Commissioner's directive 843: Interventions to preserve life and prevent serious bodily harm

RESPONSIBILITIES

1. The Assistant Commissioner, Health Services, will authorize the development of Guidelines that must be followed with respect to the use of enhanced observation and the Pinel Restraint System.
2. The Institutional Head will ensure that:
   1. staff receive suicide and self-injury intervention training and training on the use of the Pinel Restraint System, in accordance with the target groups of the National Training Standards
   2. an appropriate bed, chair, or stretcher to accommodate the Pinel Restraint System is available in the institution (not mandatory in minimum security institutions and Healing Lodges)
   3. for cases in which the inmate is engaged in self-injury which is deemed likely to result in serious bodily harm, and all other less restrictive measures have been attempted and were unsuccessful at ceasing the behaviour, they, or the Executive Director in a Treatment Centre as their designate determined by a Standing Order, authorize the use of the Pinel Restraint System
   4. they, or the Executive Director in a Treatment Centre as their designate determined by a Standing Order, authorize initial placement on High Watch or Modified Watch and any subsequent modifications to the conditions (monitoring and access to personal items) based on an ongoing assessment of risk
   5. they authorize Mental Health Monitoring when a health care professional is not available
   6. all video-recordings of the use of the Pinel Restraint System are reviewed, in consultation with the Chief, Mental Health Services, and that any concerns are reported to the Regional and National Complex Mental Health Committees
   7. they consider risk-related advice from Health Services, whenever possible, prior to authorizing or changing the use of the Pinel Restraint System, or authorizing High or Modified Watch
   8. if any of the required assessments (i.e., mental health or physical health assessment) cannot be facilitated while on High or Modified Watch or while in the Pinel Restraint System within the timeframes stated in this policy, the inmate is transferred, as soon as practicable, to a Regional Treatment Centre or an appropriate health care facility/unit

   Note: Upon transfer, the receiving facility assumes authority for the management of the Pinel Restraint System and High or Modified Watch.

   9. a communication process is in place so that staff and contractors who have regular interaction with an inmate are informed when the inmate has been placed in the Pinel Restraint System, or has been placed on High Watch, Modified Watch or Mental Health Monitoring or when the enhanced observation level and/or conditions of observation have been changed
   10. any application, modification of use, or removal of the Pinel Restraint System, as well as any placement of an inmate on an enhanced observation level or change to the enhanced observation level, are documented per standard security, case management and health processes
   11. inmates placed on an enhanced observation level or in the Pinel Restraint System are informed of the right to have access to a Chaplain/Elder/Spiritual Advisor as well as to spiritual practices
   12. information on suicide prevention is available to inmates
   13. associated Standing Orders are regularly reviewed and updated as required.
3. All staff and contractors will:
   1. intervene immediately when an inmate is discovered in the act of self-injury or attempting suicide. Interventions must be in accordance with CD 567 – Management of Security Incidents and CD 567-2 – Use of and Responding to Alarms
   2. ensure that interventions with a self-injurious or suicidal inmate or an inmate with serious mental illness with significant impairment requiring enhanced observation under this policy are communicated to other staff and contractors who have regular interaction with the inmate
   3. document all behavioural indications, threats and actual situations of self-injury and/or attempted suicide
   4. communicate openly with the inmate to support collaborative work on their recovery and wellness while ensuring the protection of their dignity and safety
   5. support de-escalation, wellness and comfort activities for inmates
   6. respect gender, cultural, religious and linguistic differences, and be responsive to the special needs of women and Indigenous peoples.
4. A health care professional:
   1. may authorize Mental Health Monitoring
   2. will conduct mental health and physical health assessments within their scope of practice and competence
   3. will provide ongoing advice and recommendations to the Institutional Head on the mitigation of risk of serious bodily harm to the inmate or others
   4. will engage the inmate in a treatment plan to work on their recovery per the Integrated Mental Health Guidelines
   5. will engage Elders and Spiritual Advisors to facilitate the provision of culturally appropriate supports for Indigenous inmates
   6. will report to the Chief, Mental Health Services, or Chief, Clinical Services, whenever they consider that an inmate’s physical or mental health has been or will be adversely affected by any practices or conditions of observation
   7. based on an in-person mental health assessment, will document, within 24 hours of an inmate being placed in the Pinel Restraint System or on enhanced observation, whether the inmate's needs can be met at their existing institution or if a referral to a Treatment Centre/health care facility should be initiated.
5. Unlicensed mental health staff may provide any of the required monitoring, assessment and intervention under the clinical/functional supervision of a licensed mental health professional.

SCREENING FOR SUCIDE RISK BY NON-HEALTH CARE PROFESSIONALS

6. The Immediate Needs Checklist – Suicide Risk (CSC/SCC 1433e) will be used:
   1. within 24 hours of arrival to any CSC institution (including intake, inter/intra-regional transfers, warrant of suspension, following a court return, and transfers and movements between security levels within a clustered site and women offender institutions). This does not include movements between levels of intermediate mental health care within a clustered site or when an inmate is transferred while continuously on an enhanced observation level
   2. upon admission to administrative segregation
   3. as a stand-alone screening tool by any non-health care staff or contractor interacting with the inmate when there is reason to believe that the inmate may present some risk for suicide and a health care professional is not immediately available.
7. Referral to a health care professional will be made using the Referral for Health Services form (CSC/SCC 4000-01e) and documented in a Casework Record.

PROCEDURES FOR ASSIGNING ENHANCED OBSERVATION LEVELS

Enhanced Observation Levels (High Watch, Modified Watch and Mental Health Monitoring)

8. High or Modified Watch will only be used as a last resort after all reasonable efforts to use alternative, less restrictive measures and de-escalation strategies have been considered or implemented and assessed as not effective. The decision to use High Watch or Modified Watch is based on an individualized risk assessment.
9. High and Modified Watch are to be used for the shortest possible duration.
10. An inmate who is at elevated or imminent risk for suicide, is actively engaged in self-injurious behaviour, or has been identified by a health care professional as having a serious mental illness with significant impairment and whose risk cannot be safely managed within the normal institutional routine may be placed on High or Modified Watch if the requirements of paragraph 8 have been met and the inmate’s risk has not been sufficiently mitigated.
11. An inmate assessed as requiring High or Modified Watch will:
    1. be placed in an observation cell
    2. have a mental health assessment completed, in person, by a health care professional as soon as practicable, but within 24 hours; the frequency of subsequent mental health assessments will be determined by a health care professional but these assessments will occur no less than once every 24 hours. The health care professional will review and initial the Seclusion and Restraint Observation Report (CSC/SCC 1006) and incorporate any relevant information into the assessment
    3. be given the opportunity to provide input on the use of enhanced observation, be informed of the reason for placement on enhanced observation, and be provided reasonable access to relevant documentation
    4. be informed of the right to engage an advocate.
12. Should an inmate remain continuously on High or Modified Watch for a period greater than 72 hours, the case will be presented to the Interdisciplinary Mental Health Team (IMHT) to consider strategies for reducing time placed in enhanced observation. This review must take place as soon as practicable following 72 hours on High or Modified Watch. The review will, at a minimum, look at the following areas:
    1. whether a treatment plan is in place
    2. consideration of all alternatives to the High or Modified Watch
    3. whether a plan to discontinue the Watch is in place
    4. the need for additional reviews.
13. Should an inmate remain continuously on High or Modified Watch for a period greater than five days, the case will be reviewed by the Chief, Mental Health Services.
14. Should an inmate remain continuously on High or Modified Watch for a period greater than seven days, the case will be reviewed by the Regional Complex Mental Health Committee. The review must take place as soon as practicable following seven days on High or Modified Watch.
15. In the exceptional case of an inmate remaining continuously on High or Modified Watch for a period greater than 15 days, the Regional Complex Mental Health Committee will notify the National Complex Mental Health Committee.
16. In the case of inmates on High or Modified Watch, the Correctional Officer/Primary Worker (or it may be health care staff in Regional Treatment Centres) will document the inmate’s activities on a Seclusion and Restraint Observation Report (CSC/SCC 1006), as required, but at least every 15 minutes.
17. When an inmate has been assigned an observation level, the Nurse will review the inmate's medication administration profile within 24 hours, taking into account the inmate’s level of risk for self-injurious or suicidal behaviour, and consult with the Psychiatrist or the institutional Physician, as required.
18. The health care professional will document their risk-based advice and recommendations on the High Watch Observation Form (CSC/SCC 1434) or the Modified Watch Observation Form (CSC/SCC 1435) and provide the form to the Institutional Head for their review and decision. The health care professional, or in their absence, the Institutional Head authorizes Mental Health Monitoring. The health care professional or the Institutional Head will complete the Mental Health Monitoring Form (CSC/SCC 1436). A copy of the watch form will be given to the Duty Correctional Manager, who will ensure that it is accessible to staff on all shifts who have regular interaction with the inmate.
19. At shift briefings, the Duty Correctional Manager will advise Correctional Officers/Primary Workers of any inmates who are currently assigned an observation level and the conditions of the observation level.

High Watch

20. An inmate placed on High Watch will be provided with:
    1. at minimum, a security gown, at all times
    2. a security blanket and mattress, unless the inmate attempts to use these items in a manner that is self-injurious or affects staff’s ability to monitor the inmate. In this case, the items can be removed from the cell, with the intention of returning the items as soon as safely practicable
    3. the offer of a change of security gown/blanket daily, or as required
    4. fluids and food that can be easily consumed without cutlery or tableware (finger foods)
    5. hygiene items (the health care professional will advise the Institutional Head when to provide hygiene items if these items are associated with any risk for suicidal or self-injurious behaviour and will also inform the Duty Correctional Manager).
21. Inmates on High Watch will be under constant, direct observation by a Correctional Officer/Primary Worker (or it may be health care staff in Regional Treatment Centres). Monitoring via camera does not fulfill this requirement. When a male staff member is monitoring a woman inmate, he must be replaced immediately by a female staff member when the inmate requests to use the washroom or to change clothing.

Modified Watch

22. In addition to the items listed for an inmate placed on High Watch and taking into consideration the risk-based advice from the health care professional, an inmate placed on Modified Watch will be provided with:
    1. personal items, including but not limited to clothing, books and writing materials
    2. cutlery and/or tableware, and regular institutional meals in lieu of finger foods.
23. This access is given in order to move towards normalizing the inmate’s environment to the extent that is possible. It also affords the opportunity to evaluate the inmate’s response to a reduction of restrictions while the inmate is under continuous observation.
24. Inmates on Modified Watch will be monitored via direct observation as noted above, or under constant observation via closed circuit television (CCTV). If constant observation takes place via CCTV, a dedicated staff member will be assigned to complete the observation. At women offender institutions/units, only women staff will monitor inmates under camera surveillance. Monitor screens will be situated in posts in such a way as to ensure the inmate’s privacy.

Mental Health Monitoring

25. An inmate will be placed on Mental Health Monitoring by the Institutional Head or a health care professional when they are at risk for suicide or self-injury or have been identified by a health care professional as requiring an enhanced level of observation due to a serious mental illness with significant impairment. Frequency of monitoring will be determined by the health care professional.
26. An inmate on Mental Health Monitoring will not be restricted to their cell.

Modifications to Observation Level

27. If there is a perceived increase in risk to self or others, staff will immediately notify a health care professional and the Institutional Head who will modify the observation level as required.
28. Any change will be documented on the appropriate observation form (CSC/SCC 1434, 1435, or 1436).
29. The health care professional will provide recommendations to the Institutional Head when the inmate’s risk can be managed on a lower, or no, observation level.

APPLICATION OF RESTRAINT EQUIPMENT

30. The Pinel Restraint System is the only restraint system to be used for self-injurious behaviour in maximum and medium security institutions, women offender institutions, and Regional Treatment Centres. Minimum security institutions and CSC-operated Healing Lodges may use the Pinel Restraint System, if available.
31. The Pinel Restraint System will only be used as a last resort after all reasonable efforts to use alternative, less restrictive measures and de-escalation strategies have been considered or implemented and assessed as not effective. The Pinel Restraint System will be used for the shortest amount of time required to manage an emergency safety risk. The use of the Pinel Restraint System does not replace efforts to understand and address the causes of the inmate’s behaviour, nor is it intended to be the principal intervention.
32. The Pinel Restraint System will only be applied and removed by trained staff.
33. Inmates will be appropriately clothed or covered while restrained.
34. To avoid positional asphyxia, at no time will a restrained inmate be placed lying face down. An inmate restrained to an appropriate bed/chair/stretcher will be placed either in the recovery position (lying on the side) or on their back with head elevated.
35. When an inmate is placed in the Pinel Restraint system, they will:
    1. be given the opportunity to provide input on the use of the restraints, be informed of the reason for placement in restraints and be provided reasonable access to relevant documentation
    2. be informed of the right to engage an advocate.

Pregnant Inmates

36. Restraints will only be used as a last resort with pregnant inmates (per CD 567-3 – Use of Restraint Equipment for Security Purposes) and will not be used following childbirth until the physician has cleared the inmate to return to normal activities. If the Pinel Restraint System is being considered for application on a pregnant inmate, approval by a Physician will be sought if time and circumstances permit (or the Physician will be contacted immediately thereafter).
37. If restraints are applied, extreme caution will be exercised.
38. Pregnant inmates will not be positioned flat on their back at any time. Pregnant inmates who are restrained in bed will be tilted on their left side. Approval is required from the attending Physician for any other position than tilted on the left side.
39. In situations where a pregnant inmate is restrained, they will be constantly monitored, in person, by a Correctional Officer/Primary Worker (or it may be health care staff in Regional Treatment Centres).

Use of Force During Application of the Pinel Restraint System

40. Any time force is used in the application of, through to the removal of, the Pinel Restraint System, it will be in accordance with CD 567-1 – Use of Force.

Assessment and Monitoring of the Use of the Pinel Restraint System

41. In mainstream institutions, all uses of the Pinel Restraint System will be videotaped for the duration.
42. When a Nurse is present during the application of the Pinel Restraint System, they will conduct an initial assessment of the inmate’s physical and mental health once the restraints have been applied. This assessment will include, at a minimum:
    1. ability to breathe without restriction
    2. heart rate, respiratory rate and oxygen saturation
    3. circulation to the hands and feet
    4. mental status exam
    5. referral to another health care professional, as required.
43. When there is no Nurse present during the application of the Pinel Restraint System:
    1. Nurse will be called to attend the institution and complete the health assessment within two hours of its application. If this is not possible, arrangements will be made to ensure this assessment is completed by another health care professional within the two-hour timeframe
    2. while waiting for the Nurse to arrive, a First Aid/CPR certified staff member will immediately complete a First Aid assessment, take action as appropriate and notify the Duty Correctional Manager once the assessment is completed and if there are any concerns. While waiting for the Nurse to arrive, in person constant monitoring of the individual will be maintained by a First Aid/CPR certified staff member. Staff response to medical emergencies will be per GL 800-4 – Response to Medical Emergencies.
44. If the inmate refuses a post-use of force or health assessment, the Nurse may perform the assessment based only on observation and interview data. The Nurse will observe the inmate to ascertain whether or not there are any signs of physical distress which require immediate intervention. If no signs of physical distress are present, the Nurse will document the refusal and return at the next designated time to re-offer the appropriate assessment.
45. An inmate placed in the Pinel Restraint System will be under constant observation by a Correctional Officer/Primary Worker (or it may be a health care professional in Regional Treatment Centres) by direct view (face-to-face).
46. The Correctional Officer/Primary Worker (or health care professional, if applicable) will ensure the inmate's safety as well as record the inmate's general appearance and behaviour. Situations that are to be reported to the Nurse on duty (or to the Duty Correctional Manager when the Nurse has not yet arrived) include, but are not limited to:
    1. excessive sweating
    2. difficulty breathing
    3. complaints of pain
    4. increase in thirst
    5. increase in restlessness, agitation, or change in level of consciousness, or
    6. soiling of clothes.
47. The Correctional Officer/Primary Worker (or it may be health care staff in Regional Treatment Centres) will record all observations on the Seclusion and Restraint Observation Report (CSC/SCC 1006), as required, but at least every 15 minutes.
48. After the initial health assessment, a Nurse will perform an additional health assessment:
    1. every 15 minutes for the first hour (or more frequently, based on clinical need)
    2. once every hour thereafter (or more frequently, based on clinical need)
    3. following the removal of the Pinel Restraint System.

    Note: These assessments will include considerations on the appropriateness of modification of points/removal of restraints.

49. Following the first hour of the application of the Pinel Restraint System, range of motion exercises will normally be completed as part of each health assessment. If the inmate refuses to cooperate or participate, or is too agitated for the restraints to be safely removed from individual extremities, this will be documented.
50. A health care professional will complete a mental health assessment, in person, as soon as reasonably practicable. This assessment will normally take place within six hours of the application of the restraints and will include considerations on the appropriateness of modification of points/removal of restraints for recommendation to the Institutional Head.
51. In situations of continuous or repeated application of the Pinel Restraint System in a 24-hour period, the mental health assessment by the health care professional will be completed at least once every 24 hours, following the initial assessment.
52. The health assessment completed in response to the application of the Pinel Restraint System will replace any other health assessment that is required in accordance with the levels of enhanced observation.

Activities of Daily Living While in the Pinel Restraint System

53. The inmate placed in the Pinel Restraint System will be offered:
    1. the opportunity to attend to activities of daily living to the extent possible
    2. food at regular meal delivery times (if this is not feasible, accommodations will be made to ensure that no meals are missed)
    3. fluids at least every two hours while the inmate is awake
    4. the opportunity to meet their elimination needs as required. Supervision will be provided by Correctional Officers/Primary Workers of the same gender and Nurses of either gender, when required.

Pinel Restraint System: Follow-Up and Review Procedures

54. If the continuous use of restraint equipment exceeds an eight-hour period, the IMHT will develop an intervention strategy aimed at reducing and eliminating the use of restraints. The strategy must be in place no later than 24 hours from the original placement in restraints.
55. If the intervention strategy has not resulted in the removal of restraints within 24 hours of implementation, the Chief, Mental Health Services, will complete an additional review.
56. The review will, at a minimum, examine the following areas with respect to the use of the Pinel Restraint System:
    1. whether a treatment plan is in place
    2. consideration of all alternatives to the Pinel Restraint System
    3. a strategy to prevent future use of the Pinel Restraint System
    4. whether a plan to remove the restraints is in place
    5. the need for additional reviews.
57. The IMHT will continue to meet daily to evaluate the intervention strategy if the use of the Pinel Restraint System continues.
58. Should an inmate remain continuously in restraints for a period greater than 72 hours, the case will be reviewed by the Regional Complex Mental Health Committee and the Chair of the National Complex Mental Health Committee will be notified at the same time. This review will include consideration as to the need for a referral to a Regional Treatment Centre. The review must take place as soon as practicable following 72 hours.

REMOVAL OF THE PINEL RESTRAINT SYSTEM

59. Following the removal of the Pinel Restraint System, the inmate will be assessed by:
    1. a Nurse, who will complete a post-removal health assessment
    2. a health care professional, who will recommend to the Institutional Head measures to reduce the risk of serious bodily harm for the inmate, which may include an enhanced observation level.

OFFENDER MANAGEMENT SYSTEM ALERTS

60. If the inmate poses a current risk to attempt suicide and/or engage in self-injury, the Offender Management System (OMS) Current Risk of Suicide/Self-Injury Alert will be activated.
61. The Current Risk of Suicide/Self-Injury Alert and Suicide/Self-Injury History Alert will be activated and managed in accordance with OMS guidelines. The Current Risk of Suicide/Self-Injury Alert will be deactivated once the inmate is no longer at current risk. At that point, the Current Risk of Suicide/Self-Injury Alert becomes a historical record which remains viewable via the “Alerts History” link on the Alerts screen.
62. All active Current Risk of Suicide/Self-Injury Alerts will be reviewed by the institution at each monthly IMHT meeting to verify accuracy.
63. If the inmate has a serious mental illness with significant impairment, the OMS Serious Mental Illness with Significant Impairment Alert will be activated by a health care professional. The alert will be managed in accordance with OMS guidelines.
64. All active Serious Mental Illness with Significant Impairment Alerts will be reviewed weekly by the Chief, Mental Health Services, or delegate, to verify accuracy.

SUPPORT FOR INMATES

65. All staff will work to support open communication with the inmate during the use of restraints or enhanced observation and during the reintegration following its use. This will support collaborative work with the inmate on their recovery and wellness.
66. Support for inmates following self-injurious or suicidal behaviour will also be provided pursuant to CD 567 – Management of Security Incidents.

MONITORING AND QUALITY IMPROVEMENT

67. The IMHT will review all uses of restraints or enhanced observation as soon as reasonably possible following an incident in order to propose strategies to respond to future incidents.
68. In order to identify and guide quality improvement initiatives:
    1. the Chief, Mental Health Services, will collect data on the use of the Pinel Restraint System and enhanced observation and discuss the data at least monthly at the IMHT meeting
    2. the Regional Complex Mental Health Committee will review data on the use of the Pinel Restraint System and enhanced observation quarterly
    3. the National Complex Mental Health Committee will review data on the use of the Pinel Restraint System and enhanced observation bi-annually
    4. health management at the local, regional and national levels will provide data and reviews to their respective Quality Improvement and Patient Safety Committees when potential quality improvement initiatives have been identified.

TRANSFER OF INMATES

69. For any transfer of inmate at risk for suicide/self-injury, see GL 710-2-3 – Inmate Transfer Processes.
70. Where clinically appropriate, a referral to a Regional Treatment Centre or an appropriate health care facility/unit will be considered.

Commissioner,

Original signed by:

Don Head

ANNEX A

CROSS-REFERENCES AND DEFINITIONS

CROSS-REFERENCES

CD 001 – Mission, Values and Ethics Framework of the Correctional Service of Canada
CD 567 – Management of Security Incidents
CD 567-1 – Use of Force
CD 567-2 – Use of and Responding to Alarms
CD 567-3 – Use of Restraint Equipment for Security Purposes
CD 568-1 – Reporting and Recording of Security Incidents
CD 577 – Staff Protocol in Women Offender Institutions
CD 705 – Intake Assessment Process and Correctional Plan Framework
CD 705-3 – Immediate Needs Identification and Admission Interviews
CD 709 – Administrative Segregation
CD 710-1 – Progress Against the Correctional Plan
GL 710-2-3 – Inmate Transfer Processes
CD 800 – Health Services
GL 800-2 – Physical Restraints for Medical Purposes
GL 800-3 – Consent to Health Service Assessment, Treatment and Release of Information
GL 800-4 – Response to Medical Emergencies

Integrated Mental Health Guidelines (including Appendix C – Process for Suicide and Self-Injury Intervention)

DEFINITIONS

Activities of daily living : normal daily activities such as eating, bathing, dressing, and grooming.

Advocate: a person who, in the opinion of the Institutional Head, is acting or will act in the best interest of the inmate.

Appropriate bed/chair/stretcher: a bed/chair/stretcher that can be immobilized in a secured area, and is suitable to the inmate’s weight and height.

Constant observation via closed circuit television (CCTV): observation of one or more cameras by a dedicated staff member with minimal interruptions which will not jeopardize the safety of inmates under observation. Should more than one camera be used, the staff member cannot be a responder and must have a means of communicating (radio or otherwise) with other staff designated as responders.

Cooperative: when there is no verbal or physical resistance and the inmate responds to staff presence, verbal communication and complies voluntarily with verbal directions.

Health care facility/unit: community hospital, Regional Treatment Centre, Intermediate Care Unit, Regional Psychiatric Centre or CSC Regional Hospital.

Health care professional: an individual registered or licensed for the practice of health or mental health care in Canada and preferably in the province or territory of practice. (Certain positions, however, require registration in the province or territory of practice.) Individuals operate within their scope of practice and competence.

High Watch: an enhanced observation status for inmates who are at imminent risk for suicidal or self-injurious behaviour or who have been identified by a health care professional as having a serious mental illness with significant impairment where there is a risk of serious bodily harm that cannot be safely managed within the normal institutional routine, during which the inmate is under continuous direct observation.

Interdisciplinary Mental Health Team (IMHT): a team chaired by the Chief, Mental Health Services/ Psychiatrist, Clinical Manager or delegate, with team members that may include mental health staff, health care staff, Parole Officers, Correctional Managers, Elders, Spiritual Advisors and ad hoc members as required. The IMHT discusses current clinical, operational and case management issues/concerns, short-term/long-term goals, and the roles and responsibilities of all staff and contractors intervening with the inmate, in order to respond effectively, and provide advice and support to the inmate.

Mental health assessment: an observation and description of an inmate’s current state of mind, under the domains of appearance, attitude, behaviour, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgement.

Mental Health Monitoring: an enhanced observation status for inmates who are at risk for suicide or self-injury or who have a serious mental illness with significant impairment.

Modified Watch: an enhanced observation status for inmates who are at elevated risk for suicidal or self-injurious behaviour, or who have been identified by a health care professional as having a serious mental illness with significant impairment where there is a risk of serious bodily harm that cannot be safely managed within the normal institutional routine, during which the inmate is under continuous observation.

Physically uncooperative: when the inmate refuses to comply with staff directions (e.g. refuses to move from an area or leave a cell). The inmate may offer active physical, but not assaultive resistance by pulling or running away or resisting staff attempts to move them to a standing position.

Pinel Restraint System: a variable-point restraint system to ensure an inmate’s safety.

Positional asphyxia: asphyxia results when oxygen is reduced or elevated carbon dioxide levels are created in the body. Placing an inmate in restraints in certain positions or placing an officer’s body weight on an inmate to subdue them can lead to positional asphyxia.

Restraint equipment: an approved device intended to temporarily restrict or limit free movement.

Self-injury/self-injurious behaviour: the intentional, direct injuring of body tissue without suicidal intent.

Serious bodily harm: harm to a person or self that substantially interferes with the health or well-being of the individual. Examples of situations of immediate risk of serious bodily harm may include but are not limited to: threat to harm self or others; threat with a weapon/object; risk of assaultive behaviour.

Serious mental illness with significant impairment: presentation of symptoms associated with psychotic, major depressive and bipolar disorders resulting in significant impairment in functioning. Assessment of mental disorder and level of impairment is a clinical judgement and determined by a registered health care professional. Significant impairment may be characterized by severe impairment in mood, reality testing, communication or judgement, behavior that is influenced by delusions or hallucinations, inability to maintain personal hygiene and serious impairment in social and interpersonal interactions. This group includes inmates who are certified in accordance with the relevant provincial/territorial legislation.

Suicidal behaviour: a behaviour that intentionally puts one’s life at risk and may result in death, done with the intention to end life.

Suicide: an intentional act to end one’s life that results in death.