Self-Injurious Behavior in Corrections: Implementing Evidence-Based Practices and Measuring Success

Article excerpt

There is no doubt that self-injurious behaviors appear to be on the rise in the U.S. In the early 1980s, the rate was about 400 per 100,000 citizens. (1) Within two decades, the rate had more than doubled to about 1,000 per 100,000. (2) Individuals most likely to engage in self-injurious behaviors were identified as those with serious emotional disturbance or with a severe and persistent mental illness. It is not surprising, therefore, that since the percentage of prison offenders with serious mental illness has tripled in the past three decades to about 15 to 20 percent today, self-injurious behaviors occur with greater frequency among mentally ill offenders than those with no mental illness. (3)

The Problem of Self-Injurious Behaviors

In the past several years, the management of self-injurious offenders has emerged as a critical concern within the correctional mental health field and has developed into a problematic public safety/public health issue in communities throughout America. Every day, every hour, offenders in America's prisons and jails cut themselves with sharp objects, insert paperclips in their abdomens, swallow harmful substances and objects, and bang their heads against the wall. These self-destructive behaviors often occur with conscious, nonsuicidal intent and are collectively categorized under a variety of labels, such as self-injurious behavior, deliberate self-harm, self-inflicted violence, parasuicide, self-mutilation, etc. While only a small percentage (two-three percent) of the offender population repetitively engages in these deliberate self-harm behaviors, they frustrate staff, disrupt institutional operations and incur significant medical costs.

Identifying Critical Issues

In tackling the challenges associated with self-injurious behaviors, researchers and clinicians have begun to identify and address the salient issues facing correctional systems in order to gain an improved outcome for offenders as well as correctional facilities. Critical concerns that have been identified include the need to standardize the nomenclature describing the spectrum of self-injurious behaviors; standardize a classification system for distinguishing the behaviors that would fall into the "self-injurious" behavior category; understand the etiology and identify motivational factors; establish uniformity in training and programming that emphasizes interdisciplinary communication, collaboration, control and care; and develop core competencies for mental health staff in the identification, assessment, and evidence-based treatment of self-injurious behaviors. It is imperative, therefore, that the mental health leadership develops a national strategy for establishing a collaborative and integrated approach for the management of offenders that engage in deliberate self-harm behaviors.

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Classification of Self-Injurious Behaviors

Understanding the different etiologies of self-injurious behavior is a "must" first step for correctional organizations. In order to develop an appropriate classification system, each self-harming behavior occurrence should be evaluated to ascertain motivation, lethality and modes of intent (e.g. tension reduction, instrumental, mood alteration, suicide, etc.). Additional information may include demographic information, disciplinary history, housing assignment at the time of the self-injury, diagnostic history, costs of off-site associated medical treatments (such as emergency room treatment, outpatient hospital procedures, or inpatient hospitalizations), mental health history, history of medical problems, results of a suicidal risk assessment and any other pertinent historical information. Targeted analysis of the data could be utilized to create profiles for self-injurious behaviors (self-injury profiles) and to link evidence-based treatments with the etiologies and core issues surrounding the behaviors. …