Past trauma causes many women to wind up in jail

As a trauma psychologist and researcher, I applaud the article in "The New York Times" this morning, on how providing incarcerated mothers the opportunity to interact and play with their children during visits may reduce the trauma of separation. But, as the Senate thinks about bipartisan prison reform, I urge them to take a broader trauma-informed approach. This is necessary for effective correctional management, prisoner health and successful re-entry to our communities, particularly for women. 

The fastest growing population in U.S. prisons is women, entering at nearly double the rate of men. Trauma is a key contributor to their entry, duration and re-integration home from the U.S. inmate population.

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The vast majority of women in prison have elevated rates of interpersonal victimization, such as physical and sexual abuse. They also have greater exposure to family and community violence compared to women in the general population. Indeed, one study found that incarcerated females experienced on average six types of trauma in their lifetimes, with greater exposure associated with earlier age of trauma onset. In addition, almost a quarter of women report a forced sexual experience while in prison.

Incarcerated women with higher rates of trauma understandably also have higher rates of anxiety, depression and explosive anger than those without such histories. Multiple traumas are also significantly associated with current symptoms of psychosis as well as seriousness of women’s offenses, as indicated by their sentence length.

In addition, those with more severe trauma in their past are more likely to have a history of self-harm and attempted suicide before their incarceration. And, it likely comes as no surprise that trauma is a risk factor for near-lethal suicide attempts and severe self-injurious behaviors, such as cutting, while these women are incarcerated. This means that many women in jails and prisons have complex and interwoven lives of trauma, mental illness and substance abuse.

Most of these women will eventually be released from prison. Unless, they receive some kind of intervention to address their complicated trauma-related issues, they will return to their families and communities, with potentially even more severe mental health needs and fewer skills. It may seem obvious to say that the transition from prison to community is challenging for women. Unresolved trauma is a barrier to their reintegration success. Indeed, past-year trauma is one of the crucial factors associated with increased risk of recidivism.

Trauma and PTSD typically go unrecognized and untreated in this population. Addressing the traumas women have endured could provide insight into connections between women's experiences and the onset of their criminal behavior, improve their health and better prepare them for release from prison.

Currently the vast majority of our nation’s prison system is geared toward restraint and sub-dual. The policies of the criminal justice system are directed toward promoting more shame. But, this is more than ineffective. It is profoundly harmful. 

It’s imperative that prison personnel, from guards to administrators, possess basic core competencies in trauma mental health. For example, they need to understand the prevalence and impact of trauma in incarcerated persons’ lives, recognize the signs and symptoms of trauma and how that might impact incarcerated persons’ behaviors and actively resist re-traumatization.

In addition, we need to invest in behavioral healthcare services, including screening, assessment and clinical interventions for trauma.Providing trauma-informed services should be the standard of care by frontline psychiatrists, psychologists, social workers, nurses and other professionals in correctional settings. Peer-driven mentoring case management could also help women continue to address trauma-related issues as they re-enter the community from jail and prison

Trauma-informed services have been tested in some prisons. Several appear promising, showing significant reductions in post-traumatic stress disorder, anger and aggression, drug use and criminal activity post-prison release. Addressing trauma-related issues could also result in more effective parenting, housing stability and prevent future incarceration, reoffending and relapse for this high-risk population of women.

As the Senate debates potential prison reform, a trauma-informed approach appears a good bipartisan investment.

Joan Cook is a psychologist and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors and people who escaped the former World Trade Center towers on 9/11.