Section two Focus on detention issues prison, where one NPM member found men in the care and separation unit fearful of returning to their wing who had remained there for months, and one who had been in segregation for several years. Average lengths of stay in segregation units in England and Wales ranged from three days to 12 days but could be considerably longer. Some of the men in CSCs had been there continuously for several years, including one who had been selected for the CSC in 1999. In most instances, the time spent in ‘special accommodation’ lasted a few hours, but in two prisons an NPM member found several instances of prisoners being held all night or for over 15 hours. Rationale and justification In many instances, NPM members find decision-making for isolation under the specific prison rules set out above to be justified and a clear rationale given. However, in several prisons included in this review they were not convinced that all segregation or the use of special accommodation were necessary or as a last resort. In one prison, inspectors found overuse of segregation ‘pending adjudication’ or ‘pending investigation by security’. Prisoners identified as at risk of suicide or self-harm are managed using assessment, care in custody and teamwork (ACCT) procedures, which are aimed at reducing risk through care planning.62 Prisoners on an ACCT should only be segregated in exceptional circumstances, with clearly documented reasons and evidence of other options exhausted. However, NPM members have consistently raised concerns about the segregation of at-risk prisoners. In several instances in this review, NPM members found that high numbers of prisoners on ACCTs had been held in segregation and questioned whether there were, in fact, the exceptional circumstances that warranted their segregation. In one prison, 45 prisoners on ACCT documents had been segregated in the six months before the inspection. It was of great concern that five prisoners took their own lives while in segregation units in 2014–15, of whom one was on an ACCT at the time. In one prison an NPM member noted that safety algorithms were applied to take into account prisoners’ mental health before segregation was approved, and in another it was clear from interactions with staff that mental health needs and vulnerabilities were considered, but these were not recorded in full. In one prison, outside the scope of this review, inspectors found several prisoners ‘self-isolating’ because they were afraid to leave their cells because of threats from other prisoners or unresolved debt. All had extremely restricted regimes and none had any formal support, reintegration or management plans.63 Inspectors have also reported on prisons where men committed misconduct so they would be taken to the segregation unit where they would be safe from gangs and bullying, and then often transferred to another prison.64 62 National Offender Management Service, Prison Service Instruction 64/2011 Management of prisoners at risk of harm to self, to others and from others (Safer Custody). At: http://www.justice.gov.uk/downloads/offenders/psipso/psi-2011/psi-642011-safer-custody.doc (accessed 14/10/15). 63 HM Inspectorate of Prisons, 2015), Report on an unannounced inspection of HMP Humber, by HM Chief Inspector of Prisons, 13-24 July 2015. 64 HM Inspectorate of Prisons (2014), Report on an unannounced inspection of HMP Guys Marsh, by HM Chief Inspector of Prisons, 10-21 November 2014. 25