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Self-harm is a serious concern in forensic psychiatry settings, being more common there than in the general population. Recent research shows that the risk of self-harm depends more on who the patient harmed during their original offence than on the circumstances of the offence itself.
Mark M. Kaggwa, Arianna Davids, Heather Moulden, Gary A. Chaimowitz, Parwiz Mohibi, Bailea Erb, and Andrew Toyin Olagunju conducted the research to better understand why certain forensic patients harm themselves, which is key to better care and prevention.
Their research revealed that patients who harmed a healthcare worker, support staff, or another patient were more likely to harm themselves than those whose victims were strangers, family members, acquaintances, or authority figures.
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A Closer Look at the Study
The researchers reviewed Ontario Review Board hospital reports of 845 forensic psychiatric patients who had committed violent offences between 2014 and 2015. These patients were living in one of Ontario’s 12 secure forensic psychiatric facilities. The study focused on what factors were linked to self-harm in this group.
Self-harm was relatively uncommon, with 4.1% of patients harming themselves during the study year. However, most of these patients (61%) harmed themselves more than once.
The researchers tested four statistical models, each adding new information about the patients. These models allowed the researchers to see how all the factors worked together and which ones were most strongly connected to self-harm.
Victim Type Linked to Risk
The researchers suggest that the link between victim type and self-harm may be explained by patients’ ongoing contact with the people they harmed. Patients who harmed healthcare and support staff often remain under their care, and those who harmed other patients may continue living with them in shared facilities. This continued contact and ongoing reminders of the offence can increase feelings of guilt, shame, or fear and contribute to repeated self-harm.
Comprehensive and individually tailored interventions (including therapy that addresses guilt), staff training, and changes in placements or care plans can reduce the risk.
Broader policy measures are also needed to support recovery and safety. Such measures could help lower the risk of self-harm and support better recovery outcomes.
The researchers also tested what happened during the offence, including weapon use, intoxication, and whether there were multiple victims, but none of these factors were linked to self-harm. The results showed that younger patients and those with a history of self-harm were at higher risk, while older patients had fewer incidents.
Looking Ahead
Self-harm in forensic psychiatry is a complex issue shaped by many factors, not just the details of the offence. Care plans need to be comprehensive and tailored to individual vulnerabilities.
Future research should also gather more detailed information on self-harm and examine the role of psychological factors, such as guilt and shame. Expanding this knowledge can guide clinicians and policymakers in developing stronger strategies to reduce self-harm and support recovery.
Written by Kyle Roerick and approved by Dr. Mark M. Kaggwa.
