Solitary Confinement and Risk of Self-Harm Among Jail Inmates

American Journal of Public Health (Impact Factor: 4.55). 03/2014; 104(3):442-7. DOI: 10.2105/AJPH.2013.301742
Source: PubMed


We sought to better understand acts of self-harm among inmates in correctional institutions.

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.

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.

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.

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Available from: Homer Venters, Nov 19, 2014
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    • "Additionally, very little is known about the use of punishment and force by prison guards to address infractions displayed by inmates in the general prison community (Clemmer, 1940). In addition, using special housing units to garner solitude and peace of mind from the general prison or jail community has not been the focus of empirical research concerning administrative segregation (Arrigo & Bullock, 2008; Casella & Ridgeway, 2012; Grassian, 1983; Kaba et al., 2014). Given that majority of the inmates exposed to solitary confinement will return to the community, we know very little about how solitary use may affect community reintegration and public safety. "
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    ABSTRACT: The electronic health record (EHR) is a commonplace innovation designed to promote efficiency, quality, and continuity of health services. In the New York City jail system, we implemented an EHR across 12 jails between 2008 and 2011. During the same time, our work increasingly focused on the importance of human rights as an essential element to the provision of medical and mental health care for our patients. Consequently, we made major modifications to the EHR to allow for better surveillance of vulnerable populations and enable reporting and analysis of patterns of abuse, neglect, and other patient concerns related to human rights. These modifications have improved our ability to find and care for patients injured in jail and those with mental health exacerbations. More work is needed, however, to optimize the potential of the EHR as a tool to promote human rights among patients in jail.
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