Women Offender Programs and Issues

Report on Self-Injurious Behaviour in the Kingston Prison for Women

Section 2: Injury Response

    At present, a woman who engages in identified self-injurious behaviour is taken to health care services (or outside hospital services where required) for medical attention and is then taken to segregation. The prisoner must remain in segregation until an assessment by a psychologist indicates the absence of suicidal ideation. In addition, the woman most often has to appear before the Segregation Review Board. As psychologists are primarily available only during normal business hours Monday to Friday, and the Segregation Review Board meets only on Mondays and Fridays, there can be a considerable delay in releasing a non-suicidal individual from segregation.

    There appears to be some confusion as to whether this protocol is in fact policy. The Warden indicated that all that was required for release from segregation was a positive assessment by a psychologist. The psychologists indicate that it has been only recently that their assessment alone has resulted in release from segregation and at this point are unclear whether this practice is stated policy and will continue. Even if this policy is clarified and supported, it does not address the situations (e.g., weekends) where a psychologist is not available to provide immediate assessment.

    In extreme cases of self-injury, the woman can be referred to the Regional Treatment Centre at the Kingston Prison. However, this is a limited facility with only 10 beds. The programme at this facility has been developed to deal with a wide range of mental health problems and is often filled to capacity. Further, although there has been some success in reducing self-injury within the Regional Treatment Centre context, this behaviour often reappears when the woman is transferred back to the Prison for Women. Thus, the Regional Treatment Centre is not a viable option for self-injury in the majority of cases.

 

2.1 Prisoner Responses Regarding Existing Protocol

    Protocol is used here to refer to the most prevalent response to self-injurious behaviour (as outlined above). Whether this response actually reflects formal protocol is irrelevant to this discussion.

    Despite the fact that prisoners were not questioned directly on the appropriateness of segregation in response to self-injury, 39 of the 44 prisoners interviewed spontaneously addressed this issue. Of these prisoners, 97% (38) argued that segregation is an inappropriate response to self-injury. The only woman who endorsed segregation as an appropriate response had never engaged in self-injury and regarded such behaviour as a suicide attempt. This prisoner stated that segregation was necessary for monitoring purposes.

    The fact that so many prisoners discussed segregation in the absence of direct questioning indicates the extent of the distress over the existing protocol. Although the transfer to segregation is for monitoring as opposed to punitive purposes, experientially it is perceived by the women as punishment. A number of women commented that "you are treated the same [taken to segregation] whether you hurt someone else or hurt yourself." Despite the different nature of these acts the consequences are the same. Thus, at present, the intention behind the transfer to segregation notwithstanding, the women experience the transfer as punishment.

    A second issue raised by a majority of the women was the isolation imposed by segregation. Many of the prisoners (78.3%) stated that after a self-injury, the woman involved needs someone to whom she can talk. Although there was some disagreement about whether this person should be a counsellor (49%), a friend (9.8%), another prisoner who had "been there" (2.4%), or just anyone to communicate with (17.1%), the necessity of someone being there was of utmost importance for most.

    A frequent concern expressed by the women was the possibility of segregation evoking suicide attempts. Isolation and punishment (whether intentional or not) imposed on someone who is experiencing emotional difficulty, as evidenced by the self-injury, may overwhelm the individual leading to more drastic measures to stop the pain.

 

2.2 Security Personnel Responses Regarding Existing Protocol

    The majority of the CX staff (77.5%) support the transfer to segregation as a necessary action in the case of self-injury. Of these respondents, 80% stated that this transfer was necessary due to the monitoring capabilities in this area. However, many (45%) noted that in an ideal situation, the individual should be moved to a place where immediate counselling is available. A number of security staff mentioned that the lack of counselling services results in women being released from segregation in the absence of problem resolution.

    Overall, the security staff responses indicate that the possibility of self-injury puts inordinate stress on the staff. Many reported that a self-injury is very difficult for them to deal with emotionally because of the stress involved (59%) or because of the feelings of helplessness (21%) it evokes. Others (10%) noted that the frequency of self-injury had caused them to become hardened in order to cope.

    It must be noted that although the CX staff are not trained in psychological assessment they must often deal with women in emotional distress. Despite the fact that the CX staff may know a woman is in crisis, they often cannot take action until something occurs and, thus, are often placed in the situation of worrying that a woman in crisis may self-injure or suicide. One evening when I was conducting interviews on the Range post, a woman with a history of severe slashings was in distress. The CX staff increased their rounds from once an hour to once every 15 minutes to ensure she was safe. The anxiety and feelings of powerlessness of the CX staff were very apparent.

    The CX staff, as the front-line workers, must without training deal with women in emotional distress. Ultimately, the responsibility for the women’s safety lies with the security personnel. Both the concern that a woman may self-injure or suicide and the often encountered reality of dealing with a woman who has in fact self-injured or attempted/completed suicide creates an enormous emotional burden for the staff.

 

2.3 Recommendations:

• It must be clarified that self-injurious behaviour is a mental health issue as opposed to a security issue. As such, at the first indication that a woman is in emotional distress, the situation must move from the security domain to that of psychology/health care services. This will not only ensure that prisoners are provided with appropriate services, it will reduce stress among the CX staff by alleviating responsibility in areas they are not trained to handle. It is recognized that, at times, decisions will involve judgement calls by the CX staff and security issues will still have to be given credence.

• It must be recognized that segregation, due to the isolation imposed and the perceived punishment aspect, is an inappropriate response to self-injury. Given the reduction of anxiety that occurs with self-injury, the crisis is most often over once the act has taken place. Segregation can be expected to increase rather than decrease suicide potential due to the isolation it imposes. In fact, the National Task Force established by Health and Welfare Canada (1987) noted that a 1981 study conducted by the Correctional Service of Canada reported that "suicide rates were more prevalent in dissociation areas than in general cells" (p. 35). This recommendation reflects a strategic objective of Core Value 1, 1.5: "To ensure that placement in general population is the norm and to provide adequate protection, control and programs for offenders who cannot be maintained in the general population" (p.9).

• Given the above recommendation, it is further recommended that a woman who self-injures be brought to health care services where either a psychiatrist, psychologist, nurse (if properly trained in these issues), or physician (if properly trained in these issues) can assess whether the woman is best served by remaining out of the general population. If the woman is assessed as being a high suicide risk, she should remain in the health care services area or be transferred to an alternative health care facility until adequate counselling enables her safe return to the general population. This recommendation reflects the strategic objective of Core Value 1, 1.5: "To ensure that placement in general population is the norm and to provide adequate protection, control and programs for offenders who cannot be maintained in the general population" (p. 9).

• It is important in times of emotional distress that the women have someone with whom they can talk. The person best suited will depend on the individual case, and as such should be determined/identified by psychology/health care services with input from the correctional supervisors. The woman concerned would, of course, have primary input into the identification of the individual(s). This recommendation reflects a guiding principle of Core Value 1: "Offenders, as members of society, retain their rights and privileges except those necessarily removed or restricted by the fact of their incarceration" (p. 8). This surely includes the right to emotional support in times of crisis.

• Given that the nursing staff are often a prisoner’s first contact after a self-injury, the nurses should be provided training in appropriate intervention. This recommendation reflects the strategic objective of Core Value 3, 3.8: "To provide staff training and development opportunities that are based on achievement of our Mission, develop the full potential of staff members, and emphasize interpersonal skills, leadership and respect for the unique differences and needs of all offenders" (p. 13).