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How to deal with self harming inmates

A concerted, multi-disciplinary response to self-injury behavior in the correctional setting is needed

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Self-injury behavior is a misunderstood phenomenon that is quite prevalent in the inmate population.

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An inmate is sent to medical with head lacerations from repetitive head banging against a cell wall. Another is found opening an abdominal wound stitched up after the trauma of a car-chase crash.

Still another is admitted to the infirmary having sliced arms and chest with a razor in the shower. Self-injury behavior (SIB) is a misunderstood phenomenon that is quite prevalent in the inmate population.

A report on SIB in prisons estimates two to four percent of the general prison population engage in the activity. The most common forms of self-injury in the correctional setting are cutting, inserting or swallowing objects, headbanging and opening old wounds. Working in corrections, you will definitely be confronted with inmates who have self-inflicted bleeding, bruising and burning damage.

Why are they doing this?

Experts have a variety of theories on the origins and treatment of this behavior.

Although staff may initially see SIB as a desire for attention or a response to boredom, some mental health experts are finding the behavior to be motivated by a “coping deficit” when dealing with feelings of depression or powerlessness.

Many who self-injure have a history of childhood physical or sexual abuse. As you may already know, children experiencing repeated abuse often cope by dissociation from the physical and psychological pain. This same dissociation from pain is seen in some who self-injure.

They must be suicidal

It is questionable whether self-injury is a suicide attempt or an attempt to quell suicidal thoughts. Janis Witlock, PhD, suggests that self-injury acts as a “drug” to release endorphins that calm the individual, thereby relieving stress for a time.

What can be done?

No matter the cause of the behavior, a concerted, multi-disciplinary response to SIB in the correctional setting is needed. Suggested interventions include intensive therapy, group sessions and careful treatment planning. SIB must be treated as more than a disciplinary issue to be controlled. A collaboration of custody and treatment efforts is a better answer to managing this condition.

Much is still to be learned about assessing, intervening and preventing SIB. Understanding the potential causes of the behavior will help you to be a part of the team approach to treating this complex condition.

This article, originally published 02/20/2012, has been updated.

Dr. Schoenly has been a nurse for 30 years and is currently specializing in correctional healthcare. She is an author and educator seeking to improve patient safety and professional nursing practice behind bars. Her web-presence, Correctional Nurse, provides information and support to those working in correctional health care. Her books, Essentials of Correctional Nursing and The Correctional Health Care Patient Safety Handbook are available in print and digital on Amazon.

Follow on Twitter: www.twitter.com/lorryschoenly; Facebook; Blogging @ www.correctionalnurse.net; and LinkedIn.

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