‘What to do with the cutters?’ – Best practices for offender self-injurious behaviors

Abstract

This paper addresses focal concerns regarding self-injurious behavior (SIB) in offenders, provides guidance on current best practices, and explains and challenges myths often held by correctional staff and administration regarding SIB. It is organized along the following thematic areas: (1) Behavior: SIBs within corrections are complex, challenging, and often misunderstood; (2) People: reducing rates of SIB in a correctional facility is a difficult challenge that requires collaboration; and (3) Place: the challenge of providing therapeutic and medical care within a correctional setting. Subsequently, policy implications and best practices recommendations are provided in order to better address this problematic behavior.

Keywords:

• Self-injurious behaviors
• corrections
• best practices
• offenders
• inmates

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. A plethora of studies have demonstrated that SIBs and suicidality (ideation, threats, attempts and completed suicides) are related behaviors; however, these studies identify key differences in the purpose, manifestation, and necessary treatment response that is appropriate for each behavior (e.g. Brown, Comtois, & Linehan, 2002; Fulwiler, Forbes, Santangelo, & Folstein, 1997; Owens, Horrocks, & House, 2002).

2. While non-suicidal self-injury was under consideration as a new disorder in Diagnostic and Statistical Manual (DSM-5), lack of research evidence relegated it to ‘Conditions for Further Study’ (American Psychiatric Association, 2013).

3. This difference should not be used to influence institutional response and treatment. SIB is a complex behavior and some offenders do learn the behavior once incarcerated and then learn to use self-injury to cope. As such, all responses should be identical regardless of speculation regarding motivation for the SIB act.

4. Hospital staff should also be alerted to the presence of this type of vulnerable offender. Following an SIB event, this individual may awake in hospital and reenact the self-injurious event. This is usually a severe, potentially fatal, act of SIB (see Smith, 2014).

5. Challenges and failures when addressing offender SIBs often provide as much insight as published successes. For example, one of the authors presented 10 basic emotions (e.g. sad, happy, anxious, etc.) to SIB-prone offenders and asked respondents to express their current emotional state. Almost every respondent looked at the list confused and said, ‘I don’t know how to answer that’. One respondent explained this is such, ‘I guess I feel all those emotions at the same time, but I can’t explain it’. This component of the research was abandoned but the non-verbal nature of SIB-offenders was apparent. Such failures need to be published as much as successes and breakthroughs.