HM — HMP High Down

CNWL Health & Justice Mental Health and Mental Health, Completed Learning Disability Operational Policy pages 10 and 11 focuses on zoning system (Red, Amber and Green - RAG) where patients are categorised according to their needs. This policy is currently being reviewed. . All patients on staff caseload falls into Red, Amber or Green and their risk, needs will be reflected by the zone they are in. Red zone is for patients who are at high risk of harm to self, have a high level of need and are currently in crisis. There may be consideration by the team for admission to a healthcare unit/and or a referral to external services. They will require frequent review and intensive support with reflected changes to care plans, crisis plans and risk assessments. For patients in the red zone, weekly review will include completion of previously agreed actions and, where not completed, what support is appropriate to ensure the actions are completed. Minimum contact is once weekly. Amber zone is for patients for whom the current crisis has passed but who are still at risk of relapse or a further mental health or social crisis, or are at risk of relapse with triggers identified. The risk assessment must include these. For patients in amber zone, the frequency of contact may need reviewing as part of the care plan in order to aim to prevent crisis. The minimum contact in this zone is fortnightly. Green Zone is for patients who are settled in their mental health and social situation. They are monitored for progress with their recovery and their appropriateness for discharge. There needs to be a process of caseload review for those on green zone with consideration of discharge - this can be through supervision or through team meeting. Minimum contact for someone in this zone is once a month. The zone allocated to a patient will be highlighted on Systm1 and the contact the patient receives will be according to the guidelines suggested in the LOP. The Mental Health team hold a zoning meeting on a weekly basis where each patient in red and amber zones are discussed and reviewed. All other patients will be in green zone and deemed settled. The team also holds a referral meeting on a daily basis where all new referrals are discussed and allocated accordingly. Each referral is considered as to whether it is routine, urgent or an emergency. All routine referrals are considered within 3 to 5 days, urgent referrals within 24 hrs and emergency referrals are attended to within 4 hrs.

In December 2019 and July 2020 HMPPS Safety Group circulated a Senior Leaders Bulletin to remind HMPPS senior managers that incidents of serious self-harm and serious assaults (including cases of unexplained injuries) need to be thoroughly investigated to identify learning that can be used to prevent future incidents and improve safety. It also reminded senior managers of the need to consider the circumstances of the incident and the purpose of the investigation before deciding which type of investigation to commission. Senior managers were also signposted to the four HMPPS policies that provide guidance to prisons about conducting investigations following such incidents. In circumstances where it has become apparent that an individual has sustained a serious injury of the type potentially to require an independent investigation under Article 2 ECHR, the Safer Custody Casework Team in HMPPS HQ invites the Governor to review the internal investigations that have taken place and consider whether a formal investigation is required. Additionally, the process for identifying whether an Article 2 investigation is required, or not, has been reviewed and strengthened to ensure Article 2 investigations are commissioned as quickly as possible after the incident occurs. This has included an improved process for obtaining health information to inform the decision.