Women Mental Health and the Criminal Justice System

Veronica Sutton COUN 603 Prof. Clarisse Domingo October 20, 2018 Foundations of Mental Health Counseling Based on some estimates, as much as 50% of the U.S. prison population suffers from some form of mental illness.

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As a consequence, each year thousands of mentally ill men and women are sent to prisons because of limited community resources. Which, has lead to mass incarceration within correctional institutions that are poorly equipped to treat the mental ill as they are subjected to punishments inappropriate for their conditions and some serve longer sentences than the general inmate population. According to, the Bureau of Justice Statistics, 2006, women are represented at a greater percentage of the incarcerated mentally ill (National Commission on Correctional Health Care, 2002.) Data has also shown the number of women in jail, in prison, on probation, or on parole in the United States has increased dramatically over the past several decades to the point of exceeding one million.

Women entering the correctional system represent a population at high risk for substance use disorders and mental health problems. According to the Bureau of Justice Statistics, 73% of female prisoners in state institutions and 47% in federal institutions used drugs regularly prior to incarceration. Other studies suggest that as many as 80% of incarcerated women meet the criteria for at least one lifetime psychiatric disorder (Teplin et al., 1996; Jordan et al., 1996.) It is clear based on review of the literature women who experience childhood physical and sexual victimization, will develop mental health and substance abuse problems as adults, and will be sexual victimization in the year preceding incarceration. Studies further indicate that women prisoners who were both physically and sexually victimized as a child were more likely to be hospitalized as an adult for a psychological or emotional problem. Women who were sexually victimized or both physically and sexually victimized were more likely to attempt suicide. Women who experienced physical victimization as children and women who were both physically and sexually victimized were more likely to have a substance use disorder. Substance abuse or dependence, post-traumatic stress disorder (PTSD) and depression appear to be some of the most common mental health diagnosis for female prisoners.

This document will explore the issue of mentally ill incarcerated women. The growing body of research on the mental health needs of women offenders suggests one major finding is that incarcerated women are more likely than their male counterparts to report extensive histories of physical, sexual, and emotional abuse (Messina, Burdon, Hagopian, & Prendergast, 2006.) Surveys conducted among incarcerated women have also showed a strong link between childhood abuse and adult mental health issues, particularly depression, post- traumatic stress, panic, and eating disorders (Messina & Grella, 2006.) One of the most important developments in mental health care over the past several decades is the recognition that a substantial proportion of women offenders have experienced trauma which plays a vital and often unrecognized role in the evolution of a woman’s physical and mental health issues (Bloom, Owen, & Covington, 2004.) For example, 12% of females in the general have symptoms of a mental disorder, compared to 73% of females in state prison, 61% in federal prison, and 75% in local jails (James and Glaze, 2006.) Another study, comparing incarcerated women matched by age and ethnicity to those in the community, found that incarcerated women have a significantly higher incidence of mental health disorders including major depression, substance use disorders, psychosexual dysfunction, and antisocial personality disorder (Ross, Glaser, & Stiasny, 1998.)

A study of lifetime mental health and substance abuse treatment services by incarcerated women by Jordan et al. (2002) suggest that: There is a subgroup of troubled women whose impairments result not only in their receiving mental health and or substance abuse Teplin, Abram, and McClellan (1996) found that most incarcerated women with psychiatric disorders did not receive treatment services, or both, but also in their being repeatedly incarcerated (p. 324.) The authors go on to state that they do not know why, after being in treatment, the women continued to exhibit serious mental health problems and continue to engage in behaviors that led to incarceration. One might suggest exposure to trauma and previous treatment may not have addressed traumatic experiences. Another study conducted by Green, Miranda, Daroowalla, and Siddique (2005), explored exposure to trauma, mental health functioning, and treatment program needs of women in jails, found high levels of exposure to trauma (98%), especially interpersonal trauma (90%), and domestic violence (71%) among incarcerated women, along with high rates of PTSD, substance abuse issues, and depression. Such, findings acknowledge many incarcerated women are unlikely to meet goals of economic and social independence, family reunification, and reduced involvement in criminal activities without adequate treatment for PTSD and other mental health problems (p. 145.)

The authors also emphasize, unless traumatic victimization experiences, functional difficulties, and other mental health needs are taken into account in regards to, incarcerated women there is unlikelihood they will benefit from in-custody and post-release programs. I believe this issue has occurred due to their needs not being met as a result of a general lack of programming to meet incarcerated women specific needs. According to, Drapalski et al., 2009; Green et al., 2005; Teplin, Abram & McClelland, 1996; Warren et al., 2003, historically services for incarcerated women have been based on the needs of men, despite women prisoners having diverse and unique problems. Such as more experiences with trauma (i.e., prior victimization), substance abuse, and mental health. Furthermore, despite knowing the issues of incarcerated women very little has been done to develop trauma-informed interventions. As there is limited gender-specific programming in prisons although, attempts have been made over the past decade to develop and implement gender-responsive criminogenic risk and needs assessments A highlighted factor is very little is understood about how women and men prisoners differ in terms of programming and treatment needs that will lead to positive post- release outcomes and reduce re-incarceration rates (Van Voorhis, Wright, Salisbury, & Bauman, 2010.) Understanding the differences between violence, trauma and post traumatic stress disorder in regards to women is a vital key to changing the overall perspective of the correctional system. The terms violence, trauma, abuse, and post-traumatic stress disorder (PTSD) often are used interchangeably.

A way to clarify these terms is to consider trauma as a response to violence or some other devastatingly negative experience. Trauma is both episodic and there are particular responses to each episode. The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) (also known as the DSM-IV), used by mental health providers, defines trauma as follows: involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve disorganized or agitated behavior). (p. 424) PTSD is one type of disorder that results from trauma. The DSM IV lists the following symptoms of PTSD (pp. 427-429):

  • Re-experiencing the event through nightmares and flashbacks.
  • Avoidance of stimuli associated with the event (e.g., if a woman was assaulted by a blonde man, she may fear and want to avoid men with blonde hair.)
  • Estrangement (the inability to be emotionally close to anyone.) • Numbing of general responsiveness (feeling nothing most of the time.)
  • Hypervigilance (constantly scanning one’s environment for danger, whether physical or emotional.)
  • Exaggerated startle response (a tendency to jump at loud noises or unexpected touch.)

Although, there are two types of PTSD: simple and complex. Complex PTSD usually results from multiple episode of abuse and/or violence (such as childhood sexual abuse and domestic violence.) Complex PTSD is most associated with incarcerated women as suggested in a study conducted by (Najavits, Weiss, & Shaw, 1997.) They reported the combinations of effects related to post-traumatic stress disorder and substance abuse found more co-occurring mental disorders, medical problems, psychological symptoms, in-patient admissions, interpersonal problems, lower levels of functioning, poor compliance with aftercare and motivation for treatment, and other significant life problems (such as homelessness, HIV, domestic violence, and loss of custody of children) in women with both disorders than in women with PTSD or substance abuse alone. If correctional staff are able to take into consideration the medical, mental health and substance abuse history of incarcerated women it is possible that the recidivism rate will and can lessen with both services in the community that are extended during incarceration.

In order to work with women with mental health and substance abuse issues, the treatment team needs to understand the symptoms and diagnoses of mental illnesses, the roles of medications, the process and symptoms of addiction, the needed credentials of mental health providers, and have a treatment philosophy. All of this needs to be filtered through the lens of trauma instead of criminality and substance abuse only. References American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4h ed,. Text Revision).

References:

Washington, DC: 2000 p. 424 – pp.427-429. Bloom B, Owen B, Covington S. Women offenders and the gendered effects of public policy.

Review of Public Research. 2004;21 :31-48. Drapalski AL, Youman K, Stuewig J, Tangney J. Gender differences in jail inmates’ symptoms of mental illness, treatment history and treatment seeking.

Criminal Behaviour and Mental Health. 2009;19:193–206. Green BL, Miranda J, Daroowalla A, Siddique J. Trauma exposure, mental health functioning, and program needs of women in jail.

Crime and Delinquency. 2005;51:133–151. James DJ, Glaze LE. Mental Health problems of prison and jail inmates.2006 retrieved the Bureau of Justice Statistics: http://bjs.ojp,usdoj.gov/content/pub/pdf/mhppji.pdf.

Jordan K, Federman EB, Burns BJ, Schlenger WE, Fairbank JA, Caddell JM. Lifetime use of mental health and substance abuse treatment services by incarcerated women felons.

Psychiatric Services. 2002;53:317–325. Messina, N., Burdon, W., Hagopian, G., Pendergast, M. (2006). Predictors of prison therapeutic communities treatment outcomes: A comparison of men and women participants. American Journal of Drug and Alcohol Abuse, 31(1), 7-28.

Messina N, Grella C. Childhood trauma and women’s health outcomes in California Prison. American Journal of Public Health. 2006;96: 1842-1848.

National Commission on Correctional Health Care. ( 2002) The health status of soon – to-be released inmates: A report to Congress: Volumes I & II. Chicago: Author. Retrieved from http://www.ncchc.org/health-status-of-sonn-to-be-released-inmates.

Najavits LM, Weiss RD, Shaw SR, The link between substance abuse and posttraumatic stress disorder in women: Journal of Addiction. 1997;6 (4):273-83.

Ross HE, Glaser FB, Stiasny, S. Sex Differences in the Prevalence of Psychiatric Disorders in Patients With Alcohol and Drug Problems: British journal of addiction. 1998: 83(10)1179-92.

Teplin LA, Abram KM, and McClellan GM. Prevalence of psychiatric disorders among incarcerated women: Pretrial jail detainees. Archives of General Psychiatric. 1996;53:505.-512 p. 324.

Van Voorhis P, Wright EM, Salisbury E, Bauman A. Women’s risk factors and their contribrutions to existing risk/needs assessment: The current status of gender-responsive supplement.

Criminal Justice and Behavior. 2010;37:261-289. Sabol WJ, Ph.D., Couture H, Harrison PM, Bureau of Justice Statistics, 2006              

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