Changes in Mental Health Policy and Their Influence on Self-Injurious Behaviours in the Israeli Military Prison System

Article excerpt

Objective: Self-injurious behaviours (SIBs) are widespread among prisoners and are sometimes classified as potentially calculated acts intended to control others. Access to a psychiatrist may be valued by imprisoned soldiers seeking immediate release from service. The main goal of the study was to assess the effects of a new mental health regulation in the Israel Defense Forces (IDF) prison system, which requires ordering an immediate interview with a psychiatrist for inmates performing SIBs.

Method: Frequency of SIBs in 2 military prisons was examined and compared for 11 months before and 10 months after the implementation of the regulation. Severity of injuries and rates of release from service were examined for 4 months.

Results: The frequency of SIBs significantly increased after the implementation of the regulation in one prison, but not in the other. No effect was found for rate of release from service or for severity of injuries.

Conclusions: Increased accessibility to a psychiatrist for military prisoners may have resulted in increased motivation for inmates to perform SIBs. These effects are limited to the prison that serves a higher proportion of highly stressed soldiers.

(Can J Psychiatry 2007;52:591-597)

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Clinical Implications

* The rate of SIBs may increase after changes in an individual's social and physical environment and also after changes in mental health policy.

* The increase in the rate of SIBs may be limited to vulnerable populations.

* Ways for preventing SIBs in prisons should be further evaluated owing to the high rate and costs of SIBs among prisoners.

Limitations

* We did not assess the inmates' motivations for committing SIBs. Also, we cannot rule out that other changes took place in the prison milieu during the study.

* The study duration was rather short and the effect of the policy change on SIBs and on discharge rates might have evolved after the study's termination.

* Our findings in a specific setting may be only partially applied to different settings.

Key Words: self-injurious behaviours, mental health policy, self-injuries prevention, prison, military

Abbreviations used in this article

ANOVA analysis of variance

IDF Israel Defense Forces

ns not significant

SIB self-injurious behaviour

Suicide attempts and nonfatal SIBs, inflicted with no intent to die, are conceptualized in the literature as serious public health problems with annual rates that have ranged from 2.6 to 1100 per 100 000, with a lifetime prevalence rate of 720 to 5930 per 100 000.1 SIBs and parasuicide are often used as indicators of suicide risk,2,3 with a recent systematic review of 90 papers reporting that 15% to 16% will repeat parasuicide at 1 year and 7% will die by suicide within 9 years.4 In an earlier systematic review, a history of parasuicide increased the risk of suicide to 40 times that of the general population.5

Prisoner suicide is a significant problem in many countries, with the World Health Organization6 considering suicide as the most frequent single cause of death in correctional settings-so much so that, in 1999, Her Majesty's Chief Inspector of Prisons for England and Wales7 conducted a thematic review of prisoner suicides rates and found that they had more than doubled between 1982 and 1998 and that the increase was grossly disproportionate to the rise in the prisoner population. A recent large cross-sectional survey of prisoners in England and Wales by the Office of National Statistics8 found very high rates of parasuicide. Twenty-seven percent of male remand prisoners and 20% of male sentenced prisoners had a history of parasuicide. In Australia, research has consistently shown that suicide is the leading cause of death in Australian prisons,9-11 reaching 45% of deaths. …