Suicide and self-harm prevention in prison Nigel Newcomen Prisons - - PowerPoint PPT Presentation

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suicide and self harm prevention in prison
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Suicide and self-harm prevention in prison Nigel Newcomen Prisons - - PowerPoint PPT Presentation

Nov 22, 2023 191 likes •350 views

Suicide and self-harm prevention in prison Nigel Newcomen Prisons and Probation Ombudsman Bradley Group meeting 20 June 2017 Agenda The PPO A system still in crisis? Still a rising toll of despair What is ACCT? Is ACCT

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Nigel Newcomen Prisons and Probation Ombudsman

Suicide and self-harm prevention in prison

Bradley Group meeting 20 June 2017

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2 20 June 2017 Bradley Group

  • The PPO
  • A system still in crisis?
  • Still a rising toll of despair
  • What is ACCT?
  • Is ACCT still fit for purpose?
  • Conclusion

Agenda

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3 20 June 2017 Bradley Group

  • Roles

– Independent investigation of complaints from prisoners, immigration detainees, child detainees and those under probation supervision – Independent investigation of deaths in prisons, IRCs, STCs, SCHs and probation approved premises – Newer emphasis on thematic learning, library of 40 publications since 2012

  • Vision: carry out independent investigations to make

custody and community supervision safer and fairer

About the PPO

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Bradley Group 20 June 2017

  • We started investigations into 361 deaths 2016-17 (up 19%)
  • 115 self inflicted (up 11%)
  • 208 natural causes (up 19%)
  • 4 homicides (down from 6) and 34 “other”
  • Of all deaths, 88% were adult males
  • Female deaths more than doubled (23)
  • 11 deaths in APs, 3 in IRCs, 2 in SCHs
  • 5,026 complaints (up 5%), of which 2,569 eligible (up 10%)
  • Unprecedented levels of violence
  • Many of the same issues recurring and lessons either not being

learned or learning not being sustained

System still in crisis

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Bradley Group 20 June 2017

  • Continuing, tragic 11% rise in self-inflicted deaths may be less than

the 34% rise 2015-16 but no grounds for complacency

  • Hard to be definitive about cause of continuing rise:

– Staffing cuts, crowding and regime restrictions must all play a part in reducing protective factors against self-inflicted deaths – So must troubling levels of mental ill health – And an epidemic of new psychoactive substances – But each case is an individual crisis, an individual story and no simple, single explanation suffices

Still a rising toll of despair

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Bradley Group 20 June 2017 “Learning from PPO investigations: prisoner mental health” Published January 2016 A thematic review of the identification of mental health needs and the provision of mental health care for prisoners, based on the learning from our fatal incident investigations. Available online: http://www.ppo.gov.uk/?p=6737

15/11/2016 European Custody and Detention Summit

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Bradley Group 20 June 2017

“Learning lessons bulletin: new psychoactive substances”

Published July 2015 Examines the death of prisoners suspected to have been using NPS Considers risks and behaviour related to NPS use Available online: http://www.ppo.gov.uk/?p=6137

15/11/2016 European Custody and Detention Summit

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Bradley Group 20 June 2017

  • In a complex context, without simple answers, effective efforts by

staff are key to preventing self-inflicted deaths.

  • PPO investigations show much commendable work by staff
  • But, in a strained prison system, suicide and self-harm procedures

(ACCT) not being consistently applied.

  • As a result, investigations often repeat the same lessons.
  • This is not good enough and I frequently have to call on prison

staff to redouble their efforts.

  • On the basis of these repeat failures - and what staff tell us - I also

continue to question whether effective ACCT still deliverable within current resources

Still a rising toll of self-inflicted deaths

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Bradley Group 20 June 2017

  • Introduced in 2005, Assessment Care in Custody and Teamwork

(ACCT) is the HMPPS care-planning system used to support prisoners at risk of suicide or self-harm.

  • Its purpose is to try to determine the level of risk, how to reduce

the risk and how best to monitor and supervise the prisoner.

  • Process:
  • initial assessment of prisoner’s main concerns
  • set levels of supervision and interactions according to perceived

risk of harm

  • checks should be irregular to prevent the prisoner anticipating

when they will occur.

What is ACCT?

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Bradley Group 20 June 2017

  • There should be regular multi-disciplinary review meetings

involving the prisoner.

  • A caremap (plan of care, support and intervention) should be put

in place and the ACCT not closed until all actions completed.

  • All decisions and any relevant observations should be written in

the ACCT booklet, which should accompany the prisoner as they move around the prison.

  • Guidance on ACCT procedures is set out in Prison Service

Instruction (PSI) 64/2011.

What is ACCT?

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Bradley Group 20 June 2017

  • In concept, as good as any suicide and self-harm prevention

system in any other jurisdiction taking a holistic “whole prison approach” not a limited medical model

  • Need to be honest and acknowledge that no set of processes will

prevent all self-inflicted deaths

  • Alos mustn’t underestimate role of a safe environment, activity,

good staff\prisoner interactions and supportive healthcare

  • But repeat failures in ACCT reported in investigations suggest

disconnect between policy and practice

  • My (last) annual report (July 2017) will again call on HMPPS to

assure itself that staff can effectively implement ACCT.

Is ACCT fit for purpose?

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Bradley Group 20 June 2017

  • Can’t escape resource question: ACCT devised at a time when

fewer prisoners and more staff

  • Dependent on ordinary staff – hence Harris review called for

creation of specialist Custody and Rehabilitation Officers

  • Requires resources staff often complain do not exist
  • Reception and first night key times to identify risk but also among the

busiest processes in local prison

  • Huge amount of risk and need to manage
  • Training essential but often deficient
  • Struggle to achieve continuity of care and case management
  • Entirely paper based

Is ACCT fit for purpose? Issues

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Bradley Group 20 June 2017

  • Last time I raised similar concerns (2013) there was a cursory

review, followed by record numbers of suicides and more repeated PPO recommendations

  • Now some hope with prison reform agenda, which is reinvesting

in prisons and prioritising safer custody

  • New operational assurance programme underway which may

help answer concerns over ACCT

  • Key workers may increase consistent interactions
  • Devolution may encourage innovation
  • But a long, long way to go

Is ACCT fit for purpose?

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Bradley Group 20 June 2017

  • Prisons in England and Wales facing huge challenges, not least

continued and unacceptable increase in self-inflicted deaths

  • No simple answers
  • But unacceptable that some deaths reflect repeated failings
  • These repeated failures – and staff concerns - raise questions over

fitness for purpose of ACCT, or at least its deliverability

  • Much hinges on prison reform but progress will be limited without

greater safety and fairness

  • Prisons need to get better at learning lessons
  • PPO investigations and thematic learning will continue to support

the search for improvement and greater safety

Conclusion