Dear Ms Kearsley Re: Mohammed Saeed-Alim formerly known as Rellly (Deceased) Regulation 28 Report GMMH Response Furtherrto your email highlighting your concerns following Mr Nicky Reilly's Inquest please see below the Trust's response to this concerns: Complete Separation of the Mental Health In-Reach Team and Psychology Team When prisonertis_receiving both Mental Health input and Psychological input within prison; there should be access to the patient's mental health records in order for each service to have clear understanding of the patient's clinical presentations and need: Havlng access to the totality %f the Information should then assist in appropriatelyassessing a patlents risk to self and others Where a prisoner is receiving input from the prison psychology team access to the NHS record can be requested by the psychologist responsible for delivering that input to the patient; subjecoto the normal consent being given: prison psychology team have been informed of how can gain access to the patients clinical record. Where such access is given, it is expected that the psychologist will document their involvement withithe patient in the clinical record, t0 inform the muiti-disciplinary healthcare team OVohee thatis being provided; Psychology access to the system will allow them to see the carrent input of care that is delivered by medical and mental health services package Tho Trust f8 committed to safequarding children; young people and vulnerable adults and requlres ell etaff and volunteors to share this commitment Grealer Manchester Mental Heallh NHS Foundatlon The Curve: Bury New Road, Preslwich Improving Lives Manchesler M25 3BL (Tel: 0161 773 9121) Bury Way Nicky The they being Trst;

NHS An audit of psychology access to the system, patients Greater Manchester viewed and documented entries made, will be conducted Mental Health by the Head of Healthcare Mental Health and psychology staff now attend the weekly Complex e+Easgqednion Fichsar are minuted, where those prisoners with complex needs are reviewed by the multi-disciplinary team_ This allows multi ~disciplinary approach to care planning and a forum for the sharing of infomation. HMP Manchester has just received funding from NHS England from the 1s' April 2019,to increase mental health services within the prison: Part of this funding will be used to fund a PSvchologist; emploved by Greater Manchester Mental Health Trust; to provide psychologically informed, evidence based specialist support for all those assessed as requiring interventions to address mental health, personality disorder; and support for individuals with learning disabilities Asa GMMH employee this psychologist will be expected to document all patient interactions within the patient's systmone clinical records. Medlcation Refusals Court heard evldence as to the lack of action taken by staff following NR's refusal of medication: The Court heard process which should happen but thls is not clearly documented Iin one policy which covers the situation for both weekdays and also weekends: There remains risk particularly at weekend that an appropriate escalation process would not be actioned Is proposed guidance document for staff, for patients who are non-concordant with medication, been rewritten This guidance document now makes reference to the actions staff should take if a patient misses critical medication during the weekend as well as during the week. This document was circulated to all staff in December 2018 and has been added to the Trust Health and Justice Intranet for all staff to view: Ms Kearsley, hope vou and Mr Reilly's family are satisfied with the response We have provided. If you have any further questions in relation to the contents of this letter, please do let me know;

Dear Ms Kearsley,

Inquest into the death of Nicky Reilly, also known as Mohamed Saeed-Alim

Thank you for your Regulation 28 Report of 4 January 2019, following the conclusion of the inquest into the death of Nicky Reilly, also known as Mohamed Saeed-Alim. As Director General for Prisons, I am responding on behalf of Her Majesty’s Prison and Probation Service (HMPPS). I am grateful to you for bringing to my attention your concerns as directed at HMPPS, and for this opportunity to respond to them.

I know that you will share a copy of this response with Nicky’s family, and I would first like to express my sincere condolences for their loss. Every death in custody is a tragedy, and the safety of those in our care is my absolute priority.

Your first concern is that, when Nicky was returned to the prison estate from Broadmoor, the Care Programme Approach (CPA) was not continued. As the CPA is a clinically-led programme to support those with mental health needs, the healthcare provider, or mental health services at a prison, is responsible for determining whether a CPA is required for an individual.

During his time managed by the Managing Challenging Behaviour Strategy (MCBS), Nicky was supported by a co-ordinated, multi-disciplinary case management approach, the Care and Management Plan. In Nicky’s case, this process resulted in him being located at the Specialist Intervention Unit (SIU) at Manchester, with the intention of re-integrating him into the custodial environment and stabilising his behaviour, at that time his most pressing identified needs. The Care and Management Plan aimed to support Nicky through to the Personality Disorder service on the Westgate Unit, seen as the best available option for clinical and operational support once he had adjusted and was ready to access treatment in a prison setting. His care at the SIU was overseen by the central management group, a multi-disciplinary team including mental health services and a dedicated mental health nurse.

Whilst recognising the significance of the introduction of the new national case management model, Challenge Support Intervention Plan (CSIP), which replaced the MCBS policy on 1 February this year and is currently being implemented and embedded across the prison estate, you have expressed concern that some of the issues covered during the inquest may still be relevant. You have specifically referred to poor record keeping, the lack of multi- disciplinary attendees and the lack of requirement for formal reports.

CSIP is a multi-disciplinary approach which focuses on those who pose a raised risk of being violent, and works to change their behaviour. It is centred on the needs of the individual,

providing them with the right support to improve and manage behaviour. As part of the implementation process all establishments were provided with guidance and a range of materials, including terms of reference that set out the need for multi-disciplinary engagement and a template for the agenda and minutes for the multi-disciplinary risk management Safety Intervention Meeting (SIM). This will ensure that information sharing is embedded in the process, along with a requirement to maintain effective records of the information which informed decision making.

HMP Manchester has been holding a weekly multi-disciplinary meeting to manage complex and challenging prisoners since April 2018, and CSIP was introduced in June 2018. The purpose of the weekly meeting is assist the Residential function by providing multi- disciplinary case management for prisoners who require additional resources over and above their CSIP or ACCT Intervention, Support or Care plans. Departments who do not attend are expected to provide written submissions to the meeting. The meetings are chaired by a Senior Manager from the Residential and Safety function, and minutes are kept to ensure an ongoing record of decision-making is maintained.

Your next concern is that Nicky did not have an allocated psychologist in the SIU and that no interventions were carried out following his completion of the Extremism Risk Assessment. While I recognise both points, I should clarify that Nicky’s allocation to the SIU was based on a range of factors, not solely so that formal interventions could be delivered. It is not uncommon for some complex individuals to be encouraged to focus on their involvement in the regime rather than on specific interventions at certain times. Nicky’s difficultly in coping within the custodial environment and the potential for this to present a high risk both to himself and to others meant that the SIU, as a small unit with a high staffing level, was considered the best environment for him to readjust to the prison setting and be offered sufficient support and care from staff.

You have referred to mental health and psychology services record-keeping operating separately, with clinical records being held on SystmOne to which psychologists do not have access. While I recognise that this separation does carry the risk that information is not effectively shared, I must respect the medical in-confidence issues that make this necessary, and I expect all staff working in prisons to use the many forums available to them to work in a multi-disciplinary, collaborative way to ensure that decisions about prisoners are made with all available information.

You have also raised the issue of training for staff in how to support and manage prisoners with Asperger syndrome or personality disorders. Prior to starting work on the unit, all staff receive a training module which provides guidance on managing those prisoners with challenging behaviour including as a result of personality disorders or learning disability. This ‘Working with Challenging Behaviour’ training is available to staff across the Close Supervision Centre system and those working in segregation units.

A number of establishments have delivered awareness events aimed at improving staff confidence in dealing with prisoners with these needs, and nationally a toolkit has been developed to help staff better meet the needs of those in our care with Learning Disabilities and Challenges (LDC). The toolkit is designed for prisons and for probation service operational leaders at prisons, helping them to look at how their support, services and surroundings can better meet those needs and provide a more equal and fair service for those with LDC needs. It includes resources and practical tips, such as how to display information and make environments more engaging and inclusive.

We are also increasing our support for prisoners with autism with a new, dedicated unit due to open in 2019 at HMP Wakefield. This unit will cater for men on the autistic spectrum who

struggle to cope in the mainstream prison regime. The unit has been developed in consultation with the National Autistic Society, and will operate to an agreed set of standards which will lead to it being assessed and accredited by the National Autistic Society. Our Head of Psychology at Wakefield was named as Outstanding Health or Social Care Professional at the 2019 Autism Professionals Awards, which recognise and reward services and professionals who are leading the way in innovative autism practice and making a real difference to the lives of autistic people in the UK.

Thank you again for bringing these matters of concern to my attention. I hope that this response provides assurance that lessons have been learned from the circumstances of Nicky’s tragic death.