SPECIALISED SERVICES DIRECTORATE

SECURITY HANDBOOK

“SECURITY IN MIND SECURE IN BODY”

Collected by QNFMHS

CONTENTS

Page No

• Therapeutic Security 2 • Physical Security 3

• Procedural Security 4

• Relational Security 5

• Principles of Security 6

• Personal Safety 8

• Staff Responsibilities 10

• Security Group (Security Leads) 11

• The Role of Clinical Risk & Security

Liaison Staff. 12

• Security and Clinical Teams 13

• Risk Assessment 14

• Security Policies and Procedures 15

• Security Audits 16

• Security Training 17

• Security Information and Intelligence 18

• Fire Prevention 19

• Leave of Absence 20

• Raising Concerns 21

• Training Records 23

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THERAPUTIC SECURITY

The Specialised Services Directorate provides treatment for mentally disordered patients who, because of their dangerous, violent or criminal behaviour, need to be cared for in medium secure conditions for the protection of the public. Similarly, both the patients and staff caring for them need to be protected from harm.

The long-term aim of treatment is to help patients to recover their mental stability and self control, thus reducing their dangerousness so they can safely return to the community or a less secure environment. Unless this is achieved, security will be necessary to contain patients so that they receive the treatment they need with minimal risk to everyone.

Security and treatment share common features:

• Staff are responsible for both tasks, and a multidisciplinary approach is

required.

• Both require all the modern methods available in their fields to be used.

• Both are dependant on the development of good professional relationships with patients.

• Staff must be able to identify both acceptable and unacceptable risks in

activities. In addition staff must understand, accept and implement the action necessary to manage them.

• The aim of both is to create a confident workforce, peace of mind and a safer

society.

Given the above, we must work towards integrating the two activities to achieve Therapeutic Security. This is defined as:

“The management of risk to provide a safe working and living environment where the primary objective of rehabilitation can be achieved. In addition to physical and procedural measures, such security depends on all staff developing constructive relationships with their colleagues and patients, a commitment to therapeutic activity the provision of safeguards based on the level of risk presented by individual patients. Therapeutic security is a dynamic rather than a static process. It allows the highest quality multidisciplinary approach to the care and treatment of patients whilst protecting society’s wider interests.” (Elvins R. 1989)

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PHYSICAL SECURITY

Physical security measures are those elements which most people associate with the word, “security”. Within the Specialised Services Directorate these include:

• The structure and design of our buildings.

• Locks and keys – manual and electronic system. • Closed Circuit Television (CCTV) and alarm systems. • Communications equipment. • Staff. All need to be maintained to high standards and kept free from compromise. Effective physical security should: • Give an impression of strength and safety rather than oppression. • Provide a structured environment with different levels of security inside its

perimeter. • Provide reasonable and safe living conditions. • Enhance treatment. • Provide a safe setting where patients can test out their progress. • Make escape by our patients difficult.

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PROCEDURAL SECURITY

Procedural security is only as good as the people who operate it and their methods of working. Procedural security therefore refers to the methods and systems used to manage patients and maintain security.

It includes:

• Policies and procedures.

• Necessary checks and maintenance of physical security. • A system for reporting, collating and analysing security information and

imparting the intelligence gained. • Reception and screening of people and goods entering the Unit. • Search practices. • Techniques for dealing with aggression and violence. These systems must be: • Known, understood, accepted and implemented by all staff (Security as a “state

of mind”). • Be as unobtrusive as possible. • Based on clear policy statements and written operational instructions. • Backed by high calibre staff and sound personnel policies.

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RELATIONAL SECURITY

Sound professional relationships with colleagues, patients, their visitors and outside agencies, are essential to good security. Relational security provides the base on which high quality care and treatment is provided.

Relational security requires:

• Well motivated and trained staff.

• A detailed knowledge of patients, their problems, strengths and weaknesses. • Good multidisciplinary working, communication, support and clinical supervision. • Patient focused activity: - treatment programmes, education, rehabilitation, work,

leisure, social and spiritual activities. • Close liaison between clinical teams and their security colleagues. Whilst relational security can sometimes be difficult and demanding for staff, its value should never be underestimated. It is the element that enhances all forms of security and ensures effective treatment. • Staff must always be aware of their duty of care to patients. • Always maintain professional boundaries in your relationships with patients.

Remember many are emotionally damaged individuals who have previously been abused and are vulnerable.

• Staff should not form liaisons, no matter how well intentioned, which could be viewed as being exploitative or constitute a breach of professional codes of conduct and practice.

Staff should be aware that some patients, in particular those who may have a degree of personality disorder, may try to be subversive. This process may show itself in many ways. “Splitting is a common mechanism used to divide staff. By using this patient tries to “play one staff member off against another”. Another example is “conditioning”. The patient may try to manipulate and exploit staff by lulling them into a false sense of security, thus creating complacency and lack of attention to detail. This can be a very slow and insidious process. The aim is to acquire special concessions or advantage. This can be particularly dangerous when the practice is used on escorting staff, who place inappropriate trust in the patient. A consistent approach by all members of the clinical team, reinforced by good support and effective clinical leadership and supervision, is essential to counteract and minimise the effects of these processes.

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PRINCIPLES OF SECURITY Good security practices depend on an understanding of the principles which underpin them. They are: 1. The source of the breach of security is known-about, the quicker action can

be taken to prevent harm: Patient checks, tool and cutlery checks, searches, security information reports, alarms, electronic door controls and CCTV systems, are some of the early warning systems which can prevent potentially harmful incidents occurring.

2. The first breach occurs when it is known that a weakness exists: Failure to deal with security hazards increases the risk of harm occurring. Staff vigilance is important as patients may exploit weaknesses before we become aware of them. All weaknesses must be reported immediately, all security checks must be completed.

3. Security is everyone’s responsibility: Whatever their role in the organisation,

everybody is responsible for ensuring the protection of people and property and following security and Health and Safety at Work policies and procedures.

4. Security measures must be commensurate with risk: Security measure

should be based on the level of risk presented by patients and whenever possible, they should not be subjected to greater security than they require. The Wessex Forensic Psychiatry Service has evolved a system which allows for various levels of security depending on patient progress and response to treatment.

5. Security must have a good image: Security is required to make possible the

safe treatment of our patients, no obstruct it. Security tasks must be carried out in a fair, sensitive and professional manner.

6. Access is based on a need to go or need to know: Access by patients and

staff to certain places or information may be restricted or denied. Failure to comply with such restrictions would seriously threaten security or confidentiality.

7. No single measure provides effective security: A combination of several,

rather than single measures, gives best protection. Physical security must be reinforced by good relational and procedural security and effective treatment programmes.

8. Security measures should have an element of surprise for those attempting

to breach them: Never discuss security precautions with, or show keys, unit plan, security policies and procedures, etc., to patients or other people not professionally involved in our work. Security depends on co-operation: All staff in the Specialised Services Directorate have a vested interest in maintaining a safe environment and must work together towards that end. Equally, we should encourage the co-operation of patients and visitors in achieving this aim.

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9. Security depends on maximum compliance: All staff have a personal responsibility to ensure the unit’s security procedures are followed and must comply with security policies and procedures. One person’s non-compliance may seriously affect the safety of others. The compliance of patients and visitors should also be sought and appropriate action taken where this is not forthcoming.

10. Those responsible for breaches of security should be identified: This is

important if we are to prevent the breach escalating into a serious incident or take action to avoid a repetition of the behaviour.

11. An individual’s level of dangerousness is seldom constant: Few people are

dangerous all the time but are likely to pose a risk in certain situations, at certain times or to certain individuals. Good relational security and knowledge of patients would assist us to predict and manage those risks pro-actively. It is also vital that other security systems including treatment plans are sufficiently flexible and robust to adapt to changes of risk.

12. The level of some types of risk may be increased in patients suffering

certain mental disorders: Whist we should as far as possible avoid stereotypes, there is evidence which demonstrates that certain categories of patient pose greater risks than others. Research demonstrates for example, that personality disordered patients are frequently involved in acts which threaten security and the therapeutic environment (e.g. escape, violence, exploitation and intimidation of others, etc.). Multidisciplinary teams should take such considerations into account when treatment planning.

13. Security measures should not unduly affect human rights: Our aim is to

provide a safe environment where patients can be treated, not punished. Every effort should be made to ensure that our practices are humane and do not infringe human dignity and rights unnecessarily

Remember: “The guiding principle must always be that the most effective form of security, and indeed, safety, lies in the treatment of the patient”. (Kinsley J. 1992)

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PERSONAL SAFETY Whilst the Specialised Services Directorate takes all reasonable measures to ensure the safety of its staff, there is much that individuals can do to protect themselves and others from harm. Personal safety is a state of mind. It is about being prepared and using common sense to avoid victimisation. Sadly, many preventable incidents are inadvertently caused by staff actions. The following advice is intended to minimise such occurrences: • Staff must always wear ID badges when at work. • Always wear clothing and footwear appropriate to your job. If working in patient

areas, be aware that scarves, non clip-on ties, high heeled shoes etc., may contribute to injury if involved in a violent incident.

• Don’t wear large amounts of jewellery at work particularly items that may cause

harm to self or others (e.g. chains, large rings or earrings, brooches, body piercings, etc.).

• Don’t bring dangerous items (e.g. penknives, scissors, steel combs, etc.) to

work. • Take care of personal items, such as wallets, handbags, car and house keys.

Don’t carry large amounts of cash or personal documents. • Always report loss of items that might pose a security risk to the Nurse/Person

in Charge. • Be sensible about personal information that you give to patients and their

relatives. Never tell them your address, telephone number or complete details about your family or car.

• Dispose of plastic and polythene bags, sharps, glass items and tins in

accordance with unit policy. Alcohol is not allowed inside the unit. • Never take out mail and parcels for patients or bring in items for them without

permission from a senior manager. • Never trade with or accept gifts from patients and their relatives without

permission. Report any attempts by patients or their relatives to intimidate you into breaching the unit’s security, to your line manager and Clinical Risk & Security Liaison Nurse.

• When entering wards/departments, always report your presence to the person

in charge and notify them when you leave. • When working in patient areas remain vigilant and aware of what is happening

around your area. If working alone with a patient always make colleagues aware of your location and, if possible, remain within sight or sound of them or arrange for colleagues to carry out regular checks.

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• Trust your intuition. If you feel a situation is becoming unsafe, seek assistance. It is better to be embarrassed than victimised. If attacked, call for help from your colleagues by using your personal alarm, or radio if carried.

• Regularly read and update your knowledge of security policies and procedures. • Report any loss of ID badges or keys to the Reception, or Nurse/Person in

charge immediately. • Inform Reception of changes of address, telephone number or vehicle. • Park vehicles only in approved places and always secure them.

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STAFF RESPONSIBILITIES Everyone working in the Specialised Services Directorate contributes in some way to the treatment and care of patient. Similarly, we all have a part to play in ensuring that such treatment is delivered safely. All of us are responsible for ensuring the ongoing safety of the public, our patients, our colleagues and ourselves. Each of us must: • comply with security policies and procedures. • report any breaches of security immediately. • report any concerns about security immediately. • report any approaches from outsiders about patients or security measures. • be aware of potential security hazards and manage them appropriately. • never do anything which jeopardises the physical security of the unit. • never bring items which are a security risk into the unit without prior approval of

Clinical Risk & Security Liaison Nurse. • always consider the impact of our actions may have on public safety. • co-operate with each other and promote Multidisciplinary Team working. • never develop inappropriate relationships with patients or their relatives. • Seek advice from the Clinical Risk & Security Liaison Nurse if in any doubt.

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SECURITY LEADS Since security is fundamental to the Directorates function, it is vital that there is a central body accountable to the Clinical Governance Group which monitors and co-ordinates security matters. That role is provided by the Security Group, through Security Leads. The Security Group is a multi-disciplinary body. Its membership includes: Clinical Risk & Security Liaison Nurse + ` Clinical Risk & Security Liaison Support Worker.

Medical Representative Support Services Representative. Psychology Representative Social Work Representative. 0.T Representation Representative from each ward

The Security Leads: • Provides a forum for discussion on all security issues. • Develops and / monitors security policy. • Provides advice on security matters to the Clinical Governance Forum. • Analyses and distributes security intelligence to relevant parties. • Ensures that any security lessons to be learned from official inquiries are

disseminated.

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THE ROLE OF SECURITY STAFF The Clinical Risk & Security Liaison Nurse and his team oversee all security matters within the unit. They provide a vital support function to Multidisciplinary Teams and other departments. They have developed particular knowledge and expertise in security matters and have established links with other agencies in the Health and Criminal Justice systems. Advice can be given on a wide range of security issues including the assessment and management of risks associated with patients, public safety, policies and procedures and maintaining a safe environment. Please do not hesitate to use us. Security Service Personnel: • control all pedestrian and vehicular access into and out of the units. • control lock and key issues. • assist in the development of security policies and procedures and contingency

planning for a variety of incidents. • provide advice and support to Multidisciplinary Teams. • liaise locally and nationally with a number of agencies, including Police, Prisons

and other Medium and High Secure Facilities. • conduct Security Audits. • monitor incidents. • collect, collate and distribute information and intelligence on security matters. • organise and provide security training.

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SECURITY AND MULTIDISCIPLINARY TEAMS The ongoing safety of the public is ultimately dependent on the effectiveness of the treatment of patients have in hospital. All members of the Clinical Team under the leadership of the patient’s Consultant Psychiatrist (Responsible Medical Officer) have a vital role to play in this process. Effective treatment can only be delivered if patients and staff are confident that they can safely engage together in what can sometimes be threatening and stressful circumstances for all involved. Multidisciplinary Teams must: • ensure proper and due consideration is given to security and forensic issues. • identify potential risks and ensure that treatment plans take the management of

these into account. • ensure as wide as possible representation of the disciplines involved in a

patient’s care particularly are present when assessing risk to others and the public.

• address the concerns of any MDT member or patient about any proposed

course of action. • ensure that all information and decisions relating to risk

assessment/management issues are appropriately recorded and disseminated. • involve the Clinical Risk & Security Liaison Nurse in their discussions whenever

possible and always when the safety of individual or the public is at issue. • maintain a safe environment in all areas where treatment of patients is

provided.

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RISK ASSESSMENT A belief that security or treatment measures can totally eradicate all elements of risk is not only false but dangerous and undesirable. Attempts to achieve a totally secure environment would create resentment and invite attempts to overcome it. Successful treatment of our patients requires us to take some risks. These need to be carefully assessed and managed so as to obtain maximum, benefit for patients whilst minimising harm to others. Good risk assessment requires us to integrate therapeutic and security skills so that identified risks can be managed appropriately. Effective Risk Assessment should: • consider information from ALL of the MDT’s. • consider information from other sources (e.g. previous reports, etc.). • involve the patient whenever possible. • identify foreseeable hazards and their consequences. • rate the likelihood or risks and potential for harm to people or property. • agree measures to control identified risks, minimise their occurrence and

maximise intended benefits. • record the decision making process and how decisions were reached. • specify individual responsibilities and resources required. • specify any limitations of the assessment and how they may be addressed in

the future. • be regularly reviewed and updated. • influence treatment, care and management of the patients. • have contingency plans for the management of untoward incidents. Good inter-disciplinary communication and understanding is the key to successful risk assessment and management.

“All tragedy is the failure of communication” (J. Wilson)

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SECURITY POLICIES AND PROCEDURES Good security policies and procedures are essential to our daily practice. Without them our physical and relational security measures would be severely compromised. They have been dev eloped following wide consultation and in the light of previous experience of events within the hospital and other Medium facilities. Security Policies and Procedures • must be complied with at all times. • can only be changed by the Clinical Governance Forum following the

appropriate consultation papers. • are regularly reviewed and updated when necessary. • must be read, signed and understood by all staff who should update their

knowledge regularly. • must be available in all work areas. • are the responsibility of every Manager/Departmental Head to implement. • must only be disclosed to patients or outsiders on a need to know basis.

Policies and procedures exist to protect us all. Maximum compliance offers greatest safety.

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SECURITY AUDITS As an organisation we need to know that security policies and procedures work and are being carried out effectively. To ensure that this is the case Security Audits, which systematically examine security practices, are to be carried out regularly. The Audits: • Cover all wards and departments inside the secure area. • Identify how well procedures are working. • Identify deficiencies in physical, procedural and relational security. • Motivate staff to provide a high quality service. • Assess the knowledge of staff. • Provide feedback to the area audited, Senior Management Team and the

Clinical Governance Group. • Provide an action plan for rectifying deficiencies. • Allow opportunities to highlight best practice. • Guard against complacency. • Identify training needs. • Allow us to be proactive rather than reactive by preventing problems creating

incidents. • Raise confidence and give peace of mind.

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SECURITY TRAINING Training to raise security awareness is given a high priority. Such training, which is multidisciplinary, aims to promote understanding of the complementary relationship between security and therapy. Training organised or provided by Security Services includes: • Security awareness (all induction courses). • Security updates. • Search training. • Use of radio. • Use and care of keys. • Drug recognition / awareness. • Risk assessment / management. • Escorting procedures.

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SECURITY INFORMATION AND INTELLIGENCE The collection, collation, analysis and distribution of security information about patients and their activities is a key function of Security. It enables us to develop security intelligence which allows managers and clinical teams to make effective operational decisions and be proactive. Effective security intelligence depends on: • Staff awareness of they key role in supplying information to us. In effect you are

“eyes and ears” and will often see or hear events of which we may be unaware. • “Raw data” in the form of information from a variety of sources. These include

staff, patients, visitors, verbal and written reports, etc. • Staff reporting information promptly to us. Never think that your information will

be useless because it only affects your work area, or the event has passed. What you tell us may help us build up a better picture of what is happening on a wider basis within the hospital.

• The quality of information. Whilst any information is better than none the best

will generally be in written form which identifies its source and supplies any supporting evidence. The Security report forms will often be the best means of doing this. However, other methods such as an E-mail or verbal report will be acceptable.

• Security staff collate the information by putting it into some sort of order for

analysis. Written information helps this process particularly if it gives details of WHEN, WHERE, WHO, WHAT, WHY and HOW.

• Effective analysis and evaluation of the information by Security personnel.

Sometimes we may require further assistance in obtaining further information to fill in gaps or increase the reliability of the intelligence.

• Feedback being given, whenever possible, to the people who have assisted us

by supplying information. Intelligence will always be passed to the people best able to act on it and prevent harm or disruption to the hospital’s work.

• Trust, respect and a genuine desire to ensure that security and treatment are

integrated to create a safe workplace.

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FIRE PREVENTION The risk of fire in the Specialised Services Directorate is increased because some of our patients have a history of fire-setting. In addition the obvious dangers of fire, it can also be a security risk. To prevent fire and minimise security risk: • Staff who smoke, are not permitted to carry a personal lighter at work. • Loss of these items must be immediately reported to the Reception. • Lighter fuel must not be brought into the hospital. • On Malcolm Faulk ward only ward lighters should be in use, any other lighters

found on patients should be removed and the fact reported to the Ward Manager and Clinical Risk & Liaison Nurse.

• Smoking should only take place in designated smoking areas. Ashtrays must

be used. These should be regularly and safely emptied. • Do not allow rubbish to build up in work areas – it may fuel a fire. • Know what action to take in the event of fire – always know the policy and

attend annual Fire and Safety updates. • Remember that the preservation of life is a priority. • If a fire appears to have been deliberately set, be aware that it could be to

create a diversion for a breach of security elsewhere in the unit.

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LEAVE OF ABSENCE Patients are taken outside the Unit for a number of reasons either as part of their treatment plan (e.g. rehabilitation trips, compassionate visits, medical treatment at other hospitals) or for legal reasons (e.g. court appearances, transfer to prison). During these events there will/may be some degree of risk to the public. Whilst that risk is usually low, as is the incidence of absconding, staff should never become complacent. When escorting patients outside in the community, we have less control over the environment and support may be limited. Therefore, all access should be carefully planned and everything done to ensure that risk to the public, staff and patient is kept to a minimum. To ensure that Leaves of Absence are carried out safely, MDT’s must: • Ensure that the purpose of the LOA is clearly justified as part of the treatment

plan, or is for legal, compassionate or quality of life reasons. • Ensure that in the case of restricted patients, Home Office permission has been

obtained for the LOA. • Hold a multidisciplinary meeting to assess any associated risks (e.g. venue,

absconding, child protection issues, etc.), decide a plan to manage these and the resources required. A written record must be made in the patient’s notes.

• Ensure that the benefits of the LOA outweigh the risks. • Ensure that the LOA access sheet is completed and signed by the RMO well

before the date it is to take place. (Section 17). • Involve the Clinical Risk & Security Liaison Nurse whenever possible, and

always where it is thought that an LOA, which is not necessary on legal or medical grounds, carries a high risk.

• Ensure that at least one of the escorts has had regular clinical contact with the

patient prior to the LOA. • Ensure that escorting staff have read the Nursing Notes, are aware of their role,

the patient’s history, any specific treatment or security requirements and know what action to take in the event of an absconding or other emergency.

• Ensure that on the day of the LOA an assessment is carried out by the nurse in

charge prior to the patient and escort leaving the Unit. If concerns are raised at this time, the visit should be postponed pending clinical review.

• Ensure that a written report is provided by escorting staff, on completion of the

LOA.

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RAISING CONCERNS We all have a vested interest in maintaining a secure environment. If you have any concerns about security, or any suggestions to make about improving it, please let us know. You can raise such issues: With your Charge Nurse, Ward Manager, Departmental Head. With the Clinical Risk & Security Liaison Nurse. Through the Security Leads. Monthly open forum Open forums and honest communication is always welcome – security is too important for you not to raise your concerns.

“Silence is the virtue of fools” Francis Bacon 1561 - 1628

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REMEMBER SECURITY IS YOUR RESPONSIBILITY

SAFETY STARTS WITH YOU.

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NOTES.

RADIO TRAINING

FULL TRAINING COURSE DATE

SIGNATURE

ESCORT TRAINING

FULL TRAINING COURSE DATE

SIGNATURE

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ANNUAL SECURITY TRAINING

FULL TRAINING COURSE DATE

SIGNATURE

Jan. 2007 Alex J. Bone. Clinical Risk & Security Liaison Nurse.

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