shift. Where possible, the handover from one supervisor to another should involve the person-atrisk so that they are aware of what is being said about them.
38. New staff coming onto Constant Supervision duty must be appropriately briefed about the
offender and their ACCT Plan, and it must be recorded that this has been done. Such briefing must
include; the offenders history, background, specific risk factors and particular needs, as well as any
potential risks in the environment, emergency procedures and any information about the location
where the offender is held relevant to facilitating safe activities outside the room/cell.
[Link to examples of Handover Briefing Sheets from New Hall and Foston Hall] [Not yet available]
39. The role of Constant Supervision officer, when carried out properly, can be a demanding and
sometimes frustrating one. Unit Managers/Orderly Officers must support Constant Supervision
officers by providing the opportunity to debrief, and establishment protocols must include how
additional support might best be offered – for example, from the Safer Custody team, via clinical
supervision, via the Care Team.
40. Managers must ensure that staff carrying out Constant Supervision duties have the following:

Way of summoning help quickly if required, e.g. a radio

Protective gloves so that staff feel confident to deal with an act of self-harm if body fluids
have been spilt

Cut-down tools if local policy and risk assessment (see Chapter 11) indicates that it is
safe

Information sheet (can be local operating procedures) to be issued reminding staff of
local instructions of what to do in an emergency in regard to opening a cell. Also to include actions
to be taken in the event of the offender ligaturing, cutting or overdosing.
[Link to Annex 8R – Template information sheet] [Not yet available]
67
Port Reference
Home Office Reference:
Annex 15
DC Ref:
Details Of Port Responsible For Case (If Other Than Above)
Port:
Reference:
Tel:
IS 91 RA Part C: Supplementary Information To IS91 RA Part A
NAME:
D.O.B
Sex
:
Nationality:
This form should be completed as soon as either a) further information becomes available or b) the detainee's
behaviour and / or statements indicate a possible alteration to this detainee's risk factor.
Enter details of changes to risk factors
To ****************************
In the light of this it is considered that the risk factors associated with this detainee may have increased / decreased* in which
case a new IS 91 should be issued. You may also wish to consider whether a change of detention location is appropriate. *(delete
as appropriate)
Signed:
Print name:
Position:
For Completion by DEPMU / MODCU
Date:
Organisation:
This detainee's location does / does not (delete as appropriate) need to be changed.
The reasons for any change, for example from one removal centre to another or to prison or vice versa, MUST
be recorded in the comments section above and be accompanied by the issue of a revised IS91.
Detaining Office to issue new IS91:
Signed:
Print name:
Yes / No
Date:
Signature to be at CIO / HEO level or above if detainee to be located in or transferred from a prison, otherwise
at EO / IO level.
69