Self-injurious behaviors in prisons: A nationwide survey of correctional mental health directors

Background: Self-injurious behavior (SIB) by correctional inmates has serious health, safety, operational, security and fiscal consequences. In addition to injury to the inmate, other inmates and correctional staff can suffer harm when intervening or through exposure. Serious incidents require a freeze in facility operations and those needing outside medical attention create additional security risks. The interruption of normal operations, staff diversion, outside care costs, and medical and mental health resource drains all have significant fiscal consequences. This study examines the nationwide extent of SIB by inmates (including incidence, prevalence, adverse consequences, and management) and identifies prison systems that have developed behavioral interventions and programs to manage SIB.

Methods: The University of Massachusetts Medical School's Commonwealth Medicine/Correctional Health Program, with nationwide collaborators, developed and implemented a multi-method (on-line, email and paper-based) survey of state and federal Departments of Corrections' Directors of Mental Health Services.

Results: With 60% of prison systems responding from all regions of the country and all sizes of correctional systems, approximately 2% of inmates engage in SIB yet 67% of prison systems report events occurring at least several times/week to more than once/day. 55% of systems report these events as moderately to extremely disruptive to facility operations; only 17% report minimal disruption. For 72% of systems, SIBs have a moderate or extreme impact on mental health services or resources. In 60% of systems, SIB events require treatment outside the prison facility at least 5% and up to 50% of the time. Only 53% of systems maintain data on SIB events, with inmate housing unit the most common variable (40%). Fewer track critical data such as type of SIB behavior (37%), diagnosis (20%), behavior precipitants (17%), and administration of sanctions (7%). Although considerably variable, interventions such as restraints, medications, and behavior management plans tend not to be used. 82% of respondents report interest in participating in further studies of this problem.

Conclusions: A relatively small proportion of inmates are responsible for frequent episodes of SIB which typically result in moderate to extreme disruptions of custodial and mental health operations. States generally collect limited data on SIBs, and management approaches lack widespread consistency. Despite the important fiscal, operational, public health and safety problems associated with SIB, relatively little is known about its epidemiology or effective interventions. The wide difference in management of SIBs and expressed interest in future studies suggest a lack of best practice models in this area.