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STRATEGY FOR PREVENTING

SUDDEN DEATHS IN APPROVED Probation


PREMISES Circular
PURPOSE REFERENCE NO:
1. To issue a final version of the strategy and practice guidance 40/2004
2. To request implementation of area strategic plans by November
2004.
ISSUE DATE:
3. To introduce a new self-harm monitoring sheet.
16 July 2004
ACTION
IMPLEMENTATION DATE:
All staff managing, working in, or referring to Approved Premises,
should note the contents and timescales of the strategy. Relevant Immediate
managers should take appropriate action to include: designing and
implementing a strategic plan to tackle sudden deaths in approved EXPIRY DATE:
premises, auditing practice within their approved premises and July 2009
introducing the monitoring of incidents of self-harm.
TO:
RELEVANT PREVIOUS PROBATION CIRCULARS Chairs of Probation Boards
PC02/2004 - Deaths of Approved Premises' Residents Chief Officers of Probation
Secretaries of Probation Boards
CONTACT FOR ENQUIRIES Chairs of Voluntary Management
John Russell Committees
Tel: 020 7217 0772 Fax: 020 7217 0756 Approved Premises Managers
E-mail: JohnFyfe.Russell@homeoffice.gsi.gov.uk
CC:
Colin Pinfold Board Treasurers
Tel: 020 7217 8226 Fax: 020 7217 0756 Regional Managers
E-mail: Colin.Pinfold2@homeoffice.gsi.gov.uk
AUTHORISED BY:
Liz Hill, Head of Public Protection
and Courts Unit

ATTACHED:
Annex A - Strategy, Annex B -
Practice Guidance, Annex C -
Guidance in event of incident,
Annex D - Monitoring Form

National Probation Directorate


Horseferry House, Dean Ryle Street, London, SW1P 2AW General Enquiries: 020 7217 0659 Fax: 020 7217 0660
ANNEX A

NATIONAL PROBATION SERVICE STRATEGY FOR PREVENTING


SUDDEN DEATHS IN APPROVED PREMISES

1 Purpose

1.1 The aim of this strategy and the accompanying practice guidance note is to
reduce the numbers of sudden deaths amongst residents of Approved
Premises.

1.2 The intended audience for the strategy and guidance include:-
‰ Probation Boards and Chief Officers;
‰ Management Committees of Voluntary Approved Premises;
‰ those with senior managerial responsibility for Approved Premises
such as Assistant Chief Officers and managers of individual approved
premises;
‰ staff of Approved Premises;
‰ those making referrals to Approved Premises including court staff, bail
information officers, staff in prisons, and probation staff in the
community e.g. high-risk, public protection and resettlement teams.

2 Background

2.1 The strategy has been developed and implemented so as to make a


contribution to the Government’s Health Service strategic plan for the
reduction of suicide in the community as set out in the Department of Health’s
National Suicide Prevention Strategy for England (2002), which is useful
additional reading.

2.2 Each year, a number of Approved Premises residents lose their lives.

YEAR Suicide Overdose Natural causes Accident Total


1999 4 4 1 0 9
2000 8 13 2 1 24
2001 3 12 5 2 22
2002 3 8 8 2 21
2003 4 3 3 1 11
TOTALS 22 40 19 6 87
2.3 Whilst some of the deaths are attributable to natural causes, others such as
those attributable to accidental drugs overdoses or suicides may be
preventable. It should also be borne in mind that evidence shows that those
on probation supervision do have a higher incidence of both accidental death
and suicide, therefore, residents in Approved Premises may be particularly
vulnerable and in need of rapid access to assistance to services such as
Samaritans, mental health and drugs services as well as more intensive
levels of help and support from Approved Premises staff.

3 DEFINITIONS

3.1 Some sudden deaths can be unintentional, that is when a death occurs without
intent to cause harm, for example, the harm which results from recreational
drug misuse.

For the purposes of this strategy, we adopt the following definition;

“Suicide is the intentional act of taking one’s life, either as a result of mental
illness or as a result of various other motivations which outweigh the instinct
to continue to live.”

3.2 The strategy links together the phenomena of suicide, sudden death, and
what might be regarded as ‘potentially preventable deaths’. It does not
assume that those that are suicidal will have previously self-harmed, that self-
harm is an indicator of a potential suicide or that those who resume significant
drug misuse after a considerable period of abstinence (e.g. in custody) which
results in sudden death, are offenders who would regard themselves as self-
harmers or suicidal. All categories might have an element of inter-
relatedness but any assumption that there are always strong links should be
avoided.

4 Principles

4.1 Measuring the impact of any measures to reduce sudden, or potentially


preventable deaths, is difficult given that it would involve measuring negative
performance indicators.
4.2 Whilst the range of preventative activity might be limited, and the resources
available might be restricted, this does not prevent effective action being
devised and implemented.

4.3 This matter is best regarded as a multi-agency and multi-disciplinary subject.

4.4 There are no models with guaranteed accuracy for assessing the risks of
suicide and self-harm.

4.5 People that self-harm or are prone to suicidal tendencies may well not be self-
harming or suicidal for most of the time.

4.6 The strategy will be integrated with forthcoming strategic plans by the
National Probation Directorate, for example, the Strategy for Mentally
Disordered Offenders, and the Approved Premises and Accommodation
Strategy for High Risk Offenders.

5 THE STRATEGY

5.1 This is the first strategic plan devised to reduce deaths of Approved Premises
residents. It will be reviewed and evaluated by the National Probation
Directorate in July 2005. The strategy recognises the need to ensure
effective flows of information at the referrals, reception and move-on stages
including the need to establish a protocol on information sharing between HM
Prison Service and the National Probation Service as well as protocols with
partner agencies.

What the strategy should achieve is:


‰ The number of recorded sudden deaths per year in Approved
Premises is reduced.
‰ Improved and more clearly focused risk assessments of residents.
‰ Improved and more clearly focused risk management plans.
‰ Access to health and advice services.
‰ Increased staff awareness and training in sudden death and self-harm
issues.
‰ Mandatory local monitoring of instances of self-harm.
‰ Learning from experience and innovative practice is integrated into the
wider operation of Approved Premises.
‰ As far as possible, sudden deaths are avoided.
6 A Strategic Framework for the National Probation Service

6.1 There have been no requirements on the National Probation Service or


Approved Premises to have a strategic plan to manage the risks of self-harm
or potential suicide amongst offenders. This strategic plan begins to address
that position.

6.2 Some Approved Premises will already have a strategy to tackle sudden
deaths but these are likely to be centred on individual premises rather than
part of a more co-ordinated plan, or indeed, a strategy over all of the
Approved Premises within an Area or region. Approved Premises may have
developed practices to manage this area of work without the formality of a
written policy and some may have been able to provide some degree of staff
training. However, a national strategy will consolidate work to date and
contribute to greater consistency.

6.3 The strategic framework is ambitious but achievable. It is a starting point for
building expertise and sharing best practice.

ACTION

In order to be able to demonstrate efforts to reduce sudden deaths:

7 The National Probation Directorate will;

Follow the interim guidance (issued in PC2/2004 (Deaths of Approved


Premises Residents)) with the issue of full guidance to Probation Areas
regarding changes to the investigative procedure to be implemented from 1
April 2004, to include what will be required at a local level by the Prisons and
Probation Ombudsman’s investigating officer. (Completed).

7.2 The NPD will continue to collect and collate information on deaths
investigated by the Office of the Prisons and Probation Ombudsman for feed-
back to Areas and Ministers.

7.3 Receive and review each report on a death in Approved Premises, consider
the implications for the national estate and take appropriate action.
(Underway).
7.4 Meet with HM Prison Service Safer Custody Group to review the findings and
recommendations of reports which have cross-organisation implications.

7.5 Continue to be represented at the Ministerial ‘Round Table’ on suicide and


self-harm prevention in the criminal justice system.

7.6 Continue to be represented on HM Prison Service’s Safer Custody Strategy


Steering Group to ensure pan-correctional services liaison.

7.7 Support innovation at Area level, in the first instance running a pilot scheme in
13 London approved premises with mobile phones to enable private and swift
access to key services such as Samaritans. Subject to the evaluation of the
pilot trials in 2004/05 and the resources being available, a nationwide ‘roll-out’
will be considered. (Underway).

7.8 Before December 2004, evaluate the feasibility of implementing a pilot


scheme of ‘listeners’ to mirror the successful schemes that have developed
within prisons.

7.9 Before January 2004, commission a literature review of deaths in residential


settings, consider the findings and take appropriate action. (Completed -
publication awaited).

7.10 Before August 2004, require all Approved Premises areas to devise and
commence implementation of a strategic plan for the reduction of self-harm
and sudden death amongst residents. (All Approved Premises within an Area
should be integrated within the strategic plan and wherever possible, the
strategy should be regional). (Completed).

7.11 Before April 2004 produce practice guidance for Approved Premises staff.
(Completed). (See Probation Circular 2/2004 (Deaths of Approved Premises
Residents) and also annex B to this circular).

7.12 Produce reference material to advise staff on the operation of the Coroner’s
Court and how to contribute effectively. (Completed).
8 In addition Probation Areas with Approved Premises will:

8.1 Devise a strategic plan to reduce incidents of sudden death in Approved


Premises within the Area. If there is more than one Approved Premises the
plan will usually be common to all Approved Premises (including those that
have voluntary management committees) within an Area. Where possible the
strategy should be common to all Approved Premises within a region.
Approved Premises with a Voluntary Management Committee are included in
the requirement to produce a strategic plan. The plans should be completed
before October 2004.

8.2 Implementation of the plan should have commenced by November 2004.

8.3 Part of the plan should demonstrate the arrangements for staff development
and staff training, including First Aid and emergency treatment training and
refresher courses.

8.4 The plan should be compatible with other strategic plans for example, Drug
Action Team plans to reduce deaths by drug misuse.

8.5 By January 2005, devise and implement systems that are common to all
Probation Board or Voluntary Committee managed Approved Premises within
an Area (and ideally within a region) to record significant incidents of self-
harm. (See Annex D of this Circular for sample monitoring form).

8.6 Approved Premises managers should have in place systems to review each
incident of self-harm and the implications for the supervision of the case but
also to consider the implications for training, regime or policy that might
reduce incidents, or contribute to greater safety.

8.7 As part of the local plan Approved Premises managers might consider
nominating a member of supervisory staff team as Suicide Prevention
Coordinator, given the positive impact that SPCs have had within prisons on
practice improvements, liaison and consistency, and raising the profile of
active prevention of deaths.

8.8 Consideration should be given to including representation within each


Probation region at ACO level (normally an ACO with responsibility for
Approved Premises) on the HM Prison Service Area Suicide Prevention
Forum meetings with a view to a joint approach on areas of common interest.

9 Evaluation

9.1 The content and effectiveness of the strategy will be evaluated by the
National Probation Directorate in July 2005.

July 2004
ANNEX B

PREVENTION OF SUDDEN DEATHS IN APPROVED PREMISES

PRACTICE GUIDANCE and CHECKLIST

This checklist is to be used as an audit tool to ensure that good practice is in place - or
that steps are being taken to introduce such good practice - to prevent sudden deaths of
approved premises residents.

For each required action the form asks for the name of the lead person from each
approved premises who will ensure that the action is implemented, and has a space for
a date to show that work is underway to implement each action, and another space to
show that work has been completed on each action point.

1. CASEWORK ISSUES

1.1 REFERRALS

Ensure that for each referral there are systems in place to:

1. Establish whether there is any evidence that the person being referred has
previously been suicidal.

LEAD PERSON UNDERWAY COMPLETED

2. If currently in custody, to establish whether there is any history of F20/52 SH or


ACCT registration in accordance with HM Prison Service procedures when a ‘risk of
self-harm or suicide’ has been identified.

LEAD PERSON UNDERWAY COMPLETED

3. Ensure that the approved premises referrals officer is able to obtain any current or
previous F20/52 SH or ACCT.

LEAD PERSON UNDERWAY COMPLETED

4. Ensure that checks are undertaken for other indicators of vulnerability to suicide or
sudden death.

LEAD PERSON UNDERWAY COMPLETED


5. Ensure that checks are undertaken to confirm if the person is currently receiving
treatment or medication and, if so, what it is.

LEAD PERSON UNDERWAY COMPLETED

1.2. PRE-ADMISSION

Ensure that before admission, arrangements are in place:

1. To ensure the safe transition from custody to admission in the Approved Premises.

LEAD PERSON UNDERWAY COMPLETED

2. For an assessment to be made to see if allocation to a single or a shared room


would assist in containing or reducing risk.

LEAD PERSON UNDERWAY COMPLETED

3. That in relevant cases the suitability of any other shared room occupant is assessed.

LEAD PERSON UNDERWAY COMPLETED

4. That the advantages of allocation of a particular room (e.g. in close proximity to the
main office) are assessed.

LEAD PERSON UNDERWAY COMPLETED

5. That consideration is given to pairing the new admission with an existing trustworthy
resident (Buddy scheme) to assist in reducing or managing risk.

LEAD PERSON UNDERWAY COMPLETED

6. That the resident’s needs are assessed for access to any specialised services and,
where necessary, arrangements can be put into place in advance of admission.

LEAD PERSON UNDERWAY COMPLETED

7. There is access to a GP in place.

LEAD PERSON UNDERWAY COMPLETED


1.3. ADMISSION AND INDUCTION

Ensure that there are systems in place to ensure that:

1. Staff who will be on duty are briefed to expect vulnerable residents on their first day.

LEAD PERSON UNDERWAY COMPLETED

2. Details about Samaritans and other similar organisations are available in residents’
induction packs and on residents’ notice boards.

LEAD PERSON UNDERWAY COMPLETED

3. The dangers of substance misuse and warnings about the dangers of resuming drug
misuse after a period of abstinence are included in induction packs.

LEAD PERSON UNDERWAY COMPLETED

4. Each resident is clear about ‘points of help’ from within the approved premises and in
the wider community.

LEAD PERSON UNDERWAY COMPLETED

5. There are detailed risk of self-harm/suicide assessments and plans to manage the
identified risks in each relevant case. (The plan must include who is going to do
what and why as well as what the contingency or follow-on action should be. It
should address any ‘warning indicators’ that have been identified in the assessment).

LEAD PERSON UNDERWAY COMPLETED

6. Such plans available to all staff from the day of admission.

LEAD PERSON UNDERWAY COMPLETED

1.4. DURATION OF PERIOD OF RESIDENCE

Ensure that it is clear that:

1. All staff can identify any resident assessed as being at risk, what the risk assessment
is, and what the details of the risk management plan are.

LEAD PERSON UNDERWAY COMPLETED


2. The specific actions identified in the risk management plan are allocated to specific
members of staff for them to carry them out.

LEAD PERSON UNDERWAY COMPLETED

3. Risk of self-harm or sudden death management plans are reviewed with all relevant
staff and other parties.

LEAD PERSON UNDERWAY COMPLETED

4. It is always clear in risk management plans exactly what will be done to contain or
reduce risks of self harm or sudden death, what factors may increase the risk and
what will be done to prevent escalation.

LEAD PERSON UNDERWAY COMPLETED

5. Identifying features and next of kin details always satisfactorily recorded.

LEAD PERSON UNDERWAY COMPLETED

6. Potentially serious allergies are recorded and acted upon appropriately.

LEAD PERSON UNDERWAY COMPLETED

1.5. DEPARTURE

Ensure that systems are in place to ensure that:

1. Information about risk of self-harm or sudden death would be passed to other


agencies or organisations in the event of a request for recall, breach or planned
departure.

LEAD PERSON UNDERWAY COMPLETED

2. When appropriate, there would be a plan to manage the risks of self-injury or


potential fatality during the transition between the Approved Premises and the ‘move-
on’ location.

LEAD PERSON UNDERWAY COMPLETED


2. MANAGEMENT ISSUES

2.1 APPROVED PREMISES ENVIRONMENT

Ensure that arrangements are in place to:

1. Ensure that the building is regularly assessed, possibly as part of routine ‘health and
safety’ checks, to identify possible adverse design features. (Ligature points, lack of
safety-glass in glazed areas etc.).

LEAD PERSON UNDERWAY COMPLETED

2. Check if there are any infrequently used or unsecured outbuildings which present
opportunity and risk that are not regularly checked or have not been made secure.

LEAD PERSON UNDERWAY COMPLETED

3. Give consideration to installing blue ‘anti-injection’ lighting in bathrooms and toilets.

LEAD PERSON UNDERWAY COMPLETED

4. Ensure that kitchen knives and other sharp utensils and any tool-kits are kept in
secured areas and systematically accounted for.

LEAD PERSON UNDERWAY COMPLETED

5. Check if there is sufficient discreet visibility into communal areas.

LEAD PERSON UNDERWAY COMPLETED

6. Ensure that medication is kept in accordance with Approved Premises practice


guidance, including good recording systems for issue and checks are made to
ensure that medication has been issued to the resident in accordance with the
prescription.

LEAD PERSON UNDERWAY COMPLETED

7. Check that there are first aid/resuscitation packs at principal points around the
premises/or routinely carried by all supervisory staff.

LEAD PERSON UNDERWAY COMPLETED


8. Ensure that there is good access to telephone and contact addresses for those
organisations who could offer a potential service to relevant residents.

LEAD PERSON UNDERWAY COMPLETED

2.2 STAFF TRAINING AND AWARENESS

Ensure that arrangements are in place to:

1. Give consideration to the feasibility of appointing a Suicide Prevention Co-ordinator


within each Approved Premises team to ensure that the issues of sudden death
remain a priority and there is a central point for learning.

LEAD PERSON UNDERWAY COMPLETED

2. Check that this matter is included as part of new staff induction.

LEAD PERSON UNDERWAY COMPLETED

3. Ensure that sudden death issues are included in staff training plans or in individual
staff members development plans.

LEAD PERSON UNDERWAY COMPLETED

4. Ensure that there are routes to ensure that practice ideas and learning from all
Approved Premises within the region are shared.

LEAD PERSON UNDERWAY COMPLETED

5. Ensure that there are ‘advisory’ links with other professionals (CPN/ SPCs in prisons,
Samaritans etc.), to give general advice to the Approved Premises team or specific
case advice.

LEAD PERSON UNDERWAY COMPLETED

6. Ensure that all staff are aware of those residents statistically most at risk and the
statistically most ‘at-risk’ periods.

LEAD PERSON UNDERWAY COMPLETED


7. Ensure that there is a staff-training plan for first aid and emergency treatment and
‘refresher’ training.

LEAD PERSON UNDERWAY COMPLETED

8. Give consideration to the feasibility of running training exercises or ‘practice runs’ to


build staff confidence and ensure staff are familiar with procedures.

LEAD PERSON UNDERWAY COMPLETED

2.3 STRUCTURES AND SYSTEMS

1. Ensure that there is an Approved Premises strategic plan for the prevention of
sudden death and that this is compatible or shared across all Approved Premises
within the Area (and ideally within the region).

LEAD PERSON UNDERWAY COMPLETED

2. Ensure that referring staff are aware of the strategic plan.

LEAD PERSON UNDERWAY COMPLETED

3. Ensure that there are systems in place to ensure that those most at risk can be
(discretely) identified by all staff.

LEAD PERSON UNDERWAY COMPLETED

4. Ensure that there are arrangements in place to ensure that the whole of the building
and relevant out-side space is routinely checked several times a day every day of the
week, including during the night, and that when this has been done it is accurately
recorded in the log.

LEAD PERSON UNDERWAY COMPLETED

5. Ensure that as part of the Leadership task, managers demonstrate that Sudden
Death Prevention is an important element of any well-managed, well-run Approved
Premises.

LEAD PERSON UNDERWAY COMPLETED


6. Ensure that there are systems in place to record serious incidents of significant self-
harm and other events where a fatality might have occurred.

LEAD PERSON UNDERWAY COMPLETED

7. Ensure that the above incidents receive a review to take the opportunity of
recognising good practice and identifying areas for improvement or change.

LEAD PERSON UNDERWAY COMPLETED

8. Ensure that there are structures in place to ensure that the Public Protection and
Courts Unit of the National Probation Directorate and the Office of the Ombudsman
are notified of a death and given all relevant details and thereafter kept informed of
key developments.

LEAD PERSON UNDERWAY COMPLETED


ANNEX C

WHAT TO DO IN THE EVENT OF AN INCIDENT OF SIGNIFICANT SELF-


HARM OR A FATALITY

(Note that this is a general guide. More detailed instructions tailored to the
individual circumstances and staffing arrangements are desirable)

If there is an event on-site of serious self-harm or sudden death:


• Call an ambulance.
• If an obvious serious attempt at suicide or an obvious fatality call police.
• Every possible effort should be made to save life in accordance with the limited skills
of approved premises staff in first-aid and resuscitation techniques.
• Do not leave resident unattended unless absolutely unavoidable.
• Staff must be aware of own safety (bodily fluids and physical dangers such as
electricity and glass).
• Keep the area as free as possible from other residents and unnecessary staff.
• Take any advice of paramedics or police.
• If GP certifies death, police will notify next of kin.
• Seal the area and take police advice on securing the personal belongings of the
deceased.
• Notify on-call manager, Assistant Chief Officer as soon as practicable.

If a death has occurred:


• ACO to notify Chief Officer, Chair of Board, and Public Protection and Courts Unit at
the National Probation Directorate and also ensure Ombudsman’s Office has been
notified and the local PR officer.
• Details of incident should be recorded on the case file/log as appropriate to include
when the resident was last seen.
• All members of staff are advised to make their own personal notes of the sequence
and timing of the events for future reference if required.
• Police may require statements by staff and residents – have an office or space
available for this, with refreshments if possible and retain a copy of statements
made.
• Emotional and physical well-being of other residents and staff should be attended to.
• Notify any other staff members (especially in other teams, or approved premises staff
at home in some cases as necessary). Inform Probation Victim Liaison if
appropriate.
• Assess any damage to premises and arrange repair or take any necessary
measures in the interests of safety.
• All electronic and paper files on resident to be made secure.
• Two members of staff, or Approved Premises member of staff and police officer to
pack residents belongings – record contents – and keep securely.
• If family visit ensure that there are arrangements to see them in privacy and be
aware that they may wish to see the resident’s bedroom or the scene of the death.
• The police will have arrangements with undertakers to remove the deceased from
the building. The funeral directors address and contact details should be recorded
for easy access to inform the family or any other enquiry.
• It is not appropriate for the family to view the deceased at the Approved Premises.
• Be prepared on issues of confidentiality when family visit, especially if they were
previously estranged.
• Take some sensitive steps to ensure identity before possessions are released.
• All Approved Premises should already have contacts for faith and community leaders
in the area and such people might give helpful advice on customs and expectations
as well as being present if the family visit.
• Careful consideration should be given to the release of possessions. Never hand
over property in carrier bags or bin-liners. Clothes should be laundered and neatly
parcelled, discretion used on the disposal of perishable items, pornography, etc, and
families advised on any potentially upsetting contents such as unsent letters or
cards.
• Consideration should be given to what may need to be done to achieve any changes
to an area of the building before it is re-opened or rooms reallocated.
• It is not unusual for the inquest to be opened and then adjourned in order that the
body can be released for burial.
• Attendance at the funeral will be a matter of judgement in each case. It might be that
seeking the family’s approval to send a representative would be appropriate in some
cases. In others, staff should be aware that they may be the only attendees at the
service.
• ACO should write to Coroner’s office requesting notification of the date, time and
place of the inquest.
• Prepare for the Inquest: ensure knowledge of procedure, identify who will attend,
decide which documents and records should be taken to the Court and by whom
(although it is useful to prepare a brief summary of all the key information such as
dates and reason for admission). It is useful to ensure there is some media
statement in reserve in the event of a press enquiry.
• Prepare for the visit of the Ombudsman’s Investigator: liaise with the Ombudsman’s
Office about requirements, ensure availability of all assessments, records, and files
including electronic files, as well as copies of staff statements. Staff availability,
office/interviewing space, keys, information to staff and residents where appropriate.
• Advise the NPD and the Ombudsman’s Office in writing of the verdict.
ANNEX D

NATIONAL PROBATION SERVICE STRATEGY FOR PREVENTING SUDDEN


DEATHS IN APPROVED PREMISES

SELF-HARM MONITORING FORM

Attached is a self-harm monitoring form. This must be completed in all cases where staff
become aware that a resident of an approved premises has deliberately harmed themselves.

One copy of the completed form should go on to the resident's file. Another copy should be
filed separately and these completed forms should be collated and discussed at team
meetings. This should be a regular agenda item at team meetings, so that any trends can be
quickly identified, and appropriate action taken.
SELF–HARM MONITORING FORM
Self-Harm is any act where a resident deliberately harms themselves irrespective of method,
intent or severity of any injury. Noose/ligature making should also be reported. Anorexia,
Bulimia Nervosa or food refusal should not be reported on this form. Staff should report all
incidents that they are aware of.

Approved Premises: …………………………………………….


Resident: ………………………………… Gender: M/F ………
Ethnic Origin:……………………………………………………
Age Range: Under 20 20-30 31-40
41-50 51-60 61+
Order Type: Licence Community order Bail Other
(Please specify if other) .………………………………………...
Reporting Staff: …………………………………………………
Date of Report: ………………………………………………….

1. Accommodation 7. Self-poisoning / Overdose


Substances / Swallowing
1.1 Annex or cluster
1.2 Shared room no other occupant 7.1 Own Medication
1.3 Shared room with other occupant 7.2 Other person’s medication
7.3 Illegal drugs
2. Time of Incident 7.4 Cleaning materials
7.5 Razor Blades
2.1 7am to 11am 7.6 Batteries
2.2 11am to 7pm 7.7 Other specify: ………………………………..
2.3 7pm to 11pm
2.4 11pm to 7am 8. Required treatment as
2.5 Not known
8.1 Outpatient
3. Period of residence 8.2 Inpatient

3.1 Within one week of admission 9. Was Resuscitation required?


3.2 Within two weeks of admission
3.3 Within three weeks of admission Yes No
3.4 Within four weeks of admission
3.5 After four weeks of admission 10. Was treatment administered by:
3.6 Within one month of planned departure
10.1 Resident
4. Was the incident prior to an imminent 10.2 Duty staff
court appearance? 10.3 GP
10.4 Paramedics/Ambulance
Yes No 10.5 No treatment

5. Place of Incident
11. Self-harm Assessment -Was Resident:
5.1 Resident bedroom
5.2 Communal area 11.1 Un-assessed for self-harm
5.3 Outside of the building 11.2 Assessed, but not assessed as risk of self-harm
5.4 Toilet or bathroom area 11.3 Assessed as risk of self-harm but no
5.5 Other management plan in place
11.4 Assessed as risk of self-harm and plan in place
to manage
6. Self Harm Method
12. Follow up action
6.1 Cutting or scratching
6.2 Self poisoning ……………………………………………
6.3 Burning ……………………………………………
6.4 Swallowing objects
6.5 Head banging – wall-punching
6.6 Suffocation 13. Approved Premises Manager
6.7 Wound aggravation comments
6.8 Strangulation
6.9 Hanging
6.10 Other (specify below) ……………………………………………
……………………………………… ……………………………………………
……………………………………… ……………………………………………