Procedure - At-Risk Management (Self Harm/Suicide)

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Purpose
1.	Process
		PART A - At-risk management - custody
2.	Prisoner management
3.	Identification of at-risk prisoners
3.1	Admission
3.2	Self harm/Suicide Risk Assessment
4.	Immediate response to identification (not including Helana Jones Centre and Princess Alexandra Hospital Secure Unit (PAHSU))
4.1	Initial assessment and initial response plan
4.2	Initial assessment and initial response plan - after business hours
4.3	Low security (including Helana Jones Centre)
4.4	Contingency Checklists
5.	Transfer and escort to high security facility
6.	Self harm/suicide risk assessment - custody (except PAHSU)
6.1	Correctional supervisor
6.2	Psychologist
6.3	Cultural Liaison Officer
6.4	Risk Assessment Team meeting
7.	Management of at-risk prisoners -custody
7.1	Princess Alexandra Hospital Secure Unit (PAHSU)
8.	Observations - custody
8.1	PAHSU
8.2	Other than the PAHSU
9.	Review of the at-risk management plan - high security
10.	Discharge of prisoners currently or previously at-risk
11.	Termination of the At-Risk Management Plan - custody
12.	Prisoners identified as having an elevated baseline risk of self harm or suicide
12.1	Use of suicide resistant cells
12.2	Continuity in supervisory oversight of at-risk prisoner's case-notes
12.3	Use of an Intensive Management Plan
13.	Progression of a prisoner with an elevated baseline risk through the custodial system
13.1	Low security accommodation
13.2	Work Camp accommodation
		PART B. At-Risk management - Community supervision
14.	Admission - community
15.	Identification of at-risk offenders - community
16.	Activation of the Self Harm Episode History (SHEH) flag - community
17.	Managing offenders at immediate risk - community
17.1	Initial response - community
17.2	Immediate intervention strategies - community
18.	Managing offenders not at immediate risk - community
19.	Identification and management of offenders with a history of self harm or suicide in community settings
19.1	Managing risk - levels of service
20.	Transfer of at-risk offenders - community
21.	Amendment of Parole Order due to risk of self harm or suicide
22.	Completion of community-based supervision order
23.	Debriefing following incidents

Purpose

To minimise harm and to prevent loss of life by the identification and safe management of offenders who are at-risk of self harm or suicide.

Definitions

“at-risk offender” - a prisoner or offender who is considered to be at-risk of suicide or self harm.

“elevated baseline risk (EBLR)” - a prisoner or offender who has been identified as having an increased baseline risk of self harm or suicide as demonstrated through a history of self harm or suicide attempts.

“general manager's nominee” includes deputy general manager, correctional manager and duty manager.

1. Process

The agency has a duty of care to provide a safe environment for offenders managed within Queensland corrective services facilities and is committed to minimising the risk of offenders self harming and suicide.

Any action taken by a person to end his/her life must be treated as an attempt to commit suicide. All action taken to preserve a person's life must continue until the person has been declared life extinct by a registered nurse, ambulance officer or doctor.

The relevant manager must ensure that protocols, contingency plans and staff training are implemented to manage at risk and self harming behaviour by offenders within the workplace, in particular, the critical period from the commencement of the emergency.

The relevant manager must ensure that the assessment and/or observations of at risk offenders are prioritised.

The relevant manager must ensure that appropriate emergency telephone contacts for an “at risk behaviour” situation are clearly identified and displayed in prominent positions within the workplace.

Staff must not place themselves in a position where there is risk to their own personal safety when responding to an emergent incident.

All staff involved in the management of offenders have responsibilities and professional accountabilities in minimising harm and preventing loss of life by-

1. receiving relevant training (including for cultural awareness);
   
   For example, staff must have an understanding of Aboriginal and Torres Strait Islander culture and history and how these factors influence the risk of self harm or suicide for Aboriginal and Torres Strait Islander prisoners in custody.
2. being thoroughly familiar with the process of identification and management of "at-risk" offenders within the corrections environment;
3. being alert to behaviours that may indicate that an offender is at-risk (refer appendix - Indicators of At Risk Behaviour);
4. being aware that particular events in an offender's life may elicit self harm, suicide and attempted suicide and should address any perceived anxiety an offender may have in relation to the at-risk management process (refer appendix - Periods of Critical Risk);
5. being aware of individuals and groups who are more vulnerable to At-Risk behaviour (refer appendix - Predisposing Risk Issues); and
6. having a knowledge and understanding of the responsibilities of officers responding to emergency incidents.

Refer procedures - Accreditation, Registration and Qualifications; Disclosure of Confidential Information; First Officer Response - Medical and Assault.

In accordance with Corrective Services Act 2006 (CSA) ss 3 and 266, staff must maintain an awareness of the specific at-risk management issues pertaining to offenders with special needs including-

1. Aboriginal and Torres Strait Islander offenders;
2. female offenders;
3. young offenders;
4. offenders from culturally and linguistically diverse backgrounds;
5. offenders with intellectual disability/cognitive impairment;
6. offenders with psychological/psychiatric disability or disorder;
7. offenders with a history of self harm or attempted suicide;
8. aged offenders; and
9. transgender offenders (refer procedure - Transgender Offenders.

PART A - At-risk management - custody

2. Prisoner management

For an international resource by the World Health Organisation that informs this procedure, refer Preventing Suicide: A Resource for Prison Officers.

Any prisoner management processes should-

1. be the least intrusive measures possible without compromising the prisoner's wellbeing so as to make it more likely that they will self-report feeling of self harm and suicide;
2. attempt to reduce prisoner anxiety levels; and
3. address any perception by the relevant prisoner that the measures taken are punitive rather than therapeutic.

If relevant, refer procedure - Sexual Assault.

Suicide resistant sheets, gowns, pillows, doonas and physical restraints must be available at all high security facilities for issue to and use in the management of prisoners identified as being at risk of self harm or suicide.

3. Identification of at-risk prisoners

3.1 Admission

Admission is a time of critical risk.

Prisoner records, including Integrated Offender Management System (IOMS), should be accessed to ascertain the prisoner's history of self harm and suicidal behaviour. If available information indicates that a prisoner has previously made an attempt to self harm or suicide or has displayed previous self harming behaviour, whether in custody or not, this information must be communicated to staff involved in the management of that prisoner.

When admitted to custody, a prisoner must be assessed for risk of self harm or suicidal behaviour (refer procedure - Admission). If it is identified (eg through the Immediate Risk/Needs Assessment (IRNA)) that the prisoner has a history of deliberate self harm or suicidal behaviour, the staff member who becomes aware of this information must advise the senior psychologist and request that the self harm episode (history) offender warning indicator is activated in IOMS. The relevant correctional supervisor must also be advised, and is then responsible for ensuring that the information is disseminated as soon as practicable to all relevant staff members, including the senior psychologist.

When raising the SHEH warning flag, the senior psychologist is to ensure that sufficient comments are recorded to describe the self harm history information obtained (eg number, frequency, methods, triggers, known risk or protective factors).

Refer IOMS - File Contents > Offender Details > Warnings and Flags - select 'Self Harm Episode History'

3.2 Self harm/Suicide Risk Assessment

A self harm/suicide risk assessment must be undertaken-

1. if officers are alerted to behaviours that may indicate that a prisoner is at risk of self harm or suicide (refer appendix - Indicators of At Risk Behaviour);
2. if officers are aware of particular events in a prisoner's life that may elicit self harm or suicide (refer appendix - Periods of Critical Risk);
3. following transfer of a prisoner (refer procedure - Transfer of Prisoners);
4. if a prisoner applies for protection status (refer procedure - Protection);
5. if a prisoner demonstrates self harming/suicidal behaviour;
6. if a prisoner expresses an intent to self harm or commit suicide (refer procedure - Hunger Strikes); or
7. if other events arise for a prisoner that may be potentially distressing (eg outcome from a court/board proceeding, pending discharge from custody to the community) (refer appendix - Periods of Critical Risk).

Staff must ensure that appropriate notifications and referrals for assessment are conducted and the referring officer must record the event as a case note. Refer IOMS - Current Self harm episode > Actions > New Self harm document > Case note. If a Notification of Concern is not required, the assessing psychologist (or registered nurse in private prisons) must record the details of the assessment as a case note.

4. Immediate response to identification (not including Helana Jones Centre and Princess Alexandra Hospital Secure Unit (PAHSU))

If, after an outcome from a court / board proceeding that may be potentially distressing (eg refusal of bail, jury verdict of guilty, sentence of imprisonment, refusal/deferment of a prisoner's application to the Parole Board; suspension/cancellation of an Parole Board order), the prisoner is brought to, remains in, is transferred or is returned to a corrective services facility, the prisoner must be accommodated in a supervised 'observation' facility until a self harm/suicide risk assessment/reassessment is conducted by a registered nurse, doctor, psychologist or counsellor.

If there is reason to believe that a prisoner may be at risk of self harm or suicide, the prisoner must be kept in a corrective services officer's line of sight at all times to minimise the risk of self harm and suicide until an assessment/reassessment is conducted by a psychologist (or registered nurse in private prisons) and until any required subsequent action is taken (eg observations commenced).

If an attempted self harm, suicide or apparent death is discovered, refer procedure - First Officer Response - Medical and Assault.

If a prisoner is identified as being at risk of self harm or suicide, a corrective services officer must immediately report these observations to the correctional supervisor and complete administrative form - Notification of Concern.

A notification of concern must be completed and forwarded to the correctional supervisor as soon as practicable using administrative form - Notification of Concern.

Once advised that a prisoner may be at risk of self harm or suicide, the correctional supervisor must immediately ensure the safety of the prisoner and must notify-

1. the relevant accommodation manager (or duty manager after hours); and
2. the senior psychologist/psychologist (or registered nurse in private prisons).

The prisoner must remain in the line of sight of a custodial officer until a risk assessment can be successfully completed and any required subsequent action is taken (eg observations commenced).

If the prisoner identifies as an Aboriginal or Torres Strait Islander, the correctional supervisor must also notify the relevant Aboriginal and Torres Strait Islander staff members (eg cultural liaison officer, counsellor, support worker and/or any other relevant corrective services officer).

The correctional supervisor may, if appropriate and in line with Queensland Government Information Privacy Principles notify family members and/or Aboriginal and Torres Strait Islander elders to arrange contact with the prisoner (eg via a visit, telephone call or video link-up). Queensland Government Information Privacy Principles are available at: http://www.rti.qld.gov.au/information-privacy-act/privacy-principles

In low security facilities where adequate assessment and ongoing observation are not possible, the general manager or nominee should arrange for the transfer of the prisoner to an appropriate high security facility where appropriate levels of support and intervention may be received (refer section 5).

For at-risk prisoners accommodated in the Maximum Security Unit, refer standard operating procedure - Maximum Security Units (in-confidence).

If possible, the assessing psychologist (or registered nurse in private prisons) should consult with the senior psychologist in order to determine the appropriate observation level for the prisoner. The immediate management of an at-risk prisoner must ensure his/her physical safety from self harm or suicide.

In addition to observation, this may include-

1. other support actions such as visits (eg from an elder for Aboriginal and Torres Strait Islander prisoners), phone calls to/from family members (if deemed appropriate by the senior psychologist or Risk Assessment Team);
2. removal of property from a cell that may pose a risk to self harming activity;
3. accommodation in the Health Centre at night;
4. separate accommodation area for day/night placement;
5. increasing the level of observations; and
6. if it is considered necessary and only if required-
   
   
   1. search the prisoner (which may require the removal of clothing);
   2. placement in cell accommodation appropriate to the level of assessed risk; and
   3. use of suicide resistant gown and bedding;
   4. use of paper underwear for female prisoners; and
   
   
7. placing the prisoner on a Safety Order.

The senior psychologist should give consideration to contacting the prisoner's next of kin/family members to seek information regarding issues of concern. If deemed appropriate, this should only be done with the informed consent of the prisoner.

The Buddy System must not be used as a suicide prevention strategy.

All staff involved in the management of a prisoner who may be at risk must be advised of the risk level of the prisoner and of any specific management requirements.

Medical and psychological assistance must be provided to the prisoner as soon as practicable. If necessary, a transfer without notice should be arranged to a high security facility where these services can be provided (refer section 5).

4.1 Initial assessment and initial response plan

Following the completion of a Notification of Concern, an initial assessment of risk must be conducted by a psychologist (or a registered nurse in private prisons) as soon as practicable.

If a prisoner will not co-operate with an at-risk assessment, it should be assumed that they are at-risk until this can be determined otherwise. The prisoner should remain in the line of sight of a custodial officer until a risk assessment can be completed and any required subsequent action is taken (eg observations commenced).

After the initial assessment has been completed, the correctional supervisor and the psychologist (or registered nurse in private prisons) must develop an initial response plan (refer administrative form - Initial Response Plan). The observation level must be set by the assessing psychologist (or registered nurse in private prisons), in consultation with the senior psychologist where possible. The consultation outcomes and attendees names (eg assessment officer and senior psychologist) must be recorded as a case note in IOMS. Refer IOMS - File Contents>Offender Management>Case File>Case Note.

The correctional supervisor must record details of the prisoner's placement and frequency of observations using administrative form - Instruction - At-Risk Prisoner.

If it is determined that the prisoner must be separated, the prisoner must be placed on a Safety Order (refer standard operating procedure - Safety Orders).

Hard copies of the administrative forms - Notification of Concern, Initial Assessment (in-confidence) , and Initial Response Plan and Instruction - At-Risk Prisoner must be forwarded to the-

1. correctional supervisor;
2. Queensland Health Nurse Unit Manager/registered nurse;
3. senior psychologist/psychologist;
4. relevant manager;
5. observing officer; and
6. general manager or nominee of the facility.

For prisoners assessed during the Initial Assessment as not being at risk, the assessing officer must ensure that the most conservative approach to the ongoing management of the prisoner has been adopted in consultation with the notifying officer and relevant correctional supervisor. The assessing officer must consult the senior psychologist before determining that an Initial Response Plan is not required. The case conferencing outcomes and attendees must be recorded as a case note in IOMS. Refer IOMS - File Contents>Offender Management>Case File>Case Note.

If an Initial Response Plan is generated, the relevant information from the Notification of Concern, Initial Assessment and Initial Response Plan must be entered into IOMS (NoC-IA-IRP) as soon as practicable by the assessing officer. The hard copy documents must be placed on the offender management file and noted in IOMS as physical document references. Refer IOMS - File Contents>Offender Management>Self Harm>Actions>New Self Harm Document>NoC-IA-IRP.

If an Initial Response Plan is not generated, the relevant information from the Notification of Concern and Initial Assessment must be entered in IOMS (Case Note) as soon as practicable by the assessing officer. The hard copy documents must be placed on the offender management file and noted in IOMS as a physical document reference. Refer IOMS - File Contents>Offender Details>Attachments>Attach other>physical document reference.

4.2 Initial assessment and initial response plan - after business hours

Where an Initial Assessment following a Notification of Concern cannot be conducted as there are no psychologists available after business hours, the prisoner is to be placed on a conservative level of observations and an Initial Response Plan and Instruction - At-Risk Prisoner form are to be completed by the correctional supervisor.

The correctional supervisor is to brief the duty manager and gain approval for the Initial Response Plan. This approval is to be written onto the Initial Response Plan and entered as an IOMS case note, under the At-Risk (Suicide/Self-harm) Management category. The prisoner is to remain in a corrective officer's line of sight at all times until the Initial Response Plan has been approved.

A psychologist is to conduct an Initial Assessment as soon as practicable on the next business day, at which time the assessing psychologist, in consultation with the senior psychologist will determine whether continuing observations are required.

If it is determined that ongoing observations are required, the psychologist is responsible for entering the Notification of Concern, Initial Assessment (in-confidence) and a new Initial Response Plan, completed in conjunction with the correctional supervisor, onto IOMS. The original Initial Response Plan (created by the correctional supervisor and approved by the duty manager) must be attached to IOMS. The hard copy documents must be placed on the offender management file and noted in IOMS as physical document references.

The correctional supervisor must also complete a new Instruction - At-Risk Prisoner form and initiate a new Observation Log - At-Risk Prisoner. The previous Instruction - At-Risk Prisoner form is to be terminated and ratified by the general manager or nominee.

If it is determined that continuing observations are not required, then the psychologist must enter the relevant information from the Notification of Concern and the Initial Assessment into an IOMS case note under the At-Risk (Suicide/Self-harm) Management category. The Instruction - At-Risk Prisoner form is to be terminated and ratified by the general manager or nominee. The hard copy documents must be placed on the offender management file and noted in IOMS as physical document references.

4.3 Low security (including Helana Jones Centre)

If a prisoner may be at-risk of self harm or suicide, the officer must-

1. undertake an appropriate interim action (eg talk with the prisoner, show concern, ask questions, identify precipitators);
2. advise staff in the immediate area of the officer's concerns;
3. arrange for placement of the prisoner in an area where he/she can be closely monitored until any required subsequent action is taken (eg observations commenced);
4. ensure that the general manager or nominee is notified as soon as practicable;
5. if services are available, notify the Queensland Health Nurse Unit Manager/registered nurse;
6. notify the senior psychologist/psychologists; and
7. complete the administrative form - Notification of Concern as soon as possible and forward to the general manager or nominee.

The relevant manager must, at a minimum-

1. coordinate the internal and external responses to manage the security and integrity of the entire facility;
2. arrange further assessment;
3. if appropriately qualified, personally determine at-risk level; or
4. where assessment and ongoing observation are not possible, arrange for the transfer of the prisoner to an appropriate high security facility where appropriate levels of support and intervention can be received (refer section 5).

If an attempted self harm, suicide or apparent death is discovered, refer procedure - First Officer Response - Medical and Assault.

4.4 Contingency Checklists

The Contingency Checklists must be completed by the relevant person.

Refer administrative forms - At Risk First Officer Response Low Security; At Risk Supervisor Response Low Security; At Risk Manager Response Low Security

5. Transfer and escort to high security facility

Refer procedures - Transfer of Prisoners; Escort of Prisoners (in-confidence)

If an at-risk prisoner is to be transferred between corrective services facilities, the officer responsible for authorising the transfer must ensure that-

1. a sending facility staff member advises an appropriate receiving facility staff member (eg correctional supervisor, senior psychologist, sentence management co-ordinator) and transporting officer, verbally at minimum, of the prisoner's risk level as assessed prior to departure from the sending facility. The sending facility must provide this advice prior to the prisoner's departure from that facility. The sending facility staff member must also confirm with the receiving facility staff member that the receiving facility has the capacity to conduct observations of the prisoner to the required level; and
2. the escorting officers are provided with all necessary documentation including a copy of the At Risk Management Plan and sufficient copies of administrative form - Observation Log - At-Risk Prisoner to record observations throughout the escort

Upon arrival at the receiving facility, the transporting officers must provide the receiving facility with -

1. administrative form - Transfer Summary and Form 9 - Order for Transfer of a Prisoner;
2. all necessary documentation including a copy of the At Risk Management Plan and completed copies of administrative form - Observation Log - At-Risk Prisoner that record observations throughout the escort; and
3. a verbal report of the prisoner's presentation during the transfer, with a particular focus on any issues that may be pertinent to the prisoner's at-risk status.

Receiving facility staff members who are given any information about the prisoner's at-risk status (including the verbal report from the transporting officer) must ensure that the correctional supervisor is advised of this information as soon as practicable, and for making a case note of the information they received from the transporting officer. The correctional supervisor must then take the required steps to ensure that appropriate at-risk management strategies are identified and utilised for that prisoner.

6. Self harm/suicide risk assessment - custody (except PAHSU)

A Risk Assessment Team (RAT) meeting must be convened as soon as practicable following initial assessment and invocation of an initial response plan. The purpose of the meeting is to develop and document a comprehensive At Risk Management Plan (ARMP) based on a range of professional assessments to ensure the safe management of each at-risk prisoner including the level of observations attributed to each case.

At a minimum, the RAT must consist of a representative from each of the following areas-

1. custodial supervision;
2. psychological services; and
3. Aboriginal and Torres Strait Islander representative if the at-risk prisoner identifies as an Aboriginal or Torres Strait Islander person.

The RAT must independently conduct a personal assessment of each prisoner as soon as practicable, but on the same day, prior to the meeting, in accordance with his/her professional role and area of employment. The At Risk Assessment reports must be completed using IOMS prior to the RAT Meeting. The signed hard copies of these reports should be placed on the Offender File after the meeting. Refer IOMS - File Contents>Offender Management>Self Harm>Actions>New Self Harm Document>At Risk Assessment>Create At Risk Assessment>Edit.

These reports should include, but are not limited to, the following information-

6.1 Correctional supervisor

1. an assessment of risk;
2. a summary of information obtained from interview with the prisoner;
3. a summary of the prisoner's behaviour and interactions (including with other prisoners) within the unit compiled from the observation records since the last risk assessment meeting;
4. a summary of log notes;
5. a summary of ARUNTA tapes (if possible, practicable and/or relevant);
6. a recommendation on where an prisoner should be placed; and
7. whether a temporary Safety Order/Safety Order is in existence or should be made/ extended.

6.2 Psychologist

1. an assessment of risk;
2. a report on the psychological status of the prisoner;
3. recommendations for ongoing support;
4. recommendations for specialist intervention (if required);
5. any behavioural problems;
6. an assessment of the prisoner's social, relationship, family matters (stressors);
7. any welfare/personal issues such as religious needs, visits and phone calls; and
8. any information that may assist in the effective management of the prisoner.

6.3 Cultural Liaison Officer

1. an assessment of risk;
2. an overview of any welfare needs or cultural issues being experienced by the prisoner; and
3. a summary of cultural supports and links to community;

6.4 Risk Assessment Team meeting

The RAT meeting must-

1. be chaired by the senior psychologist or relevant manager where the senior psychologist is not available;
2. the chair of the RAT meeting should not have completed an assessment of a prisoner under review at the meeting to ensure that objectivity is maintained;
3. ensure minutes are recorded (refer administrative form - Minutes of Risk Assessment Team Meeting)
4. be held at least once per week for each at risk prisoner;
5. consider all reports (including any current/recent ARMP, special treatment order or separate confinement order) and suitable containment and intervention options for each at risk prisoner (refer appendix - Special Containment And Intervention Options - High Security);
6. develop and document an ARMP for each at risk prisoner. If members propose different plans, the team should adopt the most conservative approach to observations and cessation of the ARMP (eg if most of the team suggests 60 minute observations, but one member wants 30 min observations, 30 min observations should be conducted) (refer administrative form - At Risk Management Plan);
7. consider whether a Safety Order is made with conditions which are the same as an ARMP (refer standard operating procedure - Safety Orders);
8. complete administrative form - Instruction - At-Risk Prisoner; and
9. present to the general manager or nominee for ratification and signature for each prisoner-
   
   
   1. an ARMP;
   2. administrative form - Instruction - At-Risk Prisoner; and
   3. administrative form - Minutes of Risk Assessment Team Meeting.
   
   

Hard copies of the administrative forms - Minutes of Risk Assessment Team Meeting and At Risk Management Plan must be completed by the meeting chair and placed on the Offender File. As soon as possible after the meeting, a designated person must note these documents as physical document references in the IOMS At Risk Management Plan and enter the required information in the system. Refer IOMS - File Contents>Offender Management>Self Harm>Actions>New Self Harm Document>At Risk Management Plan.

7. Management of at-risk prisoners -custody

Following authorisation by the general manager or nominee, an at-risk prisoner must be managed in accordance with the ARMP ensuring that the prisoner has a high level of support and intervention.

All original forms completed for an at-risk prisoner must be placed on the offender file with copies on the medical file and in IOMS.

7.1 Princess Alexandra Hospital Secure Unit (PAHSU)

Management of prisoners admitted as inpatients to the PAHSU will become the responsibility of the PAHSU Medical Director.

The PAHSU Medical Director, Nursing Coordinator, correctional supervisor or custodial representative in consultation will determine the appropriate management of at-risk prisoners whilst admitted as inpatients.

8. Observations - custody

8.1 PAHSU

The PAHSU Medical Director will determine observation requirements for prisoners admitted to the PAHSU.

Custodial officers situated in the outpatients ward are responsible for conducting observations of at-risk PAHSU day patients.

8.2 Other than the PAHSU

The general manager or nominee may authorise cessation or reduction of observation levels.

If it is determined that the most appropriate method of conducting observations of an at-risk prisoner results in the prisoner's separate confinement in a detention unit, safety unit or health centre, a Safety Order must be approved by the general manager or nominee prior to the prisoner's separate confinement. The prisoner must be kept in a corrective services officer's line of sight at all times until observations commence in the detention unit, safety unit or health centre. Conditions imposed under section 53(3) must be clearly defined and documented on the order prior to the prisoner commencing separate confinement (refer CSA, s 53, Form 5 - Safety Order, procedure - Detention Units, standard operating procedure - Safety Orders).

Observations may occur, such as-

1. Physical Observation - to physically observe the prisoner move or respond (ie move around freely or at least to note and observe them breathing normally); and
2. Visual Observation - to monitor the prisoner using CCTV.

Visual observations can be used as a supplement to, but never a substitute for, scheduled physical observations. Visual observations must not be used to replace physical observations at any time. For example, if a prisoner requires 15 minute observations, they should not be placed on 30 minute observations with the intention of observing them visually half way through this period. They must be physically observed every 15 minutes and may be visually observed between physical observations.

The correctional supervisor must brief the corrective services officer responsible for observation of the prisoner and provide administrative form - Observation Log - At-Risk Prisoner for recording observations.

Each observing officer must-

1. sign the administrative form - Instruction - At-Risk Prisoner to acknowledge that they have received, reviewed and understood the contents of the form; and
2. brief any other officer performing relieving duties of the observation requirements.

The correctional supervisor or nominated corrective services officer must record each observation log in IOMS as a physical document reference of the creation of that log. Refer IOMS - File Contents>Offender Management>Self Harm>Actions>New Attachment> Attach>Observation log.

The frequency of observations must take into account the nature of the situation and the level of risk refer appendix - Risk Level/Observation Guidelines. The correctional supervisor must ensure the required observations occur in a manner that ensures the continued well-being of the prisoner.

Observations must be expressed in terms of frequency relative to the level of risk. A prisoner considered an extreme risk of suicide or self harm should be monitored under continuous observations. 15 minute or 30 minute observations is considered as being managed as a high risk of self harm or suicide. A prisoner on 60 minute observations is considered as being managed as a medium risk of self harm or suicide and a prisoner on 120 minute observations is considered as being managed as a low risk.

If a prisoner's identified level of risk is reduced, the level of observations must also be reduced.

For example, if an prisoner's identified level of risk is reduced from high risk to medium risk, the level of observations will be reduced from 30 minutes to 60 minutes.

If continuous observations are ordered, a corrective services officer must be assigned for the specific purpose of continuous observation. During continuous observation of a prisoner, the officer responsible must indicate that observations are continuous and record observations at ten minute intervals according to the relevant frequency using administrative form - Observation Log - At-Risk Prisoner. This information must also be recorded in IOMS.

The correctional supervisor must review and sign administrative form - Observation Log - At-Risk Prisoner to ensure compliance with the administrative form - Instruction - At-Risk Prisoner at least once per shift, unless greater frequency is determined.

The frequency of review of observations is determined on an as needs basis in consultation with the RAT however the minimum requirement for a review of observations is once per week per prisoner.

If an observing officer has concerns about an prisoner's escalating risk of self harm or suicide, these concerns must be documented on the observation log and the correctional supervisor must be notified immediately. Consideration should be given to increasing observation levels and other appropriate action/s.

If any staff member has concerns about an at-risk prisoner's escalating risk of self harm or suicide, a new administrative form - Notification of Concern must be initiated and all relevant steps from sections 4 - 11 must be followed (ie as though a new at-risk episode has been initiated).

9. Review of the at-risk management plan - high security

The reports of all RAT team members must be provided and considered during the RAT meeting. The most conservative approach to the management of an at-risk prisoner must be taken.

For example, if two members of the RAT consider a prisoner to be at medium risk and two members of the RAT consider a prisoner to be at low risk, the prisoner would be considered as being at medium risk of self harm or suicide.

Where a prisoner is under extreme, high, or medium levels of observation, he/she must be progressed down through each observation level prior to removal from the ARMP, at which time all members of the RAT must agree that the prisoner is no longer at an elevated risk of self harm or suicide.

10. Discharge of prisoners currently or previously at-risk

If a prisoner in custody who is subject to a current At-Risk Management Plan is to be discharged to the community (eg release to liberty, release to parole), the prisoner's at-risk status must be considered for transitional and pre-release planning. This should also occur for prisoners who have previously been assessed to be at-risk or have a history of self-harm or suicide attempts.

For prisoners in custody who are subject to a current At-Risk Management Plan and are to be discharged from custody and subject to community supervision, contact should be made with the relevant Probation and Parole office to advise them of the prisoners risk status. Staff must ensure that appropriate notifications are conducted and the referring officer must record the event as a case note. Refer IOMS - Current Self harm episode > Actions > New Self harm document > Case note.

11. Termination of the At-Risk Management Plan - custody

Following review of the ARMP, the correctional supervisor must discontinue the ARMP using administrative forms - At Risk Management Plan and Instruction - At-Risk Prisoner and present to the general manager or nominee for ratification and signature. This information must be attached as a physical document reference in IOMS using a New Self Harm Document, At-Risk Management Plan.

If a prisoner is no longer considered at an elevated risk of self harm or suicide and the ARMP is no longer required, the general manager or nominee may determine that the prisoner is still not ready to be managed within the Agency's mainstream correctional environment. In such circumstances, an intensive management plan should be devised (refer standard operating procedure - Intensive Management Plans).

If the prisoner is placed on a Safety Order, an Intensive Management Plan should be developed to assist in the prisoner's reintegration into the mainstream population (refer standard operating procedure - Intensive Management Plans).

12. Prisoners identified as having an elevated baseline risk of self harm or suicide

Those prisoners who have a history of self harm or attempted suicide are considered to be at an elevated baseline risk (EBLR) for self harm and/or suicide. Individuals who are identified as EBLR require specialised management. All prisoners who have a history of self harm or attempted suicide must have a Self Harm Episode History (SHEH) warning flag raised in IOMS.

Appropriate steps must be taken to ensure the ongoing effective management of prisoners identified as being at EBLR. At minimum this includes:

1. accommodation in a suicide resistant cell;
2. ensuring continuity in supervisory oversight of case notes where practicable; and
3. use of an Intensive Management Plan where appropriate.

In addition, centres can also utilise other strategies to assist in the management of this vulnerable population eg Persons of Concern process.

Refer standard operating procedures - Prisoner Management and Intensive Management Plans.

12.1 Use of suicide resistant cells

Prisoners with an elevated baseline risk must be accommodated in a modern suicide resistant cell (ie a cell with reduced hanging points). In extenuating situations where reasonable factors warrant against allocating a prisoner identified as EBLR to a modern cell, the justification for the individual decision must be recorded in a case note on IOMS by a correctional supervisor after consultation with a correctional manager or the duty manager.

12.2 Continuity in supervisory oversight of at-risk prisoner's case-notes

As part of the monthly case note auditing process, prisoners who are identified as being at EBLR are to be allocated a supervisor or manager who will assume the responsibility for regularly reviewing case notes, where practicable. This nominated supervisor or manager will provide ongoing review of those prisoners' case notes on a monthly basis. This requires the nominated supervisor or manager to review the case notes recorded for the prisoner over the preceding month and give consideration to the prisoner's stability and self-regulation. The nominated supervisor or manager must record the results of the case note review in a case note.

Should risk indicators or patterns of risk behaviour be revealed through the case note review process, a Notification of Concern should be initiated and discussed with the senior psychologist. The nominated supervisor or manager is to record their consultation and any action taken in the monthly case note.

For example, a prisoner may have received a distressing telephone call from a family member, have a parole board application rejected, and start isolating themselves from others.

Refer standard operating procedure - Prisoner Management; appendices - Indicators of At-Risk Behaviour; and - Periods of Critical Risk.

12.3 Use of an Intensive Management Plan

Some EBLR prisoners, where appropriate, may benefit from additional management and intervention. These prisoners should be managed as per a developed IMP. If used for a prisoner identified as being at EBLR, the IMP must provide for both the monitoring of dynamic risk and for interventions during periods of critical risk.

Further, in situations where a Notification of Concern has been raised for a prisoner identified as being at EBLR (and that prisoner is not placed under at-risk observations) the senior psychologist must consider referring the prisoner to the IMP panel to determine if an IMP is appropriate.

Please note: Prisoners can not be under an IMP and an ARMP at the same time. The ARMP takes precedence. Refer standard operating procedure - Intensive Management Plans.

13. Progression of a prisoner with an elevated baseline risk through the custodial system

Being identified as EBLR must not impact upon a prisoner's ability to progress through the custodial system. A prisoner with an EBLR can progress to alternative accommodation (e.g. residential, farm or work camp) provided they are deemed suitable via the classification, placement and transfer review process. Refer procedures - Transfer of Prisoners and Assessment.

13.1 Low security accommodation

Prisoners who have been identified as being at EBLR are able to be housed in low security accommodation. Such prisoners must be managed under ELBR conditions; however, as they have been deemed suitable for transfer via the transfer review process, they are not required to be housed in suicide resistant cells. Refer procedures - Transfer of Prisoners and -Assessment.

13.2 Work Camp accommodation

Prisoners deemed as suitable for work camp accommodation are not required to be managed in accordance with the EBLR procedure whilst residing at a work camp.

PART B. At-Risk management - Community supervision

14. Admission - community

The admission process provides an important opportunity to capture information about an offender's risk of self harm or suicide.

When admitted to community supervision, an offender must be assessed for risk of self harm or suicidal behaviour. As part of this process, supervising officers must conduct an Immediate Risk Assessment (IRA) for all new offenders at the first contact between the offender and the probation and parole officer upon release from custody, following the receipt of a community based or parole order or following a level of service change from compliance to any other level of service. The IRA enables the officer to identify any immediate risks including the risk of self harm or suicide.

Refer operational practice guidelines - Admission and Induction; appendix - Immediate Risk Assessment - Completion Considerations.

15. Identification of at-risk offenders - community

A probation and parole officer may become aware of an offender's current risk or history of self harm episodes or suicide attempts by-

1. the offender disclosing their risk or history to a probation and parole officer as part of the initial assessment (i.e. IRA);
2. the offender disclosing their risk or history at any other time during supervision;
3. collateral information received from a credible source is confirmed by the offender; or
4. the offender's IOMS file has the Self Harm Episode History (SHEH) flag activated.

If it is identified through the IRA or other means that the offender is at immediate risk of suicide or self harm, the supervising officer must immediately intervene to ensure the safety of the offender. Additionally, where a risk of harm to self is identified, a case conference must take place, with the district manager notified of the outcomes.

The safety of the staff member is the primary concern at all times throughout the process.

16. Activation of the Self Harm Episode History (SHEH) flag - community

A history of self harm or suicide is considered to be the strongest predictor of future suicidal behaviours. The risk of suicide following a suicide attempt remains no matter how long it has been since the initial self-harm episode/suicide attempt.

If it is identified (through the IRA or other means) that the offender has a history of self harm or suicide attempts, the responding officer must notify a supervisor or district manager before raising the SHEH warning flag in IOMS.

The SHEH flag gives all officers involved in the management of an offender with this elevated risk an immediate indication that the offender has this particular vulnerability.

The officer who raises the SHEH flag is to ensure that sufficient comments are recorded to describe the self harm history information obtained (eg number, frequency, methods, triggers, known risk or protective factors).

Refer IOMS - File Contents > Offender Details > Warnings and Flags > self 'Self Harm Episode History'.

Following activation of the SHEH flag, the supervisor or district manager is then responsible for ensuring that the information is disseminated as soon as practicable to all staff members who may be involved in the offender's management.

SHEH flags are never de-activated on IOMS, even when an offender completes an order.

17. Managing offenders at immediate risk - community

17.1 Initial response - community

The supervising officer must determine the immediacy of the risk of self harm/suicide by asking the offender directly if they're thinking of suicide or self harm. The supervising officer must also assess the level of risk and determine -

1. presence of a plan;
2. access to means;
3. level of intent;
4. a history of previous attempts; and
5. protective factors / people.

In the event that an offender is considered at immediate risk of self harm or suicide (refer appendix - Risk Level/Observation Guidelines) the staff member who discovers the at-risk situation must immediately notify a supervisor or the district manager.

The district manager must take control of the situation until its resolution or by the arrival of emergency services personnel.

In the absence of the district manager, the most senior staff member present, as listed on the administrative form -At Risk Management Incident Control - Staff Seniority List must take control of the situation as per administrative form -At Risk District Manager Response. This person becomes the incident controller.

Where appropriate, the district manager or incident controller should manage the at-risk situation in accordance with the contingency plan (refer operational practice guideline -Safety and Security; appendices -At Risk District Manager Response; -At Risk First Officer Response - Probation and Parole). The contingency plan must be published and located in an easily accessible area within the district office. All new staff employed within the office must be made aware of the contingency plan upon commencing employment.

Refer operational practice guideline -Safety and Security; appendices - At Risk District Manager Response; At Risk First Officer Response - Probation and Parole; Factors for Consideration - Suicide Contingency Planning and Risk Level/Observation Guidelines

The district manager (or incident controller) must nominate an individual to create and maintain an incident log, where circumstances permit. At a minimum, the incident log should record the time at which particular events and actions occur. Refer administrative form -Major Incident Log - At-Risk Management - Probation and Parole.

All staff and visitors to the office must follow the instructions given by the incident controller during the emergency.

The incident controller may refer the crisis-counselling role to another staff member considered most appropriate in the circumstances (e.g. the individual's supervising officer). However, responding officers should consider the possibility of an offender being reluctant to restate their self harm or suicide concerns multiple times to different officers.

17.2 Immediate intervention strategies - community

The incident controller should implement immediate interventions to ensure the safety of the offender. Interventions should match the severity and immediacy of the offender's risk.

The incident controller or another officer must stay with the offender until additional support arrives. The safety of the officers, and all staff, is the primary concern at all times.

In intervening, officers should also consider the following actions-

1. contact the next of kin/family member/community support person/elders for Aboriginal and Torres Strait Islander offenders/Adult Guardian where appropriate (if the offender provides consent);
2. contact the offender's current service provider/s (e.g. psychologist, GP, counsellor) to seek collateral information;
3. arrange for a referral to an acute mental health unit; and
4. call emergency services (e.g. ambulance, police).

Staff must ensure that appropriate notifications and referrals for assessment are conducted and the referring officer must record the event and any actions taken as a contact summary. Refer IOMS - File Contents > Community Contacts > Summary.

The relevant manager must ensure that the assessment of offenders identified as potentially at-risk, and any subsequent actions required are prioritised and that the assessing staff member has access to consultation or advice from a senior staff member or colleague during the process.

In reporting centres, it may be necessary to make telephone contact with the district office to consult with a senior member of staff.

In all instances, contact should be made with the relevant district manager and decisions regarding the management of the offender must occur in consultation with the relevant district manager or supervisor.

In the event that the offender leaves the office prior to management arrangements being finalised, staff should attempt to locate the offender. If there is serious concern that the offender will engage in imminent self harm or attempt suicide, the police should immediately be notified and provided details of the situation, a description of the offender, and possible location/s of the offender.

The safety of all staff members assessing or intervening with at-risk offender is the primary concern at all times. The level of observation/supervision needs to be considered while the offender is being assessed and while additional referral arrangements are being made.

18. Managing offenders not at immediate risk - community

If an offender is considered to be at-risk of self harm or suicide, but the risk is not deemed to be imminent, the supervising officer should-

1. notify the district manager/regional manager or a supervisor of the situation as soon as practicable;
2. undertake appropriate interim actions (eg talk with the offender, determine precipitators);
3. establish if the offender is accessing external support agencies, and if so, contact and refer as appropriate;
4. contact the next of kin/family member/community support person/elders for Aboriginal and Torres Strait Islander offenders/Adult Guardian (if deemed appropriate and offender's consent is obtained) to advise of the situation;
5. organise for the offender to be to be collected from the office by an identified support person, if appropriate;
6. organise referral to community support agency/counselling/mental health service if available and/or link in with telephone counselling service prior to the offender leaving the office;
7. in the event that counselling/mental health service is not available, organise referral to a General Practitioner, who may then refer the offender to a psychiatrist/psychologist; and
8. organise an appointment with the offender for the next business day, and in consultation with supervisor or district manager increase the offender's level of contact/supervision for the period he/she is considered to be at-risk.

Staff must ensure that appropriate notifications and referrals for assessment are conducted and the referring officer must record the event and any actions taken as a contact summary. Refer IOMS - File Contents > Community Contacts > Summary.

19. Identification and management of offenders with a history of self harm or suicide in community settings

A previous history of suicide attempts or self harm is a major predictor of future suicidal behaviours. As such, offenders with a history of suicide attempts or self harm episodes may be at greater risk of suicide or self harm. The Self Harm Episode History (SHEH) flag is used to identify offenders with this history.

Refer Section 16 - Activation of the Self Harm Episode History (SHEH) flag - community.

Probation and parole officers must be vigilant in identifying potential warning signs in physical contacts with offenders with a SHEH flag. This involves enquiring about the mental health and wellbeing of offenders at each face to face contact, and assessing risk of self harm or suicide when offenders present with relevant indicators (refer appendix -Indicators of At Risk Behaviour).

Probation and parole officers should also refer offenders with a SHEH flag to case conferencing and external service providers as appropriate.

19.1 Managing risk - levels of service

Offenders with a history of self harm or suicide attempts should have their mental health needs and risks monitored as part of their regular face-to-face contacts with probation and parole officers.

Offenders allocated to Standard, Enhanced, Intensive and Extreme levels of service will receive as a minimum the Benchmark assessment and the Dynamic Supervision Instrument (DSI). The DSI will identify and track key areas at each supervision visit, including mental health. Officers should consider the offender's risk in relation to self harm or suicide through this mechanism. The level of frequency of face-to-face contacts will vary for offenders allocated to Standard or higher levels of service.

Offenders allocated to the Low Risk level of service receive the IRA, but no other assessment or planning. Low Risk level offenders may be allocated to physical contacts every three months. Any offender allocated to the Low Risk level of service who has a SHEH flag will have their risk of self harm or suicide assessed at physical contacts if they present with relevant indicators.

If an offender allocated to the Low Risk level of service reports a current risk of self harm or suicidal behaviours during the IRA, the supervising officers may give consideration to elevating the level of service. Refer appendix -Level of Service Change - Completion Considerations.

Offenders serving reparation orders (ie those allocated to the Compliance level of service) have limited contact with probation and parole officers. These offenders will not receive the IRA so the risk of self harm or suicidal behaviour will not be identified. As such, any offender allocated to the Compliance level of service who has a SHEH flag is not required to be managed differently or have their level of service elevated.

An offender with a history of self harm episodes or suicide attempts who is currently experiencing acute suicide risk must have their immediate acute needs met as a priority.

Refer Section 17.1 - Initial response - Community; appendix -Factors for Consideration - Suicide Contingency Planning.

20. Transfer of at-risk offenders - community

In considering the transfer of an at-risk offender, the supervising officer must assess the suitability of the new location in terms of accessibility to relevant service providers and other support.

If an offender identified as being at-risk of suicide or self harm is transferred to a different probation and parole district office, the supervising officer at the sending office must ensure that a relevant staff member at the receiving office is advised both verbally and in writing of this risk. The supervising officer at the sending office should also include information on the offender's suicide or self harm history in the transfer summary contact summary in IOMS.

If an at-risk offender transfers interstate, the supervising officer at the sending officer must give written advice to the receiving office of the offender's self harm and suicide attempt history, the current level of risk, and current management strategies.

Refer operational practice guideline -Travel and Transfer

If an offender has been identified as being at-risk of suicide or self harm and is returned to a corrective services facility, the supervising officer must ensure that the general manager or nominee of the facility to which the offender is first taken, including a watch house, is advised in writing that the offender is at-risk.

Refer operational practice guideline -Contravention Management

21. Amendment of Parole Order due to risk of self harm or suicide

A Parole Order may be amended if an offender poses a serious and immediate risk of harm to him or herself.

However, under the current legislation, risk of suicide or self harm is NOT an acceptable reason to suspend a Parole Order.

Refer Corrective Services Act 2006 ss201, 205; operational practice guideline -Contravention Management.

22. Completion of community-based supervision order

When an offender who is identified as at-risk, or has an elevated baseline risk completes their order, the supervising officer should provide the offender with a list of emergency contacts at the final contact.

If the suicide of an offender occurs during the period of supervision, confirmation is required in order to ensure the offender is registered as deceased. The supervising officer must complete an incident report on IOMS, including all available information relating to the offender's death.

Refer operational practice guideline -Review and Exit.

23. Debriefing following incidents

If there is an incident of self harm or attempted suicide, the regional manager or district manager should refer all staff involved in the incident to the agency's employee assistance service.

Refer intranet -

http://intranet/content/Staff/HR_Services/employee_assistance_services.shtml .

In addition, the regional manager or district manager should consider holding a debriefing session with relevant staff who were involved in the incident.

Endorsed by:

MARK RALLINGS

Executive Director, Specialist Operations

Approved by

MARLENE MORISON
Commissioner

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