INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH, 11: 33–50, 2012 Copyright C  International Association of Forensic Mental Health Services ISSN: 1499-9013 print / 1932-9903 online DOI: 10.1080/14999013.2012.667513 Non-Suicidal Self-Injury Within Offender Populations: A Systematic Review Katherine Dixon-Gordon Simon Fraser University, Burnaby, British Columbia, Canada and University of Mississippi Medical Center, Jackson, Mississippi, USA Natalie Harrison and Ronald Roesch Simon Fraser University, Burnaby, British Columbia, Canada Non-suicidal self-injury (NSSI), defined as deliberate self-directed tissue damage, presents a serious health concern for offender populations. Approximately one-third of offenders report a history of NSSI, and it is the most common reason for mental health treatment within correctional settings. To date, no review exists with a specific focus on NSSI in criminal justice contexts. Therefore, the primary aim of this article is to review research on NSSI within correctional settings. Specifically, we explore the role of risk factors for NSSI. We also examine the functions of NSSI within correctional contexts. In addition, we evaluate the evidence for potential assessment tools and treatments for NSSI. Taken together, our review suggests that risk factors for NSSI must be considered differently in correctional settings, due to the high base rates of these vulnerabilities. Further, although environmental control is a more salient function of NSSI within correctional settings, the primary motive for engaging in this behavior remains emotion regulation. Finally, despite the emergence of several promising treatments for NSSI within correctional settings, larger scale studies are necessary to determine the efficacy of these interventions. Keywords: self harm, self-injury, offenders Non-suicidal self-injury (NSSI) is a serious health concern for offender populations. NSSI involves deliberate, self-directed tissue damage, such as cutting or burning (www.isssweb.org, International Society for the Study of Self-Injury, 2007). Between 7% (Lader, Singleton, & Meltzer, 2003) and 48% (Chapman, Specht & Cellucci, 2005) of offenders report a history of engaging in NSSI. Among mentally-disordered incarcerated offenders, the proportion of offenders identified as engaging in NSSI is even higher (61%; Gray et al., 2003; 48%; Loughran & Seewoonarain, 2005; 52.9%; Mannion, 2009). This rate far exceeds that of the general population, in which 4% of adults (Briere & Gil, 1998; Klonsky, Oltmanns, & Turkheimer, 2003) and 13 to 15% of adolescents (Ross & Heath, 2002) report a history of NSSI, and instead is more comparable to the high rates found among young adult undergraduate students (e.g., 35%; Gratz, 2001). Perhaps Address correspondence to Katherine Dixon-Gordon, University of Mis- sissippi Medical Center, Psychiatry and Human Behavior, 2500 North State Street, Jackson, MS 39216. E-mail: kdixongo@sfu.ca more alarmingly, 75% of lifetime incidences of NSSI for a large sample of youth in custody occurred in prison (Kenny, Lennings & Munn, 2008), and up to 24% of young offenders (Kirchner, Forns, & Mohino, 2008) and 35% of adult offenders (Sakelliadis, Papadodima, Sergentanis, Giotakos, & Spiliopoulou, 2010) engaged in NSSI while in custody, suggesting the prison environment may foster this behavior. Individuals who engage in NSSI present a significant cost to institutional resources. Incarcerated offenders who delib- erately injure themselves or threaten to injure themselves are often transferred from the general prison population to men- tal health treatment programs or special hospitals (Loughran & Seewoonarain, 2005; Melzer et al, 2004). In fact, studies reveal that 18% (Loughran & Seewoonarain, 2005) to 23% (Franklin, 1988) of offenders receiving mental health care were admitted because of NSSI or threat of NSSI, and 48% to 67% of those referred had a history of NSSI (Bland, Mezey & Dolan, 1999; Loughran & Seewoonarain, 2005). Moreover, after transfer to mental health treatment, inmates who engage in NSSI are more likely to be admitted to medium security psychiatric care than low security care (Melzer et al., 2004). Downloaded by [Ronald Roesch] at 07:29 17 April 2012