CAEFS takes the position that women with mental health problems do not belong in prisons and that the treatment, support and assistance they need should be provided to them in the community, rather than in prison.
The above statement clearly outlines central problem areas that should be the focus of investigation. As this study and others emphasize, women who enter prison with mental issues and problems require intensive support. However, this is at present not the case and many women prisoners who suffer from mental problems are not afforded the necessary support and adequate intensive therapy. Some critics also suggest that alternatives be investigated for women with mental issues. "... The public need for the appearance of retribution may deter government from considering alternatives to sentencing persons with mental disabilities to imprisonment." www.elizabethfry.ca/submissn/dawn/17.htm" (ibid)
Another factor which relates to mental and psychological issues is that women experience stress by being confined in an institution with mainly male authority structures. One issue that has only recently been studied is post-traumatic stress within prisons. A woman entering prison may experience extreme states of stress which can lead to further psychological problems. "A woman's first symptoms of post-traumatic stress syndrome may be encountered here, something not considered for either sex until recently, and then mistakenly thought to be confined to combat veterans. "
Ross and Lawrence)
Women with prior problems
Many women who enter prison bring with them various problems that are in fact exacerbated within prison and can lead to treatment problems. The statistics are alarming in this regard... "most women are in jail as a direct result of drug and alcohol addiction." (Schwartz, C.) and "the number of women under correctional supervision has increased by 71.8%; and drug offenders were the largest source of growth. (ibid)
Another factor is that many women who enter prison have been subjected to prior physical or sexual abuse. This in turn increases problems associated with entering the prison system. Recent studies of female inmates in the U.S. reveal that a significant number of women have a history of prior physical and/or sexual abuse. (RETALIATION AGAINST WOMEN in MICHIGAN STATE PRISONS) Statistics also show that prior physical and sexual abuse is high for many women entering prison.
Nearly 6 in 10 women in State prisons had experienced physical or sexual abuse in the past; just over a third of imprisoned women had been abused by an intimate in the past; and just under a quarter reported prior abuses by a family member. (Women Offenders: Bureau of Justice special report)
As these and other studies point out, the most important aspect for those suffering from the effects of sexual or physical abuse in an environment which is conducive to the process of psychological healing. Women with these histories of abuse may also suffer from post-traumatic stress as well as self-esteem issues. The sexual abuse often encountered within prison serves only to increase the suffering of those women with prior histories. As one study clearly states:
It is difficult enough for a woman with no history of abuse to cope with sexual assault. It is potentially devastating for a woman with a history of abuse to be abused again. For women with or without a history of abuse, to be punished for reporting the abuse is to be made acutely aware of one's powerlessness and vulnerability. Several of the women we interviewed had suffered serious psychological harm as a result of having been abused in prison.
In a recent survey of the problems facing women entering correctional facilities Amnesty International states that "the federal government should establish an inquiry into mental health services for women in jails and prisons, including the use of psychotropic medications." (Ketcham L.) a study also adds that abused women inmates often exhibit histories of long duration involving multiple episodes at the hands of fathers, husbands, boyfriends and strangers, and this abuse is often directly linked to the offenses for which they find themselves in jail.
Ross and Lawrence)
Mothers and pregnant women
As numerous studies point out, "one of the most serious pains of imprisonment for a mother is to be separated from her children. Even if her relationships with her children were less than ideal when she was in the community, she may develop unrealistic memories of that time."
Morton and Williams, p.98)
This is an especially troubling area as mothers are incarcerated they leave numerous problems and concerns outside the prison walls, which may have a negative influence on the prisoners' mental and emotional state. The situation is often even worse for pregnant women who are admitted to prison. Interestingly it was found that allowing women have their children in prison, many of the problems associated with separation anxiety were reduced. This was the case in 1890 when Mattie Scott was sentenced to the Missouri State Penitentiary. The judge allowed her to take her four-month year old baby to jail with her. "The administration noticed a difference in the other women convicts after being exposed to this child; they became much calmer and gentler and less likely to break the rules. Even the most vicious women softened perceptibly with a baby in their midst. " (MISSOURI DEPARTMENT of CORRECTIONS) the issue of separation may be traumatic for women and increases instability and tension within the institution.
Mothers who are primary caregivers also form a relatively high statistic and this creates serious problems not only for the mother on entering prison but also for the children who have lost their caregiver. This in turn exacerbates women prisoners' anxiety and psychological trauma.
Many mothers were the primary caregivers just prior to arrest," says Dee Ann Newell, executive director of Centers for Youth and Families in Little Rock, Ark., making rising incarceration rates among women even more alarming. The number of women in prison has increased 106% since 1990, doubling the number of children with mothers in prison. According to Newell, the 685 women housed in the Ronald McPherson Correctional Facility for women in Arkansas have a total of nearly 1,500 children who are minors.
Bilchik, Seymour and Kreisher)
The situation where mothers leave their children is strongly related to the issue of mental health and most studies find a negative correlation in this regard. For example, there has been a measured increase in depression and anxiety disorders among mothers over time. Anxiety disorders predominated among incarcerated mothers and grew proportionately over time. "A high prevalence of depression was found among... mothers..."
Ross and Lawrence)
Furthermore incarceration may mean that mothers have extreme difficulty in maintaining a relationship with their children.
The most common concerns voiced by mothers in prison revolve around what is happening to their children while they are gone. More than 56,000 children have mothers in prison. (2) These children miss their mothers and have difficulty understanding why they cannot be with them.
Morton and Williams)
The issue of the treatment of pregnant women has also been highlighted in a variety of studies. A study by Amnesty International found that for example, pregnant inmates should not be handcuffed and shackled when in labor as is common practice in the U.S. The use of leg shackles particularly poses a threat to the woman and the child by restricting movement and, should the correctional officer be away from the delivery room, there is no way to remove the restraints in case of an emergency.
7. Health care
The Amnesty International report also highlights the issue of health care for women entering prison. The report states clearly that "incarcerated women do not receive adequate physical and mental health services; most do not receive routine medical exams at the time of incarceration despite the fact that many of them experience significant health problems." (ibid)
The issue of health care for women is also related to the increase in women prisoners over the last decade and to the fact that this increase in numbers has not been reflected in an increase in health care provision and facilities for women. A study by Ross and Lawrence indicates that the focus on treatment issues of women in prison should be on health. "... The real change in focus on women is associated with the impact on correctional systems of increasing and intensified demand for specialized health care services hitherto not delivered on a large scale in prisons and jails."
Ross and Lawrence)
These health care issues include the high prevalence of HIV / AIDS and high risk pregnancies which are not, according to many reports, adequately catered for. The situation is more serious with regard to women inmates from urban minorities who have the "highest rates of HIV infection and associated tuberculosis (TB), far exceeding rates for male offenders. In New York, mortality among incarcerated women remains more than twice that of women in the same age group in the community."