Expected outcomes:
Inmates at risk of self-harm or suicide are identified at an early stage, and a care and support plan is drawn up, implemented and monitored. Inmates who have been identified as vulnerable should be encouraged to participate in all purposeful activity. All staff are aware of and alert to vulnerability issues, are appropriately trained and have access to proper equipment and support.
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| 3.16 |
Levels of self-harm were low. Overall, there was a very caring approach for those at risk. Care was multidisciplinary, led by psychology and was particularly good on the SLE. But initial responses were too reliant on the use of segregation and protective clothing. There was no coordinated safer custody strategy to bring together all those involved.
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| 3.17 |
Levels of self-harm were low. T he relaxed and open environment was a significant contributory factor to this, and helped women to deal with stressful events.
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| 3.18 |
There was no single register documenting incidents but some information about those at risk was available through a system of 'active alerts, flags and needs' on the computer-based offender management system (OMS). One report recorded that 30 women currently at GVIW had disclosed some history of self-harm, seven had self-injured at GVIW since January 2004 and four of these had harmed themselves on several occasions.
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| 3.19 |
One woman had killed herself in 2003 and some, but not all, of the subsequent recommendations from the coroner's investigation had been implemented. These included suicide awareness workshops for women, several of which had taken place during 2004 with women co-facilitating alongside staff and suicide prevention trainers. Recommendations that had not been implemented included 24-hour healthcare and the provision of an on-site defibrillator.
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| 3.20 |
There had been few very serious or near-fatal self-harm incidents. A report by the warden on the attempted suicide of one woman analysed the action taken and considered what, if anything, could be learned from how staff had responded to the incident.
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| 3.21 |
The psychology team took the lead in the care of those at risk of self-harm, and the acting senior psychologist was the suicide prevention coordinator. Three psychologists were based in the healthcare department. Much of their time was taken up with their responsibilities on the SLE and secure unit and this was reflected in the minutes of their weekly departmental meeting. There were insufficient resources to respond adequately to other needs within the general population.
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| 3.22 |
All new receptions were seen within 24 hours for an intake assessment that considered the risk of self-harm. In some cases, previous information about self-harm history from the community-based parole officer was available through the OMS. Any woman who had self-injured was referred to psychology who, in consultation with the team leader responsible for her unit, decided on a care plan. The warden or deputy warden approved the plan and informed the case management team.
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| 3.23 |
The usual response to an incident of self-harm was to locate the woman in the segregation unit. A psychologist decided the frequency of the watch and whether she would be observed by a closed-circuit television camera. Six of the seven women who had self-harmed at GVIW had been placed in protective gowns in cells in the segregation unit where there were obvious ligature points. No specific record was kept of the use of security or protective clothing. One woman described how this had made her feel worse.
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| 3.24 |
One woman was being held in these conditions during the inspection. No thorough assessment had been made of her previous history as the relevant reports were written in French and had not been translated. These had identified her as being at potential risk of self-harm.
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| 3.25 |
A good range of resources was available to help the small number of women at risk of self-harm. Behavioural counsellors provided regular support to women in the SLE and secure unit, and to those moved to the general population. Staff on the SLE also provided 24-hour support and several primary workers had been trained in dialectical behaviour therapy. Multidisciplinary team meetings were held weekly to review all new admissions and other on-going cases where there were concerns. Additional weekly case meetings were held on the SLE and secure unit. A strong group of volunteers contributed to the support of women in the institution and some, such as the Elizabeth Fry Society, helped women after release. There was, however, insufficient sexual abuse counselling (see section on programs) and the limited direct contact with inmates' families or significant others was usually made by the chaplain following a crisis. Families were not included as part of the correctional plan.
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| 3.26 |
Women provided a lot of mutual support but there was little formal peer support (see section on reception). In our survey, 51% of women, against an English comparator of 72%, said they were able to speak to a member of the peer support team at any time if they wanted to.
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| 3.27 |
Standing Order 843 Prevention of Suicide and Self-Inflicted Injuries (issued 1/04/05 and reviewed annually) provided guidance for staff on procedures. Incidents of self-harm were recorded in observation reports, discussed at a morning meeting and referred to psychology for follow up. Although levels of self-harm were low, the different areas that contribute to safer custody, such as links with muscling, the pressures of the early days in custody, alternative strategies to segregation and the role of peer support, were not brought together under an overall strategy.
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| 3.28 |
From the training records provided, it appeared that all staff who have direct contact with offenders had received some training as part of the correctional training program, the new employee orientation program or from modules on the women-centred training or dialectical behaviour therapy course. Training for some had been some years previously and there was no refresher training. It was planned that this would be delivered through computer-based training by November 2005.
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| 3.29 |
Staff carried a protective mask, gloves and ligature cutters to respond to emergencies.
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Action points |
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| 3.30 |
The records of incidents of self-harm should be improved to identify any emerging trends, and record use of segregation, protective clothing and other interventions.
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| 3.31 |
The psychology-led behaviourist approach to women at risk of self-harm should be developed to involve primary workers in managing cases and a formal support scheme which should include overnight facilities where peer supporters can help women at risk.
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| 3.32 |
All recommendations from the coroner's investigation into the self-inflicted death in custody should be implemented.
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| 3.33 |
The resources available to the psychology department should be reviewed to ensure that it meets the needs of the entire population.
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| 3.34 |
Systems should be put in place to ensure appropriate care for Francophone women at risk of self-harm and that all relevant reports are available in English before a transfer to GVIW.
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| 3.35 |
Families and other significant people should be contacted and involved when a woman is at risk of self-harm, where this is appropriate and with the woman's agreement.
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| 3.36 |
A safer custody forum should be developed to consider the relationship between the policy areas that contribute to feelings of safety. These include muscling, early days of custody, peer support and alternatives to segregation.
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