Solitary Confinement and Risk of Self-Harm Among Jail Inmates

Objectives. We sought to better understand acts of self-harm among inmates in correctional institutions.Methods. We analyzed data from medical records on 244 699 incarcerations in the New York City jail system from January 1, 2010, through January 31, 2013.Results. In 1303 (0.05%) of these incarcerations, 2182 acts of self-harm were committed, (103 potentially fatal and 7 fatal). Although only 7.3% of admissions included any solitary confinement, 53.3% of acts of self-harm and 45.0% of acts of potentially fatal self-harm occurred within this group. After we controlled for gender, age, race/ethnicity, serious mental illness, and length of stay, we found self-harm to be associated significantly with being in solitary confinement at least once, serious mental illness, being aged 18 years or younger, and being Latino or White, regardless of gender.Conclusions. These self-harm predictors are consistent with our clinical impressions as jail health service managers. Because of this concern, the New York City jail system has modified its practices to direct inmates with mental illness who violate jail rules to more clinical settings and eliminate solitary confinement for those with serious mental illness.Self-harm is a prevalent and dangerous occurrence within correctional settings.1 Inmates in jails and prisons attempt to harm themselves in many ways, resulting in outcomes ranging from trivial to fatal. Suicide is a leading cause of death among the incarcerated; however, suicide and suicide attempt represent a small share of all acts of self-harm.2 The motivations of inmates who harm themselves are complex and often difficult to discern.3 Inmates often arrive in correctional settings with significant pre-existing mental illness and histories of self-harm, but they may also be influenced by environmental stressors within correctional settings or aim to avoid certain situations or punishments.4Approximately one third of those admitted to the jail in New York City (NYC) receive care for mental health services during their incarceration, a proportion that has been increasing over time. Inmates who harm themselves become patients in the mental health service. Those who harm themselves while in solitary confinement may be diverted from that punitive setting to a therapeutic setting outside solitary confinement, which may provide an incentive for self-harm. The purpose of this analysis was to better understand the complex risk factors associated with self-harm and consider whether patients might be better served with innovative approaches to their behavioral issues.