Histories of Childhood Victimization and Subsequent Mental Health Problems, Substance Use, and Sexual Victimization for a Sample of Incarcerated Women in the US

Introduction

Women are entering US prisons at nearly double the rate of men, making them the fastest-growing prison population.
Existing research focuses on the prevalence of women's incarceration, but there's a lack of studies on the different paths that lead women to prison.
Women prisoners often have more experiences of prior victimization, mental health issues, and substance use than their male counterparts.
This study aims to understand the prevalence of childhood victimization and its connection to adult mental health problems, substance abuse, and sexual victimization among incarcerated women.
The research team interviewed 125 women prisoners who were soon to be released, gathering information on
- Childhood physical and sexual victimization
- Adult mental health and substance abuse
- Sexual victimization in the year before incarceration
The study found that women prisoners who experienced both physical and sexual victimization as children were more likely to be hospitalized as adults for psychological or emotional problems.
Women who were sexually victimized or both physically and sexually victimized were more likely to attempt suicide.
Women who experienced physical victimization as children, and those who were both physically and sexually victimized, were more likely to have a substance use disorder.
Women who were sexually abused as children, or both physically and sexually victimized, were more likely to be sexually abused in the year before prison.
The article emphasizes the importance of prisons providing treatment for women prisoners, based on their unique experiences, which often include childhood victimization and subsequent mental health and substance use issues.

Background

Mass Incarceration

The era of mass incarceration began in the U.S. approximately 40 years ago.
The U.S. has the highest incarceration and criminal justice involvement rates in the world.
The number of incarcerated individuals has increased significantly since 1971, from approximately 198,000 to 1.6 million in 2010 $(\text{Guerino \textit{et al}., 2011})$ .
Women comprise the fastest-growing population in U.S. prisons, with numbers increasing from 6,329 in 1971 to 112,797 in 2010 (\text{Guerino \textit{et al}., 2011}; \text{Pew Center on the States, 2008}; \text{West & Sabol, 2009}).
Women constitute approximately 7% of all incarcerated people in the U.S., but their rate of increase is almost double that of men $(\text{Guerino \textit{et al}., 2011}; \text{Talvi, 2007})$ .

Reasons for Increased Incarceration of Women

The increase in women's incarceration rates has been largely attributed to:
1. The War on Drugs: This involved criminalizing illicit substance use and distribution.
2. Mandatory minimum sentencing: This removed judicial discretion for certain offenses.
3. Lack of correctional programming designed to meet incarcerated women's needs (\text{Bloom, Owen, & Covington, 2004}; \text{Gaskins, 2004}; \text{Hall \textit{et al}., 2004}; \text{Mauer, Potler, & Wolf, 1999}; \text{Messina, Burdon, & Prendergast, 2006}; \text{Petersilia, 2009}; \text{Prothrow-Stith & Spivak, 2005}).

Unique Needs of Women Prisoners

Women prisoners have different needs than men, including greater experiences of prior victimization, more reports of mental illnesses (such as serious depression), and higher rates of illicit substance use (\text{Messina, Burdon, Hagopian, & Prendergast, 2006}).
There is a clear connection between mental health problems and drug use among women prisoners.
Approximately 73% of women prisoners have a mental health problem (\text{James & Glaze, 2006}) and approximately 60% used drugs in the month before the offense that led to incarceration (\text{Mumola & Karberg, 2007}).
Approximately 75% of women prisoners who report mental health problems also meet the criteria for substance dependence or abuse (\text{James & Glaze, 2006}).
Many women prisoners with mental health and/or substance use problems are victims of childhood victimization (\text{Islam-Zwart & Vik, 2004}; \text{Salisbury & Van Voorhis, 2009}; \text{Widom & Ames, 1994}; \text{Windle \textit{et al}., 1995}).
Understanding the associations between different types of childhood victimization (physical, sexual abuse) and subsequent mental health/substance abuse problems is crucial for effectively treating women prisoners by addressing their trauma.
Targeted and trauma focused interventions could promote positive post-release outcomes of women prisoners and decrease recidivism rates.

Prevalence of Victimization

Researchers reported the prevalence of physical and sexual victimization among incarcerated women approximately a decade ago (\text{Browne, Miller, & Maguin, 1999}; \text{Warren, Hurt, Loper, Bale, Friend, & Chauhan, 2002}), but little victimization research has been done since then.
There is a need to better understand the prevalence of childhood victimization in women offenders and its ability to predict mental health and substance abuse problems (\text{Bergseth, Jens, Bergeron-Vigesaa, & McDonald, 2011}).
This study seeks to understand childhood physical and sexual victimization among women prisoners and assess the association between previous victimization and adult mental health problems, adult sexual victimization, and substance abuse.

War on Drugs

The War on Drugs, initiated by President Richard Nixon in 1971, led to the criminalization of illicit substance use and de-emphasized rehabilitation for substance addictions (\text{Moore & Elkavich, 2008}).
In 2008, 500,000 people were imprisoned for drug crimes.
In 1971, when the War on Drugs started, there were 6,329 women incarcerated in State or Federal prisons. This number increased to 112,797 women in 2010 $(\text{Guerino \textit{et al}., 2011})$ .
The steep increase of women prisoners is attributed to increases in illicit drug use and drug-related convictions among women (\text{Covington, 1998}; \text{Green, Miranda, Daroowalla, & Siddique, 2005}).
Almost 30% of women offenders are arrested for drug-related crimes, and an additional 33% report using or obtaining drugs when arrested $(\text{Guerino \textit{et al}., 2011}; \text{Hall \textit{et al}., 2004}; \text{Messina \textit{et al}., 2006})$ .

Mandatory Minimum Sentencing

Mandatory minimum sentencing limits judicial discretion, as people convicted of certain crimes are subjected to a pre-determined sentencing grid $(\text{Gaskins, 2004})$ .
Judges are unable to consider mitigating circumstances, which may have prevented more women from going to prison in the past
Women are incarcerated and receive harsh sentences because men in their lives persuade, force, or trick them into carrying drugs $(\text{Gaskins, 2004})$ .

Lack of Programming for Women

A general lack of programming designed to meet women-specific needs has been argued to also contribute to the recidivism rates of formerly incarcerated women (\text{Petersilia, 2009}; \text{Travis, 2005}; \text{von Wormer & Kaplan, 2009}).
Historically, services for incarcerated women have been based on the needs of men, despite women prisoners having diverse and unique problems, such as more experiences with trauma (i.e., prior victimization), substance abuse, and mental health problems (\text{Drapalski \textit{et al}., 2009}; \text{Green \textit{et al}., 2005}; \text{Teplin, Abram, & McClelland, 1996}; \text{Warren \textit{et al}., 2003}).
Women prisoners have higher exposure to trauma than men prisoners and have higher rates of both mental health disorders and substance abuse problems (\text{Battle, Zlotnick, Najavits, Gutierrez, & Winsor, 2003}; \text{Green \textit{et al}., 2005}; \text{Jordan, Federman, Burns, Schlenger, Fairbank, & Caddell, 2002}; \text{Messina & Grella, 2006}; \text{Teplin \textit{et al}, 1996}).
Very few correctional and prisoner reentry programs address histories of trauma and mental health problems (\text{Bergseth \textit{et al}., 2011}; \text{Calhoun, Messina, Cartier, & Torres, 2010}; \text{Petersilia, 2009}; \text{von Wormer & Kaplan, 2009}).
Limited gender-specific programming in prisons has continued despite efforts to develop gender-responsive criminogenic risk and needs assessments (\text{Van Voorhis, Wright, Salisbury, & Bauman, 2010}).
Extant literature on PTSD and trauma exposure indicates that the type of trauma and victimization experiences must be appropriately matched with the type of therapeutic intervention.
This study contributes to the literature by offering a recent snapshot of prior victimization experiences and substance use and mental health problems on a random sample of women prisoners.

Victimization

Women prisoners have more extensive histories of physical and sexual victimization than male prisoners $(\text{Drapalski \textit{et al}., 2009})$ .
Up to 78% of incarcerated women reported being physically or sexually abused prior to prison (\text{McDaniels & Belknap, 2008}), while approximately 15% of male prisoners report victimization prior to prison (\text{Drapalski \textit{et al}., 2009}; \text{Wolff, Shi, & Siegel, 2009}).
Approximately 55% of women prisoners report childhood sexual victimization, and approximately 47% report childhood physical victimization (\text{Browne \textit{et al}., 1999}; \text{Islam-Zwart & Vik, 2004}; \text{Warren \textit{et al}., 2002}).
Women prisoners have victimization rates at higher levels than the general non-incarcerated women population in the U.S. (\text{Islam-Zwart & Vik, 2004}; \text{Messina \textit{et al}., 2006}; \text{Wolff, Blitz, & Shi, 2007}).
Much of the existing theoretical and program development research on prisoner populations has been conducted using samples of male current and former prisoners or male adolescents at risk of imprisonment.
Trauma exposure may lead to exacerbated substance use and mental health problems (\text{Garland, Pettus-Davis, & Howard, 2012}; \text{Jordan \textit{et al}, 2002}).

Effects of Childhood Victimization

Childhood victimization is associated with substance use problems, criminal behavior, and continued victimization throughout the victimized person's life.
Women victims of childhood sexual abuse or severe physical abuse by parents or guardians are at higher risk for substance abuse and other addictions as both teenagers and adults (\text{Browne \textit{et al}., 1999}; \text{Salisbury & Van Voorhis, 2009}; \text{Windle \textit{et al}., 1995}).
Physically abused female children were more likely to be arrested as adolescents, and sexually abused female children were more likely to be arrested as an adult for prostitution (\text{Widom & Ames, 1994}).
Girls who are sexually abused are more likely to be victims of domestic violence as adults (\text{Beitchman, Zucker, Hood, DaCosta, Akman, & Cassavia, 1992}; \text{Browne \textit{et al}., 1999}; \text{Green \textit{et al}., 2005})

Salisbury and Van Voorhis Model:

Developed a model connecting childhood victimization, adult mental health problems, and criminal offending that results in correctional supervision in the community (i.e., probation) (\text{Salisbury & Van Voorhis, 2009}).
The model asserts that childhood victimization engenders mental health problems, which leads to self-medication behaviors using illegal substances, leading to arrest and conviction for drug-related crimes.
This study focuses on women with criminal histories severe enough to warrant removal from the community and incarceration in a state prison.

Study Purpose and Research Questions

The purpose of this study is twofold:
1. To assess the relationships between childhood victimization, substance abuse, mental health problems, and adult sexual victimization with women prisoners soon to be released from prison.
2. To evaluate whether childhood physical abuse and childhood sexual abuse lead to outcomes as adults such as hospitalization for a psychological or emotional problem, suicidal ideations, substance use, or further sexual victimization.
Research Questions:
1. Is childhood victimization associated with mental health problems in a sample of incarcerated women?
  - Are there differences between childhood physical abuse and childhood sexual abuse in the ability to predict adult mental health problems?
2. Is childhood victimization associated with substance use as an adult in a sample of incarcerated women?
  - Are there differences between childhood physical abuse and childhood sexual abuse in their ability to predict adult substance use problems?
3. Is childhood victimization associated with being victimized as an adult in a sample of incarcerated women?
  - Are there differences between childhood physical abuse and childhood sexual abuse in their ability to predict sexual victimization as an adult?
4. What is the relationship between mental health problems and substance use in a sample of incarcerated women?

Methods

Participants

A random sample of women prisoners $(n = 125)$ was obtained from two state prisons in North Carolina.
Participation was voluntary with an 83% positive response rate.
One prison housed over 1,300 prisoners (maximum, medium, and minimum security levels), while the other housed approximately 200 prisoners (minimum security).
Demographics:
- Average age: $34.3 \; (SD = 9.94)$ , range: 19-62
- Approximately 53% Caucasian, 43% African American, 4% Hispanic
Victimization:
- 32.5%
  Both physically and sexually abused as a child
- 20.3%
  Physically abused but not sexually abused as a child
- 11.4%
  Sexually abused but not physically abused as a child
- 35.8%
  Not abused as a child
- 27.9%
  Sexually abused the year preceding incarceration
Substance use: 62.1% had a substance abuse disorder; 52.8% were treated for drug abuse.
Mental health: 27.6% were hospitalized as an adult for a psychological or emotional problem; 25.8% had attempted suicide.

Procedures

The sample was randomly selected from a census of eligible women scheduled to release within 30 to 120 days of the data collection period.
Eligibility criteria included being at least 18 years old, English-speaking, and cognitively functioning to provide informed consent.
Prison employees and researchers randomly selected names from lists and invited women to participate, explaining the study and consent form.
Data collection occurred from December 2010 to May 2011.
All procedures were approved by the Florida State University and North Carolina Department of Correction Human Subject Review Boards.
Interviews took approximately 45 minutes to 1.5 hours.
Five members of the research team conducted the interviews; all had clinical experience working with women and/or trauma, or experience interviewing research participants in prisons.
Interviewers read out loud the measurements and wrote down the participant responses.

Measures

Victimization, mental health problems, and substance use were measured with six standardized interviews.

Substance Use Problems

The Substance Abuse Module (SAM) (\text{Cottler, Robins, & Helzer, 1989}) is a 38-item measure that assesses DSM-IV diagnostic criteria for current and lifetime substance use disorders.
Researchers administered the entire scale and used the following 3 items to determine how many times a participant received treatment for substance related problems:
1. How many times in the 12 months prior to prison have you been treated for substance abuse?
2. How many of these treatments for detox only?
3. How many times have you been treated in an outpatient settings (e.g. counseling, NA/AA, or drug use) in your lifetime and in the 12 months prior to prison?
Two variables assessed substance use problems:
- Whether the participant met the criteria for a substance use disorder (dichotomous variable)
- How many times the participant has been treated for substance abuse problems (continuous variable)

Mental Health Problems

History of treatment for psychiatric problems was obtained from participant responses to the Addiction Severity Index (ASI) $(\text{McLellan \textit{et al}., 1992})$ .
The participants completed the psychiatric problems section of the ASI by being asked whether they have experienced symptoms of the following in the past 30 days or lifetime: depression, anxiety, hallucinations, suicidal thoughts, and prescribed psychiatric medications.
Participants were also asked if they had ever attempted suicide, and if so, the number of times along with how many times they have been hospitalized for a psychological or emotional problem.
For the analyses in this study, mental health problems were defined by:
- Whether the participant has been hospitalized as an adult for mental health problems
- Whether the participant has ever attempted suicide
Both of these variables are dichotomous.

Victimization

Histories of childhood physical and sexual abuse were assessed using the Childhood Trauma Questionnaire (CTQ) (\text{Bernstein, Fink, Handelsman, & Foot, 1994}).
The CTQ is a 28-item measure that provides screenings for histories of abuse.
The participants were asked if they ever experienced the question being asked on a five point Likert scale.
The researchers administered a 20-item version of the CTQ and, for this particular study, the participant was considered to have been sexually victimized as a child if they answered affirmatively to any of the following from the CTQ:
1. I believe I was sexually abused
2. Someone molested me
3. Someone threatened to hurt me or tell lies about me unless I did something sexual to them
Whether the participant was sexual victimized as a child is a dichotomous variable.
The participant was considered to have been victimized physically as a child if they responded affirmatively to the following item from the CTQ: When I was growing up, people in my family hit me so hard that it left me with bruises or marks.
Whether the participant was physically victimized as a child is a dichotomous variable.
The National Violence Against Women Survey (\text{Tjaden & Thoennes, 2000}) measures lifetime histories of both physical and sexual victimization and was used as validation for the CTQ in determining whether a participant was physically abused as a child.
- Whether the participant was sexual victimized as a child is a dichotomous variable.
The Experiences of Sexual Victimization (ESV) survey (\text{Koss & Oros, 1982}) is a 12-item yes-no questionnaire that assesses previous experiences of sexual victimization
- If the participant responded affirmatively to any of the following items, and it corroborated with results from the CTQ, than the participant was considered to have been sexually abused as a child:
  1. Had sexual intercourse with somebody when you did not want to because they threatened to use physical force if you did not cooperate
  2. Had sexual intercourse with somebody when you did not want to because they used some degree of physical force
  3. Been in a situation where somebody obtained sexual acts with you such as anal or oral intercourse when you did not want to by using threats or physical force.
  4. Have ever been raped.
The Abuse Behavior Inventory (ABI) is a 29-item Likert scale measure of physical and psychological intimate partner abuse in the prior year (\text{Zinc, Klesges, Levin, & Putnam, 2007}).
Whether the participant was sexually victimized by a family member or intimate partner in the year before incarceration is a dichotomous variable in these analyses.

Data Analysis

Binary logistic regression models were used to assess the relationship between victimization, mental health, and substance use for this sample.
Assumptions:
- Outcome variables were binary
- The sample was independently and randomly selected

Model Specification:

Four logistic models were created, with variables selected based on empirically supported risk factors and the researchers' theory.
The predictor variables described below were considered for each of the four models. The dependent variable differed for each model in order to explore the separate research questions.
- Age: Coded as a continuous variable. Associated with continued criminal justice involvement and chronic antisocial behaviors (\text{Bartusch, Jeglum, Moffitt, & Silva, 1997}; \text{Gottfredson & Hirschi, 1990}; \text{Moffitt, Caspi, Dickinson, Silva, & Stantond, 1996}).
- Race: Coded as a dichotomous variable (minority or not a minority). African Americans are disproportionately represented in prisons (\text{Cullent & Sundt, 2000}; \text{Guerino \textit{et al}., 2011}) and African Americans have higher rates of recidivism to criminal justice involvement when compared to their white counterparts (\text{Langan & Levin, 2002}).
- Sexual victimization: Coded as a dichotomous variable (whether the participant was sexually victimized as a child and not physically victimized).
- Physical victimization: Coded as a dichotomous variable (whether the participant was physically victimized as a child and not sexually victimized).
- Physical and sexual victimization: Coded as a dichotomous variable (whether the participant was both physically and sexually victimized as a child).
- Not victimized: Coded as a dichotomous variable.
- Residential drug treatment: Coded as a continuous variable (the amount of times the participant reported attending residential drug treatment).
Predictor variables were included in a forced entry approach.

Model 1:

Included age, race, four childhood victimization variables, and residential drug treatment as the predictor variables.
Hospitalization as an adult for psychological or emotional problems as the dependent variable.

Model 2:

Included the same predictor variables as Model 1.
Whether the participant had attempted suicide as the dependent variable.

Model 3:

Included age, race, and the same four childhood victimization variables as the predictor variables.
Whether the participant was assessed has having a substance abuse disorder as the dependent variable.

Model 4:

Included the same predictor variables as Model 3.
Whether the participant was sexually abused by an intimate partner or family member the year preceding incarceration as the dependent variable.
Differences between samples for categorical variables were evaluated using chi-square tests. Differences in means between samples for continuous variables were evaluated using t-tests. In those cases in which the cell count was less than five, we used a Fisher’s exact test instead of chi-square.

Results

Predicting Adult Mental Health Problems (Model 1 and 2)

The first research question asks if childhood victimization is associated with mental health problems and if there are differences between childhood physical and sexual victimization.

Findings:

Having experienced both physical and sexual victimization as a child was the statistically significant predictor variable related to psychiatric hospitalization as an adult (OR = 3.99, p = .012).
Women who were both physically and sexually victimized as children were close to four times more likely to be hospitalized as an adult than women who were not both physically and sexually abused.
The second regression model indicated there is a relationship between the dependent variable and the combination of predictor variables
Women who were sexually victimized as a child but not physically victimized were approximately 7.7 times more likely to have attempted suicide than women who were not in this category (OR = 7.74, p = .029).
Women who were both physically and sexually victimized as a child were close to 21.6 times more likely to have attempted suicide than women who were not both physically and sexually victimized as a child (OR = 21.56, p< . 001).
Additionally, all else being equal, a 1-unit increase in times treated for drug problems was associated with being approximately 24% more likely to have attempted suicide (OR = 1.241, p = .021).

Summary:

Childhood victimization is associated with mental health problems as an adult.
Women who were both sexually and physically victimized as children were significantly more likely to be hospitalized for a mental health or emotional problem as an adult.
Women who were sexually victimized as a child and women who were both physically and sexually victimized as a child were more likely to have attempted suicide at a statistically significant level.
There was a significant relationship between the number of times the participant attended drug treatment and whether she had attempted suicide, indicating a relationship between substance abuse and mental health.

Predicting Substance Abuse Problems (Model 3)

The second research question asks whether childhood victimization is associated with substance use problems, and if there are differences between physical and sexual victimization.
This logistic regression model indicated there is a relationship between the dependent variable and the combination of predictor variables. (p = .001)
All else being equal, a 1-unit increase in age is associated with being 4.5% less likely to have a substance abuse disorder (OR = .955, p= .033).
Minority women in this sample were approximately 65% less likely to have a substance abuse disorder than white women (OR = .331, p = .007).
Participants who were physically victimized as children but not sexually victimized were approximately 4.8 times more likely to have a substance abuse disorder than women who were not in this category (OR = 4.752, p = .010)
Participants who were both physically and sexually victimized were approximately 3.2 times more likely to have a substance abuse disorder than women who were not both physically and sexually victimized (OR = 3.225, p = .017).

Summary:

There is a relationship between childhood victimization and adult substance use problems.
Childhood physical victimization is associated with having a substance abuse disorder as an adult, and participants who were both physically and sexually victimized as children are more likely to have a substance abuse disorder as an adult.

Predicting Sexual Abuse The Year Preceding Incarceration (Model 4)

Women sexually victimized as children and women both physically and sexually victimized as children were more likely to be sexually victimized by a family member or an intimate partner in the year preceding incarceration.
Participants who were sexually victimized as a child but not physically victimized were approximately 5.5 times more likely to be sexually victimized in the year preceding prison than women not in this category (OR = 5.496, p = .043).
Participants who were both physically and sexually victimized as children were approximately 12.8 times more likely to be sexually victimized the year preceding prison than participants who were not both physically and sexually victimized as children (OR = 12.82, p < .001).

Interaction Effects

One significant interaction at p=.047 between age and history of physical abuse in model 4. After Bonferoni postestimation, the interaction effect was no longer statistically significant.

Discussion

This study explored the relationship between childhood victimization and outcomes in adulthood such as mental health problems, substance use problems, and sexual victimization for a random sample of women prisoners in the US soon to be released from prison.
Child victimization was related to severe mental health problems, substance abuse, and further sexual victimization.
- Women prisoners who were both physically and sexually abused as children were more likely to suffer from psychological and emotional problems that required hospitalization.
- Women prisoners who were either sexually abused and not physically abused or both physically and sexually abused were more likely to have attempted suicide than women not in these categories. These women were also more likely to be sexually victimized as adults by an intimate partner or family member.
- Women who were physically abused as a child and women who were both physically and sexually abused were more likely to have a substance use disorder than women who were not.
The relationship among mental health problems, substance use, and victimization is complex.
- Although childhood sexual abuse is related to subsequent mental health problems in adulthood, sexual abuse was not a statistically significant predictor of substance abuse.
- Conversely, although childhood physical abuse predicted substance abuse in adulthood, it was not statistically related to mental health problems.
It is unclear which mechanisms differ and how between childhood victimization and subsequent mental health and substance use problems for women prisoners.
Does our current use of mandatory minimums and sentencing guidelines prohibit rehabilitative responses to women offenders?
If our legal responses to women offenders do not consider their therapeutic needs in order to function fully in society, does this imply that correctional institutions should be mandated to provide women-specific programming that addresses victimization, trauma, and subsequent consequences?

Strengths

The researchers were able to gain access to lists of all women at the two prisons who met the eligibility criteria and select a random sample of research participants from these lists.
Interviews were conducted with women from the general prison population, not women already enrolled in mental health or substance abuse programs.
The study assessed/analyzed:
- Childhood physical victimization
- Childhood sexual victimization separately
- Influence of being both physically and sexually abused

Limitations

Approximately 83% of women asked to participate agreed to do so, there is no way to know if the other 17% have differing levels of victimization, mental health problem, and substance abuse problems.
For those women who chose to participate, social desirability bias could also lead to the underreporting or overreporting of victimization, mental health issues, and substance use problems.
This study was conducted in one southeastern state, prohibiting generalization to the experience of all women prisoners within the United States.

Implications

Researchers need to conduct:
- Larger multi-state study is needed to increase the generalizability of the study results
- Studies that address unanswered questions regarding childhood victimization and its long term consequences (e.g. Why is there such a large difference in the prevalence of childhood victimization between the general population of women and women who end up in prison?, Do women victims who end up in prison have differential access to treatment resources than those who do not?)
Consistent with other research on the victimization histories of prisoners: Women prisoners have disproportionately higher rates of childhood victimization than previous research reveals for the general population of women.
The best way to identify the necessary components of multimodal interventions is to first identify psychosocial mechanisms (e.g., substance use problems) that can be targeted by interventions.

Societal Responsibilities

What are our societal responsibilities to victims of childhood abuse?
If we failed to protect them as children, is it our responsibility to protect them as adults – from themselves, from others?
What role do mandatory minimums, sentencing guidelines, punitive legal responses to crime associated with drugs perform in this discussion? Is incarceration a just, appropriate response?
Because we failed to protect women offenders as children when they were subjected to physical and sexual abuse, do we, at a minimum, owe them appropriate treatment options when we incarcerate them as adults?
Treatment for women prisoners potentially protects them from continued consequences of their previous abuse, and it also decreases the chances of committing further crimes, which protects the general society and decreases the number of future victims of crime.
Unfortunately mental health services for women prisoners are rare, and when they do exist, they are often based on the needs for male prisoners because more is known about that population.