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Institutional Responses to Self-injurious Behavior Among Inmates

by Dana D. DeHart, Hayden P. Smith, & Robert J. Kaminski (2009).  Journal of Correctional Health Care, 15(2): 129-141.

Prisoners' self-injurious behavior has been identified as the most pressing problem for correctional mental health staff in South Carolina. Little is known about the origins, nature, and institutional responses to this form of inmate behavior. Self-injurious behavior is often posited as a form of coping behavior, but many correctional mental health staff perceives it as form of manipulative behavior. This is potentially troublesome, the authors suggest, because "it is important that mental health professionals not lose sight of self-injury's function as a response to stress. To do so may lead to gaps in surveillance, with minor wounds being dismissed rather than being viewed as potential precursors to more severe self-injury."

This study, conducted by criminology and social work researchers at the University of South Carolina, uses qualitative as well as quantitative methods to survey the perceptions of South Carolina correctional mental health staff on the origins, motivations, and manifestations of prisoners' self-injurious behavior. The study also queried staff members on the effectiveness of management responses to this form of behavior. Study participants included 54 correctional mental health licensed clinicians from 14 facilities, housing male and female inmates at all security levels. These professionals included high-level administrators, program managers, registered nurses, social workers, clinical counselors, human services coordinators, psychologists, and psychiatrists.

The various types of self-injurious behavior these correctional mental health staff members observed over a six-month period included cutting oneself with an object (most common), scratching oneself without an object, opening old wounds, inserting objects into the body or under the skin, attempted suicide, head banging, burning or branding oneself, biting oneself, pulling one's own hair, and bone breaking (least common). These self-inflicted injuries were often quite serious and severe, as when wounds revealed intestines.

Correctional mental health professions in South Carolina viewed inmate self-injurious behavior as a mix of manipulation and self-expression. These workers acknowledged that inmates self-injury partially as a coping mechanism, such as to express anger, send a message, or to respond to the stress of incarceration or bad news from home, but overwhelmingly suggested the manipulative basis for this behavior, including as means to improve one's situation, to transfer out of lock-up, to transfer into hospital accommodations, to transfer away from harassing or dangerous situations, or even to obtain medications.

Women prisoners were viewed as being less overt, or just not as likely to self-injure. Women were more likely to self-injure in response to being separated from their children. Mental health workers were also less likely to use such devices as "restraint chairs" for women because of concerns about reviving past experiences of abuse.

Management responses to self-injury focused primarily on isolation, although counseling was also introduced to accompany isolation. Other responses included psychological counseling, reporting behavior, applying first aid, and confiscating objects used to self-injure. Some responses were immediate, some involved "crisis intervention cells," and others were tiered to include multiple, successive strategies. In addition, "Some professionals expressed a need for intensive inpatient work with self-injurers, but special management units were limited in space and resources to accommodate such need. At least one facility has established a multibed 'cutters unit' in one of the dormitories, combining behavioral management with regular individual and group therapy."

Lastly, the cost of such behavior and resulting interventions was high: transportation costs, paperwork-related costs, medical care costs, and monitoring costs. Such behavior also had costs for correctional mental health staff who described "a range of initial reactions to inmate self-injury, including panic, shock, nausea, and anger. Professionals spoke of blaming themselves for inability to stop self-injury and struggling with frustration, feelings of detachment, and burnout. Often they developed methods for dealing with such incidents over time, including vigilance to boundaries between self and the client, showing concern without getting caught up in the inmate's affect, and staying attuned to one's professional responsibilities without bearing the onus of the inmate's actions. Professionals contextualized self-injury within the broder issues of inmate mental disorder or distress. Assuring staff supervision and thorough debriefing around traumatic incidents was also helpful in professional coping."

For further information, contact Hayden Smith, University of South Carolina, Department of Criminology and Criminal Justice, 1305 Greene St., Room 106, Columbia, SC 29208, (e-mail) SmithHP@mailbox.sc.edu.




Posted Mon, Jun 20 2011 10:52 AM by Tracey Vessels

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