National Preventive Mechanism Eleventh Annual Report 2019–20 There continued to be significant concerns about safety raised by IMBs with rises in both self-harm and violence in many prisons, often caused by drugs and debt. Prisons holding young adults remained particularly volatile. The HMYOI Feltham IMB reported an increase in prisoner on prisoner assaults and at HMYOI Deerbolt, though violence had reduced by the third quarter of the year, the IMB reported that the HM Prison and Probation Service (HMPPS) challenge, support and intervention process was being used punitively and for those who were vulnerable and bullied. Many young people were said to be transgressing so they could go into the relative safety of segregation.120 At HMYOI Aylesbury, self-harm had increased by over 50% and assaults by over 100%. At HMP/YOI Swinfen Hall, the Board noted that violence was twice as high as in 2015, though there had been a notable increase in self-harm, with the under-21 population accounting for over 70% of self-harm incidents and 87% of resulting hospital admissions. The IMB also noted the connection between violence and a poor regime: as the regime stabilised, violent incidents decreased.121 Some IMBs reported on new approaches to reduce the use, and length, of segregation in prisons in England and Wales. However, concerns remain that too many prisoners with serious mental ill health issues were being segregated, often in extreme conditions for lengthy periods. Boards reported that four prisoners at HMP Woodhill were segregated for over 200 days, awaiting transfer either to the close supervision centres or to a mental health setting, while at HMP Lowdham Grange stays in segregation of over 100 days were recorded, with one prisoner still awaiting a mental health placement after 191 days. Boards also reported the segregation of prisoners at risk of suicide and self-harm and on assessment, care in custody and teamwork case management for prisoners at risk of suicide or self-harm (ACCT) reviews. More positively, at HMP Erlestoke the Board noted a decrease in the number of segregated prisoners on ACCTs and a 60% decrease in the use of segregation. The Board at HMP Littlehey also reported an overall reduction in the use of segregation.122 120 IMB, September 2020, Independent Monitoring Boards National Annual Report, 2019-20 https://s3-eu-west-2.amazonaws. com/imb-prod-storage-1ocod6bqky0vo/uploads/2020/10/IMB-national-annual-report-201920-amended-FINAL-.pdf [accessed 30/10/2020] 121 IMB, September 2020, Independent Monitoring Boards National Annual Report, 2019-20 https://s3-eu-west-2.amazonaws. com/imb-prod-storage-1ocod6bqky0vo/uploads/2020/10/IMB-national-annual-report-201920-amended-FINAL-.pdf [accessed 30/10/2020] 122 IMB, September 2020, Independent Monitoring Boards National Annual Report, 2019-20 https://s3-eu-west-2.amazonaws. com/imb-prod-storage-1ocod6bqky0vo/uploads/2020/10/IMB-national-annual-report-201920-amended-FINAL-.pdf [accessed 30/10/2020] 40