Mental health among female offenders in the United States

People in prison are more likely than the general United States population to have received a mental disorder diagnosis, and women in prison have higher rates of mental illness and mental health treatment than do men in prison. Furthermore, women in prisons are three times more likely than the general population to report poor physical and mental health. Women are the fastest growing demographic of the United States prison population. As of 2010 there were over 110,000 women incarcerated in state and federal prisons in the United States and women comprised roughly 7% of all inmates in the United States.

In 2011, 11% of male inmates had an overnight hospital stay due to psychiatric problems, while the proportion of women who did was roughly twice that of men. In 2010, 73% of incarcerated women and 55% of incarcerated men self-reported mental health problems. This statistic accounts for the reporting of at least one of two criteria, as a self-reported mental or emotional problem, or a reported overnight hospital stay. The most common mental health problems among incarcerated women are substance abuse/dependence, post-traumatic stress disorder, and depression. Other common disorders include schizophrenia, bipolar disorder, and dysthymia.

Before crime

Early experiences of victimization 
Criminality among females is intimately associated with experiences of trauma and victimization occurring early in life. The majority of incarcerated females have experienced some kind of victimization, defined as experiences of physical, sexual, or emotional trauma. Among female offenders 78% of have reported prior sexual or physical abuse, compared to only 30% of male offenders. Furthermore, "research consistently links histories of violence with negative mental health outcomes, such as depression, substance abuse, and intimate partner violence among incarcerated women at higher rates than those in the general female population". Early experiences of victimization predispose women to be more likely to suffer from certain psychiatric disorders, particularly post-traumatic stress disorder (PTSD), depression, and dysthymia.  By the estimate of one study, 78% of incarcerated women have experienced a traumatic or "extreme" event as defined by DSM-III-R criteria within their lifetime, while 30% have experienced multiple symptoms of PTSD within the last six months.

Following PTSD and substance abuse/dependence, depression is the third most common psychiatric disorder among incarcerated women. Depression and substance abuse, too, are closely linked with experiences of victimization or PTSD, and more so for women than for men. In fact, according to the National Comorbidity Survey, women are twice as likely as men to experience co-occurring PTSD and depression.  The prevalence of depression among incarcerated females links to trends within the general population as well. While women are more likely than men to suffer internalized problems, such as anxiety and depression, men are more likely to be treated for externalized problems such as delinquency, aggression, and substance abuse. This difference coincides with a gendered discrepancy in the experiences of mentally ill offenders once they enter the criminal justice system.

Victimization and criminal offending 
In both males and females, sexual abuse, physical abuse, and neglect increase the likelihood of arrest for a juvenile by 59% and as an adult by 28%. Although sociologists do not point to a single explanation for the association between victimization, trauma, and incarceration, researchers have found that trauma frequently cause women to abuse drugs and alcohol as a coping mechanism. Sociologists also point out that early victimization increases the likelihood of women's continued or exacerbated involvement in harmful settings. According to one ethnography of female offenders in Boston, "In fact, running away from home—often to escape abuse in households dominated by violent men—is the charge in the first arrest for nearly a quarter of girls in the juvenile justice system… On the streets, women are vulnerable to harassment, exploitation, and drug use, all of which drag them into the correctional circuit". In addition to symptoms of trauma, other mental health problems such as major depression, schizophrenia, and mania are linked with patterns of violent offending and homelessness prior to arrest.

Substance abuse 
Substance abuse and dependence are the most common mental health problems among incarcerated females, and drug use is the most common reason for women's incarceration. Seventy percent of incarcerated females suffer from drug abuse or dependence, and incarcerated females are nine times more likely than the general population to experience substance abuse and dependence. Social researchers have linked substance abuse to experiences of trauma and victimization.

Sociologists have conducted extensive research in favor of a self-medication hypothesis in relation to women's drug use and abuse, positing that women use drugs as a way to cope with experiences of sexual or physical trauma. Research suggests, "in all likelihood, a vicious cycle exists in which painful consequences of childhood sexual abuse—such as depression, low self-esteem, conflicted relationships, and sexual dysfunction—increase a woman's risk of self-medicative use of alcohol and other drugs"

In the courts 
Within the United States justice system, women's criminal activity is more likely than men's to be medicalized, in connection with a tendency to perceive female offenders as "mad, rather than bad." Female offenders are more likely than men to receive psychiatric evaluations, even when they have not self-reported a mental illness. Sociologists have noted that gendered stereotypes among men and women contribute to this discrepancy in mental health evaluations. While criminal behavior and aggression are more associated with masculinity, traits such as passivity and submission are more associated with feminine roles. Female offenders are more likely to be identified as having engaged in role-incongruent or deviant behavior that is explained, diagnosed, and treated psychiatrically. Receiving a psychiatric evaluation reduces the chances that a defendant will have charges dropped against her or him, and also increases the likelihood of conviction, incarceration, and lengthier prison sentences.  Because women who have engaged in crime are thought to have violated gender norms, some sociologists posit that female offenders may receive harsher sentences than men. However, among men and women in the general population, sociologists have not reached a consensus on the differences in sentencing, treatment, and leniency among males and females in general. For instance, among juveniles, males are more likely to be arrested, petitioned, and adjudicated than females. Among juvenile females who are sentenced, studies vary on whether these women receive lighter or harsher sentences. Some studies find that women are treated more leniently by courts. Other studies show that juvenile women may be sentenced more harshly than their male counterparts

During incarceration

Prevalence of mental illness 
Several studies have found that rates of mental illness in prisons are higher than those in the general population and that rates of mental illness in women's prisons are higher than those in men's prisons. In 1999 a report for the Department of Justice estimated16% of the prison population had some form of mental disorder. However, much research in this area "lack[s] specificity regarding important subpopulations, such as female offenders." That work which has looked at female offenders as an "important subpopulation" has found that they experience mental health problems at greater rates than their male counterparts.

A study through the Mental Health Prevalence Project which used "three major indicators of mental illness: diagnosis of a serious mental illness, history of inpatient psychiatric care, and psychotropic medication use" found that female offenders have "on average, twice the rate of various indicators as males." The study found (using a weighted sample) that 17.8% of male offenders and 35.1% of female offenders have a mental health problem upon being committed. This study did not treat substance abuse as a mental health disorder.

Other studies report much higher rates of mental illness among prisoners. One Bureau of Justice Statistics survey in 2004 found that 55% of male inmates and 73% of female inmates self-reported a mental health problem. The Sentencing Project, in their 2007 Briefing Sheets, also report that 73.1% of women in prisons have a mental health problem.

Mental health treatment and services 
For many offenders, incarceration provides a rare opportunity to access mental health services not available to offenders within their communities. Despite the growing prison population in the United States and the prevalence of mental health problems "In-prison services have not expanded sufficiently to meet treatment needs. In fact, between 1988 and 2000, prison mental health services declined, and those services that are available are concentrated only in the most secure facilities." One study found that 41% of female inmates report use of mental health services while incarcerated, while 73% report mental health problems.

According to the Bureau of Justice Statistics "All Federal prisons and most State prisons and jail jurisdictions, as a matter of policy, provide mental health services to inmates, including screening inmates at intake for mental health problems, providing therapy or counseling by trained mental health professionals, and distributing psychotropic medication." Researchers working with the Mental Health Prevalence Project note that "legal mandates and humanitarian concerns alone require that [mental health] services be provided. In addition, the effective, safe, and orderly management of correctional facilities require that these needs be met."

While sociologists have recommended trauma-focused treatments for offenders, these services are still lacking. Researchers have also noted that "there is strong empirical support for gender-specific, trauma-focused treatments". In one study, researchers offered 25 therapeutic group sessions to female inmates with mental health problems. It was found that the sessions were "successful at significantly decreasing post-traumatic stress disorder (PTSD) and substance use disorder (SUD) symptoms, with almost 50% of participants no longer meeting criteria for the disorder and 65% reporting no substance use at the 3-month follow up". Reasons for the lack of gender-specific treatment in women's prisons despite their proven use may be the difficulties of setting up such programs, including navigation of "legal and logistical barriers."

It has been found that female inmates are medicated at  higher rates than their male counterparts. Women are also treated differently than men in prisons in regard to mental illness. Studies suggest "that female inmates' behaviour is more likely than males' to be 'psychiatrized' by correctional staff". One study shows that "role incongruence" effects how female and male inmates are treated. According to the study "female inmates who perpetrated acts of violence against others and/or property, or who demonstrated aggressiveness or agitation, were significantly more likely than men exhibiting similar behaviours to be placed in mental health units". Furthermore, the researchers found that men exhibiting "female psychiatric disorders (e.g., depression)" were more likely to receive mental health care than females exhibiting the same disorders. The study suggests that differential treatment of male and female inmates may be based on the inmates adherence to gender norms, and that a breaking of these norms is likely to be treated psychiatrically.  Therapeutic or rehabilitation programs in prisons also differ for men and women, with male prisons providing more access to programs for anger management, and female prisons providing more access to programs addressing trauma or loss.

After prison 
In many instances, living in prison obligates individuals to adapt socially and psychologically, making it difficult to reintegrate into daily life outside of prison and to develop healthy relationships. Furthermore, due to the prevalence of chronic diseases within jails, offenders returning to low-income communities may be inadvertently contributing to health inequities in low-income areas. The difficulties facing women upon their release from prison range from "finding housing, getting a job, earning enough money to support themselves, reconnecting with children and family." Failure to find work and a stable home may lead women back to committing crime and back to prison. The recidivism rates among prisoners is so high that it has been termed the "revolving door phenomenon." Studies have found that among women released from prison in 1994 "58% were arrested" within three and a half years of release, and "39% were returned to prison". A 2011 study by Pew Center of the States find similar recidivism rates. The release and reentry difficulties that female prisoners face are often exacerbated by mental health challenges.

The high rates of mental health problems among female offenders follows them past prison and into reentry.  A study published in 2010 by the Reentry Planning for Offenders with Mental Disorders: Policy and Practice found that "of 357 women released  from prison in six states, 44% reported they had been diagnosed with bipolar disorder, depression, obsessive compulsive disorder, post traumatic stress disorder, phobia, or schizophrenia." A majority, 56%, of these women, felt they were currently in need of treatment. However, studies find that mental health and substance abuse treatment is not readily available to women returning to their communities from prison. Furthermore,  upon release many women often have trouble keeping up with medication they had access to in prison. These mental health problems may hinder offenders as they try to find a job and housing. Their health problems may be so severe they cannot work, they face the additional job of managing their health problem and mental illness increases the likelihood of engaging in "inappropriate behaviour that provokes a law enforcement response." These challenges may increase recidivism rates.

See also 

 Incarceration of women in the United States

References

Category:Penal system in the United States
Category:Imprisonment and detention in the United States