220219 Self-injurious behaviors in prisons: A nationwide survey of correctional mental health directors

Monday, November 8, 2010 : 1:00 PM - 1:15 PM

Judith Savageau, MPH , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Kenneth Appelbaum, MD , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Robert Trestman, PhD, MD , Correctional Managed Health Care, University of Connecticut Health Center, Farmington, CT
Jeffrey Metzner, MD , Department of Psychiatry, University of Colorado School of Medicine, Denver, CO
Jacques Baillargeon, PhD , Division of Epidemiology and Outcomes / Correctional Managed Care, University of Texas Medical Branch, Galveston, TX
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.

Learning Areas:
Administration, management, leadership
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Participants will be able to: 1. Describe the prevalence of self-injurious behavior in the prison setting. 2. List correctional facility factors related to self-injurious behaviors in prisons and the policies and practices related to its management. 3. Evaluate implications for best practice models of care in this area.

Keywords: Correctional Health Care, Mental Health Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked closely and collaboratively with all 4 co-investigators on this project (all of whom are intimately involved with corrections health at both state and national levels) on the study's design, implementation, management, and data analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.