COMMISSIONER'S DIRECTIVE

PREVENTION, MANAGEMENT AND RESPONSE TO SUICIDE AND SELF-INJURIES

Policy Bulletin 184

POLICY OBJECTIVE

1. To ensure the safety of and intervention for offenders who are suicidal or self-injurious.

Note: For the purposes of this directive, Community Correctional Centres shall follow the directions relating to offenders.

AUTHORITY

2. Sections 85-88 of the Corrections and Conditional Release Act.

CROSS-REFERENCES

3. Commissioner's Directive 041 - Incident Investigations;
Commissioner's Directive 253 - Employee Assistance Program;
Commissioner's Directive 530 - Death of Inmates and Day Parolees;
Commissioner's Directive 567-3 - Use of Restraint Equipment;
Commissioner's Directive 580 - Discipline of Inmates;
Commissioner's Directive 590 - Administrative Segregation;
Commissioner's Directive 568-1 - Reporting and Recording of Security Incidents; and
Standard Operating Practices 700-04 - Offender Intake Assessment and Correctional Planning.

DEFINITIONS

4. Medical emergency: an injury or condition that poses an immediate threat to a person's health or life which requires medical intervention.

5. Suicide: the intentional taking of one's own life.

6. Suicide attempt: an intentional self-inflicted injury or action that does not result in death although death was intended.

7. Self-injury: the deliberate harm of one's body without conscious suicidal intent.

8. Suicide watch: the isolation of an inmate in response to an assessment of imminent danger of self-injury or suicide.

PRINCIPLES

9. Protection of life takes precedence over preservation of evidence.

10. Self-injurious or suicidal offenders shall not be subject to disciplinary measures for their self-injurious behaviour.

11. With the offender's consent, the input of support persons or groups shall be taken into consideration in the treatment plan to respond to the risk of self-injurious or suicidal behaviour.

RESPONSIBILITIES

12. Institutional Heads and District Directors shall:

1. ensure that:
   1. all correctional officers have received the approved CSC Suicide Prevention and Intervention training either as a component of the Correctional Training Program (CTP) or on a stand-alone basis;
   2. all other staff who have regular interactions with offenders have received the Suicide Awareness component of the New Employee Orientation Program (NEOP) either as a component of their orientation or on a stand-alone basis; and
   3. all staff who have regular interactions with offenders shall be provided with two hours of refresher training in suicide prevention every two years.
2. ensure that staff are aware of the relevant institutional or community procedures and resources regarding intervention for suicide and self-injury;
3. ensure that offenders at high risk for suicide or self-injury are referred on an emergency basis to the institutional psychologist, the district psychologist or appropriate community resources;
4. ensure that an interdisciplinary mental health team, led by the institutional psychologist, is established for inmates at risk for suicide or self-injury;
5. ensure that the district psychologist, in consultation with the parole officer, determines the form of support most appropriate for an offender in the community at risk for suicide or self-injury;
6. establish a reporting system to ensure key personnel are informed of the status of offenders at high risk for suicide or self-injury until they no longer present a high risk;
7. ensure that potential or actual self-injuries, suicide attempts and suicides are thoroughly documented by those responsible for any aspect of the case; and
8. ensure that inmates have access to approved suicide awareness and prevention workshops and that offenders in the community have access to relevant community resources and information.

ASSESSMENT

13. The sections of the Offender Intake Assessment pertaining to suicide and mental health shall be administered to all inmates:

1. within 24 hours of the initial admission; and
2. within 24 hours of a transfer from another institution.

14. Inmates who are potentially suicidal or self-injurious shall be referred to a psychologist on an emergency basis.

15. The psychologist or a designated member of the interdisciplinary mental health team shall closely manage the case.

RESTRAINTS

16. Restraints, including security garments, may be used to reduce the risk of self-injury. This shall be done in accordance with Commissioner's Directive 567-3 - Use of Restraint Equipment.

RESPONSE TO SUICIDAL AND SELF-INJURIOUS OFFENDERS

17. Staff shall take the necessary actions to ensure that suicidal and self-injurious offenders are referred on an emergency basis to a psychologist or a health service professional for appropriate intervention.

18. The psychologist or designated members of the interdisciplinary mental health team shall determine the degree of risk for suicide or self-injury and the appropriate level of intervention.

19. An inmate identified as being at a high risk for suicide or self-injury shall be placed on suicide watch, if the level of risk has not or cannot be reduced to an acceptably low level through other interventions.

20. When an inmate is identified as being at a high risk for suicide or self-injury, the psychiatrist or institutional physician shall review the inmate's medication profile and method of medication administration taking into account the inmate's suicide status.

21. If there will be a delay before an inmate is seen by a psychologist or health professional, the manager in charge may choose to place the inmate on suicide watch.

22. The psychologist or designated members of the interdisciplinary mental health team managing the case shall provide staff with directions on the specific conditions of the suicide watch, including the procedures to be used to monitor the inmate's activities.

23. Inmates placed on suicide watch shall be accommodated in a suicide watch cell designated by the institution, under continuous staff observation.

24. The psychologist or designated member of the interdisciplinary mental health team will recommend to the manager in charge when the suicide watch can be terminated.

TRANSFERS

25. No inmate considered imminently suicidal or self-injurious shall be transferred to an institution other than a treatment facility unless the psychologist managing the case, in consultation with other health service professionals, deems that the transfer would reduce or eliminate the inmate's potential for suicide or self-injury.

26. It may be necessary to transfer a minimum-security inmate to a higher security institution for suicide watch or other interventions.

27. The psychologist of the sending institution shall advise the psychologist at the receiving institution prior to the transfer and provide written notification of the inmate's suicidal state to ensure continuity of care with respect to treatment and monitoring.

MEDICAL EMERGENCY SITUATIONS

28. In responding to a medical emergency, the primary goal is the preservation of life and each staff member has an important role to play:

1. staff arriving on the scene of a possible medical emergency must immediately call for assistance, secure the area and initiate CPR/first aid without delay;
2. responding staff must attempt CPR/first aid where physically feasible even in cases where signs of life are not apparent (the decision to discontinue CPR/first aid can be taken only by authorized health personnel or the ambulance service in accordance with provincial laws);
3. staff must use approved protective equipment when administering CPR/first aid;
4. once initiated, staff will continue to perform CPR until relieved by Health Services staff or the ambulance service;
5. as soon as a possible medical emergency is identified, the Correctional Supervisor or officer-in-charge must notify Health Services and the ambulance service in accordance with the Institutional Contingency Plan, Standing Orders or Post Orders;
6. the Correctional Supervisor or officer-in-charge must immediately establish appropriate security for responding staff and the ambulance service;
7. once on the scene, Health Services or the ambulance service shall be responsible for determining the medical response to the situation;
8. correctional staff on the scene will continue to provide assistance as directed by Health Services or the ambulance service;
9. the Institutional Head shall ensure all staff have ready access to necessary protective and first aid equipment in all work locations;
10. all correctional officers shall be issued approved protective masks and gloves that must be carried on their person; and
11. the Institutional Head shall ensure that debriefings occur immediately following a medical emergency and offer Critical Incident Stress Debriefing (CISD) to all staff involved in the incident as set out in the Guidelines on Critical Incident Stress Management and within two working days.

29. The Institutional Head must ensure there are quarterly on-site simulations of medical emergencies that will allow staff to practice and remain current in skills. The scenarios used for the medical emergency exercises shall be developed in consideration of the particular institution's circumstances relating to the availability of medical resources within the community and will emphasize the specific needs of the midnight shift.

30. When a death by suicide occurs, psychologists, health care professionals, chaplains or appropriate others such as elders shall offer support services to offenders. In addition, the following policies shall take effect:

1. Commissioner's Directive 041 - Incident Investigations;
2. Commissioner's Directive 253 - Employee Assistance Program; and
3. Commissioner's Directive 568-1 - Recording and Reporting of Security Incidents.

A/Commissioner,

Original signed by
Don Head

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