Self-harm and solitary confinement in the NYC jail system

The bureau of Correctional Health Services (CHS) of the New York City Department of Health and Mental Hygiene is responsible for all aspects of health care in the NYC jail system. Routine health surveillance by CHS revealed a significant increase in acts of self-harm in 2009-2012. In 2009, 483 acts of self-harm were recorded among patients. This number increased 77% in the subsequent years to 854 in 2012, despite a 9% drop in the average daily population of the jail system. During the time of this increase, the use of solitary confinement increased approximately 60%. Based on these observations, CHS conducted a review of all acts of self-harm among patients admitted in 2010-2012. During this time there were 245,109 admissions, representing 137,530 individuals. A total of 1,927 self-harm gestures were recorded, representing 1,149 individuals. The most common types of gestures were laceration (33%), ligature/hanging (26%), overdose (12%), swallowed foreign object (12%), other (13%) and multiple (4%). Among these 1,926 acts of self-harm, 412 required transfer from the jail clinic (which all have 24/7 physicians) to another site, either a hospital emergency room or an on-island emergency medicine physician. A total of 82 gestures were assessed as high lethality, including 7 deaths. As compared to patients who did not self-harm, patients with self-harm gestures had higher rates of recidivism (67% vs. 38%), serious mental illness (12% vs. 2%) and solitary confinement (53% vs 8%). A regression model was created for predicting self-harm using the variables of solitary confinement, serious mental illness, age, length of stay in jail. Solitary confinement and serious mental illness were highly predictive of self-harm (OR 8.5 and 10.1 respectively with CI 7.5-9.7 and 7.9-12.8 respectively, p<0.0001 for both). Age under 24 years and length of stay over 6 months in jail were also predictive of self-harm (OR 2.5 and 1.5 respectively, CI 2.25-2.86 and 1.39-1.54 respectively, p<0.0001 for both). These findings underscore the need to tailor clinical services towards patients who self-harm and also working collaboratively with CHS partners to address the health consequences of solitary confinement.