In recent years, the criminal legal system has experienced a gradual shift towards rehabilitation, emphasizing the creation and implementation of broad treatment programs for Severe Mental Illness (SMI), Substance Use Disorder (SUD), and Current Co-Occurring Disorders (CCOD) to decrease recidivism. This shift, however, frequently goes unfelt in women's prisons, as incarcerated women have significantly less access to treatment when compared to incarcerated men, even though the number of women incarcerated in the U.S. has increased by about 750% since 1980. The few treatment programs that do exist for addressing women’s SMIs, SUDs, and CCODs have been designed with the average incarcerated man in mind. Although effective for tackling these issues in the general population of incarcerated men, the therapy component of these treatments rarely touches upon the effects of trauma, especially those traumas related to childhood sexual abuse, violent victimization, and intimate partner violence, which are experienced at much higher rates by incarcerated women than incarcerated men. Statistics show that anywhere from 80% to over 90% of incarcerated women have experienced some form of trauma, which is often noted as a key contributor to their substance abuse, persisting mental illness, and ultimately, incarceration. In fact, over half of women in prisons present as having lifelong Post Traumatic Stress Disorder (PTSD) compared to the 10% prevalence found in the general population. By implementing prison programs that fail to address the complex issues faced by the majority of incarcerated women, prisons cannot tackle the root cause of many SUDs, SMIs, and CCODs, leaving women at a substantial rehabilitative disadvantage.
It is important to note that this blog and the data presented within it focuses exclusively on cisgender women and does not aim to diminish the many issues faced by trans-women and female-presenting persons in prisons and jails across the country. A discussion on this topic that would take gender presentation and, specifically, the trauma faced by transgender persons in prisons, into account would likely require its own blog post entirely.
Research has shown that the most effective means of tackling this issue is to implement gender-responsive treatment and trauma-informed care in women's prisons. Trauma-informed care requires professionals to carefully address and center conversations around how past traumas impact an individual’s daily life, including how they are likely to respond to mental health or substance abuse treatment. Trauma-informed care asks the question, “What happened to this woman?” rather than “What is wrong with this woman?” and involves training correctional staff on validating women’s pain and trauma responses, avoiding phrases and actions that may retraumatize, and displaying unwavering empathy, care, and compassion. Similarly, gender-responsive treatment is based on acknowledging the all-encompassing impact that trauma has on a woman's psychological development, aiming to create a therapeutic environment where women feel comfortable discussing their histories of abuse and addiction with staff members who have been trained to navigate the intersections of SMIs, SUDs, CCODs, and trauma. A study showed that incarcerated women who had undergone gender-responsive treatment experienced a greater reduction in drug use, were less likely to be reincarcerated, felt more supported in their day-to-day interactions, experienced increased feelings of safety, and were overall more dedicated to seeking out treatment following their release when compared to women who underwent the general treatment administered in men’s prisons.
In a 2017 study on gender-responsive prison programming, the National Institute of Justice (NIJ) found that 37% of state correctional systems utilized gender-responsive treatment. They also noted that the U.S. facilities best equipped to tackle the complex needs of women all emphasized the need for gender-responsive and trauma-informed approaches in tackling substance abuse, administering specialized staff training on careful approaches to addressing trauma, crisis intervention, and de-escalation. Furthermore, many offered programs that partnered with local community-based organizations to promote the formation of strong social bonds, provide outside legal advice, and ensure continued access to treatment beyond incarceration as a means of mitigating the effects of trauma. However, most state corrections departments still need to incorporate these practices into established policies, procedures, or officially mandated staff training protocols, leaving the implementation of these crucial programs entirely in the hands of individual prisons. The NIJ holds that to tackle incarcerated women’s trauma and its implications, these evidence-based practices must become the standard, which can only be achieved through policy. These programs work, but only if their administration is standardized rather than splintered by state, county, or facility.
A gap continues to exist between our current prison programming policies and the abundance of research supporting the idea that women require gender-specific treatment for their complex SUDs, SMIs, and CCODs. Too often, the criminal legal space experiences a large disparity between what the research says works and what policymakers promote and implement. The next step forward is simple: judges, attorneys, and legislators must continue listening to the research and vigorously promote its implications. As the rate of women’s incarceration continues to grow faster than that of men, we see a stronger need now more than ever to give women a real chance at recovery and rehabilitation through comprehensive treatment options that specifically tackle women’s trauma.
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