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Tackling suicide and self-harm in prison

MoJ research investigates ACCT procedures to try to prevent suicide and self-harm in prison.

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Last week (22 March 2019), The MoJ published a summary of research carried out in the summer of 2015 into the Assessment, Care in Custody and Teamwork (ACCT) are planning process designed to reduce the risk of suicide and self-harm. Although only published last week, the findings of the research have already been taken into account by HMPPS which will be piloting a new version of the ACCT form and a new guidance manual later this year.

What is ACCT?

Many who work in prisons will be familiar with ACCT, but here is the official process:

  • Any prisoner identified as being at risk of suicide or self-harm must be managed through the ACCT process. ACCT was first developed in 2005. The ACCT process requires that certain actions are taken within different time frames, to ensure that the risk of suicide and self-harm is reduced. Some of the actions that are required include:
  • Any staff member who receives information, including from family members or external agencies, or observes behaviour, which may indicate a risk of suicide/self-harm, must consider opening an ACCT by completing a ‘Concern and Keep Safe’ form.
  • Within one hour of an ACCT being opened, staff must talk to the prisoner and complete an Immediate Action Plan (IAP) to ensure the prisoner is safe from harm.
  • The trained ACCT Assessor must interview the at-risk prisoner within 24 hours of the ‘Concern and Keep Safe’ form being completed. Every effort must be made to engage with the prisoner. The outcome of this interview should be recorded in the ACCT Plan.
  • A first case multidisciplinary case review meeting must be held within 24 hours ofthe ACCT being opened, ideally immediately after the assessment interview has been carried out.
  • The frequency of conversations, observations and support day and night (night requirements may be different) must be agreed and recorded in the ACCT documents.
  • Staff managing the ACCT must complete the CAREMAP giving detailed and time-bound actions aimed at reducing the risk posed by the prisoner.
  • Multidisciplinary case review meetings, to monitor progress with the CAREMAP actions and review the level of conversations and observations, must continue at a frequency that reflects the risks being managed.

An ACCT is closed by the multidisciplinary case management team when the individual prisoner is no longer considered to be at risk. The ACCT is then held in a post-closure state for 7 days, during which time it can be re-opened if additional concerns arise. A post-closure interview with the prisoner is then conducted.

© Andy Aitchison

Key findings

The key findings of the report are set out below:

  • Staff were aware of the different stages of the ACCTprocess, and of what was required of them and other members of staff at each stage; they knew the different reasons why an ACCT could be opened, and had a detailed knowledge of the processes and what actions needed to take place at each stage.
  • However, staff highlighted a number of challenges in ensuring the ACCT process was completed as instructed, including difficulties in ensuring case review meetings were multidisciplinary, and in finding the time to properly engage with prisoners as well as to promptly record detailed observation entries, alongside their other duties.
  • Staff reported variation in the amount and quality of ACCT training they had received. Suggested additional training included refresher training, training focussed on mental health and training on handling prisoners misusing or dependent on ACCT.
  • Most staff were very concerned about what would happen if an ACCT was not opened, or was closed too early, in particular if there was a death in custody; there was a perceived lack of opportunity to use discretion in the ACCT process, and a fear of being heavily criticised for their decisions reported by some staff.
  • Prisoners said they felt supported when on an ACCT, but a few felt that the purpose of ACCT and what being on an ACCT involved had not been sufficiently explained to them.
  • Prisoners highlighted some difficulties they experienced with ACCT, including reports by some prisoners of disruption to sleep caused by observations during the night, and a lack of clarity about why they were being observed. A key concern for many prisoners was that they felt there was a lack of confidentiality about them being on an ACCT.
  • Staff and prisoners made a number of suggestions about how ACCT could be improved, including: dedicated time and resource for managing ACCT; more frequent training and training on additional areas; guidance on how to adapt the ACCT process to meet individual prisoner’s needs; and improvements to the physical ACCT document. Staff also gave examples of local practices, including: producing a pocket guide for staff detailing key risks and triggers for suicide and self-harm; and providing all new prisoners on an ACCT with a leaflet to explain the process.


 We must hope that this review and the new guidance help the prison service get to grips with the ever-growing number of incidents of self harm. The most recent figures (for the year up to September 2018) recorded 52,814 incidents of self-harm, a massive rise of 23% on the previous year and the highest figure ever recorded.

Thanks to Andy Aitchison for kind permission to use the images in this post. The header image is of the anti-suicide netting at HMP Wandsworth designed to prevent prisoners jumping to their death from the upper landing. You can see Andy’s work here.

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