Decarceration—and support on the outside—is the answer, not therapy behind bars

A new report finds little evidence supporting the idea that building new prisons for women will lead to better outcomes, even with gender-responsive and trauma-informed programming.

by Prison Policy Initiative, February 3, 2021

In January, as the United States government prepared to execute Lisa Montgomery, news stories described the horrific sexual and physical abuse Montgomery experienced throughout her childhood and adult life. These accounts are shocking — but devastatingly, not so unusual. Studies suggest that more than half of women in state prisons survived physical and/or sexual abuse prior to their incarceration.

Prison is a horrible place for people struggling with symptoms of past trauma, as well as those with histories of mental illness and substance abuse. Well-meaning policymakers sometimes suggest building “kinder, gentler” prisons that offer needed counseling — and indeed, one such project has recently been proposed for convicted women in Massachusetts — but in practice, prisons themselves are fundamentally in opposition with goals of supportive programming.

In fact, Professor Susan Sered, along with Erica Taft and Cherry Russell, have just published an extensive review of the research on the outcomes of existing, prison-based therapeutic treatments — particularly for women. They conclude that the value gained from prison-based trauma, mental health, and substance abuse interventions are far outweighed by the harms caused by incarceration. Instead, they argue, alternatives outside of prisons that provide trauma-informed support, alongside practical interventions such as housing assistance and health care, are far more beneficial than anything that can be offered in a prison setting.

Prison is inherently traumatizing

Incarceration itself is retraumatizing and damaging to mental health. “Prisons are full of trauma-triggers,” Sered and her co-authors write, “such as unexpected noises, sounds of distress from other people, barked orders, pat-downs, strip searches, and looming threats of punishment for breaking any one of myriad rules.” Incarcerated women often experience new traumas and indignities, including the loss of their children and families, their bodily privacy, and their freedom of movement, time, and personal space. Meanwhile, “prison conditions including noise, crowding, lack of privacy, substandard diet, insufficient fresh air, harassment and ongoing threats of violence and punishment are further associated with negative health impacts.”

Even the most well-designed and decorated prison is still a prison, and inherently unconducive to trauma-informed therapeutic programs, where participants are encouraged to acknowledge their trauma and engage in practices that promote recovery and wellness. “Treatment can retraumatize clients when authoritative or coercive methods are used,” the authors explain. “Ideally, trauma-informed treatment should take place in a warm, welcoming and uncrowded space that provides room for a ‘time-out’ option. These conditions are difficult to meet in a prison context.”

There is insufficient study of the long-term benefits of prison-based therapy

Prison-based therapy programs show some benefits: The review notes that “a meta-analysis of studies published between 2000 and 2013 identified reduced recidivism rates for women who participated in gender-informed correctional interventions.”

However, the authors also point out that there has been little study of long-term benefits. This is in part due to logistical challenges: It can be difficult to locate and follow up with study participants post-release. Summarizing a study from 2020, they write: “while mental health services in prison can partially protect some women from some of the strains of being in prison, there is little evidence that these services are of much benefit after they leave prison.” They further note that they “could not identify any studies that evaluate program impact in terms of variables such as post-incarceration employment, health or family reunification.”

What’s more, while gender-sensitive prison-based programs may benefit participants in some ways in the short term (a welcome effect in a prison setting), troublingly, at least one cited study suggests that these programs may over-emphasize “individual pathology.” Along the same lines, another study finds that staff often urge incarcerated women to see the error of their ways and “self-improve.” Incarcerated men, meanwhile, are more likely to report more practical supports, such as staff helping them gain real-world job and educational skills.

Similar problems plague drug treatment in prisons

Prisons are also inherently difficult places to participate in substance abuse treatment. “The prison environment itself creates added stress which may lead some people to seek psychotropic substances—both prescribed and illicit,” the authors write, noting that many prisons also resist evidence-driven, medication-assisted substance abuse treatment.

To study the results of compulsory drug treatment, the authors point to a 2018 Canadian review of court-mandated drug programs, which found that “forced treatment did not improve outcomes for substance use. Instead, findings showed higher levels of mental duress, homelessness, relapse and overdose among adults after discharge from mandated treatment.” They also quote a 2016 meta-analysis of compulsory drug treatments, which concluded: “Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms.”

Recommendations:

Unfortunately, while there are numerous models for community-based alternatives to incarceration, they generally suffer from a similar lack of rigorous, long-term research as prison-based therapies. Therefore, the authors cannot recommend specific programs.

They do note, however, that studies suggest successful prison alternatives would “set realistic expectations for participants, avoid using threats of punishment to obtain compliance, and refrain from sending participants to prison because of drug use.” Research into the reentry needs of formerly incarcerated women shows that justice-involved women often benefit from support in the areas of economic marginalization and poverty, housing, trauma, and family reunification.

This fits with the recommendations of Sered and her coauthors: They suggest that alternatives-to-prison programs for women provide practical support, including housing assistance, family reunification, help establishing community relationships, health care and substance abuse support, and restorative justice programs. When executed correctly, the authors argue that community-based alternatives could be cost-effective and help keep women out of prison in the first place.