M.05.03 Observing and managing at-risk prisoners

The purpose of observing and managing at-risk prisoners is to ensure that they are managed safely through accurate recording of information, frequent observation, following a management plan, and careful consideration of transfer.

M.05.03.01 Managing a prisoner at risk to themselves

Prisoners who have been assessed at risk must:

be strip searched each time the prisoner enters an at-risk cell, until an at-risk management and care plan is established for the prisoner. Thereafter only in specific situations set out in the at-risk management and care plan, or where reasonable grounds exist.

If a prisoner is entering an at-risk cell and they have already undergone a strip search on arrival to prison or from having a reasonable grounds search, and they have been supervised by an officer since the strip search was conducted, and an officer considers a further strip search is unnecessary then there is no need to strip search them again on entering an at-risk cell.

have the same opportunities for involvement in prison activities as other prisoners, consistent with maintaining their safety and the safety of others
be provided suitable resources for their management, including:
1. appropriate accommodation, i.e. special needs units, dedicated care units, Intervention and Support Unit (ISU) etc. (The items specified in [Part A of Schedule 2 of the Corrections Regulations 2005] and as far as practicable those in [Part C and D of Schedule 2 of the Corrections Regulations 2005] and the at-risk cell must have natural lighting.
2. bedding and clothing designed to assist with suicide prevention that is checked daily for signs of damage and deterioration and replaced if it has been tampered with.
3. Prisoner clothing inclusive of underwear will be determined case by case, in collaboration with health services with decisions recorded in the prisoner’s at-risk management and care plan.
4. authorised property, unless in collaboration with health services there is reason to refuse or restrict certain property. These decisions must be recorded in the prisoner’s at-risk management plan.

For prisons that have an Intervention Support Unit, a daily Multi-Disciplinary Team must be established within 24hours of the assessment being confirmed. The daily Multi-Disciplinary Team will consider each prisoner’s personal circumstances and provide information to inform the at-risk management and care plan (see [M.05.03.Res.03 Daily Intervention and Support Unit (ISU) Multi-Disciplinary Team] for further guidance and information).

Custodial staff will provide an overview of the behaviourand actions of the prisoner over the past 24hours,to provide insight for health staff and mental health staff to support the collaborative approach to daily management of the prisoner.

The physical health care and mental health care components of the at-risk management and care plan will be determined by the relevant health care professionals and any comments that are required to be entered into the plan will be provided by, and agreed to, by the health professionals.

If a prisoner requires mechanical restraints to prevent further self-harm, the officer in charge of the incident must:
1. seek the approval of the general manager custodial before applying any restraint (other than for escorting the prisoner)
2. complete form [IR.02.Form.01 Approval for / report on the use of mechanical restraints] if the circumstances require an immediate reaction and it is impractical to gain the approval of the general manager custodial but must, as soon as possible inform the general manager custodial
3. ensure that a prison nurse examines the prisoner within 3 hours if the type of restraint used is a head protector.
Any prisoner who has been placed in a mechanical restraint to prevent further self-harm must be referred to the At Risk Multi Disciplinary team by the general manager custodial (see [M.05.03.Res.01 Managing at-risk prisoners requiring mechanical restraints] for information on the At Risk Multi Disciplinary team actions and responsibilities).
All actions are designed to ensure that prisoners are only restrained for the least time necessary to safeguard their wellbeing.
Staff managing at-risk prisoners who have been authorised to be placed in mechanical restraints must follow the guidelines detailed in the Custodial Practice Manual.
The general manager custodial or delegate must obtain the advice of the health centre manager or delegate within 24 hours following the initial at-risk assessment. After considering the advice, the general manager custodial or delegate must either reverse the at-risk assessment if they consider that the prisoner is not at risk of self-harm, or confirm the at-risk assessment if the general manager custodial considers that the prisoner is at risk of self-harm. If confirmed, an at-risk management and care plan must be established in consultation with the health centre manager or a health professional with relevant expertise or knowledge.

M.05.03.02 Prisoner at-risk file

The primary file for prisoners who have been assessed as being at risk of self-harm will be held in IOMS and staff must create a separate “at-risk” file that is established and maintained in the unit the prisoner is being accommodated. This file is to be used to hold paper copies of all documentation used to manage the prisoner, until it has been uploaded to the At-Risk folder in IOMS. This will include copies of:
1. the daily observation reports completed during the at-risk period
2. copies of the signed at-risk management and care plan provided to the prisoner
3. any other documentation the prisoner has been requested to sign
4. any relevant secondary reports that would help the management of the prisoner.
The at-risk file should be clearly identifiable to all staff and, when the prisoner is no longer deemed to be at-risk, all the remaining documentation is to be uploaded to theAt-Risk folder in IOMS.
The current penal file of an at-risk prisoner, or former at-risk prisoner, is identified with an “At-Risk” stamp on the front.
The health centre manager must ensure that a registered health professional visits the prisoner at least twice per day (unless they are satisfied that it is not necessary in the circumstances).
All interactions by a registered healthcare practitioner with the patient must be documented and include a consideration of whether the ‘at-risk’ status and the level of restriction to associate remains appropriate. This consideration will be documented in the prisoner’s electronic health record and be included in the daily offender notes required by custodial staff.

M.05.03.03 Observing an at-risk prisoner

Prisoners identified as at-risk who do not have an at-risk management and care plan must be observed:
1. by way of physical sightings (not by camera, unless being escorted in a single cell vehicle with CCTV fitted in the cells – refer [M.04.01.Res.04 Instructions for using single cell escort vehicle])
2. at intervals no longer than 15 minutes until a plan is developed.
Prisoners with an at-risk management and care plan must be observed:
1. by way of physical sightings (not by camera, unless being escorted in a single cell vehicle with CCTV fitted in the cells – refer [M.04.01.Res.04 Instructions for using single cell escort vehicle])
2. at intervals no longer than those specified in the at-risk management and care plan.
Staff must print the [M.05.03.Form.01 Observations] from IOMS and record all observations (behavioural patterns) or if IOMS is down print the POM form [M.05.03.Form.01 Observations]and use this form instead, and:
1. use a new form each day (i.e. beginning of standard work hours)
2. refer recorded behavioural patterns to appropriate support personnel at the daily Multi-Disciplinary Team meeting.
Observation sheets for the 24 hour period of the previous day are to be reviewed and signed by a PCO within each 24 hour period and then uploaded into IOMS.

M.05.03.04 At-risk management and care plan

Prisoners who have been assessed as being at risk must have an at-risk management and care plan ([M.05.03 Form.02 At-risk management and care plan]). The plans must:

reflect their at-risk assessment

be developed in consultation with appropriate support personnel, including input from health services , i.e. health centre manager or delegate and health / mental health staff, cultural advisers, and relevant internal and external parties including whānau.

Part one the at-risk management and care plan must be completed within 24 hours of the prisoner’s assessment and following the general manager custodial or their delegate consulting with and receiving advice from the health centre manager or their delegate, confirming the at-risk status of the prisoner.

The prisoner's at-risk management and care plans must include:

details of any restrictions on or denial of the opportunity of the prisoner to associate with other prisoners per a direction made under [section 61CA of the Corrections Act 2004] by the general manager custodial or delegate.
type of risk and reason for at-risk status
frequency of any observations

prisoner clothing and underwear requirements

Underwear will remain issued to a prisoner assessed as at-risk unless, after consultation with health services staff, it is determined underwear is not to be issued to assist with suicide prevention and maintaining the persons safety.

prisoner’s access to authorised property, including any without property and/or requirements
prisoner’s access to any support systems, programmes, or special requirements, including spiritual, cultural, social, religious, mental health, special or personal needs
details of any restrictions on the opportunity to associate with other prisoners. (If the plan specifies restrictions on the opportunity to associate with other prisoners, the prisoner must be informed, in writing (via a copy of [M.05.03.Form.02 At risk management and care plan]), of the restrictions on association and the reasons for those restrictions.)
all the situations / circumstances where the prisoner must be strip searched. The plan may also include any additional searches necessary for the safe custodial management of the prisoner, i.e. rubdown, scanner searches or a reasonable grounds strip search.

whether drop pin use in conjunction with handcuffs is recommended for staff consideration when facilitating any escort of the prisoner. (If drop pin use is not recommended in the at-risk management and care plan staff are not authorised and must not use drop pins on the prisoner).

Recommendation for drop pin use on the prisoner’s at-risk management and care plan does not warrant automatic use for every escort.

Where use is recommended, staff are to assess whether the prisoner poses a risk of injury or harm to any person, to determine if drop pin use in conjunction with handcuffs is necessary for the escort being undertaken.

Where drop pin use is assesses as necessary, the reasons for this determination are to be recorded in the daily at-risk notes for the prisoner.

times when the prisoner’s at-risk status is to be reviewed
names and roles of key people involved in determining and implementing the prisoner’s at-risk management and care plan.

The at-risk management and care plan of the prisoner ends when the general manager custodial, after consulting with and obtaining advice from the health centre manager, revokes the at-risk status of the prisoner.

M.05.03.05 Reviews and revocation of the confirmed at-risk assessment

The general manager custodial or delegate must regularly consult with the health centre manager to discuss the prisoner’s needs, including whether (based on the required daily health checks) the prisoner’s at-risk status should be reviewed and/or revoked, and whether any direction to restrict or deny association should be reviewed and/or revoked. This will be considered via the daily Multi-Disciplinary Team meeting
Where there is agreement that a complex care review meeting (or similar daily Multi-Disciplinary Team meeting) is required to discuss the needs of a prisoner who has been assessed as being at-risk of self-harm the general manager custodial or delegate will attend to provide information or advice where relevant and appropriate.

Where the health centre manager advises the general manager custodial that a prisoner is no longer at-risk of self-harm and the general manager custodial is satisfied that the prisoner is no longer at risk of self-harm, they must remove the at-risk status. Following this, the general manager custodial must ensure that the prisoner is moved out of an at-risk cell.

Pae Ora currently have an escalation process in place where the health centre manager escalates to the general manager Pao Ora to discuss with the general manager custodial where, after four days, there is not a clear plan in place to move a person out of the Intervention and Support Unit (ISU) who Pae Ora have recommended should be exited.

If a general manager custodial, or deputy general manager / deputy general manager pathways considers that a prisoner assessed as at-risk and with a direction that denies or restricts their association with other prisoners is no longer needed for their safety, then in consultation with the health centre manager, they may revoke that direction so that the prisoner may associate with other prisoners. Following this revocation the prisoner’s at-risk management and care plan must be updated and approved by the general manager custodial, or deputy general manager / deputy general manager pathways.
The RISK OF SELF HARM alert on IOMS is deactivated before the prisoner is moved out of the Intervention and Support Unit (ISU).
Note: The review date for the alert should be the sentence release date for sentenced prisoners or remand end date for remand / accused prisoner. If the prisoner returns to custody, the RISK OF SUICIDE historic alert must be re-activated.
For prisoners who are identified that may struggle reintegrating back into the general prison population after being in the Intervention Support Unit (ISU), they may have a transition plan ([M.05.03.Form.04 Transition plan]), completed by custody and health staff. The need for a transition plan is identified during the MDT process. The transition plan sets goals and objectives for the prisoner to reintegrate back into the general prison population and is completed by custodial staff, with an input from health staff.

M.05.03.06 At-risk prisoner transfers

Careful consideration must be given to the appropriateness of placing an at-risk prisoner on escort to another prison. Where such an escort is necessary and adjudged safe, the at-risk file and all relevant advice and information must be provided to escorting staff.
An at-risk file is transferred with the prisoner when the prisoner transfers between units, or between prisons. All at-risk files relating to the period of imprisonment must arrive at the new location with the prisoner.