The risk of reception prisons
Our latest learning lessons bulletin summarises learning from 170 of our investigations into the self-inflicted deaths of prisoners in reception prisons that occurred over a five-year period.
Reception prisons have one of the highest rates of self-inflicted deaths of all prison functions so we decided to look into this further to identify what might be contributing to this.
In 11% of cases assessed, self-inflicted deaths occurred within the first 48 hours of entering the reception prison, and 30% occurred within in the next three weeks. This suggests that individuals arriving at reception prisons require particularly careful assessment and appropriate and ongoing support to manage risk.
The importance of early days in reception prisons
Reception prisons are an entry point for people into prison. Prisoners arriving at these prisons often present with a combination of vulnerabilities that heighten their risk during the early days of custody.
41% of our sample took their own life within the first month of entering a reception prison. Some of the potential contributory factors to this high number is set out below.
The risk of sentence type
A high number of prisoners in reception prisons will be on remand or awaiting sentencing (64% of our sample), and for some, it may be their first time in prison (28%). Remanded and unsentenced prisoners often experience uncertainty about their future which can place them at an increased risk of deteriorating mental health.
Failure in early days assessments
The high levels of churn in reception prisons is a contributory factor to risk as staff have very limited time to build rapport or conduct in-depth assessments which are vital in those early days.
The Prison Safety Policy Framework requires that all staff be aware of the risk factors and triggers that might increase a prisoner’s risk. 66% of prisoners in our sample were not on an ACCT at the time of their death, and concerningly 21% did not have an ACCT started when the prisoner first entered the reception prison, when it should have been.
The role of reception staff working in a reception prison is therefore particularly important to potentially reduce the number of self-inflicted deaths early on by appropriately reviewing risk information and working collaboratively with healthcare staff to put in place appropriate support measures.
The importance of communication and engagement
It is clear that communication and engagement with this vulnerable group of prisoners is essential.
We found examples of staff basing their decisions primarily on how a prisoner was presenting themselves rather than an objective assessment of their known risk factors.
Our Ombudsman Adrian Usher has also been vocal in the past about the importance of familial contact for prisoners and in 7% of cases, there were issues with the prisoner’s phone account, preventing them from having contact with their support network. These early days are when protective factors such as friends, family and staff relationships are crucial. In numerous cases, we were alarmed by the amount of time it took to set up a prisoner’s PIN phone account.
Challenges beyond early days
Our research has shown that the early days in reception prisons present the highest period of risk. However, we know that a proportion of prisoners remain in reception prisons for several months, sometimes years.
36% of prisoners in our sample took their life beyond three months at a reception prison, suggesting that risk of self-inflicted deaths continues beyond the early days.
The risk of court dates
41% of the deaths assessed occurred near a court hearing. The Prison Safety Policy Framework states that prisoners must be risk assessed regardless of whether their court appearance was in person or by video link. In 32% of cases, this did not happen.
Outcomes for prisoners can change after hearings, so it is vital that their risk is reassessed after this takes place.
Lack of key worker schemes
Key worker schemes are an important part of HMPPS’ response to self-inflicted deaths and are intended to improve safety by engaging prisoners.
Many prisoners in our sample had very few or no key work sessions, with some seeing different members of staff due to staff shortages. We expect an introduction to key work to take place during prisoner’s induction and formal sessions to begin within their first month at the prison. This is especially important for prisoners who are staying in reception prisons longer than usual.
Key work sessions present important opportunities to identify changes to a prisoner’s risk and support their mental health.
The importance of effective ACCT management
In conducting this review, we found weaknesses in how ACCT was managed. In 40% of cases, checks were not carried out as frequently as required and inadequate record keeping led to prisoners not being given the support they needed.
A key part of ACCT is staff undertaking visual checks of the prisoner and failure to keep to these checks can lead to delays in emergency response. In 40% of our cases, we found that prisoners did not have the number of checks that they should have had while on ACCT.
We also found that staff had falsified records in several cases. We find this far too often in our investigations. In addition, the lack of ACCT governance in these cases revealed that some prisoners had inconsistent case reviews with different members of staff, making it difficult for staff to maintain a clear understanding of a prisoner’s risk.
Individuals in reception prisons clearly require careful assessment and ongoing support from staff to manage their risk.
Governors and Heads of Healthcare should ensure that staff in reception prisons and staff that work in reception understand the increased risk of prisoners in early days. Support for prisoners should be prioritised to ensure the high number of self-inflicted deaths occurring within the first 48 hours is reduced.
Furthermore, the importance of training for reception staff cannot be overemphasised. This training should be accredited and repeated regularly so staff are properly trained to identify and manage risk.