Non-suicidal self-injury (NSSI) presents a complex and challenging issue within the realm of corrections psychiatry, requiring a nuanced understanding and specialized approach for effective intervention. Dealing with the intricate dynamics of NSSI in corrections requires not only clinical expertise but also a compassionate commitment to the overall mental health and well-being of the inmate patients. CorrHealth skillfully combines both qualities to deliver comprehensive inmate mental and behavioral health programs and services to the communities we so proudly serve.
Understanding NSSI: Coping Mechanism in a Corrections Setting
In a corrections setting, individuals facing incarceration often grapple with a multitude of stressors, ranging from the loss of personal freedoms to the challenge of adapting to a confined and regimented lifestyle. Non-suicidal self-injury (NSSI) can emerge as a coping mechanism for inmates attempting to manage overwhelming emotions, express internal pain, or regain a sense of control within the constraints of their new environment. As such, recognizing the prevalence and significance of NSSI is a vital skill for not only psychiatry and mental health professionals but all medical personnel and the security staff.
Root Causes Of NSSI
Understanding the root causes of non-suicidal self-injury (NSSI) is a crucial element to providing effective care. The most evidence-based reason for NSSI is emotional dysregulation, or an inability to control how we show the world our feelings. Inmate patients within the corrections system may battle with heightened levels of stress, isolation, and a perceived lack of control over their circumstances. These factors, combined with a history of trauma, abuse, and pre-existing mental illness, can contribute to the development of NSSI as a maladaptive coping mechanism.
When isolated (jail, prison, mental hospital), the environment itself sets the scene to increase risk. Interpersonal conflicts with staff and peers can lead to an increase in emotional distress that overrides their impulse-control threshold. The NSSI behavior may establish a feeling of control and autonomy for them. It is a maladaptive coping skill, driven by primitive drivers, but still a coping mechanism that can relieve those internal pressures.
For others, NSSI can be a powerful retaliation behavior or also used to achieve secondary gains (perceived needs), especially in those with Antisocial Personality disorder (ASPD) or strong ASPD traits. The act of NSSI is most often preceded by emotions of anger, anxiety, or even boredom, often followed by relief or calm. This is a reinforcement cycle, increasing the risk of recurrent behaviors.
NSSI Behavior and Risk Factors
Risk factors can be identified during initial screening and subsequent follow-up screenings to help assess the risk of the occurrence of these behaviors. The three strongest risk factors are homelessness, unemployment prior to incarceration, and age under 30 years old. Other risk factors include:
- Lengthy incarceration or threat of lengthy sentence
- History of child/adolescent abuse, especially sexual abuse
- Family history of suicide and/or NSSI
- Young, single, female; or any age LGBTQ+
Early adverse childhood events (ACEs) and violence in adulthood are statistically linked to non-suicidal self-injury, especially in females and LGBTQ+ populations, and low levels of social support further compound all risk factors. Intellectual disability (ID), Autistic Spectrum disorder (ASD), and other neurodiverse populations have poor impulse control as part of the developmental malady, increasing the risk of more primitive NSSI, such as head banging, scratching, hitting self in head/face, hand biting, and other child-like behaviors.
Interventions for NSSI: A Multidisciplinary Approach
Interventions for NSSI in corrections settings demand a multidisciplinary approach, where medical and mental health professionals come together to develop a behavioral plan and mutual understanding of the treatment approach. Interventions using techniques from Cognitive Behavioral Therapy and Dialectical Behavioral Therapy have demonstrated efficacy in addressing the underlying cognitive, emotional, and impulsive aspects of NSSI. Education programs that raise awareness about mental health, adaptive coping strategies, and available support systems can contribute to creating a more supportive and understanding environment in the jail.
Promoting Empathy and Understanding in Correctional Health Services
Correctional health services, both medical and mental health, can promote a culture of empathy, support, and understanding, recognizing that each inmate-patient is an individual with unique experiences and challenges.
Dr. C.J. Rush D.O., M.S.(MedEd), CCHP
Chief Psychiatric Officer