Solitary Confinement and Risk of Self-Harm Among Jail Inmates

• Published in: American journal of public health (1971) 2014-03, Vol.104 (3), p.442-447
• Main Authors: KABA, Fatos, LEWIS, Andrea, VENTERS, Homer, GLOWA-KOLLISCH, Sarah, HADLER, James, LEE, David, ALPER, Howard, SELLING, Daniel, MACDONALD, Ross, SOLIMO, Angela, PARSONS, Amanda
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Age; Age Distribution; Behavior; Biological and medical sciences; Electronic health records; Ethics; Ethnicity; Female; Gender; General aspects; Health services; Hispanic Americans; Hispanic people; Human Rights; Humans; Imprisonment; Injury/Emergency Care/Violence; Length of stay; Male; Medical Audit; Medical sciences; Mental disorders; Mental Disorders - epidemiology; Mental Health; Mental health care; Middle Aged; Miscellaneous; Multivariate Analysis; New York City - epidemiology; Prisoners; Prisoners - psychology; Prisons; Psychiatrists; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research and Practice; Risk Assessment; Self destructive behavior; Self-Injurious Behavior - epidemiology; Self-Injurious Behavior - etiology; Sex Distribution; Social Isolation - psychology; Solitary confinement; Suicide; Suicides & suicide attempts; Teenagers; Variables; Young Adult
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2013.301742

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.