Identifying, monitoring and managing prisoners at risk of self-harm/suicide in England and Wales

Rates of self-harm/suicide in prisons are high and procedures for the management of risk are important in reducing such rates. The aim of this study was to evaluate a pilot initiative developed to improve the management of those at risk of self-harm/suicide (Assessment, Care in Custody and Teamwork [ACCT]). The method involved reception screening, clinical presentations of prisoners, care planning and mental health provision for prisoners at risk being compared before and after the pilot. The results were as follows: At reception, there was no change in the proportion of prisoners with suicidal ideation who were placed on an at risk document. While in prison, ACCTs being more likely to be opened following factors indicative of risk rather than actual self-harm and were more likely to contain 'quality' entries suggesting improved care of and engagement with vulnerable prisoners. While under the care of an at risk system, a higher proportion of prisoners were likely to be receiving primary mental health care input prior to ACCT implementation and prisoners on ACCT were more likely to be depressed but to be receiving no mental health care. Post-closure reviews were significantly less likely after the introduction of ACCT. The ACCT was piloted followed by phased implementation across the prison estate and findings are discussed in relation to further policy developments.