The prison provides a safe environment which reduces the risk of self-harm and suicide. Prisoners at risk of self-harm or suicide are identified and given appropriate care and support. All vulnerable adults at risk are identified, protected from harm and neglect and receive effective care and support.

Suicide and self-harm prevention

16. The prison provides a safe and secure environment which actively reduces the risk of self-harm and suicide.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it:

  • There is a clear strategy for preventing suicide and self-harm.
  • Staff are clear about their responsibility to preserve life, when to enter a locked cell and what do to in an emergency.
  • Staff are trained in suicide prevention processes and know how to support prisoners who self-harm.
  • Staff are trained to identify and support prisoners who may have mental health problems, or who have been affected by trauma.
  • Prisoners’ family and friends know how to raise a concern about the risk of self-harm or suicide, can ask for assessment, care in custody and teamwork (ACCT) processes to be initiated, and are kept appropriately informed.
  • Appropriate first aid equipment is readily available and sufficient discipline staff are trained to use it.
  • A multidisciplinary committee monitors the prison’s self-harm and suicide prevention policy and procedures and ensures support for the most vulnerable prisoners.
  • Self-harm data is monitored and any emerging patterns are identified and acted on.
  • Investigations into serious ‘near miss’ incidents are thorough and appropriately independent and identify opportunities for improvement which are rigorously pursued.
  • Staff respond quickly and comprehensively to Prisons and Probation Ombudsman (PPO) death in custody investigations.
  • PPO and Coroner’s Court recommendations are prioritised, acted upon and regularly reviewed.
  • Prisoners at risk of suicide or self-harm are only held in special/unfurnished accommodation or given anti-rip clothing in clearly documented exceptional circumstances on the authority of the governor and in consultation with the mental health team.
  • Personal possessions are only removed in documented exceptional circumstances, following a multidisciplinary review.

17. Prisoners at risk of self-harm or suicide receive individualised care from a multidisciplinary team and have unhindered access to help, including from their families.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it:

  • Staff use multidisciplinary care and support plans, developed in consultation with the prisoner, to identify risks and needs and implement strategies for reducing risk.
  • Consistent case managers are allocated for all prisoners at risk and are responsible for oversight of care plans between reviews.
  • Prisoners with complex self-harm/suicidal behaviours are managed using enhanced multidisciplinary case reviews.
  • Assessment, care in custody and teamwork (ACCT) procedures are used properly and are rigorously quality-assured.
  • Staff engage in a supportive and constructive way with prisoners in crisis.
  • Suitably trained and supported prisoner peer workers provide listening support to prisoners in crisis 24 hours a day, seven days a week.
  • Prisoners in crisis have access to an appropriate care suite.
  • Constant supervision is infrequent. When it is necessary, staff create a positive environment which encourages and facilitates access to a purposeful regime.
  • Prisoners can access a range of support services and staff encourage prisoners to involve their family or friends in their care.
  • Information about prisoners at risk of self-harm or suicide is communicated to the supervising officer in the community, when release is imminent.

Protection of adults at risk

18. Prisoners, particularly vulnerable adults at risk - as defined in the Care Act 2014 - are provided with a safe and secure environment which protects them from harm and neglect.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it:

  • There is a local safeguarding strategy to protect adults at risk, and a nominated local manager.
  • Staff are aware of their responsibility to protect adults at risk and know how to recognise signs of harm.
  • Prisoners are protected from extremist ideologies.
  • Prisoners can access a range of support services and staff encourage prisoners to involve their family or friends in their care.
  • Where harm or abuse is alleged or suspected, prompt action is taken to protect the individual and to investigate.
  • Prisoners whose health is likely to be injuriously affected by their imprisonment are safeguarded (Prison Rule 21).
  • There is a clear understanding of which prisoners at risk should be referred to the local authority adult safeguarding board and how to make the referral.
  • When required, prisoners can access advocates and/or appropriate adults to help them understand and give informed consent.
  • Staff engage with all relevant agencies to ensure prisoners are appropriately cared for and supported.

19. Adults at risk are appropriately located and supported by trained staff who are resourced to meet their needs.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it:

  • Prisoners at risk of harm are located in an environment where they can easily access the support they need and a purposeful regime.
  • Prisoners at risk of harm are not held in segregation unless this is justified in writing on the basis of exceptional circumstances by a senior manager.
  • Individual care plans are developed to manage a prisoner’s assessed needs.
  • Consistent case managers are allocated for all prisoners at risk and are responsible for oversight of care plans between reviews.
  • Punitive approaches to managing behaviour are only used for prisoners with complex needs if this is part of an individual care or support plan and in addition to other approaches designed to improve behaviour.

Further resources

The use of the person escort record with detainees at risk of self-harm

A thematic review: The use of the person escort record with detainees at risk of self-harm (22 October 2012)

Prison Rules 1999, Rule 21 (1)

The Care Act 2014 defines an adult at risk as an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs); and
  • is experiencing, or is at risk of, abuse or neglect; and
  • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse and neglect.

Human rights standards

Suicide and self-harm prevention
Human rights standards relating generally to keeping prisoners safe, treating them with respect for their human rights, and the obligations arising from the right to life (ECHR 2; ICCPR 6) are all relevant to suicide and self-harm prevention. Specific standards require prompt and impartial investigation where there are reasonable grounds to believe an act of torture or ill-treatment has been committed, and that any allegations of torture or ill- treatment from individuals are promptly and impartially examined by competent authorities. See: SMR 1, 30.c, 71–72; EPR 1, 47.2; BOP 34; CAT 12, 13, 16; ECHR 3.

Protection of adults at risk
Human rights standards relating to vulnerable prisoners are relevant. See: SMR 2.2, 33, 109.1. See also CRPD 12, 14–17.