Crime and Punishment: Women Mental Health in Prison

An unsafe living environment is a risk factor for many future crimes, as young women who run away from home to avoid abuse are more likely to get involved in drug distribution, prostitution and property crime (DeHart, 2008). Drug distribution, prostitution and property crime (such as robbery and theft) become their only source of fast and reliable income while substance abuse is an unfortunate and tragic by-product of the drug trade, as many women self-medicate in an attempt to cope with their history of trauma.

While each woman’s specific path to incarceration may differ, the closest link between sexual trauma and incarceration and sexual trauma and mental illness is certainly substance abuse and post-traumatic stress disorder (PTSD). While it’s important to note that depressive disorders, Borderline Personality Disorder (BPD), PTSD and Substance Use Disorders (SUD), are much higher in the female prison population than the average women’s population, there is also a high prevalence of co-morbidities (also known as co-occurring disorders/diseases, or COD), having two or more coexisting mental illnesses.

44% of incarcerated women were found to have PTSD as a result of physical or sexual trauma, and those who did meet the diagnostic criteria for PTSD were also more likely to report another COD (Harner et al., 2015). The incidence of comorbidities is common with PTSD, but PTSD is not the only common co-occurring disease. In a study conducted by James and Glaze (2006), it was discovered 42-49% of incarcerated women have both a SUD and another co-occurring mental illness, compared to less than a quarter of women having either a SUD or a different singular psychiatric disorder. Thus, we can see how closely trauma (and the resulting PTSD), SUD, and other mental illnesses are intertwined. This becomes extremely relevant in the broader context of developing effective mental health treatment and substance abuse programs and evaluating their potential effectiveness as women are released from prison and rejoin society. The negative impacts of sexual trauma and untreated mental illness in incarcerated women cannot be overstated.

These effects are long-lasting, hindering the lives of women and their families for many years, continuing beyond the prison walls. After incarceration, these women have an especially difficult time successfully reintegrating into society, a complex home and work environment under much less control with potential repeated exposure to risk factors of incarceration. Women with untreated mental health issues who have been incarcerated struggle to reach personal, economic and social goals after prison (Green et al., 2005). Mental illness and criminal history are strong inhibitors to both finding a stable job and reduced involvement in criminal activities that serve as a source of income. Mental illness also makes it much more difficult to navigate the complexities of interpersonal relationships and communication in home life, eroding hopes of healthy family reunification. Untreated mental illness also directly impacts the incidence of relapse into substance abuse and recidivism. Increased recidivism is not only devastating to the individual, but also the family they may have left behind, and society as a whole. Children with incarcerated parents are more likely to experience “psychological strain, antisocial behavior, suspension or expulsion from school, economic hardship, and criminal activity” (Martin, 2017).

This strain on the family is exacerbated when women are the primary caregiver for children, as is typically the case in our society. In other words, having an incarcerated parent is in and of itself a risk factor for the child’s future incarceration. Recidivism impacts everyone else who resides in the United States as well. From a purely economic standpoint, the more times women are re-incarcerated, the more taxpayers must pay to feed, house, and supervise them in the prison system. When this issue is of such far-reaching consequence for not only those directly impacted but society as whole, why does it not receive more national attention? Incarcerated women are often overlooked and disregarded by society because they are a marginalized, vulnerable population due to several different factors. First of all, most are minorities/women of color. According to the Federal Bureau of Prisons (2018), 38.1% of inmates are black, while 32.2% identify as Hispanic, compared to 12% black and 16% Hispanic in the general population, demonstrating how people of color are incarcerated at a disproportionately high rate. Race or ethnicity itself has a visible and measurable impact on life outcomes. One only has to watch the daily news to witness the state of race relations in this nation, especially involving the distrust between people of color and law enforcement.

Second, many incarcerated women have low socioeconomic status (SES). Many of the distal causes of poor health outcomes tied to low SES as discussed in class are also risk factors for incarceration. For example, the instability of a neighborhood (due to crime and lack of resources) can easily predispose its residents to the possibility of incarceration. Finally, the fact that these individuals are women puts them at a higher propensity for certain risk factors. One way women are marginalized in the context of the corrections system is through a sort of “knowledge gap”. Just as the “default” in the medical system is the male body, the corrections system was designed around the lives and needs of male inmates. As is evident by the relative novelty of the research referenced in this paper, the unique needs of incarcerated women were ignored for almost the entire history of corrections in the United States and any existing mental health and substance abuse programs, created for men, do not acknowledge gender-specific factors for incarcerated women.

As discussed previously, women “come into the criminal justice system via different pathways; respond to supervision and custody differently; exhibit differences in terms of substance abuse, trauma, mental illness, parenting responsibilities, and employment histories; and represent different levels of risk within both the institution and the community” (Covington & Bloom, 2006). In order to effectively develop mental health and substance abuse programming and services for these incarcerated women, these background factors must be taken into account. Unfortunately, the lack of care and attention given to the mental health of incarcerated women positively correlates with resource availability in women’s prisons. Not only do the sparse and underfunded current programs not account for women’s gender-specific needs, but there is also a massive shortage in trained psychiatric professionals in prison. To fully get a grasp of these shortages, the United States Government Health Resources and Services Administration has a website that contains data on Health Professionals Shortage Areas (HPSA). An HPSA designation indicates which areas have a severe need for primary care, mental, or dental health providers. There are several criteria that must be met for a geographic region or special population to be designated an HPSA.

To qualify, correctional facilities must contain at least 250 inmates and the ratio of full-time trained mental health professionals to inmates must be greater than 2000:1. Any person can search the HPSA page online, but according to research conducted in 2012, 457 correctional facilities in the United States have HPSA designation (Fuehrlein et al.). This statistic also does not include smaller county or city jails that may have fewer than 250 inmates so they cannot apply for HPSA status. As of December 1, 2018, in Texas alone, 65 correctional facilities were designated as shortage areas. Taking into account the research on the prevalence of mental illness and trauma in female prison populations, it is evident there is a monumental need for mental health professionals. Yet nearly 500 correctional facilities employ less than one mental health professional for every 2,000 incarcerated women when research indicates at least 1,000 of those 2,000 need mental health treatment. Another deficiency in mental health treatment in prisons is mental health screening upon admission to prison and lack of medication/treatment continuity.

Thorough screening for various mental health issues upon incarceration is critical for identifying the specific needs of each individual inmate. If preliminary screens are conducted, corrections officers have more of an idea of the individual challenges of each woman and can respond to their behavior in a more informed manner. Although the vast majority of incarcerated women have a mental disorder that is either undiagnosed or untreated, 18% of women with mental illness were on a medication regimen to treat their mental disorder prior to incarceration. However, more than 50% of this already small minority of women did not receive pharmacotherapy (prescribed medication) once admitted to prison (Gonzalez & Connell, 2014). This discontinuity demonstrates how in prison not only are th\BLAHHHHHH When there is such a shortage of mental health professionals and a lack of proper treatment or continuity of treatment, those currently working within existing infrastructure, the corrections officer themselves, serve an especially important role. However, due to lack of training, studies indicate that corrections officers are ill-equipped to deal with the needs of inmates with mental illness.

Women with mental health issues are more likely to experience severe disciplinary response to minor conduct violations (Houser & Belenko, 2015). Corrections officers are not trained to distinguish when misbehavior is symptomatic of a mental disorder. Essentially, those most directly charged with the care of these incarcerated women are responding in a punitive manner to misbehavior or conduct violations that are truly manifestations of mental disorder and thus not within the individual’s scope of control. Sadly, a common disciplinary measure, especially in understaffed prisons with a lack of resources, is the use of administrative segregation, also known as special/segregated housing units (SHU) or solitary confinement. Between 80,000 to 100,000 inmates are currently housed in some segregation or solitary confinement for 22 to 24 hours per day, for days, weeks, or months at a time (Baumgartel et al., 2015).

Solitary confinement has deleterious effects on the human brain. Psychologist Stuart Grassian (1983) concluded that solitary housing had such an impact on mental health in various ways, he dubbed the condition “SHU syndrome”. SHU syndrome is characterized by “perceptual changes; affective disturbance; difficulty with thinking, concentration, and memory; disturbance of thought content; and problems with impulse control”. In addition, most inmates who had lived through solitary confinement reported extreme anxiety and symptoms consistent with panic disorders. These harmful effects were observed in previously mentally healthy individuals so one can only imagine how destructive solitary confinement is for those who already struggle with their mental health. Mainstream media coverage around women’s mental health and incarceration is scattered, although a few media outlets have broached the topic and many non-governmental organizations and other activists have online material that can easily be found if searched for. Alisa Roth, the author of “Insane”, a book about America’s treatment of mentally ill prisoners, was interviewed for an article by NPR and highlighted the scarcity of mental health treatment in correctional facilities. In addition, an article in the Chicago Tribune featured activists in Illinois advocating for criminal justice reforms that take into account the gender-specific risk factors that lead women to incarceration.

More and more, coverage on this issue is acknowledging the disparities in race and socioeconomic status that lead to incarceration, and viewing the issue within a more sociological framework. Also, substance use disorders have been prominent in the national conversation lately, as we struggle to address and cope with the opioid crisis. Although the opioid crisis primarily impacts those who are white, the discussion about substance use disorders is being handled with more compassion and empathy than ever before, which bodes well for future discussions to improve mental health and substance abuse programs within prisons. Effective solutions must include rethinking how women are treated in correctional facilities and substance abuse/ mental health treatment. Bloom and Covington, prominent researchers who have conducted several studies about the unique risk factors and challenges for females in correctional settings, outline six primary governing principles to consider when developing treatment programs for incarcerated women.

The first is “acknowledging gender makes a difference”. In other words, as previously mentioned, the gender-specific risk factors and background histories must be the foundational cornerstone in all potential solutions. Second is focusing on “creating an environment based on safety, respect, and dignity”. Due to the prevalence of PTSD and the trauma histories of incarcerated women, in order to effect real and lasting change in these women’s lives, they first must feel safe and secure. Third is to “develop policies, practices, and programs that are relational and promote healthy connections to children, family, significant others, and the community”. Because of past trauma and mental illness, many incarcerated women struggle with interpersonal relationships so programming should facilitate healthy connections that can serve as a tether for them once they are released into the complexities of the outside world. Fourth is “addressing substance abuse, trauma, and mental health issues through comprehensive, integrated, and culturally relevant services and appropriate supervision”. Fifth is to “provide women with opportunities to improve their socioeconomic conditions”. This may include programming to obtain a GED or training for a specific job.

And finally, “establishing a system of community supervision and reentry with comprehensive, collaborative services”. Because many of these women struggle with release from prison, especially in regards to substance abuse relapse and recidivism, support is essential to easing the transition. There are many ways to approach solutions to these issues, and the following are a few proposed in light of these six guiding principles. The first and most important step is education and awareness. Many people are unaware of this crisis because it is rarely discussed and does not directly impact them. Heightening awareness of the issue through media coverage puts pressure on leaders in society and those charged with allocating funds and resources to acknowledge there is a problem. Investing in women’s crisis/trauma centers. Improved training for corrections officers so they are informed and prepared to interact with mentally ill prisoners is a relatively simple way to positively impact the lives of women living with mental illness in prison. All of these are social engineering perspectives, ways to address certain problems within the framework of the current system.

While implementing any of these potential solutions would improve its current state, the best reform is to and create a new idea of the current prison system using these six guiding principles. Legislation is the primary way t a more social transformation approach. First, the punitive measures that negatively impact those struggling with mental illness must be limited. Regulating the use of solitary confinement and increasing accountability of corrections officers to follow legal procedures (that do not involve solitary confinement) in response to conduct violations is critical to improving the quality of life of incarcerated individuals. Allocating more money to invest in mental health professionals is also crucial to see improvement in these shortages. Because correctional psychiatry is a difficult field to work in, incentives must be put in place to recruit more individuals trained to handle the complex issues and trauma that incarcerated women have undergone. Finally, increased government spending on social services to help those living in high-risk environments avoid incarceration is beneficial for everyone in the long run.    

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