Helping Female Inmates Heal from the Inside
Mahoney, Diana, Clinical Psychiatry News
Most women incarcerated in the United States are in trouble long before the door on their prison cell slams shut.
According to the U.S. Department of Justice's Bureau of Justice Statistics, at year end 2005, 107,518 women were in U.S. federal or state prisons, and 93,963 were in local jails; those numbers represent a staggering 57% increase from 1995.
For most of these women, the road to incarceration was paved by a history of trauma: More than 57% of women in state prisons and 55% of women in local jails have past histories of physical and/or sexual abuse, often perpetrated by an intimate partner.
Also, more than 37% of women in state prisons have been raped before their incarceration; and women in state prisons or local jails are at least two times as likely as women in the general public to have a history of childhood physical or sexual abuse. Not surprisingly, about 73% of the nation's female inmates have symptoms or a clinical diagnosis of mental illness, and most present with a co-occurring substance use disorder.
In addition to these shared characteristics, many women entering jail are either pregnant or have children for whom they are the sole financial supporters (www.ojp.usdoj.gov/bjs).
For these reasons, "women offenders present a unique population within the criminal justice system," according to Karen A. Duncan, a licensed clinical social worker and the author of "Healing From the Trauma of Childhood Sexual Abuse: The Journey for Women" (West-port, Conn.: Praeger Publishers, 2004).
"Women have primarily been incarcerated within a criminal justice system developed for men," Ms. Duncan said, which contributes to them "being ignored, diminished, and further marginalized within a punitive system that often retraumatizes them."
It is well understood that history of abuse is a correlate of behavior leading to involvement with the justice system and that experience of past trauma is disproportionately high among women, compared with men. Most correctional facilities, however, "don't take into account history of victimization or gender differences, which occur in such areas as response to being in custody and the punitive environment of prison, mental health issues, and parenting concerns," said Susan Marcus-Mendoza, Ph.D., associate professor of human relations and women's studies and chair of the department of human relations at the University of Oklahoma in Norman.
"Most of the time, where intervention programs do exist, they are not evidence-based," Dr. Marcus-Mendoza said. "There is a heavy reliance on cognitive-behavioral programs that are based on broad generalizations about [male] offenders, rather than sound psychological principles."
Some prison interventions go beyond being unhelpful to being downright dangerous for inmates with a history of trauma exposure. "Programs that feature punishment and intimidation, such as boot camps, can be very difficult for survivors of trauma or abuse," Dr. Marcus-Mendoza said.
Such interventions contribute to trauma victims' already enhanced sense of powerlessness, she noted.
Given the high rates of lifetime trauma exposure among women in prison, good psychiatric practice suggests that early identification of trauma history should top the therapeutic agenda, as it is critical for the development of treatment decisions and for planning inmates' reentry into the community and reentry into their children's lives, according to Dr. Marcus-Mendoza.
All too often, however, "interventions are implemented by correctional personnel with inappropriate educational preparation and no skills to deal with the feelings and memories that might come up during an intervention."
Some prison staff intentionally avoid discussing issues of abuse for fear of the consequences, Dr. Marcus-Mendoza stated. "I was once told by a prison psychologist not to ask anything about abuse on my survey of the women because they would come to him and want to talk about it. …