USA: locked up and vulnerable, when prison makes things worse

Many incarcerated women are victims themselves – of mental health problems, and of crimes worse than their own. Is prison the wrong place for them?¶

– Before –¶

Joanne¹ speaks calmly and gently, despite discussing some of the most traumatic events of her life.

After the birth of her first son, she went through a bout of severe post-natal depression (PND), which went undiagnosed. She links it directly to long-term domestic abuse from her violent ex-partner – the father of her son.

Her depression, coupled with an increasing dependence on alcohol, led to a mental breakdown. In 2015, at 28 years old, she was charged with child neglect and abandonment. “My world literally caved in around my ears,” she says. “I felt like a terrible human. I had let my son down. I pleaded guilty to everything.”

The judge was understanding and gave her a 12-month community probation order. But when her first probation officer left, Joanne fell through the cracks. Her PND had still not been addressed and she returned to her abusive relationship.

One alcohol-fuelled night, she says, someone had invited two men over who seemed intent on stealing her possessions. She insisted they leave. When they refused, there was a serious violent interaction. She prefers not to discuss it in detail, but the police were called and Joanne was charged with violent assault with intent, later reduced to without intent. She spent three days in custody and six days at a women’s prison.

She describes the experience as “hell”: while there, she was given no support for her addiction or mental ill health. And though her sentence was only six days, it would have a dramatic impact on the following months.

Joanne is one of hundreds of thousands of women sent to prison each year. Globally, there are more than 714,000 women and girls in prison, with the highest number in the United States – about 219,000.

And female offenders are more likely to have mental health issues compared to men. In the UK, almost half have anxiety or depression, 25% report psychosis symptoms and the majority have substance abuse issues, often in addition to other mental illness. In the US, 66% of women reported a previous mental health condition.

“The majority of women are serving short sentences for non-violent crimes“

Female offenders are also more likely to be first-time offenders, and less likely to reoffend, compared to men, 2015 statistics from the UK show. The majority of women (84%) are serving short sentences for non-violent crimes. This means only 16% are sentenced for violent crimes compared to 29% for men.

Many of the issues that contribute to imprisonment are interlinked. Like Joanne, for example, a high proportion of these women have been victims of crime themselves – more than half of those given prison time in the UK in 2017, which may even be an underestimate. There was a similar trend in the US. This has led some researchers to call out that imprisoning these women is “victimising the victimised”, especially considering that in many cases, the crimes against them were worse than what they were sent to prison for.

Often, the women have experienced domestic abuse, child abuse – or both, including physical, emotional and sexual abuse. Victims of abuse are more likely to suffer from mental health issues. The evidence also shows that victims of childhood abuse are more likely to end up in abusive relationships later in life, which can exacerbate or even cause mental illness. Such a situation can lead to substance abuse as a ‘coping mechanism’ – which can have other knock-on effects, such as homelessness.

An offence can be linked to any one of those things. Claire Cain of the charity Women in Prison heard of one woman doing time for stealing a bottle of vodka. She recalls another woman who was given time for an Asbo (antisocial behaviour order) when she shouted at someone in the street.

But once in prison, resources for mental health issues can be stretched or scarce. At the same time, the realities of day-to-day life – whether being separated from loved ones or subject to potentially traumatising experiences like solitary confinement or strip searches – can exacerbate problems even further.

In the UK, the majority of women are serving short sentences for offences that can include non-payment of their TV licence or council tax. Theft is one of the most common convictions. In fact, in its 2017 report, the charity Prison Reform Trust found that many women are being locked up for offences less serious than the crimes against them. The charity cites one woman, Mary, who used cannabis to cope with her anxiety and depression following years of domestic abuse. She was convicted for driving while under influence.

“Depression is a strong predictor for excessive drinking“

Worsening the situation, if an offender is seen as an addict their mental health issues may be overlooked.

“In some cases, it’s not even recognised as mental health as [support services] think someone is high, so often the key to unlocking the substance abuse lies in the mental health and trauma that someone has experienced. That is so often ignored,“ says Cain.

Studies show in fact, that depression is a strong predictor for excessive drinking. And those who drink too much are also more likely to become depressed. Joanne says that some charities first said she had to seek help for her alcohol addiction before she could get help for her depression – even though her drinking, she says, was directly caused by her “mental pain”.

This goes in line with what is now well understood by psychiatrists, that mental illness and substance abuse often go hand in hand. Judith Edersheim, a psychiatrist and director of the MGH Center for Law, Brain & Behavior, has worked with offenders in the US. She found those who showed the characteristics typical of a personality disorder often featured a combination of depression, substance abuse and PTSD.

“The overlap between these categories was really speaking to the deprivation, victimisation, physical and sexual abuse that these women were enduring,“ she says.

Research shows that individuals with several mental health issues at once (also called comorbid mental disorders) are more likely to have substance abuse issues, which can lead to violence and other criminal behaviour.

There is an important caveat to note here. People who are mentally unwell are actually far more likely to be victims of crime rather than perpetrators. “There’s a tremendous misconception that mentally ill people are responsible for significant crime. It’s a stereotype, a scapegoat, and a stigmatisation that they don’t deserve,” says Edersheim.

For those victims who experience abuse or neglect at a young age, the consequences can manifest as not only behavioural issues but physical changes, etched onto a victim’s biology. This can be seen on brain scans. One change is a smaller hippocampus on the left side of the brain, an area which helps people respond to stress. Another change of chronic childhood abuse is a smaller amygdala, an area important for emotions and decisions, such as processing fear.

“You’re looking at a neurodevelopmental, social and psychological trajectory that puts [victims] at risk and keeps them at risk,“ says Edersheim.

“Moving parts get broken,” she continues. That is, childhood is a time when the brain is rapidly developing and learning complex social skills and behaviours. When those key developmental stages are disrupted, important skills may not develop properly. “If children get traumatised in those years… with a lack of attachment, they will be fundamentally and irretrievably harmed,” she says.

Leah¹ is one example. Today, she attributes her mental health disorder in part to emotional neglect from her father in childhood, recalling suicidal thoughts even before puberty. She has always heard voices, she says, and is now diagnosed with “mixed emotional, unstable personality disorder”, as well as post-traumatic stress disorder (PTSD ) from two abusive ex-partners. Her second partner was also violent towards her son, something she says she was too ill to realise. She was charged with child-neglect and abandonment.
Her sentence took two years to come to trial. Leah recalls receiving little support during this time, which meant that during her court case she was unwell. “When I was in court they didn’t put my mental health into my case. I didn’t know in my own head, did he do it… what’s going on…” she says. “They made me feel the worst person of all – and I couldn’t explain [what was going on in my head], so I decided to hide it and ignore it.” She was sentenced to 3.5 years in prison, and served just under two, while her ex-partner received 14 years for grievous bodily harm.

– During –¶

Unfortunately, magistrates facing women like Leah can be left with little option but to give prison time – especially if there is nowhere else to place those convicted of crimes. Mental health facilities for offenders have faced significant cuts the UK and there are few secure mental health hospitals. Psychiatrists in 2017 also warned that they are sometimes unable to “deliver adequate mental health services” in prison. This could mean, says Cain, that magistrates believe that women will get the psychological help they need behind bars instead.

Criminal psychologist Tammi Walker has seen this too. “There’s an idea that they are in a better location by being in prison than being out of prison,” she says. That’s if their mental health issues have been previously identified – many are not. Cain recalls one instance where a woman was sentenced for an antisocial behaviour order (Asbo) and was only diagnosed with a mental health disorder once she entered Holloway prison – a women’s only prison that closed in 2016.

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