The ACDT System
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Those who are noted to be distressed, have self-harmed, or to have expressed suicidal thoughts, are monitored and managed in all centres in the first instance by custody officers rather than health care staff, through the Assessment care in detention and teamwork (ACDT) system. This is a process imported from the prison system, which allows any member of Home Office staff, supplier or healthcare staff who has identified concerns that a detained person is at risk of self-harm or suicide to start the ACDT process. The policy sets out potential situations of heightened risk (see page 7 of the ). ACDT is a highly document heavy process with many requirements for strict timing and recording of decisions about the person and sharing this information within the detention estate.
The ACDT process involves documentation of identified risks, triggers and protective factors for the individual, with regular multidisciplinary case review meetings to consider what actions can mitigate the overall risk to the person. In practice this generally means placing the person under regular observations and contact with staff. In some cases, this can involve periods of constant observation where the person is not permitted to be alone and is continually in the presence of staff. It can also result in moving the person within the detention site to places to manage the risk. This can include accommodation in Enhanced Care Unit within the healthcare environment or placing the person in segregation conditions and so separating them from the rest of the detained population. Other options include considering the availability of additional support, including contact with people from outside detention. Although visitors are not mentioned in the policy, the requirement to consider external sources of support may offer the opportunity for increased contact with the person being visited.
Whilst a person is under the ACDT process they should not generally be transferred to another detention site. If this happens then there is a procedure for information about the person to be shared with the receiving institution. Where a person is released from detention whilst still under the ACDT process then there is a limited obligation on the Home Office to signpost the person to sources of support in the community and to share information with other agencies such as social services or the NHS or other medical organisations.
The ACDT process is only permitted to end after a case review which decides that the individual is no longer at a raised risk and where all actions initiated as part of the case reviews are complete. The final action is a further review meeting held seven days after the decision to end placing the individual under ACDT processes.
