Addressing the Issue of Offender Self-Injury: Summary of Expert Roundtable

Introduction

The Correctional Service of Canada (CSC) is committed to addressing the number of offenders who engage in self-injurious behaviours. In recognition of a commitment made in response to the Office of the Correctional Investigator’s (OCI) 2011-12 Annual Report, and to further CSC’s capacity to address the needs of offenders who self-injure, CSC hosted an expert panel roundtable on this issue in October 2012. The goal of the roundtable was to identify best practices to inform the way CSC manages repeat self-injurious offenders.

Responding to the mental health needs of offenders is one of CSC’s top priorities. Significant gains have been made in strengthening the continuum of mental health care for offenders. These gains include the introduction of a more comprehensive mental health screening process at intake; building capacity in mainstream institutions to respond to mental health needs; providing Fundamentals of Mental Health training to front-line staff working in both institutions and the community; and assisting offenders with significant mental health needs as they transition from the institution to the community.

Addressing the issue of offender self-injury is vital to the safety and well-being of offenders under CSC jurisdiction. Ensuring that offenders receive the mental health services they need creates safer institutions and enhances successful reintegration, which directly contributes to public safety. Self-injurious behaviour is a complex clinical and operational issue that requires a comprehensive, inter-disciplinary approach. CSC has identified four strategic priorities in this area:

  • Research
  • Strengthened Policy and Tools
  • Supporting Staff
  • Improved Interventions

Expert Roundtable

Experts from Canada, the United States and the United Kingdom participated in this roundtable. They included:

  • Dr. Robert Trestman is the Executive Director of the University of Connecticut Health Center’s Correctional Managed Health Care and a Professor of Medicine, Psychiatry and Nursing.
  • Dr. John Bradford is the Head Professor in the Division of Forensic Psychiatry, Professor of Psychiatry Faculty of Medicine at the University of Ottawa. He was also recently appointed to the Order of Canada.
  • Dr. John Livesley is a Fellow at the Royal Society of Canada and editor of the Journal of Personality Disorders. He has also held academic appointments in psychology at the University of Liverpool and in psychiatry at the Universities of Edinburgh and Calgary.
  • Dr. Stanley Yaren is the Director of Adult Forensic Psychiatry Program for Manitoba and the Winnipeg Regional Health Authority. He also serves as the Deputy Clinical Head of the Mental Health Program of the Winnipeg Sciences Centre, and is an Associate Professor of Psychiatry at the University of Manitoba.

The following five themes were identified during the roundtable:

  1. Self-injurious behaviour is a symptom
    • Self-injury should be seen as a symptom. The underlying causes of this behaviour will differ from one offender to the next. Identification and treatment of the underlying cause is paramount.
  2. Appropriate clinical interventions for self-injurious offenders should be determined on a case-by-case basis
    • A case-by-case assessment, including the offender’s history, level of risk, and essential collateral information, is required to determine the best clinical course. Interventions should be informed by the assessment. Second opinions may be necessary for some cases.
  3. A clear and conceptualized model for treatment is essential
    • A modular approach to program development with core modules as well as modules tailored to the specific needs of different offenders should be explored.
    • The treatment model for self-injurious behaviour should follow the core principles of effective programming (e.g., focus on risk, need and responsivity).
    • This model should also focus on the importance of the therapeutic relationship between offenders who self-injure and the CSC health care staff who assist them.
    • In all cases, consent is required prior to the provision of treatment.
  4. A decentralized approach to manage chronically self-injurious offenders, not a national program
    • One national resource for the treatment of self-injurious offenders is not recommended, as it could mean that offenders are moved from their region and community supports/families in order to participate in the program. Involving family and supports is often integral to good outcomes for offenders.
    • Instead, increased regional capacity to deal with these offenders is recommended.
  5. Chronically self-injurious offenders are better managed in a mixed population of offenders
    • Institutional units with appropriate resources and diverse offender populations are preferable to a specialised unit that only accommodates self-injurious offenders grouped together. This reduces staff burnout and the possibility of contagion of self-injury (a cycle in which one individual engages in self-injury leading others in the immediate environment to engage in the behavior).