PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 1 of 16. Number I PSO 2700

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1 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 1 of 16 [--LMPRISON SERVICE i Number Prison Service Instruction 18/2005 I Introducing - the replacement ACCT (Assessment, for the F2052SH Care in(risk Custody of Self-Harm). & Teamwork) I PSO 2700 I June May 2006 CONTAINS MANDATORY INSTRUCTIONS For Action Monitored by Area Managers & Director of High Security Prisons, Heads of TDG, PECS & OCP, Governors, Directors & Controllers of C ntracted- ut Prisons Area Managers & Director of High Security Prisons, PECS, OCP, SAU & Self- Audit For Information On authority of All Prison Service staff Prison Service Management Board Contact Point See inside panel following PARA 37 Other Processes Affected PSO 2700 (Suicide and Self-Harm Area Training Plans, Prison Health Delivery Plans, Prevention), Escort Contractors Operating Procedures, _articularly Annex B (F2052SH procedures) Contracted Prisons Operating Procedures. NOTES (Note: not all establishments are introducing ACCT on the same date or necessarily this year). Guidance booklets for staff and managers and information on the Prison Service intranet support the introduction of ACCT. Mandatory Actions are written in italics and must be acted upon. Link to ACCT website. Issued 110/05/051 Introducing ACCT (Assessment, Care in Custody & Teamwork) - the replacement for the F2052SH (Risk of Self-Harm). Purpose - Assessment,_Care in Custody% 20and%20Teamwork_(ACCT).ht 11/05/05

2 PSI_I Assessment,_Care in Custody and Teamwork_(ACCT) Page 2 of This PSI introduces the new ACCT Plan (Assessment, Care in Custody & Teamwork). It replaces those elements of PSO 2700 that refer to the F2052SH as the form opened by staff in establishments when a prisoner/trainee is identified as at risk of suicide or self-harm. Escort staff (contracted or Prison Service) will continue to open a Suicide/Self-Harm Warning Form when a prisoner/trainee is identified as at risk-to-self (see PSI 51/2003), and will maintain any open ACCT Plans they receive as they now maintain open F2052SHs. 2. ACCT is being introduced to establishments throughout 2005 and Staff in establishments that have not yet implemented ACCT are to continue to use the F2052SH. A list of establishments preparing to implement ACCT, and guidance on what to do when establishments using F2052SHs receive a prisoner/trainee on an open ACCT Plan or vice versa, are contained in the ACCT website. 3. ACCT allows staff to raise their concerns, take action, and document the action taken for those prisoners/trainees they identify to be at risk of suicide or self-harm. Within 24 hours of the Plan being opened the at-risk prisoner/trainee will be seen by an Assessor and have a Case Review, the members of which will draw up a CAREMAP (a care and management plan), and have a member of staff nominated as their Case Manager. Appendix A shows the basic routes of care available once a risk-to-self is identified. Background 4. ACCT has been developed in partnership with the Department of Health and following an evaluation of the F2052SH by Manchester University as part of the Safer Custody Programme Care of At-Risk Prisoners project. It builds on existing good practice, the results of piloting in five establishments, and learning from previous incidents of suicide and self-harm. ACCT is a care-planning system whereby staff from all disciplines work together to provide individual care to prisoners/trainees in order to: Help defuse a potentially suicidal crisis and/or Help individuals with long-term needs (such as those with a pattern of repetitive selfharm) to better manage and reduce their distress. A summary of the evaluation of the F2052SH and the development of ACCT can be found on the ACCT website. 5. ACCT is being introduced to provide: An individual assessment for every prisoner/trainee identified at risk of suicide/self-harm A team of staff trained to conduct semi-structured assessment interviews Development of flexible and individualised care and management plans (CAREMAPs) Accountable management of those care plans, i.e. through Case Managers and naming those responsible for specific actions Agreed communication and referral protocols linking systems of care for suicide/self-harm and systems for mental health care Greater emphasis on supporting guidance and training (particularly around understanding self-harm and helping prisoners in crisis) And to build on: Existing and growing links with the NHS and NIMHE (National Institute for Mental Health England) and the National Assembly for Wales, particularly around Mental Health and clinical management of substance misuse Staff familiarity with the existing system (F2052SH), and that preventing suicide remains the responsibility of all staff

3 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 3 of16 And promote: An emphasis on 'people not processes' Individual care (rather than 'suicide watch') The recognised need for greater post-closure care Planning for release (linking to the resettlement agenda) Picking up identified risks early in custody Impact and Resource Assessment 6. The introduction of ACCT still requires all staff to be responsible for the prevention of prisoner suicide and self-harm, as set out in PSO Certain aspects of the new system do result in better use of or saved staff time, particularly greater flexibility when caring for prisoners/trainees who self-harm repeatedly as a coping mechanism and in caring for those considered to be at low risk, and around record keeping arrangements. However, there are other aspects that do require additional resources. These are the requirement for trained Assessors, named Case Managers, administrative support, and in particular the provision of time for training (for all staff to differing degrees, depending on their role - see Appendix D). Local business plans will need to be updated to take the training requirement into account. 7. If introducing ACCT is to work there will also need to be a meaningful commitment to supporting implementation and beyond from the Area Manager, Governor and senior managers of each establishment. Two key lessons learnt from piloting ACCT were the need for all staff to be appropriately trained and for senior managers to understand the aim of ACCT and to lead from the front rather than delegate responsibility for implementation to lower grade managers. Training 8. ACCT training courses are summarised at Appendix D. Staff released by establishments are trained as ACCT Assessors and/or ACCT Trainers to cascade ACCT training to establishments. This training has in the main been provided by Area Safer Custody Outreach workers and NIMHE Regional Leads. As the introduction of ACCT widens, Training and Development Group are taking lead responsibility and TDG Area Training Leads will be responsible for the co-ordination of ACCT training working in close collaboration with Area Managers, Safer Custody Group, Safer Custody Outreach workers, and NIMHE Regional Leads. Mental health in-reach staff or specialist staff co-ordinated by NIMHE are delivering the mental health element of the ACCT Assessor training. In Wales this is being delivered by mental health in-reach as agreed with the Prison Health Lead at the National Assembly for Wales. Implementation 9. This PSI comes into effect on 1 June As ACCT replaces the existing F2052SH throughout 2005 and 2006, Enterprise and Supply Services (ESS) are switching from printing F2052SHs to printing ACCT Plans (see 'Ordering of forms'). Mandatory Action 11. Where not specifically countered or amended in this PSI, all references to the F2052SH in PS02700 must be considered as also referring to ACCT. 12. The Head of PECS must ensure that Escort Contractors' Operating Procedures and training plans are amended to take account of the introduction and usage of ACCT and improvements - Assessment,_Care in Custody%20and%20Teamwork_(ACCT).ht 11/05/05

4 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 4 of 16 in the transfer of risk information, and fully meet the requirements set out in this PSI. Responsibilities before ACCT is introduced at an establishment 13. The Director of High Security Prisons, Area Manager or Head of OCP must ensure that their establishments" local policies, procedures and training plans are amended to take account of the introduction and usage of ACCTprior to commencing use. 14. The Director of High Security Prisons, Area Managers, or Head of OCP must be satisfied that the establishment meets the requirements set out in this PSI before each of their establishments commences use of ACCT (see Appendix B). 15. Prior to commencing use of ACCT in their establishment Governors and Directors of contracted-out prisons must ensure they have complied with the actions listed at Appendix B. Responsibilities once ACCT is introduced at an establishment 16. Suicide prevention is the responsibility of all staff. Whenever any member of staff believes a prisoner is at risk of suicide or self-harm they must open an ACCT Plan. (Note: Escort staff (contracted or Prison Service) continue to use the Suicide/Self-Harm Warning Form as the document they open in such circumstances) 17. It is important that staff are aware of which prisoners/trainees in their care are on an open ACCT Plan. All staff must ensure that when coming on duty they make an immediate check for for open ACCT Plans on the prisoners in their care, checking the frequency of conversations and observations requirements, the Triggers box and the CAREMAP for each one carefully. Whenever staff hand over prisoners on an open ACCT Plan to colleagues, they must always appropriately brief that member of staff. 18. Mandatory instructions on the opening, use and closure of ACCT Plans are contained at Appendix C. Quality control 19. Unit Managers must check observation books and ACCT Plans daily to ensure entries indicating risk of suicide or self-harm are promptly and appropriately actioned, and ensure that: that: Staff follow the A CCT procedures. Healthcare staffhave been informed of all new open ACCT Plans. All staff with prisoners trainees on open ACCT Plans in their unit are made aware of the Trigger box and CAREMAPs' contents, and that handovers take place. 20. The Duty Governor must audit the quality of ACCT Plans at least twice a week, draw deficiencies to the attention of line managers, monitor the response, and record that they have have made these checks. The ACCT Pocket Guide for Managers contains guidance on quality checks. Transfers and court movements 21. Where a prisoner trainee on an open ACCT Plan is leaving the establishment, the ACCT Plan must accompany them. Dispatching reception staff must make receiving escort staff aware that the prisoner trainee is on an open ACCT Plan. This must be recorded on the Prisoner Escort Record (PER), the bottom copy of which is retained by the establishment. 22. Escort staff must ensure they are aware of the contents and maintain the ACCT Plan. Escort staff must make receiving reception staff aware that the prisoner trainee is on an open ACCT Plan. Transfers in - Interface between F2052SHs and ACCT Plans

5 PSI Assessment,_Care in Custody and Teamwork_(ACCT) Page 5 of Where a prisoner on an open F2052SH transfers to an establishment using ACCT, the the F2052SH must be converted into an ACCT Plan. The ACCT Plan must be opened in Reception (or in the First Night Centre if this is where reception health screening takes place). Depending on local protocols, the Immediate Action Plan (page 4) will be completed by, or in conjunction between the reception staff and the manager of the receiving unit. The Assessment and first ACCT Case Review must take place within 24 hours of the ACCT Plan being opened. The F2052SH must not be closed at the receiving reception health screen; it must accompany the prisoner/trainee until they have had the first ACCT Case Review. Guidance on this is contained in the guidance booklet for staff and the ACCT website. Transfers out - Interface between ACCT Plans and F2052SHs 24. Where a prisoner on an open ACCT Plan transfers to an establishment using the F2052SH, the ACCT Plan must be converted into an F2052SH, including a Case Review. The ACCT Plan must not be closed at the receiving reception health screen; it must accompany the prisoner until they have had a F2052SH Case Review. Discharge from custody - Preparing post-release care 25. The aim is to ensure the discharged at-risk prisoner/trainee receives at least comparable support to that they have received in the establishment. Staff from agencies (and others) that will be involved in the care of the prisoner/trainee post-release should be invited to input to the Case Reviews prior to discharge. The pre-release CAREMAP should include action to link the prisoner/trainee to external organisations that provide support after release, e.g. Probation, Youth Offending Team, Social Services Department, housing, education/employment, family, healthcare, drugs treatment teams. The CAREMAP should also reflect the provision of information to the prisoner/trainee about how to obtain support from outside organisations such as Samaritans. 26. If closure of the ACCT Plan is because the prisoner is being discharged from custody, the Case Manager must involve Probation Offending Team (if the prisoner/trainee is to be under their supervision) and resettlement staff in at least the final Case Review. It is good practice to involve Probation/Youth Offending Team staff as early as possible in updating the CAREMAP to reflect planned support in the community. Local protocols will explain Probation and resettlement staff requirements in respect of this. 27. Where an at-risk prisoner trainee/immigration detainee is to be deported or removed from the UK and is being transferred to an immigration centre for this purpose, Case Reviews must consider (and reflect in the CAREMAP) what can be done to inform the receiving authority of the risks and what support is likely to benefit the person. 28. If closure of the ACCT Plan is because the prisoner is being discharged from custody, the Case Manager must update the CAREMAP to reflect the care they will.require in the community. Discharge from custody - Transfer of risk information 29. Legal advice is that the Prison Service has a legal duty to inform other relevant agencies of the self-harm or suicide risk that a prisoner/trainee presents. That duty comes from the ordinary law of negligence, and can be paraphrased as the duty of care to take reasonable steps to avoid reasonably foreseeable risks. The duty also comes from Article 2 of the ECHR, the duty to protect the life of those in the State's custody, which includes information sharing. Guidance on inter-agency information sharing is also contained in PSI 25/2002 (The Protection and Use of Confidential Health Information in Prisons and Inter-agency Information Sharing). Transfer of risk information to Probation Service or Youth Offending Team - Assessment,_Care in Custody% 20and%20Teamwork_(ACCT).ht 11/05/05

6 PSI_I Assessment,_Care in Custody and Teamwork_(ACCT) Page 6 of If the at-risk prisoner is to be under the supervision of the Probation Service Youth Offending Team upon discharge, a photocopy of the final Case Review, CAREMAP, front cover and inside front cover of the ACCT Plan must be provided to their Offender Manager/YOT worker or approved premises manager in accordance with local protocols. Ideally this should be provided at least 48 hours before discharge. A record must be maintained to show this has been done. This is in addition to any requirements in respect of updating Risk of Harm information on OASys/ASSET. 31. Where an at-risk prisoner/trainee released at court is to be under the supervision of the Probation Service Youth Offending Team upon discharge, depending which form is open either a photocopy of the Suicide/Self-Harm Warning Form, or a photocopy of the final Case Review, CAREMAP, front cover and inside front cover of the ACCT Plan must be provided to their Offender Manager/YOT worker or approved premises manager in accordance with local arrangements agreed between escort contractors and the local Probation Service Youth Offending Team (a model of such an arrangement is available from PECS Contract Managers). A record must be maintained to show this has been done. Transfer of risk information to Immigration and Nationality Directorate 32. Where an at-risk prisoner/trainee is reaching the completion of his/her sentence and is to be deported from the UK, the Immigration and Nationality Directorate's (IND) Criminal Casework Team must be informed about the risk in advance of IND taking responsibility for the escort of that person. This is to ensure that appropriate arrangements can be made for the person's care during their escort from prison and thereafter during their custody at an Immigration Service Removal Centre or to the point of departure from the UK. Calls should be made to This number is for this purpose only and should not be used as a general IND enquiry line. When such an at-risk prisoner/trainee (or an at-risk immigration detainee) is discharged, the receiving authority must be provided with a photocopy of the final Case Review, CAREMAP, front cover and inside front cover of the ACCT Plan. A record must be maintained to show this has been done. Transfer of risk information to Police 33. The police (so as to be better able to care for and support any previous at-risk prisoner who returns to their custody) can be informed through the Police National Computer (PNC) of any history of self-harm by the prisoner/trainee during this period in custody. Direct inputting to the PNC is not currently available to the Prison Service, so pending the Service receiving that capability it is good practice for establishments to ensure the PNC is updated by consulting LIDS prior to discharge and informing the local PNC Bureau of any history of self-harm by the prisoner/trainee during this period in custody. For PNC warning marker purposes 'suicide risk' refers to any self-harm incident where the prisoner/trainee involved required resuscitation and/or transfer to an outside hospital, and 'self-harm risk' refers to any act other than the above where a prisoner/trainee deliberately harms themselves irrespective of the method, intent or severity of any injury. Advice about and forms for the transfer of information to the police can be accessed on the Prison Service intranet by clicking here, or from Laura Dobinson in Safer Custody Group at laura.dobinson@hmps.gsi.gov.uk Audit and monitoring 34. Directorate of High Security Prisons, Area Offices, OCP, PECS and establishments must put in place systems to enable compliance with the mandatory actions set out in this PSI. Audit will comply with the Audit Compliance and Self-Audit Standard. 35. Pending revision of Standard 60 (Suicide Prevention) ACCT establishments can use Alternative Procedures (Safer Custody Outreach workers hold agreed template AP forms). Ordering of Forms 36. Establishments or trainers requiring additional supplies of ACCT Plans (BD008), the ACCT Pocket Guide for Staff (BD010) and the ACCT Pocket Guide for Managers (BD009) should

7 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 7 of 16 submit orders to Corby Customer Liaison Team, via their Stationery Clerk, in the normal way Advice and Information 37. Any queries regarding matters relating to this procedure that cannot be answered by the Area office, OCP or PECS (or TDG in respect of training), should be made to Safer Custody Group: For more information contact: In respect of policy issues: Jenny Rees, Safer Custody Group, 'Z , jenny.reesscg@hmps.gsi.gov.uk Mike Gibbs, Safer Custody Group mike.gibbssgc@hm_p_s.gsi.gov.uk In respect of related NHS policy issues: Richard Jordan, NIMHE, richard.jordan@dh.gsi.gov.uk Sean Duggan, NIMHE, sean.duggan@dh.gsi.gov.uk In respect of training delivery issues: Lisa Maclean, Training and Development lisa.maclean@hmps.gsi.gov.uk Group, For administration of courses: Lyn Thomas, Training and Development '_ Group, (signed) Michael Spurr Director of Operations

8 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 8 of 16 Appendix A ACCT Flowchart Complete Concern and Keep Safe form (Page 3 of ACCT) Obtain log number and inform ACCT administrative officer i!iiii!iiiiiiiiiiii i!iii_ support Pass to Unit Manager (or Night Order y Off cer) Mai ntain oonorma,, '!iiiii! iii!iii comp,et s location Immediate AGIon Plan Refer to healthcare (Page 4 of ACCT) Refer for Assessment Refer for assessment (Page 7 of ACC-P) (Page 7of ACCT) and Assessment Interview and Case Revie_._ within Case Review within 24 carried out by trained 24 hours or as soon as hours of concern raised Assessors well enough to be interviewed (see guidance on page 12) Rrst _ Review Chaired by Unit Manager within same 24-hour per;iod_ Estimation of risk by Case Review team. Refer to healthcare for mental health assessment if mental health problems and/or high risk and/or actua_ self-harm_ Arrange next Case Review and appoint Case Manager (self or minimum grade of SO officer or Nurse Grade F). AC_ can be closed at any Case Revie_v - Assessment,_Care in Custody%20and%20Teamwork_(ACCT).ht 11/05/05

9 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 9 of 16 Appendix B It should be noted that the requirements set out in this Appendix do not negate the requirements set out in Annex A to PSO 2700 regarding local suicide and self-harm prevention strategies and instructions (except that - in line with paragraph 11 of this PSI - references in that Annex to the F2052SH should be taken as references to ACCT). Prior to commencing use of ACCT in their establishment Governors and Directors of contracted-out prisons must ensure that: (a) The /oca/ suicide prevention and serf-harm management strategy and related protocols and instructions (e.g. Governors Orders or Operating Procedures), and all other/oca/policies that affect the care of prisoners trainees, inc/uding those re/ating to training plans and to the availability of staff to support ACCT processes, are amended to reflect the changes herein. (b) There are/oca/protocols on the conversion of open F2052SHs to ACCT Plans that reflect the requirement for this to happen within 24 hours of reception. (c) Where an establishment is in the process of converting from use of F2052SHs to introducing ACCT it is likely that it will be both safer and more practical to stagger the conversion programme over a number of days. Individual conversions must still not take longer than 24 hours and there must be local protocols in place to explain how this conversion programme will be managed. (d) All staff and volunteers (e.g. IMB, Samaritans) in contact with prisoners/trainees are aware of the the contents of this PSI and that the change from the F2052SH system to ACCT is to take place. (e) All staff in contact with prisoners/trainees (i.e. not only residential/discipline staff, but other staff such as chaplaincy team, resettlement, education and training, catering, healthcare, substance misuse and mental health in-reach) are familiar with ACCT, Le. trained to at least ACCT Foundation level (see Appendix D), and are aware of their role in the practice of ACCT. This will also require that there are systems in place to ensure that new staff joining the establishment receive ACCT training. (f) There is an accessible up-to-date database (or a published and easily maintained list) of who (named individuals) has received training, e.g. Assessors, Case Managers, for which ACCT role and where they work within the establishment- with contact details. (g) All prisoners/trainees are aware of what ACCT is, that # is to be introduced into the establishment, and when. (h) All ACCT Assessors have received the appropriate training (see Appendix D). (i) There is an appropriate number of ACCT Assessors to cover the needs of the establishment, and a system in place, e.g. a rota, to ensure there are always ACCT Assessors available. (j) There is a system of administrative support (e.g. using an ACCT Administrative Support Officer) to support (or manage) the above Assessor system, and to support Case Managers in the arranging and preparation of Case Reviews.

10 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 10 of 16 (k) There is a system in place to inform the Assessor Team when an ACCT Plan has been opened, e.g. by the Unit Manager/Night Orderly Officer or ACCT Administrative Support Officer. (I) There is a network of support to enable Assessors to carry out their role confidently, with authority and without compromise. Examples include: Mentorship by a mental health professional with direct access. Peer support. New Assessors to carry out initial assessment interviews in pairs. Regular Assessor Team meetings to discuss and reflect upon practice, facilitated by a mental health in-reach member or member of psychology staff. (m) All ACCT Case Managers have received the appropriate training (see Appendix D). (n) A system is in place to enable the Case Manager role to be carried out in the absence of a particular named individual. This refers to preparing for those exceptional circumstances where the named Case Manager is not available for this duty; it is not intended that this should be a regular occurance. (o) ACCT Plans and guidance documentation are available in appropriate volume to meet the establishments needs, i.e. taking into account level of risk and numbers of prisoners and staff. (p) Reception staff know what to do if they receive an F2052SH from a non-acct establishment or dispatch a prisoner on an open ACCT Plan. (q) There are local protocols to ensure that escort staff are adequately briefed when being given custody of a prisoner/trainee on an open ACCT Plan. (r) Where an establishment takes juveniles; there are local protocols consistent with local child protection procedures (see PSO 4950) to ensure that the Child Protection Coordinator is informed that the ACCT Plan has been opened. The Child Protection Co-ordinator must be consulted about the appropriateness of informing the parents/carer/next of kin about the opening of the ACCT Plan, and about whether to make an external referral to Social Services for advice, support or assessment. (s) There is a comprehensive list of establishment resources for staff to draw upon in addressing specific problems in the CAREMAP that is easily available. (t) The Primary Care Trust that commissions the establishment's health and mental health services is involved, and the roles of healthcare staff and communications and referral protocols are agreed. In England NIMHE Regional Development Centres are responsible for supporting this process, in Wales this will be the Prison Health Lead at the National Assembly. (u) These referral protocols (see above) must make clear to whom prisoners trainees who need a mental health assessment will be referred (e.g. healthcare staff, mental health inreach) and include specifications regarding 'urgent" and "routine' assessments. (v) Healthcare reception screeners must be aware of the "care pathways' that start at reception. (w) There are local procedures to obtain an ACCT log number and update LIDS (using the F2052SH fields) and the F2050A in respect of opening and closing an ACCT Plan (e.g. through a central registration point such as the control room or the ACCT Administrative Support Officer). (x) There are local protocols to ensure that the Case Manager (or Unit Manager if the prisoner has moved location) is informed when a post closure interview is due.

11 PSI_I Assessment,_Care in Custody and Teamwork_(ACCT) Page 11 of 16 (y) There are local protocols to ensure that where an at-risk prisoner is to be discharged from custody, resettlement staff (including CARATS workers) participate (preferably by attending in person) in the final Case Review and in updating the CAREMAP to reflect the care required in the community (including that relating to risks associated with drugs drugs overdoses). (z) There are local arrangements in place to ensure that where an at-risk prisoner is to be discharged from custody, the relevant external Offender Manager Offending Team and approved premises manager is invited to participate (preferably by attending in person) in the final Case Review and in updating the CAREMAP to reflect the care required in the community. (aa) There are local arrangements in place to ensure that where an at-risk prisoner is to be under the supervision of the Probation Service Youth Offending Team upon discharge, photocopies of the specified sections of the ACCT Plan are provided to their Offender Manager/YO T worker or approved premises manager. (bb) There are local protocols to ensure that where an at-risk prisoner/trainee/immigration prisoner detainee is to be deported or removed from the UK, photocopies of the specified sections of the ACCT Plan are provided to the receiving authority. (cc) There are local procedures in place to ensure that where any prisoner is to be be discharged from custody, LIDS is consulted to check for a history of self-harm during this period in custody to allow risk information to be shared with other agencies (e.g. the police through the local PNC Bureau). Further information on introducing ACCT to an establishment is provided in the ACCT website, including a link to an implementation guide, and can also be obtained from Area Safer Custody Outreach workers, TDG Area Training Leads and Regional NIMHE Leads. Appendix C The instructions below cover the most basic requirements in respect of ACCT procedures. Explanations on how to use ACCT are included throughout the ACCT Plan and in the supporting guidance booklets for staff and managers. 1. Where information reflecting a concern for a prisoner who may be at risk of self-harm or suicide is received from outside the establishment, the concerns must be recorded, e.g. in the observation book and in the F2052A (history sheet), along with the action taken, Le. ACCT Plan opened or updated. Opening an ACCT Plan 2. In the event of any incident of self-harm, or whenever a member of staff believes a prisoner/trainee is at risk of suicide or self-harm, they must (where there is not one open already) open an ACCT Plan. The person opening the ACCT Plan must: Complete the top box on the front cover and complete the 'Concern and Keep Safe' form (page 3). Obtain a log number - following local procedures - which must be inserted in the box on the front cover. Ensure the prisoner/trainee is safe and pass the ACCT Plan to the prisoner prisoner's/trainee's Unit Manager or to the Night Orderly Officer in person. Inform the ACCTAdministrative Support Officer (or equivalent). Follow local procedures to ensure LIDS (using the F2052SH fields) and the F2050A

12 PSI_I Assessment,_Care in Custody and Teamwork_(ACCT) Page 12 of 16 are updated. Record in the observation book and in the F2052A (history sheet) that an ACCT Plan has been opened (or ensure that the relevant wing staff records this). Inform Healthcare so that the opening of the ACCT Plan can be noted in the clinical record. It is the responsibility of the member of the healthcare team who receives this information to check the clinical record for any medical risk factors, and to inform the ACCT Case Manager (or Un# Manager or Night Orderly Officer if no Case Manager has yet been appointed) as appropriate. 3. It is important to involve the prisoner/trainee in their own care. The member of staff who opened the ACCT Plan must explain to the prisoner/trainee why they did this and what action has been taken to keep them safe, explaining what ACCT means and what will happen next. 4. The Unit Manager or Night Orderly Officer must - either themselves or through the ACCT Administrative Support Officer (or equivalent) - make the referral for Assessment and organise the first Case Review. 5. The Unit Manager or Night Orderly Officer must brief staff in contact with the prisoner/trainee about the case, enter details in the wing observation book and complete an F213SH (selfharm suicide form) if the prisoner/trainee has self-harmed. 6. The Unit Manager or Night Orderly Officer must keep the prisoner safe following local protocols relating to the location, supervision and support of potentially at-risk prisoners pending the Assessment and first Case Review. They must record how this is to be done on page 4 (the Immediate Action Plan). Where the ACCT Plan is opened in Reception, initial decisions about care may be made by health reception staff, in conjunction with the manager of the receiving unit. 7. When talking to the prisoner/trainee the Unit Manager or Night Orderly Officer needs to find out who they feel is likely to be supportive (e.g. family, friend, counsellor, personal officer) and if possible help facilitate their talking with the prisoner/trainee. Where the individual is under the Child Protection Co-ordinator (and parents/carer/next of kin if appropriate) must (following local protocols) be informed as soon as possible. The Unit Manager or Night Orderly Orderly Officer must ensure that prisoners on an open ACCT Plan have been offered, offered, where available, the opportunity to talk to a Listener and/or Samaritan. The Assessment 8. The Assessor Team must be notified (according to local protocols) that the ACCT Plan has been opened and an Assessor must interview the prisoner/trainee within 24 hours of the Plan being opened. 9. The Assessor must interview the prisoner/trainee and record the outcome on pages 7-9 (Assessment interview) and contribute to the first Case Review (by attending if at all possible, otherwise in writing or by telephone). 10. The Assessor must ask the prisoner to sign the "agreement to sharing information' on the inside front cover, and (assuming the prisoner/trainee has agreed) complete that form. If the prisoner/trainee does not wish to sign this, share only information that relates to the risk and how to reduce the risk. This meets legal advice that where consent to disclosure is withheld, it may nonetheless be shared/disclosed for the purposes of medical treatment, or where necessary to protect that person's safety. Any information that comes to light concerning risk to others should also be shared as appropriate to ensure the safety of those coming into contact with the prisoner/trainee. Guidance on inter-agency information sharing is also contained in PSI 25/2002 (The Protection and Use of Confidential Health Information in Prisons and Inter-agency Information Sharing). The first Case Review

13 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 13 of The first Case Review must be held within 24 hours of the Plan being opened (ideally immediately after the Assessment interview). 12. The Unit Manager must chair the first Case Review and appoint a Case Manager (it may be the same person) (minimum grade of Senior Officer or Nurse Grade F). 13. Each case must be treated individually, e.g. there should not be a 'conveyor belt' approach to case management using only the same staff for most reviews rather than those who the prisoner/trainee actually has contact with or who can add specialist insight to the discussion or who some prisoners/trainees may feel more comfortable talking to, e.g. chaplain, education, drugs counsellor or Probation. 14. The Unit Manager or Case Manager must complete the Action Following Assessment (first Case Review form) on page 10, and ensure the points listed in the paragraph 15 immediately below are reflected in the ACCT Plan. 15. The Case Review Team must: Engage with the prisoner as much as is possible. Consider all available sources of information, e.g. staff, other prisoners/trainees, Suicide/Self-harm Warning Form, PER, OASys, ASSET, note of telephone call from concerned person(s). Identify the most urgent problems and needs of the prisoner and the activities activities and people best able to provide support, and reflect these issues and solutions in the CAREMAP (see below). Agree the level of risk. Ensure that any disability needs the prisoner may have are considered and reflected in the CAREMAP (see below). Ensure that any concerns raised by the prisoner or others because of bullying or harassment (including any problems in respect of race or homophobia) are taken into account and solutions are reflected in the CAREMAP (see below). The Case Review Team must also: Make an entry in the Triggers box (inside front cover), if triggers are identified. Make an entry in the box detailing frequency of conversations and observations and required frequency of recording (on the front cover). Draw up a CAREMAP (care and management plan) on pages Decide when the next review (or post closure review) will take place and make an entry on the front cover. 16. Where the level of risk is high, or there is evidence of mental health problems, or there has been self-harm, the prisoner must be referred for a mental health assessment by a suitably competent health practitioner according to local protocols. There is no automatic requirement for all prisoners/trainees on an ACCT Plan to see a doctor. Subsequent Case Reviews 17. The Case Review Team must: Review the level of risk. Review the progress made in resolving the identified problems. Review the progress in increasing the strength of 'protective factors', e.g. contact with friends and supportive family (possibly with support of Assisted Prisons Visits Unit) and/or meaningful activity. Review the frequency of conversations and observations (and recording requirements), and where this changes update the frequency of conversations and observations box (on the front cover). Update the Triggers box if new information requires it (inside front cover). Update the CAREMAP (pages 13-14). Decide when the next review (or post closure review) will take place. - Assessment,_Care in Custody% 20and%20Teamwork_(ACCT).ht 11/05/05

14 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 14 of The Case Manager must complete a 'Record of Case Review' (pages 15-17) and inform healthcare if anything has changed that indicates a referral to a health or drug worker would be advisable. 19. When a prisoner moves units the receiving Unit Manager must appoint a Case Manager (this can just mean confirming that the existing Case Manager retains responsibility for that prisoner/trainee). 20. If the prisoner is an in-patient in healthcare, the Healthcare Manager becomes the Case Manager (ACCT Plans are to be maintained and CAREMAPs continue to be actioned whilst an at-risk prisoner/trainee is resident in the healthcare centre). An ACCT Plan can only be closed in the healthcare centre when the prisoner/trainee is a long-term patient whose return to normal location is not imminent, and in line with the paragraphs about closing an ACCT Plan (28 & 29 below) concerning the achieved reduction in risk. 21. A pre-discharge Case Review must take place before a prisoner is returned to ordinary location from being resident in the healthcare centre. The Case Review Team must: Undertake the actions as in paragraph 17 above. Arrange a follow-up healthcare appointment. 22. The Case Manager must complete the 'Review Prior to Discharge from Healthcare' form (page 18). The CAREMAP 23. The Case Manager must update the CAREMAP (page 13-14) after each Case Review. 24. The person(s) named against each of the 'actions required' in the CAREMAP must complete their actions by the date given. Where this is not possible, they must inform the Case Manager Manager who must note this and the new date for completing the action against the relevant entry in the CAREMAP. 25. The Case Manager must ensure that the person named against each of the 'actions required' in the CAREMAP has completed theirs by the date given. On-going record 26. Conversations with and observations of the at-risk prisoner/trainee must take place at least as as frequently as stated in the 'required frequency of conversations and observations' box on the front cover. Staff responsible for observing particular prisoners/trainees - including night staff - will need to ensure they are familiar with the requirements in that individual's ACCT Plan. 27. Significant events, conversations with and observations of the at-risk prisoner must be recorded in the On-Going Record (pages 21-22). The minimum required frequency of recording such conversations and observations is stated in the 'required frequency of conversations and observations and required frequency of recording' box on the front cover. Significant events, by their nature, cannot be necessarily foreseen and therefore no minimum frequency of recording these is required. Closing an ACCT Plan 28. The ACCT Plan can only be closed once the Case Review Team judges that it is safe to do so, i.e. that the problems that caused the ACCT Plan to be opened have been resolved or reduced, the prisoner/trainee is able to cope with any remaining difficulties, they have access to at least some positives, e.g. friends, family, counsellor, member of chaplaincy team, hobbies, education/employment, and they know who to contact (and how) should they need support in the future.

15 PSI_I Assessment,_Care in Custody and Teamwork_(ACCT) Page 15 of The Case Manager must enter in the record of the final Case Review why the Case Review Team feel it is safe to close the ACCT Plan, and enter the date closed and date for a post closure interview. 30. Where the closure of the ACCT Plan is because the prisoner is being discharged from custody, the final Case Review (and preferably those reviews before) must reflect consideration of what support can be offered in the community from other agencies and persons (e.g. Probation Service, Youth Offending Team, family, GP or other healthcare providers, police, social services, voluntary organisations). The CAREMAP must be updated to to reflect planning to provide such support that is appropriate and available to that individual. This requirement is irrespective of whether the prisoner/trainee/immigration detainee is to be under supervision (e.g. of the Probation Service/Youth Offending Team or IND) upon discharge. 31. The closure must be recorded in the F2052A (history sheet). 32. The closed ACCT Plan remains on the wing until completion of the post closure interview(s). Once it is confirmed there are to be no further post closure interviews the closed ACCT Plan must be stored safely in the F2050 core record. Any F2052SH closed as a result of conversion conversion to an ACCT Plan must also be stored safely in the F2050 core record. 33. The Case Manager must follow local procedures to ensure LIDS is updated (using the F2052SH fields) and that the central registration point (e.g. control room), healthcare and Administrative Support Officer (or equivalent) are informed of the closure. 34. The Case Manager (or Unff Manager if the Case Manager is unavailable) must decide at the end of the post closure interview whether there needs to be a further such interview. The post closure interview must include discussion of the points listed in the ACCT Plan (inside back cover), and this must be recorded in the F2050A (wing record)/f2052 (personal record). Appendix D ACCT Training Courses ACCT Foundation Case Manager Course ACCT Assessor Course Course - 3 hours - 1 day 3 days Uniformed and non Unit Managers, SOs, Members of ACCT uniformed staff in contact Case Managers Assessor teams with prisoners Module 1:1 hour Module 1 Part 1:2 days Mental Health Awareness Introduction to ACCT, Same as Modules 1 & 2 Role of ACCT Assessor Self-harm and suicide of Mental disorders Foundation Course Substance dependence Self injury - Assessment,_Care in Custody%20and%20Teamwork_(ACCT).ht 11/05/05

16 PSI_ Assessment,_Care in Custody and Teamwork_(ACCT) Page 16 of16 Module 2:1 hour Module 2 Part 2:1 day Doing ACCT Assessment ACCT process & Estimating & Managing Communication skills documentation Immediate Risk of Assessing suicide risk Suicide (levels of risk, Familiarisation with mental disorder, assessment & practice substances) using it (or STORM modules l& 2) Module 3:1 hour Module 3 Part 2 also includes Case Manager Module 3 Case study: Using ACCT Care planning - case to plan care study Additionally, Assessors require STORM modules 1 & 2 or ASIST Note 1: Where staff have received TDG/NIMHE led mental health awareness training, this may replace Part 1 of the ACCT Assessor Course Note 2: Case managers who have completed the foundation module do not need to do it again as part of Case Manager course Note 3: Those training to be ACCT Assessors should be familiar with the ACCT process and documentation (Foundation 2) before they do the ACCT Assessors course Note 4: STORM = Skills based Training On Risk Management, and ASIST = Applied Suicide Intervention Skills Training. Both have their own train the trainers courses.