Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

Abstract

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross‐sectional survey

“…The prevalence of forensic mental health patients who engage in self-directed aggression, also referred to as self-harming behaviour, ranges from 12% in incident report data (de Vogel & Verstegen, 2021) to 68%-70% by file examination (Brown et al, 2019;Laporte et al, 2021). The actual number of incidents is therefore likely to be higher than that reflected in incident report data, due to non-reporting or under-reporting of incidents (de Vogel & Verstegen, 2021). Types of self-harming behaviour in this clinical setting include cutting/scratching with sharp objects, head banging and ingesting foreign objects or dangerous liquids (de Vogel & Verstegen, 2021;Laporte et al, 2021).…”

“…The prevalence of forensic mental health patients who engage in self‐directed aggression, also referred to as self‐harming behaviour, ranges from 12% in incident report data (de Vogel & Verstegen, 2021) to 68%–70% by file examination (Brown et al, 2019; Laporte et al, 2021). The actual number of incidents is therefore likely to be higher than that reflected in incident report data, due to non‐reporting or under‐reporting of incidents (de Vogel & Verstegen, 2021). Types of self‐harming behaviour in this clinical setting include cutting/scratching with sharp objects, head banging and ingesting foreign objects or dangerous liquids (de Vogel & Verstegen, 2021; Laporte et al, 2021).…”

“…The actual number of incidents is therefore likely to be higher than that reflected in incident report data, due to non‐reporting or under‐reporting of incidents (de Vogel & Verstegen, 2021). Types of self‐harming behaviour in this clinical setting include cutting/scratching with sharp objects, head banging and ingesting foreign objects or dangerous liquids (de Vogel & Verstegen, 2021; Laporte et al, 2021). One study reported 64.9% of incidents to be considered severe or extreme in nature (de Vogel & Verstegen, 2021).…”

“…Types of self‐harming behaviour in this clinical setting include cutting/scratching with sharp objects, head banging and ingesting foreign objects or dangerous liquids (de Vogel & Verstegen, 2021; Laporte et al, 2021). One study reported 64.9% of incidents to be considered severe or extreme in nature (de Vogel & Verstegen, 2021). Suicide is a rare form of deliberate self‐harm, occurring in 0.1%–3.7% of forensic mental health inpatients (de Vogel & Verstegen, 2021), with hanging and suffocation being common methods (de Vogel & Verstegen, 2021).…”

“…One study reported 64.9% of incidents to be considered severe or extreme in nature (de Vogel & Verstegen, 2021). Suicide is a rare form of deliberate self‐harm, occurring in 0.1%–3.7% of forensic mental health inpatients (de Vogel & Verstegen, 2021), with hanging and suffocation being common methods (de Vogel & Verstegen, 2021).…”