I have 2 HS friends that work in a mental health hospital prison. One as a guard and one as a shop foreman (think prison industries). Some of the stories they have told me what people do to themselves when they either quit taking meds or have a bad episode. One inmate liked to repeatedly stab himself deeply all over his body, inmate has since died from his injuries, but I can believe someone with severe mental health issues stabbing themselves in the back repeatedly. I can reach fleshy parts of my back pretty easily with my own arms.