Surveillance of Suicidal and Non-Suicidal Self-Injury (NSSI) in the New York City Jail System

Suicide is frequently documented as the leading cause of death in jail systems across the nation. In addition to life-ending suicide attempts, heterogeneous acts of non-suicidal self-injury (NSSI) can result in considerable medical sequelae and high utilization of medical and mental health resources. NSSI is multi-determined and can be adaptive or intended for secondary gain such as effecting a change in housing area, avoiding punitive segregation, or facilitating transfer to a hospital. While one of the largest jail systems in the country, the rate of death by suicide in the New York City jail system is considerably below the national average. As part of a comprehensive suicide prevention and monitoring program, the New York City Jail system instituted a database of suicidal and non-suicidal self-injuries in 2007. The database captures information including inmate name, booking number, date of attempt, method (i.e. laceration to body, overdose on medication/ pills, swallowing sharp/ foreign object, hang-up), whether hospitalization followed, and the result of a targeted evaluation by senior mental health staff. This targeted evaluation is an assessment of factors such as intentionality and lethality, and ultimately determines whether the act was a suicide attempt or NSSI. Between 2007 and 2011, there were eight deaths by suicide and 2,514 acts of self-injury. Preliminary analysis of the data on self-injuries between 2007-2011 indicate most frequent methods of self-injury are lacerations and/ or scratches to the body (816), OD/ attempted OD on medication or pills (501), swallowed batteries/ cleaning solution/ a foreign object (372), tied/ placed a string or cord around the neck (296), and hang-up/ attempted hang-up (273). There were 17,029 instances of suicide watch in this time frame (2007-2011). Further analysis of the data on self-injury during this time frame is needed and ongoing. As part of a future plan for surveillance and suicide and self-injury prevention, injury reports are currently entered electronically in the heath record (eCW). In the near future, providers and administrators in the jails will be able to run reports directly from the health record which capture incident of self-harm for high risk individuals in their facility.