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Psychosis and self-harm in prison: a population-based case-control study.

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Prison inmates with psychosis are at significantly higher risk of self-harm compared to those without. Improved information sharing and appropriate use of prison alerts can enhance care for this vulnerable population.

Keywords:
Forensic psychiatryMENTAL HEALTHSchizophrenia & psychotic disordersSuicide & self-harm

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Area of Science:

  • Forensic Psychiatry
  • Clinical Psychology
  • Public Health

Background:

  • Self-harm and suicide are significant concerns within correctional facilities.
  • Limited understanding exists regarding self-harm behaviors among incarcerated individuals with psychosis.

Purpose of the Study:

  • To investigate self-harm behaviors in inmates diagnosed with psychosis in New South Wales (NSW) prisons.
  • To examine the role of self-harm-related alerts in managing inmates with psychosis.

Main Methods:

  • A retrospective case-control data-linkage study utilizing administrative data from NSW, Australia (2001-2020).
  • Inclusion of individuals diagnosed with psychosis (cases) and age/sex-matched controls without psychosis, all incarcerated during the study period.

Main Results:

  • Prisoners with psychosis exhibited a higher incidence of self-harm (15.0%) compared to controls (3.6%).
  • Schizophrenia and related psychoses were associated with the highest odds of self-harm (aOR=4.84).
  • Individuals of Aboriginal heritage and those with psychosis had increased self-harm risks, while male sex and older age at first incarceration were protective.

Conclusions:

  • The elevated risk of self-harm in individuals with psychosis necessitates improved inter-agency mental health information sharing for better in-custody care.
  • Prison alerts can be a valuable tool for staff in managing the well-being of inmates with psychosis when implemented effectively.