“Those who harm themselves while in solitary confinement may be diverted from that punitive setting to a therapeutic setting outside solitary confinement, which may provide an incentive for self-harm. The purpose of this analysis was to better understand the complex risk factors associated with self-harm and consider whether patients might be better served with innovative approaches to their behavioral issues” (p. 442). Self-harm is strongly linked to being in solitary confinement. “Inmates punished by solitary confinement were approximately 6.9 times as likely to commit acts of self-harm after we controlled for the length of jail stay, SMI [serious mental illness], age, and race/ethnicity. This association also held true for potentially fatal self-harm with a slightly lower OR [odds ratio], 6.3. It is notable that acts of self-harm often preceded the actual time spent in solitary confinement. Both SMI (OR = 7.97) and aged 18 years or younger (OR = 7.5) were also predictive of self-harm; nonetheless, the risk of self-harm and potentially fatal self-harm associated with solitary confinement was higher independent of mental illness status and age group” (p. 445).