National Immigration Detention Standards
Chapter 4.0:  Care

From: Canadian Border Services Agency

In this section

• 4.1 Food services
• 4.2 Hunger strike management
• 4.3 Health services
• 4.4 Hygiene
• 4.5 Self-harm and suicide prevention and intervention
• 4.6 Death or serious injury of an individual detained pursuant to the Immigration and Refugee Protection Act
• 4.7 Accompanied and unaccompanied minors
• 4.8 Vulnerable persons
• 4.9 Lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals

4.1  Food services

4.1.1  Purpose and scope

To provide national direction on food services to ensure that detainees in Canada Border Services Agency (CBSA) Immigration Holding Centres (IHCs) and other CBSA detention facilities are provided with appropriate and nutritional food, prepared in a sanitary and hygienic food services operation. Where a person is detained and held at a non-CBSA facility, procedures for food services are generally guided by the policies and rules of each facility and where applicable, according to the terms of signed memorandums of understanding

4.1.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedures (POSOPs) consistent with this standard

4.1.3  National standards

1. Food services facilities, equipment and operations (storage, preparation, service and disposal of waste) in IHCs meet established and applicable federal, provincial and municipal health and food safety requirements, policies, laws and regulations
2. Detainees are provided with a nutritionally balanced diet according to Canada's Food Guide
3. Menus are varied and portions sufficient
4. Special dietary requirements for medical, dental and religious reasons are met
5. This standard is to be read in conjunction with the following standards: Transportation of Persons Detained Under the Immigration and Refugee Protection Act; Hunger Strike Management; Management and Control of Contractors' Tools and Instruments; Religious Accommodation

4.1.4  National operational procedures

1)  Responsibilities

a)  CBSA

1. Oversee and monitor Food Services activities and ensure implementation of and compliance with related services agreements, where applicable or of this standard and POSOPs
2. Ensure detainees are asked whether they have any special dietary requirements and ensure they understand in case of language barriers
3. Ensure that detainees in CBSA facilities and those in or awaiting transit are provided with meals and snacks consistent with this standard
4. Ensure Food Services is aware of all special dietary requirements and that the information is clearly identified in the detainee's file
5. Monitor, log and follow-up on any food services related complaints
6. Meet quarterly, at minimum, with Food Services to review, change as required and approve the menu plan, ensuring variety and consistency with Canada's Food Guide
7. Verify that Food Services promptly addresses any issues identified during a food safety inspection
8. Inform non-CBSA facilities upon admission of any food restrictions identified by detainees

b)  Medical services

1. Inform Food Services and the CBSA of a detainee's dietary requirements or restrictions for medical and dental reasons and advise when any additional monitoring is necessary
2. Monitor a detainee's health during hunger strikes, in accordance with the standard on Hunger Strike Management

c)  Guard services

1. Document on detainee file, any special dietary requirements identified by a detainee upon admission
2. Inform Food Services of any special dietary requirements identified by a detainee upon admission consistent with the standard on Admission and Discharge of Detainees
3. Assist with distribution of meals and snacks, including meals for detainees during transportation, consistent with the standard on Transportation of Persons Detained under the Immigration and Refugee Protection Act
4. Closely supervise meal times, ensuring count and control of potentially hazardous utensils
5. Participate in searches (missing utensil, cutting knife, etc.) when directed by the CBSA
6. Complete and submit an observation report to the CBSA when it is observed that a detainee appears to be skipping meals, fasting or on a possible hunger strike, consistent with the standard on Hunger Strike Management

d)  Food services

1. Adhere to and implement established and applicable federal, provincial and municipal health and food safety requirements, policies, laws and regulations to ensure detainees are protected from harm through the application of safe practices in all aspects of food services
2. Adhere to all terms of the services agreement for food services delivery, this standard and POSOPs
3. Provide menu plans to the CBSA for review and approval, at minimum, on a quarterly basis
4. Grant access to all applicable areas, answer questions and provide documentation as required during a food safety inspection.
5. Ensure that all issues identified are addressed promptly
6. Adhere to requirements set out in the standard on Management and Control of Contractors' Tools and Instruments

2)  Operational delivery

a)  Daily requirements

1. Nutritious, varied and good quality food and beverages must be provided daily, ensuring special dietary requirements/restrictions are met (for example, during pregnancy, for nursing mother, diabetics, lactose-intolerance, vegetarian, Halal, Kosher, etc.):
   1. 3 meals every day with, at minimum, 2 main course choices at every meal of which 2 must be hot meals when at the IHC
   2. Unless otherwise specified, 2 snacks every day
2. Drinking water must be available at all times
3. A sufficient amount of meals and snacks must be available to reasonably satisfy varying appetites
4. A daily canteen or vending machine for purchase of additional snacks may be made available

b)  Other requirements

1. Light meals (such as sandwiches, fruit, muffin) must be available at all times to accommodate:
   1. Newly arriving or departing detainees (outside normal meal times)
   2. Detainees that require meals while in transit, consistent with the standard on Transportation of Persons Detained under the Immigration and Refugee Protection Act
2. Persons detained in CBSA offices following an arrest, pending processing, interview or transfer must be provided with meals, snacks and access to drinking water consistent with this standard
3. Appropriate meals and snacks must be provided for babies (0-12 months), and toddlers (1-3 years) when present in the facility (such as, baby formula, pureed food)
4. Alternative food options for children must be available
5. A reserve of 1 day's meals and snacks must be available in case of unforeseen events
6. Food services must align, where contractually required, with The Greening Government Strategy, which supports sustainability in government operations

c)  Schedule

1. Meals and snacks must be served at pre-set time periods 7 days per week, according to contract requirements and POSOPs
2. A minimum of 30 minutes must be allocated for eating
3. There must be no more than 14 hours between dinner and breakfast
4. Variations in the menu and schedule during religious and civic holidays should be approved, provided that basic nutritional goals are met and that the variations do not cause undue hardship (such as unreasonable cost, impact on operational needs, risks to safety)

4.2  Hunger strike management

4.2.1  Purpose and scope

To provide national direction on assessing and managing a detainee who chooses to engage in a hunger strike in Canada Border Services Agency (CBSA) Immigration Holding Centres (IHC) and other CBSA detention facilities, and on CBSA responsibilities towards persons detained under the Immigration and Refugee Protection Act (IRPA) held in non-CBSA facilities who engage in a hunger strike

4.2.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All Immigration Holding Centres (IHCs) and detention operations will have local Post Orders and Standard Operating Procedure (POSOPs) consistent with this standard

4.2.3  National standards

1. Detainees identified as being on a hunger strike are closely and regularly monitored, assessed, advised (of medical risks) and counselled in a language and in terms they can understand, in efforts to maintain their health and welfare
2. Detainees who refuse food and/or fluids are entitled to confidentiality and to retain responsibility for their own health wherever possible
3. Force feeding a detainee who has the capacity to understand the consequences of a hunger strike at the time the decision was made to engage in one, is illegal and therefore is not permitted unless ordered by a court of law
4. Detainees' ability to give informed consent will be assessed by appropriately trained medical professionals
5. Medical emergencies are treated in accordance with the standard on Health Services

4.2.4  Definitions

Hunger strike: Where a detainee is refusing to eat solid food and drink fluids (except water) for a period exceeding 48 hours, and where there is no evidence the person is consuming food and fluids (except water) from other sources (for example, from the canteen or other detainees). A hunger strike may be self-declared or observed. Where a detainee is fasting for religious, spiritual or other personal reasons, if the fasting exceeds 48 hours, the procedures in this standard apply

4.2.5  National operational procedures

1)  Responsibilities

a)  CBSA (regardless of where a person is detained)

1. Upon notification of a hunger strike, intervene promptly and frequently, speak and/or meet with, and attempt to establish the detainee's motivation for engaging in a hunger strike, ensuring they understand in case of language barriers (for example, engage an interpreter). Refer to the standard on Detention in Non-CBSA Facilities
2. Make all reasonable efforts to resolve the issue(s) identified by the detainee
3. Consistent with the standard on Classification and Placement of Detainees in Detention Facilities, as often as required during a hunger strike, review classification and placement based on new information/circumstances to ensure risk to the person concerned, vulnerability factors and other safety and security factors are taken into account in the classification and placement decision
4. Document in detail: all interactions with the detainee, non-CBSA facility authorities, IHC or other medical professionals (for example, non-CBSA facility or hospital) as appropriate, and CBSA management; efforts made; steps/course of action taken; responses; decisions etc. Document all pertinent information and maintain the detainee file up-to-date according to the standard on Detention Records
5. Notify CBSA management immediately after 48 hours have passed since a detainee has consumed food and fluids (according to the definition of hunger strike), and provide updates as required, consistent with the procedures for reporting significant events
6. Notify the Canadian Red Cross Society (current contractor for the monitoring of Canada's immigration detention program) by email to IDMP@REDCROSS.CA immediately after 48 hours have passed since a detainee has consumed food and fluids (according to the definition of hunger strike)

b)  CBSA (where a person is detained in an IHC)

1. Advise Medical Services immediately upon receipt of a report that a detainee has declared being on a hunger strike or upon observation that a detainee is not consuming food or fluids (except water), for appropriate follow-up and assessment
2. Direct Guard Services to:
   1. Monitor and track consumption or non-consumption of offered or non-offered solid food and fluids (all types) and behaviour/conduct throughout the day
   2. Complete and submit to CBSA a daily observation report
3. Review observation reports and maintain contact with Guard Services as required
4. Take action as deemed appropriate upon recommendation from Medical Services (for example, change in placement, admission to hospital, slowly reintegrating foods upon hunger strike termination, etc.)
5. Notify Guard Services of any action required during or following a hunger strike further to Medical Services' recommendations
6. Call 9-1-1 for any medical emergency

c)  CBSA (where a person is detained in a non-CBSA facility

1. Follow-up regularly and maintain communication, consistent with the procedures outlined in the standard on Detention in Non-CBSA Facilities

d)  Guard services

1. Promptly report to the CBSA when it is observed that a detainee refuses to eat and drink fluids (other than water) or when a detainee declares being on a hunger strike
2. Complete and submit an observation report to the CBSA on a daily basis as directed
3. Ensure all meals, snacks, fluids continue to be offered and/or made available to the detainee, and upon request
4. Immediately inform the CBSA of a medical emergency
5. Call 9-1-1 when CBSA or Medical Services are not on site or immediately responding
6. Complete and submit to the CBSA a Contracted Security Guard Incident and Use of Force Report (BSF383) as required

e)  Medical services

1. Upon notification and consent of the detainee, meet with the detainee for appropriate follow-up and assessment, including evaluation of the detainee's physical and mental health, and provide continuous care as required
2. Use an interpreter where language is a barrier to communication and full understanding
3. Counsel the detainee on the potential health risks and consequences associated with the refusal to consume solid food and fluids to ensure informed decision-making
4. Refer the detainee to other health professionals as deemed appropriate
5. Record and file in the detainee's medical file, all pertinent information related to every interaction with the detainee while on a hunger strike
6. Offer the detainee medical follow-up on a daily basis and where refused, observe and record the detainee's condition and demeanour
7. Recommend to the CBSA any course of action or changes in care deemed appropriate (for example, change in placement, admission to hospital, etc.)
8. Notify the CBSA when a hunger strike has ended
9. Provide follow-up medical care as often and for as long as necessary after the end of a hunger strike

4.3  Health services

4.3.1  Purpose and scope

To provide national direction on the delivery of health services to detainees to ensure their physical and mental health needs are met in a timely and efficient manner, within the scope of services and costs provided for under the Interim Federal Health Program (IFHP). Where a person is detained and held at a non-Canada Border Services Agency (CBSA) facility, procedures related to health services are generally guided by the policies and rules of each facility and where applicable, according to the terms of signed memorandums of understanding

4.3.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All Immigration Holding Centres (IHCs) and detention operations will have local Post Orders and Standard Operating Procedure (POSOPs) consistent with this standard

4.3.3  National standards

1. All requirements set out in the applicable medical services contract in effect are met
2. Medical Services is notified without delay at admission of a detainee's immediate health care needs, including any known risk of suicide or self-harm
3. Detainees receive an initial medical and mental health assessment by Medical Services as soon as possible after admission but no later than 24 hours
4. Detainees are regularly monitored and receive timely access to medical treatment and care throughout their detention, consistent with provisions under the IFHP
5. Screening, prevention and control measures are used to prevent or manage infectious and communicable diseases
6. Any known medical information is kept confidential
7. To be read in conjunction with the following standards: Admission and Discharge of Detainees; Orientation and Information; Classification and Placement of Detainees in Detention Facilities; Special Purpose Units; Self-Harm and Suicide Prevention and Intervention; Hunger Strike Management; Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act; Detention in Non-CBSA Facilities; Hygiene; Management and Control of Contractors' Tools and Instruments; Immigration Holding Centre Emergency Management Plans; and ENF 20 manual (Detention) (PDF)

4.3.4  Definitions

Automated external defibrillator (AED): A portable medical device that interprets heart rhythm, determines if a shock is required to re-establish a consistent rhythm, and delivers an electrical shock through the body to the heart, if necessary

Naloxone: A synthetic drug that is similar to morphine used to block opiate receptors in the nervous system. Temporarily reverses the symptoms of opioid overdose

Health services: Physical and mental health services, which include health promotion, disease prevention, health maintenance, patient education, diagnosis and treatment of illnesses, delivered in accordance with the Interim Federal Health Program (IFHP)

Interim Federal Health Program (IFHP): A federal health program that provides limited, temporary coverage of health-care benefits to people in the following groups who aren't eligible for provincial or territorial health insurance: protected persons, including resettled refugees; refugee claimants and certain other groups, including persons detained under the Immigration and Refugee Protection Act

Medical isolation unit: A unit within the IHC which is used in circumstances that necessitate the isolation of an individual who is deemed by Medical Services to have medical or mental health issues that may compromise their own and others' health and safety and/or require observation by a medical practitioner

Medical services: Staff in IHCs providing direct medical care and services to detainees. Normally includes physician(s), nurses, psychologist(s) and psychiatrist(s)

4.3.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Oversee, manage and ensure implementation of the applicable medical services contract in effect
2. Ensure that a copy of the Detainee Medical Needs (DMN) form (BSF674) is provided to Medical Services or the non-CBSA facility upon admission, and update the DMN form as stipulated in ENF 20 (PDF) manual (Detention)
3. Verify that newly-admitted detainees received a medical and mental health assessment by Medical Services as soon as possible after admission but no later than 24 hours
4. Consistent with the standard on Self-Harm and Suicide Prevention and Intervention:
   1. Promptly refer to Medical Services any detainee identified as at risk of suicide or self-harm (as identified on the DMN form (BSF 674) or if otherwise stated such as through expression of suicidal thoughts or feelings)
   2. Place a detainee at immediate risk of suicide on suicide watch (regular or continuous monitoring and observation) until seen by Medical Services
5. If possible, on-site medical staff (e.g., nurse/doctor) will be consulted prior to applying any use of force on detainees to ensure the physical and mental health needs of the detainee is considered
6. An IHC Manager will brief on-site medical staff on the type(s) of force used and the detainee's response/behavior
   In case of a death or serious injury, refer to the standard on Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act
7. In case of a hunger strike, refer to the standard on Hunger Strike Management
8. Monitor detainees held in non-CBSA facilities consistent with the standard on Detention in Non-CBSA Facilities
9. Notify in advance and ensure Medical Services provides for continuity of medical care for detainees transferred to or from another facility, or who are being released or removed from Canada
10. Inform detainees about the facility services, including health services and how to make a request for access to those services
11. Ensure detainees understand in case of language barriers, arrange for interpretation services for detainees and coordinate with Medical Services as required
12. Implement a confidential and facilitative process for detainees to request access to health services
13. Inform detainees about how to raise concerns or make a complaint including regarding health services
14. Ensure accompanied minors are escorted to Medical Services by a parent or legal guardian and that unaccompanied minors are escorted to Medical Services by Guard Services
15. Implement a process for the administration of medications by non-medical personnel in the unlikely event that Medical Services is not available on site
16. Inspect, track (inventory) and replenish all first aid kits as required or at minimum on a monthly basis
17. Ensure that Naloxone kits are available in each facility and easily accessible by the CBSA and all contracted services on site
18. Ensure that Naloxone kits are inspected, tracked and replenished as required or at a minimum on a monthly basis
19. Meet as necessary with Medical Services to discuss health services, complaints and any health-related issues
20. Escalate any health-related issues that cannot be resolved at the regional level to CBSA national headquarters

b)  Medical services

1. Deliver health services in accordance with the medical services contract in effect
2. Observe any public health guidelines, POSOPs and eligible benefits of the IFHP
3. Conduct a medical and mental health assessment of every detainee as soon as possible but no later than 24 hours after admission
4. See detainees with immediate health care needs on a priority basis (for example, those identified as at risk of suicide, displaying symptoms of illness, requiring medication to maintain life, etc.)
5. Ensure that detainees understand the health-related information being relayed in case of language barriers
6. Notify the CBSA when a detainee requires interpretation services and schedule appointments according to availability of interpretation services
7. Immediately inform the CBSA verbally and in writing when it is believed that a detainee represents a danger to himself/herself, other detainees, or IHC staff (such as risk of suicide or self-harm, contagious disease, aggressive behavior)
8. Provide the CBSA with written recommendations for monitoring and observation of a detainee when required
9. Notify the CBSA of health issues that occur within an IHC including issues pertaining to public health (in other words, infectious diseases control and prevention);
10. Consistent with the standard on Classification and Placement of Detainees in Detention Facilities:
    1. Notify the CBSA when the transfer of a detainee to the medical isolation unit is recommended and provide instructions for any special measures required when transferring
    2. Ensure detainees placed in medical isolation are reassessed by a physician every 24 hour to determine the need for continued isolation and to provide the CBSA with regular updates
    3. Advise the CBSA when a detainee should be transferred to another health facility or may be released from the medical isolation unit
    4. Conduct a medical and mental health assessment of detainees transferred to an enhanced security living unit or special purpose unit due to an escalation of behavior or medical concerns
11. Maintain a network of qualified and IFHP-registered local health care professionals outside the IHC for referrals as needed for specialized care (such as dentists, optometrist, etc.)
12. Refer detainees to outside health care professionals/off-site health facility for further evaluation or treatment as necessary
13. Ensure detainee requests and complaints are addressed in a timely manner
14. Screen for, and implement control measures to prevent or manage infectious diseases
15. Safely store, handle and dispense medications to detainees as required
16. Track, log and document in the detainee's medical file all health care related information including medications administered, provided, refused (and the reasons for refusal)
17. Ensure continuity of medical care for detainees transferred to or from another facility, or being released or removed from Canada (for example, provide/request relevant medical records, provide supply of any required medication to accompany the detainee)
18. Provide a copy of the detainee's medical records upon request from the detainee or their designated representative
19. Share a copy of the detainee's medical records to and from other medical services personnel or authorized institutions (for example, hospitals, provincial facilities) in accordance with applicable privacy laws
20. Manage bio-hazardous waste and decontaminate medical equipment in accordance with applicable federal, provincial and local regulations
21. Retain health care records as per provincial and professional order requirements
22. Meet with the CBSA as required to discuss health services, complaints and any health-related issues

c)  Guard services

1. Report to CBSA and Medical Services any detainee with observed or suspected health or mental health issues
2. Transfer a detainee when requested by Medical Services or the CBSA, ensuring to follow specific instructions
3. During a medical emergency, communicate promptly with Medical Services, CBSA and with Emergency Medical Services (9-1-1) as required
4. Ensure the immediate transfer of detainees for emergency medical care (including expedited entrance to and exit from the facility)
5. Escort (minimum 2 security guards) a detainee being transported to the hospital and remain there unless a risk assessment determines otherwise

2)  Operational delivery

a)  Equipment

1. All medical office supplies and medical equipment must be provided according to the medical services contract in effect
2. Automated External Defibrillators (AED), where available, must be accessible and regularly maintained as recommended by the manufacturer
3. First aid kits must be available throughout the facility and meet the Canada Occupational Health and Safety Regulations. Kits must be inspected, tracked (inventory) and replenished as necessary

b)  Interpretation services

1. Interpretation services may be provided over the phone, in person or otherwise
2. Arrangements for an interpreter must be made as required (scheduled and coordinated with medical appointments)
3. Interpretation by CBSA, Guard Services and other detainees must only be provided in an emergency situation

c)  Assessments/Examinations

1. Generally, only Medical Services and interpreters (when required) are present during a medical and mental health assessment/examination
2. The dignity and privacy of detainees must be protected at all times

d)  Refusal of treatment

1. To ensure informed decision-making, detainees must be counselled on the potential health risks and consequences associated with the refusal of treatment for any medical or mental health condition
2. The detainee's refusal of treatment must be recorded on their medical file
3. Monitoring and follow-up medical care must continue to be provided

e)  Medication dispensation

1. Medications (prescription and over-the-counter) must normally be administered by Medical Services (available on site 24/7)
2. A process must be in place for the administration of medications by non-medical personnel in the unlikely event that Medical Services is not available on site

f)  Dental services

1. Dental treatment for acute pain, trauma or oral infection (such as tooth extraction) must be provided according to the provisions of the IFHP

g)  Medical isolation

1. Refer to standards on Special Purpose Units and Classification and Placement of Detainees in Detention Facilities

h)  Infectious disease

1. Official public health protocols for prevention, detection and management of infectious diseases of public health importance must be operationalized
2. Upon detection of an infectious disease, Medical Services must work closely with the CBSA and federal and provincial health officials, ensuring minimal operational impact and health and safety risks
3. Detainees who contract an infectious disease must be provided with humane treatment and support, in an environment free of discrimination

i)  Terminal illness

1. Refer to ENF 20 manual (Detention) and the standard on Vulnerable Persons for additional details^{Footnote 1}
2. Where there is no danger to the public, detention of a person suffering from a severe medical condition (such as terminal illness) should be avoided or considered as a last resort
3. Alternatives to detention or release must always be considered where risk can be mitigated
4. To assess if a person's medical condition is severe enough to cause a particular hardship, the availability of services as well as the ability to satisfactorily manage that person in the detention facility must be taken into account
5. Where detention is necessary (for example, just prior to a person's removal from Canada), it should be for the shortest period of time possible and placement must take their physical and emotional well-being into consideration consistent with the standard on Classification and Placement of Detainees in Detention Facilities

j)  Confidentiality and release of medical records

1. Medical records must be received, transmitted, accessed, maintained and destroyed in accordance with professional standards, all relevant health information legislation and regulations, and the medical services contract in effect

k)  Release of medical records to a detainee

1. Copies of medical records must be released by Medical Services directly to the detainee or their designated representative, at no cost to the detainee, upon receipt of a written authorization from the detainee
2. Written authorization must comply with the relevant health information legislation and regulations
3. The written authorization must be retained in the detainee's medical record

l)  Transfer and release of detainees

1. Prior to transferring a detainee to another detention facility or to releasing or removing a detainee, Medical Services must be notified in advance when possible, to prepare what is necessary to accompany the detainee for continuity of medical care (for example, medications, medical records, etc.)

m)  Examinations by independent medical service providers and experts

1. On occasion, medical and/or mental health examinations by a practitioner or expert not associated with the detention facility may provide a detainee with information useful in administrative proceedings
2. In cases where an independent medical and/or mental health examination is requested at the detainee's own expense:
   1. The detainee or their legal representative must submit to the CBSA a written request
   2. The CBSA must forward the request to Medical Services for review and recommended response
   3. The CBSA must respond to the requester as soon as possible
   4. The independent examination must be pre-arranged and conducted in a manner consistent with security and good order

4.4  Hygiene

4.4.1  Purpose and scope

To provide national direction on the supply of items and services as well as the practices required to maintain hygiene in Canada Border Services Agency (CBSA) Immigration Holding Centres (IHCs) and other CBSA detention facilities. Where a person is detained and held at a non-CBSA facility, procedures related to hygiene are generally guided by the policies and rules of each facility and where applicable, according to the terms of signed memorandums of understanding

4.4.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedure (POSOPs) consistent with this standard

4.4.3  National standards

1. All areas of CBSA detention facilities are to be maintained in a clean and sanitary condition, consistent with federal and provincial/territorial occupational health and safety legislation and regulations to help preserve a healthy environment for detainees and staff
2. Decontamination of luggage and personal effects is used (where facilities allow) as necessary to prevent pest and bug infestations
3. Supplies and services necessary to maintain personal hygiene are provided to detainees and offered/replenished as necessary
4. Good personal hygiene practices are encouraged at all times
5. Detainees are responsible for their personal hygiene and for cleaning their clothes and tidying their personal spaces
6. To be read in conjunction with the following standards: Health Services; Admission and Discharge of Detainees; Facility Maintenance and Housekeeping; Funds, Valuables and Other Personal Property; and, Prevention and Management of Breaches

4.4.4  Definitions

Hygiene: The conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness

4.4.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Ensure supply of and sufficient inventory of basic personal hygiene items and basic clothing (under garments, socks) for all detainees
2. Inform detainees of expected personal hygiene practices and ensure they understand in case of language barriers
3. Accommodate reasonable requests for products and services to maintain hygiene
4. Encourage and promote good hygiene within the detention facility
5. Address detainee requests and/or complaints regarding items and services related to hygiene, including those from persons detained under the Immigration and Refugee Protection Act held in non-CBSA facilities and in hospitals
6. Provide direction to Guard Services regarding the use and control of razors
7. Refer to Medical Services any detainee who is demonstrating poor hygiene and self-care

b)  Guard services

1. Provide detainees with items and access to services for maintaining hygiene in accordance with this standard and POSOPs
2. Respectfully encourage and promote personal hygiene within the detention facility
3. Ensure privacy while detainees practice hygiene habits, taking safety and security of the detainees and others into consideration
4. Oversee that personal razors are distributed and managed in accordance with POSOPs
5. Inform CBSA of any requirement (such as detainee requests, repairs of equipment, replenishing of supplies, etc.) or concern related to hygiene amongst the detainee population or within the facility

c)  Medical services

1. Encourage detainees to practice personal hygiene and provide advice on steps to improve health and well-being

2)  Operational delivery

a)  Personal hygiene

1. Personal hygiene practices
   1. Detainees must have access to wheelchair-accessible (barrier-free) washrooms, including shower facilities, and access to basic personal hygiene items, to maintain good personal hygiene practices
   2. The importance of and reasons for maintaining good personal hygiene practices must be encouraged by staff through the dissemination of written and verbal information. Personal hygiene practices include:
      1. proper and frequent washing of hands with soap throughout the day
      2. daily shower (using shower sandals)
      3. oral hygiene (for example, brushing teeth)
      4. covering the nose and mouth with a tissue or sleeve when coughing or sneezing
      5. regularly changing into clean clothes
2. Basic personal hygiene items
   1. An inventory of personal hygiene items must be maintained to ensure sufficient supply and replacement as required for all detainees
   2. Basic personal hygiene items must be provided including: body wash, shampoo, toothbrush, toothpaste, deodorant, comb/hairbrush, personal razors, and as required for women and children, sanitary pads, diapers, baby wipes
   3. Detainees are not permitted to keep in their possession personal hygiene items that may jeopardize the safety and security of detainees, staff or the IHC such as curling irons, hair straighteners, dental floss, straight razors or other razors deemed unsafe by the CBSA, etc., consistent with the standard on Funds, Valuables and Other Personal Property

b)  Services in IHCs

1. Grooming
   1. Hair grooming services such as haircuts and beard trimming must be regularly offered on site
2. Bedding
   1. Clean and fit for use bedding [mattress (1), sheets (1 set), blanket (1), bath towel (1)] must be issued to each detainee and a sufficient supply maintained and replaced for all detainees as needed for the maintenance of personal hygiene
   2. Linens must be changed at a minimum once every week or more frequently as required (new detainee arrival, move to a different room, for medical or other operational reasons)
3. Clothing and laundry
   1. Detainees are permitted to keep (stored in their living unit), a reasonable amount of personal property including clothing, according to the standard on Funds, Valuables and Other Personal Property
   2. Detainees may ask and be provided with additional clothing as required for comfort and hygiene (for example, underwear, socks, etc.)
   3. Washing machines and dryers must be available to detainees in each living unit for laundering of personal items on a self-serve basis
   4. Unscented laundry detergent must be available at all times, and supplied to detainees upon request

4.5  Self-harm and suicide prevention and intervention

4.5.1  Purpose and scope

To provide national direction on preventative efforts to help ensure the safety and well-being of detainees who are or may be self-harming or suicidal in Canada Border Services Agency (CBSA) Immigration Holding Centres (IHCs) and non-CBSA facilities (within the constraints of provincial legislation, memorandums of understanding, and facility rules), and on appropriate intervention in case of an incident

4.5.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedure (POSOPs) consistent with this standard

4.5.3  National standards

1. Detainees identified as being at risk of suicide or self-harm at admission or any time during their detention are promptly referred to Medical Services for the appropriate assessment, care and follow up
2. Staff engages in dynamic security and develops and maintains appropriate and positive relationships and interactions with detainees
3. Staff receives basic training on the prevention of suicide and self-harm and any other mandatory mental health training
4. Detainees at immediate risk of suicide are placed on suicide watch (continuous monitoring/observation) and promptly referred to Medical Services
5. Detainees identified by Medical Services as being suicidal are monitored and closely observed, and placed in the living unit in IHCs that best meets their needs
6. Regardless of where a person is detained, the CBSA closely monitors and frequently inquires about the health and well-being of detainees identified as being at risk of suicide
7. For procedures on suicidal or self-harmful detainees while in short-term detention rooms or cells at ports of entry or inland enforcement offices, please refer to the ENF20 (PDF) manual (Detention)
8. To be read in conjunction with the following detention standards: Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act; Classification and Placement of Detainees in Detention Facilities; Detention in Non-CBSA Facilities; Special Purpose Units; and Health Services

4.5.4  Definitions

Depression: A sad or low mood that lasts for a long period of time. It can affect many areas of a person's life including physical health, emotions and behaviours. Depression can make it hard for someone to sleep, eat, work and relate to others. People who are depressed may think about suicide

Dynamic security: Regular and consistent interaction with detainees and timely analysis of information and sharing through observations and communication. Dynamic security is the action that contributes to the development of professional, positive relationships between staff and detainees, and is a key tool to assess a detainee's adjustment and stability

Ligature: Any item that when placed around the neck can restrict the airway. The item can be used with a ligature point or independently

Ligature cutter: Purpose specific and single use items for cutting ligatures. They must not be used for any other purpose than dealing with emergency situations involving ligatures

Monitor: To watch over

Observe: To notice or view, especially carefully or with attention to detail and register it as being significant. The observation log allows Guard Services to notate behaviour and demeanor that may indicate a risk of suicide or self-harm

Self-harm: Deliberate act of harming one's body without conscious suicidal intent. Self-harm is used as a coping mechanism. The act of self-harm may provide the person with a sense of control over their life, provide a means of dealing with intense feelings (anger, frustration, sadness, etc.) The person may self-harm to release intense internal pressures and discomfort or to obtain temporary relief from these feelings. Acts of self-harm include but are not limited to cutting, burning skin, banging one's head, biting or pulling out hair, inserting objects into parts of one's body, scratching or rubbing one's skin to produce open areas, etc. Commonly used instruments include pins and needles, pen clips, broken glass, staples, bed sheets, clothing, etc.

Serious injury: Injury that significantly alters the functioning of the individual (loss of sight, loss of limb or motor function), or which results in the death of the individual

Suicide: Intentional act to end one's life that results in death

Suicidal thoughts or feelings: When someone is thinking about killing him/herself, and feels that there is no other way to solve their problems than to end their life

Suicide watch: The regular or continuous monitoring and observation of a person who is considered to be at risk of attempting suicide. The monitoring and observation requirements are determined on a case-by-case basis by Medical Services or other health care professionals

4.5.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Ensure all inland enforcement officers and all IHC staff complete the mandatory mental health training including the Prevention of Suicide and Self-Harm Among Detainees course and any other relevant training as required (refer to standard on Training)
2. Practice dynamic security by regularly engaging with detainees in a positive and appropriate manner in efforts to get a sense of their adjustment, stability and well-being
3. Review observation logs daily to identify detainees potentially at risk for suicide or self-harm, and where identified, meet with the detainee
4. Promptly refer to Medical Services any detainee identified as being at risk of suicide or self-harm (as identified on the Detainee Medical Needs (PDF) (DMN) form (BSF674) or if otherwise stated, such as through expression of suicidal thoughts or feelings)
5. Place a detainee at immediate risk of suicide on suicide watch (constant observation) until seen by Medical Services and thereafter is deemed appropriate by Medical Services Staff
6. Closely monitor and frequently inquire about the health and well-being of detainees identified as being at risk of suicide, regardless of place of detention
7. Ensure a reassessment of classification and placement is conducted based on the new information/circumstances to ensure risk to the person concerned, vulnerability factors and other safety and security factors are taken into account in the classification and placement assessment, consistent with the standard on Classification and Placement of Detainees in Detention Facilities
8. When a detainee is placed on suicide watch or is being monitored and observed due to an identified risk, communicate the reasons for the monitoring to the detainee
9. Ensure detainees understand in case of language barriers and arrange for interpretation services for detainees as required
10. Ensure clear written instructions for monitoring and observation requirements are provided to Guard Services
11. When a detainee is placed on suicide watch, guard services or CBSA must maintain visual contact with them at all time. When this is not possible, guard services or CBSA must maintain verbal contact with the detainee on a 2 minute interval until visual contact can resume
12. Notify CBSA regional and national management of a suicide or self-harm related incident according to the Guidelines regarding significant events and where applicable ensure implementation of all steps outlined in the above-mentioned protocols and guidelines
13. Aim to have a minimum of 2 staff members (either CBSA staff contracted services or a mix of both) be present during an intervention of self-harm or suicide
14. When an officer intervenes alone, they must call for support as soon as possible in order to have a second officer assist them during the intervention, when possible
15. Ensure that all self harm or suicide intervention is documented on the detainee's file (DAMS)
16. Conduct and lead an incident debriefing following an incident
17. Offer medical and mental health support to any detainee who may be impacted by any critical incident
18. Engage the Employee Assistance Program (EAP) and/or the Critical Incident Stress Management Intervention Program (CISM) for CBSA staff in support of the health and well-being of CBSA staff, especially following a critical incident
19. Upon confirmation of the death of a detainee, notify next of kin according to the Protocol Regarding the Death of an Individual Detained Pursuant to the Immigration and Refugee Protection Act

b)  CBSA officers working in or attending non-CBSA detention facilities (Inland Enforcement Officers and/or Detention Liaison Officers

1. Complete mandatory mental health training as required, including the Prevention of Suicide and Self-Harm Among Detainees course (refer to standard on Training)
2. If transporting detainees to a non-CBSA facility, share the completed DMN form (BSF674) and verbally inform facility authorities of the risk of suicide or self-harm when it is identified on the form or if otherwise stated, and document all actions taken on the client file consistent with the standard on Detention Records
3. Consistent with the standard on Detention in Non-CBSA Facilities, regularly meet and/or speak and engage with detainees in a positive and appropriate manner in efforts to get a sense of their adjustment, stability and well-being
4. Notify facility authorities at any time during detention of any concerns that a detainee may be at risk of suicide or self-harm
5. Liaise with facility authorities on a minimum of a daily basis to obtain pertinent reports
6. Follow-up daily with facility authorities when notified or aware that a detainee is on suicide watch

c)  Guard services

1. Complete mandatory mental health training as required, including the CBSA Prevention of Suicide and Self-Harm Among Detainees course
2. If transporting detainees to non-CBSA facilities, submit the CBSA documents to the facility authorities, including the completed DMN form (BSF674) and where advised, verbally inform facility authorities of the risk of suicide or self-harm
3. Immediately notify the CBSA and Medical Services if upon admission a completed DMN form (BSF674) has markers for suicide or self-harm (as identified under the Mental Health section) or at any time if a detainee makes direct statements related to suicide or self-harm
4. Implement any directives including instructions for monitoring and observation received from CBSA and/or Medical Services
5. Practice dynamic security by regularly engaging with detainees in a positive and appropriate manner in efforts to get a sense of their adjustment, stability and well-being
6. Note in the observation log any unusual behaviour displayed by a detainee such as self-harmful behaviour or other signs that they may be considering suicide, similar to signs of depression (for example, changes in eating or sleeping habits, withdrawal from others, loss of interest in usual activities particularly those usually enjoyed, neglect of personal appearance, as per CBSA instructions)
7. Brief incoming staff and update the observation log (or any other log as indicated in POSOPs) before leaving on break and at the end of a shift
8. Aim to have a minimum of 2 staff members (either CBSA staff contracted services or a mix of both) be present during an intervention of self-harm or suicide
9. When an officer intervenes alone, they must call for support as soon as possible in order to have a second officer assist them during the intervention, when possible
10. Ensure that all self harm or suicide intervention is documented on the detainee's file (DAMS)
11. Following an incident, complete and submit to the CBSA a Contracted Security Guard Incident and Use of Force Report (BSF383)
12. Attend incident debriefings in accordance with POSOPs

d)  Medical services

1. Ensure that medical and mental health assessments for detainees identified as being at risk of suicide or self-harm, are completed within 24 hours of admission or of referral
2. Immediately inform the CBSA when it is believed that a detainee represents a danger to himself/herself. Provide the CBSA with written any specific recommendations for the monitoring and observation of a detainee when required keeping in mind that anyone identified to be on a suicide watch or at risk of harming themselves. Guard services or CBSA must maintain visual contact with them at all time. When this is not possible, guard services or CBSA must maintain verbal contact with the detainee on a 2 minute interval until visual contact can resume.
3. Keep a detainee in the medical isolation unit when deemed necessary and notify the CBSA of the transfer to and release from the unit
4. Meet a detainee placed on suicide watch at minimum daily, or more often as deemed appropriate, and provide the CBSA with regular updates
5. Ensure detainees understand in case of language barriers
6. Notify the CBSA when a detainee requires interpretation services
7. Review observation logs, adjust monitoring recommendations as required, and inform the CBSA of any changes
8. Refer detainees to in-house psychologist or psychiatrist as necessary
9. Refer a detainee to outside medical professionals for further evaluation and/or treatment as necessary
10. Inform the CBSA in writing of any changes in recommendations for monitoring or observation

2)  Operational delivery

a)  Transfers

1. Upon transfer of a detainee from an IHC to a non-CBSA facility, the CBSA must:
   1. Provide the non-CBSA facility with a copy of the DMN form (BSF674) which includes information provided by the detainee related to mental health such as self-harm/suicidal thoughts or attempts
   2. Verbally inform non-CBSA facility staff of any known previous suicidal and self-harm behaviours or actions, if any
2. Upon transfer of a detainee from a non-CBSA facility to an IHC, the CBSA must:
   1. Inquire about any known previous suicidal behaviours or actions
   2. Ensure the detainee is safe pending an evaluation by Medical Services

b)  Intervention activities ^{Footnote 2}

1. The following activities are recommended when intervening with a detainee who exhibits warning signs of potential suicide or self-harm:
   1. Maintain an appropriate attitude: Treat the situation seriously
   2. Get help/Acquire additional information:
      1. Alert other staff – When circumstances allow, the officer intervening must call for a seconf officer to attend (either CBSA staff, contracted services or a mix of both). As possible, it is favourable to have 2 staff members present during an intervention of self-harm or suicide
      2. Immediately contact Medical Services (IHC) or a medical professional (in non-CBSA facilities) and the CBSA
      3. Ask questions regarding any plans the detainee may have regarding suicide
   3. Offer help: Stay positive and show care and concern
   4. Encourage the expression of feelings: Encourage the detainee to explain reasons for this action
   5. Listen actively: Encourage the detainee to talk, remain non-judgmental
   6. Help the detainee re-evaluate the situation and explore alternatives
   7. Analyze immediate risk for suicide:
      1. If the person is considered high risk, do not leave him/her alone, get help from others before you do so (for example, supervision by Guard Services or appropriate authority in a non-CBSA facility)
      2. Where necessary, ask others to summon help from Medical Services (IHC) or a medical professional (in non-CBSA facilities) while continuing to talk to the detainee
   8. Suggest that the detainee talk to Medical Services (IHC) or a medical professional (in non-CBSA facilities)
   9. Make a referral to Medical Services or notify non-CBSA authorities of the need to refer the detainee to a medical professional
   10. Immediately follow-up with a verbal report to the CBSA and complete and submit a Security Incident Report to the CBSA

c)  Critical incidents

1. Intervention during self-harm or a suicide in progress^{Footnote 3} at an IHC
   1. If staff discover a detainee carrying out an act of self-harm or a suicide in progress, the first person on the scene must, as soon as possible:
      1. Render emergency first aid if safe to do so:
         1. If found hanging and/or suffocating, the detainee must first be freed of the restriction (in other words, supported while the restriction is removed or cut using ligature cutters in such a way to ensure preservation of the knot)
      2. Get help: Contact or direct assisting staff to call for emergency medical help (dial 9-1-1 and/or IHC Medical Services) and ensure there is more than 1 staff member at all times moving forward (CBSA staff, contracted services or a mix of both)
      3. Secure the area:
         1. Clear the area of other detainees and non-essential staff
         2. Be mindful of the need to preserve evidence for any subsequent investigation
         3. Control or segregate individuals depending on the circumstances
      4. Take note of all persons present at the time of the incident
      5. If Guard Services is first on scene, defer scene management to the CBSA, Medical Services or Emergency Medical Services (EMS) upon arrival and assist as required, including the continued application of first aid
      6. If the CBSA is first on scene, defer to Medical Services or EMS upon arrival and assist as required
      7. Report the incident immediately after the crisis to the appropriate CBSA official (for example, manager or supervisor)
      8. Follow established procedures for the reporting of security incidents
      9. Complete and submit to the CBSA the appropriate incident report (Security Incident Report (PDF) (BSF152) or Contracted Security Guard Incident and Use of Force Report (BSF383))
      10. Attend incident debriefings
   2. The person in an assisting role must:
      1. Follow all instructions provided by the first person on the scene and assist wherever possible
      2. Provide any support to the first person on the scene
      3. Assist in securing the area:
         1. Clear the area of other detainees and non-essential persons
         2. Be mindful of the need to preserve evidence for any subsequent investigation
         3. Control or segregate individuals depending on the circumstances
      4. Take note of all persons present at the time of the incident
      5. Complete and submit to the CBSA the appropriate incident report (Security Incident Report (PDF) (BSF152) or Contracted Security Guard Incident and Use of Force Report (BSF383))
      6. Follow established procedures for the reporting of security incidents
      7. Attend incident debriefings
2. Death or serious injury of a detainee
   Refer to standard on Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act
   
3. Investigation Refer to standard on Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act

4.6  Death or serious injury of an individual detained pursuant to the Immigration and Refugee Protection Act

4.6.1  Purpose and scope

To provide national direction in the event of a death or serious injury of a person detained under the Immigration and Refugee Protection Act (IRPA) while in a Canada Border Services Agency (CBSA) Immigration Holding Centre (IHC), in a hospital or in a non-CBSA detention facility

4.6.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedure (POSOPs) consistent with this standard

4.6.3  National standards

1. Comply with CBSA's established procedures, protocols and guidelines, including: the Protocol Regarding the Death of an Individual Detained Pursuant to the Immigration and Refugee Protection Act (IRPA), the CBSA Guidelines for Responding to a Serious Incident and Death in CBSA Custody or Control, the Public Communications Protocol : In Custody Death or Serious Injury, the ENF 20 manual (Detention), and the following standards: Transportation of Persons Detained under the Immigration and Refugee Protection Act; Health Services; Self-Harm and Suicide Prevention and Intervention; Detention in Non-CBSA Facilities; Communications and Media Relations; and, Detention Records

4.6.4  Definitions

CBSA Guidelines for Responding to a Serious Incident and Death in CBSA Custody or Control : Guidelines which provide guidance to CBSA staff on the steps to take when there is a serious injury or death in CBSA custody or control

In-custody death: An incident where a person has died while under the responsibility, physical care or control of the CBSA including, for example, under arrest or detention at a port of entry, in a CBSA immigration holding centre or while detained in a non-CBSA facility

Protocol Regarding the Death of an Individual Detained Pursuant to the Immigration and Refugee Protection Act: An Operational Bulletin (PRG-2014-51) which provides:

1. Instruction and operational guidance for CBSA staff and contracted service providers working within an IHC or providing transportation services
2. Guidance on situations where death occurs at a hospital, in a hearing room or any pre-hearing holding area, or during transfer between any of these locations where an individual is detained
3. Instruction and operational guidance for CBSA staff in situations where a death occurs in a non-CBSA facility (in other words, federal, provincial or municipal correctional facility) where the deceased was detained pursuant to the IRPA

Public Communications Protocol: In-Custody Death or Serious Injury: A protocol which outlines the public communications procedures related to deaths and serious injuries sustained while a person is in CBSA custody

Serious injury: An injury that significantly alters the functioning of the individual (loss of sight, loss of limb or motor function), or which results in the death of the individual

4.6.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Be familiar with, follow and apply all procedures outlined in the Protocol Regarding the Death of an Individual Detained Pursuant to the Immigration and Refugee Protection Act, the CBSA Guidelines for Responding to a Serious Incident and Death in CBSA Custody or Control and the ENF 20 manual (Detention),including (but not limited to) the following procedures:
   1. Initial response and reporting:
      1. Emergency services (call emergency medical services, police, CBSA Medical Services, as appropriate)
      2. Scene management:
         1. application of first aid
         2. preservation of evidence
      3. Notifications:
         1. next of kin (person identified as emergency contact on the Detainee Medical Needs form (BSF674)
         2. CBSA
         3. detainees within the facility (respecting the parameters of the Privacy Act)
         4. Canadian Red Cross Society (current contractor for the monitoring of Canada's immigration detention program) by email to IDMP@REDCROSS.CA who may conduct a monitoring visit to the detention facility to ensure the continued well-being of detainees
      4. Engagement of the Employee Assistance Program
      5. Mental health support for detainees and staff working at the IHC
      6. Incident reporting
   2. Internal administrative review
   3. Management response and action plan
2. Provide support to CBSA Communications (regional and headquarters) in applying a clear, consistent and transparent approach to communications while respecting federal policies and legislation such as the Privacy Act, and all other procedures outlined in the Public Communications Protocol — In-Custody Death or Serious Injury
3. Develop and implement POSOPs aligned with this standard the CBSA guidelines and protocol mentioned herein
4. Liaise with non-CBSA facilities and ensure regular contact where an incident or death of a person detained under IRPA occurs in a non-CBSA facility, consistent with the standard on Detention in Non-CBSA Facilities
5. Cooperate with police, coroner's office and medical examiner as required
6. Where a serious injury has occurred:
   1. Follow-up with the health facility at minimum daily where hospitalization is required to inquire about the detainee's health and well-being
   2. Follow procedures outlined in the standard on Detention in Non-CBSA Facilities where applicable
   3. Consistent with the standard on Classification and Placement of Detainees in Detention Facilities review classification and placement based on new information/circumstances to ensure risk to the person concerned, vulnerability factors and other safety and security factors are taken into account in the classification and placement assessment

b)  Guard services

1. Follow all procedures outlined in POSOPs
2. Immediately notify the CBSA and Medical Services if it is observed that a detainee has suffered a serious injury or death
3. Implement any directives received from the CBSA and/or Medical Services
4. In cases where death occurs in a hospital, comply with instructions provided by hospital staff
5. Brief incoming staff following an incident and share instructions received to ensure continuity
6. Following an incident, complete and submit a Contracted Security Guard Incident and Use of Force Report (BSF383)
7. Attend incident debriefings in accordance with POSOPs

c)  Medical services

1. Inform the CBSA if a detainee's medical condition is very serious or life-threatening
2. Refer a detainee as soon as possible to an off-site facility (for example, hospital) for further evaluation and/or treatment as necessary, consistent with the standard on Health Services
3. Follow-up on a regular basis with staff at the off-site facility and, where lawful consent is given by the detainee, provide the CBSA with regular updates on the detainee's condition
4. Provide the off-site facility with an IHC Medical Services contact that is available 24/7
5. Refer detainees to in-house psychologist or psychiatrist as necessary

2)  Operational delivery

a)  General

1. All procedures must be followed and applied according to the Protocol Regarding the Death of an Individual Detained Pursuant to the Immigration and Refugee Protection Act,the CBSA Guidelines for Responding to a Serious Incident and Death in CBSA Custody or Control
2. All communications procedures outlined in the Public Communications Protocol: In Custody Death or Serious Injury must be followed and applied

b)  Investigation

1. Incidents resulting in serious injury or death may be subject to a CBSA internal review, a police investigation (local police or the RCMP) and potentially other oversight bodies where applicable, and therefore:
   1. The area(s) involved in the incident must be left undisturbed and sealed for physical evidence
   2. Witnesses to the incident, including other detainees must be held separately until interviewed by the police
   3. All parties witness to an incident or involved in the response must fully cooperate with all investigative bodies

c)  File closure

1. Procedures for closing the file of a deceased detainee must include the following:
   1. Sending the detainee's fingerprint card to the RCMP stamped "Deceased" and identifying the date and place of death
   2. Placing the detainee's death certificate or medical examiner's report (original or certified copy) in the detainee's file
   3. Returning any foreign identity documents to the appropriate embassy/consulate
   4. Placing a copy of the gravesite title in the detainee's file where applicable (indigent burial only)
   5. Closing any electronic files on the detainee and retain records according to the standard on Detention Records

4.7  Accompanied and unaccompanied minors

4.7.1  Purpose and scope

To provide national direction when accompanied and unaccompanied minors are housed or detained in a Canada Border Services Agency (CBSA) Immigration Holding Centre (IHC)

4.7.2  Expected results

1. Regional Management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedures (POSOPs) consistent with this standard

4.7.3  National standards

1. Detention or housing of a minor is to be avoided to the greatest extent possible, used in extremely limited circumstances as a measure of last resort and for the shortest time possible
2. The Best Interest of the Child (BIOC) is a primary consideration
3. Alternatives to detention (ATDs) are actively and continuously considered and pursued for parents/legal guardians of minors
4. Alternative arrangements for minors (AAMs) are actively and continuously pursued when it is deemed to be in the BIOC
5. Family unity is preserved where possible and when it is in the BIOC
6. Accompanied minors are never separated from a parent/legal guardian unless it is in the BIOC or advised by Medical Services
7. Contact with other detainees within the facility, particularly those classified as high risk, is avoided at all times.
8. Minors are to only have regular contact with their parent/legal guardian and, upon assessment by CBSA, other families and minors living in the special purpose units.
9. Minors have access to educational and recreational activities according to provincial laws, this standard and other applicable standards

4.7.4  Definitions

Accompanied minor: A minor (housed or detained) who is accompanied by a responsible parent/legal guardian

Alternatives to detention (ATDs): ATDs include any condition imposed on an individual to offset a risk that person may represent to the CBSA's enforcement objectives and mandate. ATDs enable individuals to be released from detention and managed within the community. They include community programming (in-person reporting, cash or performance bond and community case management and supervision) and electronic supervision tools such as voice reporting

Alternative arrangement for minors (AAM): The transfer of custody of an accompanied or unaccompanied non-detained minor to a family member, a trusted friend/community member (who is not under CBSA custody), child protection services or a community-based organization

Best interests of the child (BIOC): An international principle to ensure children enjoy the full and effective benefit of all their rights recognized in Canadian law and the United Nations Convention on the Rights of the Child (CRC). It is also a rule of procedure that includes an assessment of the possible impact (positive or negative) of a decision on the child or children concerned. Any decision affecting children must take the child's best interest into account. Canadian laws include specific factors that parents are to look at when making decisions about their children. These factors include children's ages, special needs, relationships with the important people in their lives, the role of extended family, cultural issues, the history of the parenting of these children and the future plans for the children

Community-based organizations: Non-profit groups that work at a local level to improve life for residents. The focus is to build equality across society in all streams: health care, environment, quality of education, access to technology, access to spaces and information for the disabled, to name but a few

Detainee or Detained: An adult or minor subject to an Order for Detention under section 55 of the Immigration and Refugee Protection Act (IRPA)

Family: Consists of a parent/legal guardian and a dependent minor. This may also include family members as defined by Immigration and Refugee Protection Regulations and situations where siblings are traveling together without their parents/legal guardians

Housed minor: A foreign national, permanent resident or Canadian citizen who, after the completion of a BIOC assessment, is kept with their detained parents/legal guardians at an IHC at the latter's request. A housed minor is not subject to an Order for Detention and is free to remain and re-enter the IHC subject to the parents/legal guardians' consent in accordance with the rules and procedures of that facility

Minor: A person under the age of 18 (as defined in IRPA and the CRC)

Non-compliance: Failure or refusal to comply, as with a law, regulation, or term of a condition

Unaccompanied minor: A foreign national or permanent resident who arrives to Canada unaccompanied by a responsible adult (parent/legal guardian) and is not effectively taken into the care of such a person

High risk detainee: Persons who CBSA identifies that pose a risk to themselves, other detainees, or staff. These individuals may have a documented history or pattern of violent or aggressive crimes and / or behaviour. They may pose a significant escape risk from legal custody. Individuals may have also demonstrated behavior or non-compliance of detention facility rules causing a risk to themselves, other detainees or staff.

4.7.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Ensure that POSOPs clearly outline procedures and expectations in relation to minors
2. Ensure Guard Services understands the POSOPs, and verify that they are adhered to when a minor is admitted to the IHC
3. Ensure that all minors are seen by Medical Services in a timely manner
4. Closely and continuously monitor all minors held in the IHC and, in the rare instance where a minor may be temporarily placed in a non-CBSA facility, ensure follow-up (daily or more frequently as required) with the non-CBSA facility authorities on the status of the minor's health and well-being
5. Ensure minors and/or their parent(s) or legal guardian understand in case of language barriers
6. Verify that appropriate placement and supervision of unaccompanied minors are secured
7. Minors are not to have contact with the remaining detainee population, particularly those classified as high risk.
8. All interactions between minors and a high risk detainee(s) must be reported to CBSA management and recorded on file through an incident report
9. Notify CBSA management of all detentions or housing of minors, consistent with the Guidelines regarding significant events
10. Notify partners of the presence of an unaccompanied minor (child protection services and the Canadian Red Cross Society, the current contractor for the Immigration Detention Monitoring Program)
11. Authorize all visit requests for unaccompanied minors held in the IHC
12. Ensure any issue or incident involving a minor is addressed quickly and recorded on file (paper or electronic) in accordance with the standard on Detention Records
13. Provide access to education in accordance with the Immigration and Refugee Protection Regulations, provincial laws and this standard
14. Ensure compliance with the standard on Recreational Activities

b)  Guard services

1. Notify the CBSA of the arrival of an unaccompanied minor
2. Ensure minors receive the highest level of care and attention, in accordance with this standard, other relevant standards and POSOPs
3. Ensure that all Guard Services personnel understand and follow POSOPs related to the care of housed and detained minors
4. Ensure that minors do not have contact with the remaining detainee population, particularly those classified as high risk.
5. Guard staff must immediately notify their Supervisor if there are any interactions between a minor and a high risk detainee(s). The Supervisor will then notify the CBSA and proceed with incident reporting protocols.
6. Assign guards of the same sex as the detainee with accompanying children while in their living unit
7. Monitor closely for safety hazards the physical environment where minors and the parent/legal guardian are housed and take necessary steps where possible to prevent injuries (in other words, remove chocking hazards)
8. Report and document concerns or incidents immediately to designated authorities for appropriate action
9. Consult with the CBSA when clarification is required

c)  IHC staff (CBSA, medical services and guard services)

1. Respect the parent's/legal guardian's rights and responsibilities regarding the upbringing and development of their children or the children they care for when it is in the BIOC
2. Provide and/or seek assistance (from appropriate authorities) as required, to ensure the safety, security and well-being of minors

2)  Operational delivery

a)  Placement

1. Accompanied minors
   1. Family unity is a primary consideration in the placement of a family with minor children, consistent with the standard on Classification and Placement of Detainees in Detention Facilities
   2. Children must never be separated from a parent/legal guardian, unless it is in the BIOC or advised by Medical Services
   3. Minors must never be placed in the same unit as high risk detainees
   4. Minors are never to be in physical contact of high risk detainees
   5. CBSA and parents/legal guardians must consent to the housing of accompanied minors, and consent may be withdrawn at any time by the parents/legal guardians and under extreme circumstances by the CBSA (see National Directive for the Detention or Housing of Minors)
   6. Parents/legal guardians and their children must be placed in a family living unit which has amenities for children, and the least restrictive environment
   7. While mothers and fathers cannot sleep in the same quarters, every effort must be made to reunite families during the day to preserve family unity
2. Unaccompanied minors
   1. Where temporary placement is required for operational reasons (in other words, waiting for minor to be picked up by a family member or child protection services), the minor must be placed in a living unit (in other words, flex unit), separate from unrelated adult detainees
   2. Minors must never be placed within the proximity of high risk detainees
   4. Contact with other detainees within the facility, particularly those classified as high risk, is avoided at all times
   5. Heightened supervision by Guard Services personnel and IHC staff must be assured
   6. Access to and support from non-governmental organizations and other relevant organizations must be provided and visits and/or calls supervised by designated authorities
   7. When an emergency situation requires hospitalization of an unaccompanied minor, the CBSA must ensure accompaniment and immediately advise the designated representative (assigned by the Immigration and Refugee Board)
   8. Telephone calls must, for security purposes, be approved by the designated representative and/or the CBSA

b)  Services

1. Health and safety
   1. A secure and sanitary environment, proper nutrition, access to fresh air, access to health care services and recreation must be provided
   2. The well-being of minors must be closely monitored on a 24-hour basis
   3. Any anomalies, concerns, incidents must be recorded, reported and promptly addressed
2. Education
   1. Children have the right to education, in accordance with provincial laws. As such, all minors aged 5 to 18 (depending on applicable provincial law) must have access to education in core subjects (mathematics, languages). Qualified teachers (with appropriate credentials and clearances) will provide in-class education for minors who are at an IHC for over 7 days)
   2. The provincial school calendar will be used as a guide for summer vacation when no schooling is required
   3. A dedicated room for children's education must be provided
3. Recreation
   1. Children are free to engage in indoor and outdoor play and recreational activities with their parents and/or other children, recognizing the importance for a child's development and well-being
   2. Recreational activities will be provided in accordance with the standard on Recreational Activities
4. Accompaniment
   1. Every effort must be made for a parent/legal guardian to accompany their children at all times
   2. When this is not possible (in other words, a single parent/legal guardian is hospitalized), the parent/legal guardian must be consulted if possible on alternative care arrangements, and where not possible, local child-care agencies or child protection services must be contacted for temporary accommodations
   3. When a child is hospitalized, CBSA must make every effort for the parents/legal guardians to attend with child, unless contraindicated by Medical Services
5. Other
   1. With respect to transportation of minors, refer to the standard Transportation of Persons Detained Under the Immigration Refugee Protection Act (IRPA), section Transportation of Minors
   2. With respect to searches, refer to the standard on Searches
   3. With respect to visits, refer to the standard on Visitation

4.8  Vulnerable persons

4.8.1  Purpose and scope

To provide national direction for the care and management of vulnerable persons in detention when alternatives to detention (ATDs) are not viable

4.8.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All IHCs and detention operations will have local Post Orders and Standard Operating Procedures (POSOPs) consistent with this standard

4.8.3  National standards

1. Detention of vulnerable persons is avoided or considered as a last resort where there is no danger to the public; however, where detention is necessary (for example just prior to a person's removal from Canada), detention should be for the shortest period of time possible
2. Additional care and support is provided as required in a sensitive manner that ensures the physical and emotional well-being of vulnerable persons in detention
3. Track all vulnerable person interactions in DAMS
4. To be read in conjunction with ENF 20 (PDF) manual (Detention), ENF 34 manual (Alternatives to Detention), and the following standards: Classification and Placement of Detainees in Detention Facilities; Special Purpose Units; Accompanied and Unaccompanied Minors; Lesbian, Gay, Bisexual, Transgender and Intersex Individuals; Hunger Strike Management; Self-Harm and Suicide Prevention and Intervention; Death or Serious Injury of an Individual Detained Pursuant to the Immigration and Refugee Protection Act; Health Services; Searches; Transportation of Persons Detained Under the Immigration and Refugee Protection Act and Detention Records

4.8.4  Definitions

Alternatives to detention (ATDs): ATDs include any condition imposed on an individual to offset a risk that person may represent to the CBSA's enforcement objectives and mandate. ATDs enable individuals to be released from detention and managed within the community. They include community programming (in-person reporting, cash or performance bond and community case management and supervision) and electronic supervision tools such as voice reporting

Vulnerable person: a person for whom detention may cause a particular hardship. This includes but is not limited to: pregnant women and nursing mothers; minors (under 18 years of age); persons suffering from a medical condition or disability; persons suffering from restricted mobility which cannot be satisfactorily managed within a detention facility; persons with suspected or diagnosed mental illness; victims of human trafficking

4.8.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Ensure that POSOPs clearly outline procedures and expectations in relation to vulnerable persons
2. Ensure appropriate assessment and placement of vulnerable persons, taking their physical and emotional well-being and safety into consideration, consistent with the standard on Classification and Placement of Detainees in Detention Facilities
3. Ensure vulnerable persons receive a high level of care and attention, taking their concerns and requests into consideration, in accordance with this standard, other relevant standards and POSOPs
4. Ensure detainees understand in case of language barriers, and arrange for interpretation services as required
5. Hire personal care workers in the rare circumstance that a detainee requires assistance beyond the functions of Guard Services and Medical Services personnel
6. Provide advice and guidance to all personnel working with vulnerable persons, being careful to ensure detainee confidentiality
7. Ensure Guard Services understands the POSOPs, and verify that they are adhered to
8. Notify Medical Services and ensure vulnerable persons are seen by medical personnel in a timely manner upon admission
9. Direct Guard Services to monitor, complete and submit to CBSA a daily observation report for vulnerable detainees where close supervision is deemed necessary to ensure their well-being and safety
10. Review observation reports and maintain contact with Guard Services as required
11. Ensure any issue or incident involving a vulnerable person is addressed quickly
12. Record all pertinent information (in other words, reports) and maintain up-to-date the detainee file (paper or electronic) consistent with the standard on Detention Records
13. Record all pertinent information and interactions with a vulnerable detainee in DAMS as per ENF 20

b)  Guard services

1. Complete and submit daily, as directed by the CBSA, an observation report for vulnerable detainees
2. Monitor closely, and promptly report to the CBSA any concerns related to vulnerable persons
3. Eliminate safety hazards where possible and/or notify the CBSA in order to prevent physical injuries
4. Consult with the CBSA when clarification is required

c)  Medical services

1. Meet with the detainee for appropriate follow-up and assessment, including evaluation of the detainee's physical and mental health, and provide continuous care as required
2. Ensure detainees understand in case of language barriers and as required notify the CBSA when a detainee requires interpretation services
3. Recommend to the CBSA any course of action required to ensure the health, well-being and safety of detainees
4. Refer the detainee to other health professionals as deemed appropriate

2)  Operational delivery

a)  Placement

Refer to the standard on Classification and Placement of Detainees in Detention Facilities

4.9  Lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals

4.9.1  Purpose and scope

To provide national direction on search, admission, placement, and management procedures for lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals. For individuals detained and held at a non-Canada Border Services Agency (CBSA) detention facility, procedures will be guided by the policies and rules of each facility

4.9.2  Expected results

1. Regional management ensures implementation of this standard
2. Procedures related to this standard are understood and followed by all parties involved in the process
3. All Immigration Holding Centres (IHCs) and detention operations will have local Post Orders and Standard Operating Procedures (POSOPs) consistent with this standard

4.9.3  National standards

1. All detainees are treated with dignity, respect, fairness and professionalism regardless of their sexual orientation or gender identity
2. Searches of transgender and intersex detainees are conducted with care and in accordance with the standard on Searches
3. Placement determinations are always made on an individualized basis, in accordance with the standard on Classification and Placement of Detainees in Detention Facilities
4. Separation from other detainees is used only upon the detainee's request for protective purposes or where safety and security is a concern, in a non-restrictive living unit and for a short duration
5. A detainee's gender identity and sexual orientation are never directly or indirectly disclosed to any detainee or the public

4.9.4  Definitions^{Footnote 4}

Asexuality: The state of a person who has an ambivalent or changing sexual orientation

Bisexual: Referring to a person who is sexually attracted to people of their sex and people of a different sex

Cisgender: Referring to a person whose gender identity aligns with their sex assigned at birth

Gay: Referring to a person who is sexually attracted to people of their sex

Gender expression: The appearance usually associated with a gender. Gender can be expressed, for example, through behaviour, clothing, hairstyle, voice inflections and body language. A person's gender expression is not necessarily associated with their gender identity

Gender identity: A person's internal and deeply-felt sense of being man or woman, both, neither or somewhere along the gender spectrum. A person's gender identity may or may not align with the sex they were assigned at birth. Gender identity is not necessarily visible and is not related to sexual orientation

Heterosexual: Referring to a person who is sexually attracted to people of a different sex

Homophobia: The fear or hatred of, or hostility towards homosexuals and homosexuality, as well as prejudices against them

Homosexuality: The state of a person who is sexually attracted to people of their sex

Intersex: A term that describes a person whose primary sexual characteristics at birth do not meet the medical criteria of the male or female sex. The term "intersex" refers to biological sex features. It does not refer to sexual orientation or gender identity

Lesbian: A woman who is sexually attracted to women

Pansexuality: The state of a person who is sexually attracted to another person regardless of their gender

Sex assigned at birth: The sex of a person based on their primary sexual characteristics at birth

Sexual orientation: Sexual orientation includes, for example, asexuality, bisexuality, heterosexuality, homosexuality and pansexuality

Transgender: Referring to a person whose gender does not align with their gender assigned at birth

Transphobia: The fear and hatred of, or discomfort with, transgender people

4.9.5  National operational procedures

1)  Responsibilities

a)  CBSA

1. Ensure appropriate assessment and placement of detainees, ensuring their physical and emotional well-being and safety
2. Ensure detainees understand in case of language barriers and arrange for interpretation services as required
3. Regularly monitor detainees and reassess placement consistent with the standard on Classification and Placement of Detainees in Detention Facilities
4. Provide advice and guidance to all personnel working with LGBTI people who are in the process of affirming one's gender identity, and on prevention of transphobia/homophobia
5. Monitor for any incident in relation to homophobia and transphobia and take appropriate action

b)  Guard services

1. Notify CBSA of a transgender or intersex detainee arrival so as to ensure appropriate placement within the facility
2. Inform CBSA of any special needs and requests that do not fall within the POSOPs
3. Maintain alertness for and report incidents related to homophobia and transphobia to the CBSA

c)  Medical services

1. Consult as required, and upon consent from a detainee, prior external health and social services practitioners to obtain medical history and to ensure continuity of care as per provisions set out in the Interim Federal Health Program (IFHP)
2. Ensure detainees understand in case of language barriers and notify the CBSA when a detainee requires interpretation services
3. Inform CBSA when there are special needs and/or wishes for medication and/or items necessary to confirm gender identity that are not covered by the IFHP

2)  Operational delivery

a)  Admission

1. In the absence of a gender marker or selection of "other" as gender on any form received upon admission (in other words, National Risk Assessment for Detention (BSF754) or Detainee Medical Needs (BSF674)), the detainee should be respectfully asked which gender they identify with and treated accordingly
2. For further information, refer to standards on Admission and Discharge of Detainees and Searches

b)  Placement

1. As a matter of principle and for safety and security reasons and good order of the IHC, men and women, including couples, are separated when detained in the facility. As such, the same principle applies to gay and lesbian couples
2. Trans and intersex detainees should be placed according to their stated gender identity, and not based on a perceived gender selected by the officer
3. To the extent possible, all transgender and intersex detainees will participate in decisions regarding their placement
4. Placement must be determined case-by-case based on multiple factors, including risk to themselves or others, the person's gender identity and their views about where they would be safest (in other words, flex unit)
5. Separation from other detainees must be used only upon request for protective purposes or where safety and security is a concern, in a non-restrictive living unit with access to the same activities and privileges as other detainees and for a short duration, until a suitable alternative is found
6. Refer to the standards on Classification and Placement of Detainees in Detention Facilities and Special Purpose Units

c)  Clothing and personal items

1. Detainees are permitted to receive, possess and wear clothing and personal items in accordance with their gender identity and with the standard on Funds, Valuables and Personal Property
2. Transgender and intersex detainees may receive, possess and wear items necessary to express their gender identity (in other words, compression garments, breast inserts, bras, etc.)

d)  Privacy

1. Canadian law (in other words, Privacy Act) ensures the protection of individual privacy with respect to personal information
2. Protecting a detainee's privacy must be a key consideration in determining where they receive questions about their LGBTI status
3. Disclosure of "protected information" to any other person where that information has been obtained in an official capacity may be considered a criminal offence
4. All staff must respect the spirit of the Values and Ethics Code for the Public Service and the Treasury Board of Canada Secretariat (TBS) Code of Conduct

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