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Forensic mental health patients with intellectual disabilities (IDs) have a higher risk of self-harming than those without IDs. Female patients and patients with a history of self-harm are at even greater risk. Identifying this elevated risk early can help forensic mental health professionals act sooner and better support patients before they self-harm.
In a recent study published in BMC Psychiatry, Dr. Mark Mohan Kaggwa and colleagues examined the prevalence of self-harm among forensic mental health patients with IDs in Ontario. The researchers reviewed each patient’s demographic, clinical, and forensic history to identify the characteristics most closely associated with self-harm.
This is a plain language summary of:
Kaggwa, M. M., Abaatyo, J., Davids, A., Brenton, L., Komar, M., Bradford, J. M. W., Chaimowitz, G. A., & Olagunju, A. T. (2025). Self-harming behaviors among forensic psychiatric patients living with intellectual disability. BMC psychiatry, 25(1), 976. https://doi.org/10.1186/s12888-025-07431-w
Understanding Self-Harm in Forensic Mental Health
When self-harm occurs, it can cause serious injury, infection, psychological distress, or even unintentional death.
Past research links the elevated risk of self-harm to adverse childhood experiences (for example, sexual abuse, family breakdown, bullying, and domestic violence), problems regulating emotions, histories of aggression, and past offences of forensic mental health patients with IDs. These factors are often present among this patient group, Dr. Kaggwa and his colleagues noted in their article.
The authors reviewed Ontario Review Board (ORB) reports from 2014 to 2015 for 155 forensic mental health patients with IDs. From these reports, they extracted and analyzed demographic details, such as age, gender, and education. They reviewed clinical information recorded in the reports, including inpatient or outpatient status, and history of substance use and self-harm. They also assessed forensic system details, such as ORB status and duration in the system.
Collecting these variables allowed the authors to determine how common self-harm was among these patients and to identify which characteristics were associated with current self-harm. The researchers then compared these variables with data on patients without IDs, allowing them to better understand how self-harm differed between the two populations.
Key Findings
The authors found that patients with IDs were much more likely to self-harm than those without (9.7%, compared with 2.5%).
They also had a higher prevalence of past self-harm (21.3%, compared with 14.5%). Patients who had harmed themselves in the past were more likely to self-harm again (31.2%, compared with 4.2%).
Female forensic mental health patients with IDs were more likely to self-harm than male patients.
While substance use initially appeared to be associated with lower odds of self-harm, this finding was not statistically significant after adjusting for other factors.
The researchers could not fully assess the severity of ID because IQ information was available for fewer than half of the patients with IDs.
Why It Matters in Forensic Settings
Consistent documentation of past self-harm, trauma, and other clinical and forensic details can support early identification. Identifying elevated risk early helps clinical teams plan monitoring and treatment more proactively and reduce disruptions to treatment and rehabilitation. Reducing self-harm among forensic mental health patients with IDs supports safer recovery by lowering the risk of injury, medical complications, and death.
Together, the researchers’ findings point to three areas where improvements may strengthen care across forensic programs:
- Earlier recognition of elevated risk
Because past self-harm was the strongest predictor of self-harm, identifying this history early can help forensic mental health professionals anticipate risk and intervene before further harm occurs. - Gender-responsive supports
Knowing that female patients are more likely to self-harm than males may help clinicians better match monitoring, treatment, and supports to individual needs. - Trauma-informed interventions
As many forensic mental health patients with IDs have histories of early-life trauma, interventions for these experiences may help reduce distress that contributes to self-harm.
Looking Ahead
The authors emphasize that forensic mental health patients with IDs have complex needs that benefit from specialized approaches to care. They also noted that more detailed and consistent data across forensic programs would support better assessment and treatment planning.
They recommend longitudinal and multi-centre studies to identify additional risk and protective factors, validate assessment tools, and inform the development of targeted interventions for this high-risk population.
Written by Kyle Roerick and approved by Dr. Mark Mohan Kaggwa.
