Corrections_Today_Winter_2024-2025_Vol.86_No.4

OFFICE OF CORRECTIONAL HEALTH

Mad or bad? Assessing suicide and self-injury risk in corrections By Dr. Dean Aufderheide 4 :45 PM. Telephone rings. Inmate threatening suicide in Restrictive Housing Unit. Find nation, making the assessment of suicide and self-injury risk among

as “bad” behavior. Some correc tional mental health experts have identified this tendency to classify disturbed behavior as “mad or bad” as a distinguishing characteristic of the correctional environment. When applied to potential self-injury, clas sifying behavior as “mad” or “bad” misses the point of the assessment, which is to ascertain the level of risk. Focus on the motivation gener ating the intent may be an expedient method, but it creates a post hoc, ergo propter hoc logical fallacy (if this, therefore because of this) and subverts the principal purpose of the risk assessment. It is imperative, therefore, that we avoid the misleading labels accom panying a “mad or bad” taxonomy when conducting risk assessments. We must recognize that the critical issue in our clinical decision-making process should be the assessed level of risk and ensure the safety and treatment services match the level of the assessed needs. CT

the most exigent challenges fac ing correctional mental health professionals. Documentation must be deciphered rapidly; clini cal interviews completed promptly; precautions implemented quickly. Decisions must be clinically jus tifiable, as their ramifications will impact the allocation of institutional staff resources. Collateral sources of information often lack agreement.

medical chart and review mental health record. No pre-incarceration mental health history. Post-incarcer ation history of episodic treatment for anger management deficits, impulsiveness, and self-injurious behavior. Variable diagnoses rang ing from Malingering and Antisocial Personality Disorder to Adjustment Disorder and Psychotic Disorder NOS. Numerous entries of “ma nipulative”, “secondary gain”, and “instrumental” behavior. Multiple disciplinary reports for rule infrac tions. No diagnosis or mental health problems past two years. Check into officer's station. Review log. No disturbances in sleep or appetite. Officer confides that inmate is a “management problem” and manipulating for transfer. Conduct mental status exam. Insufficient diagnostic crite ria for presence of serious mental disorder. Low frustration tolerance. High impulsivity. Poor coping skills. Denies suicidal intent, but threat ens self-injury. Inmate angry and intransigent. Insists he will do what is necessary for transfer. Similar scenarios occur every day in jails and prisons across the

“Though this be madness, yet there be method in it.” — William Shakespeare

Consequently, frustrated clinicians frequently resort to

classifying self-injurious behavior into a taxonomy of intent, labeling inmate behavior as “instrumental” or “manipulative” versus “truly suicidal” or “due to mental health reasons.” This dichotomous tax onomy derives from the spurious assumption that self-harm threats and behavior associated with mental illness are “mad” behaviors, while risk with instrumental intent is ma nipulative and should be classified

Dr. Dean Aufderheide is a clinical and forensic

psychologist and a licensed chaplain. He is ACA’s Director of Mental Health and board certified in correctional psychology.

Corrections Today | Winter 2024-2025

112