Summary of Issues and Challenges in the Management of Prison Self-injury
- In the last 5 years, the number of self-injury incidents in federal correctional facilities has almost tripled. In 2011-12, there were 912 incidents of self-injury recorded, involving 303 offenders.
- Self-injury involves deliberate bodily harm, typically without suicidal intent, and may include cutting, head banging (which in rare cases can lead to permanent disfigurement or brain damage), self-strangulation, burning, ingesting harmful objects and other forms of self-mutilation. In 2011-12, the most common form of self-inflicted injury in prison was by cutting (42%).
- The frequency and severity of self-injury is particularly concerning among Aboriginal and federally sentenced women offenders. In 2011-12, Aboriginal offenders accounted for 45% of all self-injury incidents in federal custody. Women offenders accounted for just over one-quarter of all reported self-injury incidents; Aboriginal women accounted for 72% of that number.
- Of the more than 300 offenders who self-injured last year, a dozen individuals engaged in chronic self-injurious behaviour. These 12 individuals accounted for 36% of all recorded incidents. 8 were of Aboriginal descent; 4 were women (3 of whom were Aboriginal).
- Research suggests that self-harming behaviour in prison is most often used as a coping strategy to deal with negative emotions such as anger or frustration, depression, anxiety or fear, hopelessness and loss. Most self-injury incidents occur in the five treatment centres, the multi-level regional women’s facilities, segregation units or in maximum security facilities where the conditions of confinement are particularly austere.
- Although once almost exclusively associated with women offenders, more male offenders are engaging in self-injurious behaviour. Unlike women offenders who often come into prison with a previous history of self-harm in the community, male offenders who self-harm are more likely to begin this behaviour in a federal facility.
- Both male and female self-injurious offenders are more likely than others to have experienced childhood sexual, emotional and/or physical abuse. These offenders are often afflicted by depression, addiction, trauma or personality disorders, suggesting a strong link between a mental health concern and self-injurious behaviour.
Issues of Concern
In recent years, the Office has made a number of findings and recommendations focused on the capacity and response of the Correctional Service of Canada ( CSC ) to manage prison self-injury and the need for alternative measures for the most serious and complex cases:
- Lack of alignment between security practices and health care interventions in the management and prevention of prison self-injury.
- Reliance on use of force and control measures (e.g. physical restraints, segregation placements, and pepper spray) to manage self-injurious offenders.
- Non-compliance with voluntary and informed consent to treatment protocols.
- Lack of specialized services for women who self-injure.
- Clear policy direction for monitoring, reporting and oversight of the use of physical restraints (e.g. an exceptional measure of last resort; shortest duration possible; medical authority to apply or discontinue their use).
- Need for more core competency training in assisting front-line staff who manage and interact with offenders afflicted by a mental health problem on a daily basis.
- Inadequate physical infrastructure and capacity to manage complex needs.
Highlights from the 2011-12 Annual Report
- Response to Incidents of Self-injury
- Incidents of self-injury often result in the use of security or control interventions (e.g. physical restraints and use of inflammatory spray) that are generally disproportionate to the risk presented and often inappropriate from a mental health needs perspective. These measures simply contain or reduce the immediate risk of self-injury; they are not intended to deal with the underlying symptoms of mental illness that can manifest itself in self-injurious behaviour.
- Offenders who self-injure are often moved to segregation cells. Isolation and deprivation that prevail in segregation units can exacerbate symptoms of mental illness. A disproportionate number of prison self-injury occurs in segregation cells under close observation.
- An escalation in the security response can be met by more frequent, sometimes more desperate, and, occasionally, even lethal self-injurious behaviour.
- Policy Compliance
- Compliance with clinical measures set out in Commissioners Directive (CD) 834 - Management of Inmate Self-Injurious and Suicidal Behaviour - is, at times, lacking.
- The Office continues to intervene in cases where there was no treatment plan on file for offenders engaging in repeat self injurious behaviour.
- In one case, against its own policy, CSC has used a protective helmet to manage a case of serial head-banging. It has built Canada’s first padded prison cell despite having no specialized expertise or policy to oversee its use. The use of padded cells is controversial in the community and they have no place in a correctional facility.
- Need for Alternative Service Delivery Measures
- There are a handful of mentally disordered offenders whose symptoms, behaviours or severity of illness is beyond the capacity of CSC to safely manage. A federal penitentiary is not the place for treating complex cases of chronic self-injury.
- Despite regularly using community hospitals to treat offenders with acute physical health care needs, CSC rarely transfers offenders with acute, specialized or complex mental health care needs to external treatment facilities for ongoing care.
- The Office continues to intervene in cases where a chronic self-injurious offender would be better served if he/she were placed in a secure treatment facility in the community.
Recommendations from 2011-12 Annual Report
- An external clinical expert be contracted to conduct a compliance review against clinical measures identified in CD 843 (Management of Inmate Self-Injurious and Suicidal Behaviour) and that the results of this review and the Service’s response be made public.
- The Service prepare an expert report on the barriers to alternative mental health service delivery in federal corrections and publicly release a management action plan to mitigate these barriers, including clear timelines for implementation of new service arrangements with external healthcare providers.
- In keeping with Canada’s domestic and international human rights commitments, laws and norms, an absolute prohibition on the practice of placing mentally ill offenders and those at risk of suicide or serious self-injury in prolonged segregation.
- The Minister prohibits CSC from introducing or using padded cells in any of its treatment facilities.