Characteristics of women in jail and treatment orientations. A review

A comparison of men and women referred to provincial correctional mental health services in Ontario, Canada

BACKGROUND

Women comprise around 15% of admissions to provincial correctional institutions in Canada. Women in custody are known to have a high prevalence of mental health concerns, but little is known about how those referred to mental health services compare with referred men at a similar stage of imprisonment.

AIMS

Our aim was to describe and compare clinical, social and demographic characteristics of a complete cohort of custodially remanded men and women who were referred to mental health services while under custodial remand in two correctional institutions.

METHODS

We carried out retrospective analysis of data obtained from 4040 men and 1734 provincially detained women referred to mental health services in two correctional centres holding mainly pre-trial prisoners and serving a large mixed urban-rural catchment area in Toronto, Canada over a nearly five-year period. Men and women were first screened using the Brief Jail Mental Health Screen. Those who screened positive were assessed using the Jail Screening Assessment Tool the Brief Psychopathology Rating Scale-Expanded (BPRS-E) and the Clinical Global Impression-Corrections (CGI-C).

RESULTS

There were many similarities between men and women, but also some important differences. Women were more socioeconomically disadvantaged than men. More women than men reported having children, yet fewer reported having any form of employment or social supports, although men were more likely to report unstable housing. In addition, women were significantly more likely to have mood and anxiety problems and to be self-harming, but did not differ from men in current psychotic symptoms. We also found differences in patterns of substance use, with a higher proportion of women using heroin and methamphetamines but fewer women having accessed addiction services.

CONCLUSIONS

Our findings have implications for clinicians and service planners. They underscore the value of systematic screening for identifying need. More specifically, they suggest need for increased availability of addiction services for women as well as ensuring support for those women who have dependent-age children. Improvement in supports for entry into employment is particularly needed for women, while men are particularly likely to need access to stable housing.

Confined to Obscurity: Health Challenges of Pregnant Women in Jail

Research about pregnant women in jail is scant. This exploratory study begins to fill this gap by examining the demographics; background characteristics; and self-reported physical health, mental health, and substance use challenges reported by 27 pregnant women incarcerated in a large midwestern county jail. It further reports on the prenatal care before and during their incarceration, plans of these pregnant women for delivery of their child, caring for their infant after their release from jail, and their expectations of paternal or family support post-release. Among the sample, 66.7 percent reported a physical health care problem, 48.2 percent had received mental health treatment, and 18.5 percent had substance use treatment in the previous year, but only 51.9 percent had seen a health care professional before their incarceration. All women expected the father of their child to provide financial support, but only 76.9 percent expected the father to be involved with the child. The authors also discuss implications of the findings for jail health care services and reintegration policy and practice for pregnant women.

Parenting from a County Jail: Parenting from Beyond the Bars

The incarceration of mothers affects 1.7 million minor children who are at high risk of behavioral problems, emotional trauma, and future incarceration. The jail setting removes women from society for brief periods of time providing an opportunity to offer essential interventions for those who will be returning to the community, and possibly their children, rather quickly. Utilizing a pre- and post-test quasi-experimental design, we measured the self-reported treatment effects for female inmates, housed in a county jail in the New York metropolitan area, who completed an evidence-based parenting program. Program participants reported reduced depression, increased parental knowledge, and increased communication with their families and fellow inmates. The results indicated that alternative ways of measuring program success are needed - particularly for populations who present with long histories of criminal justice involvement and drug use.

Psychosocial Determinants of Health among Incarcerated Black Women: A Systematic Literature Review

Black women are disproportionately incarcerated and experience worse health outcomes compared with White and Hispanic women. This systematic literature review aims to identify the major psychosocial determinants of health and service utilization among incarcerated Black women. The ecological model for health behavior was used to frame the literature presented and explain how individual, interpersonal, and societal factors affect health. Nineteen articles met inclusion criteria for this review. Psychosocial factors were identified at each level, including mental health problems (individual); sexual behavior (interpersonal); and dysfunctional/negative relationships (community). The factors interact in a dynamic relationship that influences the health and service utilization of Black women. Future research should examine within-group differences to highlight the unique needs and culture within the Black community in the context of psychosocial determinants. This synthesis of relevant studies can serve to inform change in correctional policies, practices, and help reduce health disparities.

Deconstructing the Concept of “Special Populations”

As part of the April 2001 “Common Ground, Common Language, Common Goals: Bringing Substance Abuse Practice and Research Together” conference, a panel of treatment provider experts was assembled to discuss the unique treatment needs of “special populations.” The “Special Populations” panel was initially guided by the assumption that clients with unique needs should be considered as distinct homogeneous groups, outside the mainstream. However, as panel members revealed, the heterogeneity of the substance abuse treatment client population suggests that the concept of “special populations” may be inappropriate and that alternative approaches to conceptualizing diversity within the substance abuse treatment client population are needed. The present paper provides background on the use of term “special populations” in the substance abuse field and summarizes discussions that occurred during the “Special Populations” panel regarding the application of this concept to clients in substance abuse treatment.

Nonfatal suicidal behavior among women prisoners: the predictive roles of childhood victimization, childhood neglect, and childhood positive support

Women entering prison report high rates of childhood victimization. Women in prison also report higher rates of nonfatal suicidal behavior (self-reported suicide attempts) than women in the general population and similar rates to their male counterparts despite having significantly lower suicide rates than males in the general population. Yet, there is a dearth of research that addresses the relationship between childhood victimization and suicidality for women prisoners in the United States. The purpose of this study is (a) to assess the relationship between childhood victimization and nonfatal suicidal behavior for a random sample of women prisoners; (b) to investigate predictive differences between childhood physical victimization, childhood sexual victimization, childhood neglect, and childhood support; and (c) to determine whether women prisoners with higher frequencies of childhood victimization and neglect are more likely to have attempted suicide than women prisoners with lower frequencies. Results indicate that childhood victimization, neglect, and lack of support are all significantly associated with nonfatal suicidal behavior among women prisoners. Frequency of childhood neglect had a larger effect size than frequency of childhood physical victimization, childhood sexual victimization, and lack of support. The results of this study add to the growing body of literature on childhood victimization and suicidality in general, and nonfatal suicidal behavior for prisoner populations in particular. The article ends with a discussion on clinical implications; particularly the finding that frequency of childhood victimization, childhood neglect, and lack of childhood support matters when determining the risk of suicidality.

Perceived stress, external locus of control, and social support as predictors of psychological adjustment among female inmates with or without a history of sexual abuse

Given the growing number of women who are incarcerated across the United States, the current study investigated the relationships among female inmates' perceptions of their own stress, external locus of control (LOC), social support adequacy, and various aspects of psychological functioning. Generally, female inmates with a self-reported history of childhood sexual abuse did not differ from their nonabused counterparts on the variables of interest. Results suggested that female inmates' perceptions of higher stress, a higher degree of external LOC, and inadequate social support correlated with greater symptoms of depression and hopelessness as well as lower self-esteem. In regression analyses, stress and social support were significant predictors for depression and anxiety. In contrast, stress was the only significant predictor of hopelessness and self-esteem. Finally, none of the predictors examined here was significant in the prediction of traumatic stress. Overall, findings suggested the importance of stress and social support in the prediction of female inmates' adjustment, specifically their symptoms of depression and anxiety.

Criminal career-related factors among female robbers in the state of São Paulo, Brazil, and a presumed 'revolving-door' situation

INTRODUCTION

Risk-taking behaviors, family criminality, poverty, and poor parenting have been frequently associated with an earlier onset of criminal activities and a longer criminal career among male convicts.

OBJECTIVE

This study aims to identify factors related to the onset and recurrence of criminal behavior among female robbers in the State of São Paulo - Brazil.

METHOD

It was a cross-sectional study carried out inside a feminine penitentiary in São Paulo. From June 2006 to June 2010, 175 inmates convicted only for robbery were recruited to be evaluated about family antecedents of criminal conviction, alcohol and drug misuse, impulsiveness, depressive symptoms, and psychosocial features. RESULTS Having family antecedents of criminal conviction consistently predicted an earlier onset of criminal activities and a longer criminal career among female robbers. Drug use in youth and the severity of drug misuse were significantly related to the initiation and recurrence of criminal behavior, respectively.

DISCUSSION

Prisons must systematically screen detainees and provide treatments for those with health problems in general. Children of inmates should obtain help to modify the negative consequences of their parents' incarceration in order to mitigate the negative consequences of pursuing this 'static' factor.

Violence exposure and health related risk among African American adolescent female detainees: A strategy for reducing recidivism

Juvenile crime and violent victimization continue to be significant social problems (Fitzpatrick, Piko, Wright, & LaGory, 2005); in that, adolescents, females in particular, are likely to participate in health related risk behaviors as result of having been victimized or exposed to a violent environment. Specifically, abuse, neglect, sexual molestation, poverty, and witnessing violence are well known risk factors for the development of trauma-related psychopathology and poor outcomes relative to delinquency, drug and alcohol abuse, and HIV risk behaviors (Steiner, Garcia, & Matthews, 1997). HIV infection is a common public health concern disproportionally affecting adolescent African American female detainees. This unique population has a serious history of violence exposure, which subsequently tends to lead to engaging in risky sexual behaviors, mental health problems, and abusing substances. Also, as a result of little to no intervention, this population is recidivating at an alarming rate, a problem that may further exacerbate the expression of health-related risk behaviors among African American adolescent female detainees. The authors briefly describe a pilot program to be implemented in the juvenile justice system that is based on the Model of Accumulated Risk (Garbarino, 1996), Bronfenbrenner's Ecological Model (1994), and the Positive Youth Justice Model (Butts, Bazemore, & Meroe, 2009). The program proposes to reduce risky sexual behaviors, teach alternatives to abusing substances, treat mental health concerns, and reduce the rate of recidivism through "positive youth development", PYD (Butts, Bazemore, & Meroe, 2009). Tying elements of wraparound services and reeducation together, this program addresses salient concerns that may have an impact on an adolescent detainees' success following their release from prison in a holistic manner.

Brief motivational intervention to reduce HIV risk and to increase HIV testing among offenders under community supervision

Risky drug- and sex-related behaviors put criminal offenders at high risk for HIV. Intervening with this population under supervision can potentially reduce risk. This study reports a randomized trial that examines the efficacy of brief negotiation interviewing (BNI) compared to usual education activities. BNI is a computerized, self-directed intervention that combines a short structured interview with a brief counseling session. The study examined whether BNI could decrease HIV risks and increase testing for HIV in a cohort of criminal-justice-involved clients. The trial randomly assigned 212 participants to experimental (108) and control (104) conditions. Interview data were collected at baseline and at 2-month follow-up. Results indicate that the BNI intervention group had a significantly higher rate of HIV testing and was more likely to consider behavioral changes.

Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.

Treatment Needs and Completion of Community-Based Aftercare Among Substance-Abusing Women Offenders

BACKGROUND

Women offenders with substance abuse problems typically have many treatment needs on reentry to the community from prison. This paper explores the correlates of treatment needs among a sample of women offenders with substance-abuse problems (n = 1,404), and the relationship between their treatment needs and other background characteristics with completion of community-based treatment after parole.

METHODS

Treatment needs were assessed at admission into prison-based substance abuse treatment; participants were admitted into community-based treatment upon parole. Descriptive statistics and multiple regression were used to examine their treatment needs; logistic regression analysis was used to determine the factors related to completion of the aftercare program. Analysis of variance was used to examine ethnic differences in treatment needs.

RESULTS

Greater treatment needs were associated with unstable housing before incarceration, a history of sexual or physical abuse, mental health problems, alcohol or drug dependence, and first arrest at age <19; lower treatment needs were associated with having been mandated to prison-based treatment (versus volunteering). Mental health problems and earlier age at first arrest predicted treatment noncompletion. Drug dependence was associated with higher treatment needs and a greater likelihood of treatment completion, whereas African American and Hispanic ethnicity were both associated with lower treatment needs (compared with Whites) and a lower likelihood of treatment completion.

CONCLUSIONS

Interventions are needed to engage substance-abusing women offenders in community treatment after parole to address their treatment needs, improve their retention in treatment, and reduce the likelihood of recidivism.

Expressed needs and behavioral risk factors of HIV-positive inmates

Considerable research has found inmates to be at high risk for HIV/AIDS. Furthermore, research has shown additional HIV/AIDS threats faced by females in the general population and especially by those incarcerated. Behavioral interventions and educational programs have been developed based on these studies. However, few empirical studies have examined the self-expressed needs of HIV-positive inmates or the degree to which inmates' needs are gender specific. This pilot study compares the needs of HIV-positive male and female jail detainees. Results illustrate surprisingly few differences between men and women and their HIV-related needs. The primary need identified for both males and females was postrelease housing. Somewhat unexpectedly, HIV treatment and care ranked low on the list of needs. The implications of these finds are discussed.

Associations Among Childhood Trauma, Adolescent Problem Behaviors, and Adverse Adult Outcomes in Substance-Abusing Women Offenders

This article explores relationships among exposure to childhood abuse and traumatic events, adolescent conduct problems and substance abuse, and adult psychological distress and criminal behaviors in a sample of substance-abusing women offenders (N=440). Latent variable structural equation models revealed direct relationships between several childhood traumatic events and greater adolescent conduct problems and substance abuse. Conduct problems predicted more adult criminal behavior, and adolescent substance abuse predicted higher levels of current psychological distress. There were direct relationships between several types of traumatic events and current psychological distress and between traumatic events and specific criminal behaviors. Ethnic differences were also found, suggesting different pathways to criminal behavior. The findings underscore the need to provide trauma-related services for substance-abusing women offenders.

Substance abuse treatment for women: Changes in the settings where women received treatment and types of services provided, 1987–1998

Changes in social policies during the last 2 decades have had major implications for the provision of substance abuse treatment services to women. The goal of this analysis was to examine (a) changes in the proportion of women clients served within different types of treatment facilities and (b) the services provided in these facilities. Data were analyzed from national surveys of treatment providers for the period of 1987 to 1998. Overall, there were gradual increases in the proportion of women clients across treatment facilities and greater concentrations of women in more intensive treatment modalities. The provision of childcare increased over time, particularly in programs with only women clients. Treatment facilities in which there were higher proportions of women generally had higher rates of providing services related to pregnancy, parenting, and domestic violence. These findings can be used to assess the adequacy of service delivery to women in substance abuse treatment.

Jails as important but constrained venues for addressing women's health

Women in US jails have many social and health risks that merit attention from public health agencies. This article: (1) reviews national and local data on this population for indicators of social disadvantage and of several health risks/conditions (substance abuse, risky sex, and mental illness), (2) describes the impact of federal mandatory sentencing for drug violations and recent developments in states on the numbers of incarcerated women, (3) outlines the similarities and differences between jails and prisons, focusing on characteristics of jails that facilitate and constrain intervention and evaluation activities, and (4) adds lessons learned in six years of experience in county and state jails in Texas.