Gender, Psychology, and Justice: The Mental Health of Women and Girls in the Legal System - Linda Wolfe 2014

Women, Incarceration, and Reentry: The Revolving Door of Prisons
Women and Girls in Various Justice Settings

Elizabeth A. Lilliott, Elise M. Trott, Nicole C. Kellett, Amy E. Green, and Cathleen E. Willging

Women’s incarceration rates have doubled since the 1990s (Rowan-Szal et al. 2009), as policies stemming from the War on Drugs result in higher arrest rates and longer sentences for women (Aday and Farney 2014), most of whom are imprisoned for nonviolent crimes (Smyth 2012; U.S. Department of Justice 2011). Women face myriad social and economic challenges upon release, especially when returning to rural areas where the intersecting challenges of poverty, social stigma, and resource scarcity constitute formidable impediments to their well-being and future life chances. Within this stressful context, women prisoners experience elevated risks for recidivism (Willging et al. 2013) and drug overdose and suicide in the weeks after release (Binswanger et al. 2007). In the rural state of New Mexico, women prisoners have commented on the cycle of reincarceration, claiming that inmates return to prison for the security of “three hots and a cot” or, as one inmate stated, “They are not afraid to come back because it’s a roof and three squares.”

In this chapter, we analyze the layered oppressions revealed in women inmates’ description of conditions within prison and in their rural communities. We consider how their lives in rural areas are cast in a negative light in contrast to the presumed safety and predictability of existence in prison, while problematizing the facile conclusion that repeat offenders “prefer” prison. We also assess the complex challenges affecting women during and after incarceration, focusing on how negative ideologies, insufficient services and resources, and social support within and outside of prison influence well-being and chances for successful reentry.

To understand these experiences, we draw upon semistructured interview data collected between March and August 2009 from rural inmates of New Mexico’s only women’s prison. These data were collected as part of a larger multimethod study of women prisoners that included inmates in the general population who were scheduled to return to rural communities within the next six months. We interviewed a total of ninety-nine women who self-identified as Hispanic (n = 33), Native American (n = 33), non-Hispanic White (n = 32), and African American (n = 1). Interviewees ranged in age from twenty to fifty-six years old (M = 35.2, median = 34, SD = 8.4) with educational histories of four to sixteen years (M = 11.0, median = 11, SD = 1.9). Interviewees had been incarcerated from approximately nine months to three years, and almost half (47 percent) had been reincarcerated in the state prison (Willging et al. 2013).

In this chapter, we highlight our analysis of interview data. We used an iterative process of open and focused coding to analyze these data. First, segments of text ranging from a phrase to several paragraphs were assigned codes based a priori on the topics and questions that made up the interview guide. We then used open coding to identify and define new codes to capture information on emergent themes. Finally, we used focused coding to determine which themes surfaced frequently and which represented unusual or particular issues for rural women prisoners. After constantly comparing and contrasting codes, we grouped together those with similar content or meaning into broad themes that addressed the social and psychological concerns of women in prison, reentry planning, and factors that contribute to the phenomenon of reincarceration (Corbin and Strauss 2008).

Our goal is to show how the meager comforts of prison life, the stigma of being a felon, and the scarcity of resources within rural New Mexico are illustrative of the multiple oppressions that cause women released from prison to return to criminalized behavior and incarceration. We argue that the convergence of these overlapping forms of “structural violence” (Galtung 1993), combined with the effects and ideologies of neoliberalism, can prevent women from accessing resources to achieve a successful transition from prison while simultaneously facilitating the “revolving door” of reincarceration. We highlight the importance of a social justice psychology framework that attends to the structural inequities, system deficiencies, pervasive trauma, and health disparities that shape the lives of rural women prisoners. We also discuss psychologists’ efforts to spearhead social justice— and trauma-informed reentry services in order to disrupt the pernicious cycle of rural women’s incarceration and recidivism, and thereby improve their overall life chances.

Neoliberalism, Structural Violence, and Social Justice

The material conditions of rural life in New Mexico and the ideologies influencing both perceptions and social relationships of returning women prisoners are perpetuated through the socioeconomic structures and dominant discourses of neoliberalism. Neoliberalism—the guiding framework for economic and political processes in the United States since the 1970s—is characterized by the idea that human well-being is maximized through application of market exchange principles within all domains of human life. The role of the state is thus limited to the protection of free markets, private property rights, and free trade (Harvey 2005). This shifting in responsibilities is attributed to the contemporary neoliberal context and, as Marxist theorist David Harvey observes, is marked by “[d]eregulation, privatization, and withdrawal of the state from many areas of social provision” (Harvey 2005, 3). In New Mexico, for example, large-scale efforts to privatize state-funded mental healthcare for low-income people has occurred concurrently with an influx of private and for-profit interests in the prison industry.

Structures of economic and political domination, such as neoliberalism, are bolstered by ideology. In this way, neoliberalism exerts “pervasive effects on ways of thought to the point where it has become incorporated into the common-sense way many of us interpret, live in, and understand the world” (Harvey 2005, 3). A salient neoliberal notion that has become a governing principle within systems of criminal justice and public assistance in the United States is the singular emphasis on individual choice and personal responsibility (Young 2011). This principle renders individuals exclusively responsible for making “good choices,” regardless of the larger context of their everyday lives (Kellett and Willging 2011), thus absolving institutional or social structures of culpability for any harms suffered (Povinelli 2011).

We draw on scholarly understandings of “structural violence” to contest this neoliberal perspective (Farmer 2004; Galtung 1993). Structural violence refers to social conditions of racism, colonialism, gender oppression, and poverty that create unequal distributions of power. These conditions impair the capacity of individuals to ensure their own well-being by restricting allocation of resources to already privileged groups. Individuals may occupy multiple, cross-cutting positionalities (Collins 2000) through which inequality is reproduced. Feminist theories of intersectionality (Crenshaw 1991) examine these layers of inequality to advance “an intimate understanding of the multiplicative, overlapping, and cumulative effects of the simultaneous intersections of systems of oppression” (Bernard 2013, 3). Structures of violence can thus have compounded effects on individuals, such as the rural women in this chapter, who are also largely poor and Latina or Native American.

In this chapter, we point to the multidimensional effects of structural violence on rural women prisoners both within and outside of prison. To counter the ideological consequences of these oppressions, we advance a feminist read “against the grain” (hooks 1992) of dominant discourses, which posit that rural women prisoners “prefer” prison or are unwilling or unable to take responsibility for their own rehabilitation, and therefore constitute a drain on public resources. Instead, a social justice perspective allows us to elucidate the social causes of mental distress (Vasquez 2012) and to promote equality and justice in the distribution of basic human needs, such as housing, education, and medical attention (Kitchener and Anderson 2011).

Social justice psychology situates individuals within a larger social ecology that is shaped by multiple levels of influence, and seeks to engender positive change by attending to the social and political dynamics that impinge upon these different levels (Prilleltensky and Nelson 1997; Wolff 2014). Accordingly, the qualitative research described here highlights the intersecting oppressions that rural women prisoners experience and the broader structural and institutional factors that set them up for failure outside. For these women, violent legacies of colonialism, male domination, and economic marginalization (Garcia 2010; Trujillo 2009) couple with the disintegration of public assistance programs and privatization of healthcare services (Willging and Semansky 2014) to create a system of interconnected oppressions that limits material support, therapeutic resources, and, ultimately, a successful return home.

Rural Women and Incarceration

Due to the War on Drugs, rural women and girls come into contact with the criminal justice system primarily for nonviolent and drug-related offenses. Such contact also occurs under circumstances of social and economic hardship and significant physical and mental health disparities. Their positioning within historical structures of patriarchy exposes rural women to greater interlocking disadvantages, including inadequate housing, health insurance, formal education, and employment opportunities, compared to men and urban residents (Coward et al. 2006). Of the women prisoners we interviewed, only 33 percent had derived income from a job six months prior to incarceration. Forty-six percent lived in unstable housing; and 52 percent reported economic hardship during this period (Willging et al. 2013). Such disparities are compounded by serious health problems prevalent among women entering prison, including HIV, Hepatitis C, and reproductive diseases (Chandler 2003).

Rural women are also at heightened risk for mental distress (Coward et al. 2006), including depression and suicidality (Hauenstein and Peddada 2007), and have higher rates than men of co-occurring mental-health and substance-use issues (Vik 2007). While rural women in general are at higher risk for these issues, those in prison are exposed more often than the general population to adverse childhood events linked to poor physical and mental health outcomes (Bowles, DeHart, and Webb 2012). All study interviewees had experienced a traumatic event in their lifetimes, and 60 percent reported childhood physical or sexual abuse, with an average age of onset of eight years; 89 percent reported current substance dependence and/or major mental illness (Willging et al. 2013).

Rural women have a greater likelihood of intimate partner violence (IPV) (Dekeseredy, Dragiewicz, and Rennison 2012). Multiple studies document the extremely high rates of IPV among women prisoners in the year prior to incarceration (Green et al. 2005; Lake 1993; Lynch, Fritch, and Heath 2012). In fact, 91 percent of our interviewees reported experiences of IPV in the year preceding incarceration (Willging et al. 2013).

Rural women coming into contact with criminal justice systems may be further isolated and affected by high poverty rates and uneven economic expansion in their home communities. New Mexico has the second-highest poverty rate (21.9 percent in 2013) (U.S. Department of Commerce 2014) and greatest gap in income inequality between the top and bottom 5 percent in the nation (Center on Budget and Policy Priorities 2012). Its rural areas are often deficient in basic social services and suffer from chronic shortages of mental health professionals who commonly lack adequate training in culturally competent and evidence-based practices (Semansky et al. 2013). Rural women are thus burdened with interrelated physical, psychological, and socioeconomic disadvantages that undergird contact with criminal justice systems and affect their well-being before, during, and after incarceration.

Social and Psychological Concerns of Women in Prison

Within this trying context, rural women prisoners confront issues related to their physical and mental health, substance use, and social relationships. Ironically, women’s descriptions of their prison experiences show that incarceration can be an opportunity to receive care and security as never before. In the following sections, we illustrate how women prisoners report improvements in their quality of life during incarceration, including better mental and physical health, safety, social support, food security, and shelter. However, incarceration can also aggravate their physical and psychological concerns. Prison-based services designed to address women’s needs tend to be inconsistent, insufficient, and sometimes inappropriate, problems that have been linked to the privatization of prisons and prison services (Bondurant 2013). Women’s experiences thus reveal a double-edged quality to the support, safety, and “three hots and a cot” rendered in prison that can negatively impact their overall health and well-being.

Mental and Physical Health and Healthcare

Although interviewees had high rates of trauma and abuse before incarceration, few partook in therapeutic services to deal with these experiences prior to imprisonment. Having struggled with cutting and suicidality since the age of nine, one interviewee asserted, “I never saw a doctor for them [mental health issues] until I came to prison.” Other women described obtaining their first diagnoses and treatment for chronic medical conditions such as diabetes and high blood pressure. For some, routine medical checkups were experiences unique to prison. A second interviewee stated, “I had a pap smear when I came here, and the last one I had was when I was here last time.” A third explained that her health was “better because I’ve had checkups and everything, which I didn’t have [before] because I didn’t have medical insurance.”

Many women reportedly faced basic subsistence issues before incarceration. Consequently, prison provided some increased stability in diet and housing that positively affected their physical well-being. One woman made a stark comparison: “[My health] is better because I’m eating right, I’m taking vitamins, I’m doing a regular thing on a daily basis, whereas when I was out there I wasn’t eating nothing but maybe a candy bar and a Coke twice a month.”

Prison also provided access to pharmaceuticals, although many women we interviewed stated that these medications were primarily desirable for coping with prison life. One prisoner commented that without her medication, “I don’t think I’d be sitting in here right now.” A second explained, “If I don’t take it, I’m lost. I cry a lot and I think a lot.” Some women also found that medication helped curb addictions. For one inmate, Wellbutrin “took the cravings away and allowed me to actually get clean.”

While women prisoners received healthcare in prison, changes to their health were not always positive. Women attributed health declines to the prison context, including lack of specialized care for ongoing conditions. Some complained of aches and pains as a consequence of hard beds and cement floors. Numerous women reported unhealthy weight gain after a diet rich in simple carbohydrates and a lack of exercise. They also critiqued long wait times and high turnover among primary care providers in prison. One individual described backsliding on her physical therapy initiated prior to incarceration because she did not qualify for such treatment in prison and was even denied the cane upon which her mobility depended. Another resorted to requesting urgent care for her persistent conditions: “They come up with excuses. But if I have something [urgent] at the last minute, that’s when they’ll see me. Other than that they just say, ’Put your slip in and we’ll call you as soon as possible.’ They call then two months later.”

High caseloads and turnover in therapists, counselors, and case workers exacerbated difficulties obtaining individual counseling and related support services. Interviewees claimed that the prison’s mental health unit was woefully understaffed in relation to demand, and that providers restricted what medications they could take, inadequately monitored their use, or prescribed them for pacification. Interviewees speculated that they were prescribed numbing psychotropic medications that “just dope you up and you’re emotionless,” transforming them into “walking zombies.” Overall, they asserted that physical and mental health treatment was needed, but also judged these prison services as inconsistently available and largely inadequate.

Substance Use and Treatment Resources

Another way in which prison could provide a supportive and healthful environment for many interviewees was by reducing their exposure to alcohol and illicit drugs. One interviewee explained that without forced abstention from drinking during her various incarcerations, “I probably would have been dead by now with cirrhosis or something.” She explained, “Out there I can do it [drink alcohol]. But I feel better here. I mean not to be wanting to be here, but I feel safer here because I can’t get a hold of my alcohol.”

Prison also offered substance use treatment resources, albeit in limited form. Moreover, such resources were rarely accessed by our interviewees prior to prison, despite their extremely high rates of addiction. Women generally valued prison-based self-help groups and psycho-educational classes, often describing them as safe places to reflect and consider change. However, many women lamented the limited availability of such classes. One interviewee explained, “The schooling is great, but they don’t have enough therapists for the substance abuse classes. They don’t have enough staff here period. So everything’s always being canceled.” Long wait lists for group therapy also restricted participation to those with longer sentences, excluding shorter-term prisoners serving time for nonviolent crimes related to mental distress or substance dependence. Confounding distinctions between who received these services and who did not appeared arbitrary. One woman described several attempts to participate in a psycho-educational class with no results: “I don’t know. I just gave up. They definitely have their favorites here.” As with physical and mental healthcare, women’s experiences with substance use services in prison reveal significant obstacles to any efforts at rehabilitation.

Social Support

In addition to secure food and shelter and the possibility of care and treatment, prison provided an environment where women found novel and much-needed social support. Although there were accounts of hostility, fighting, and violence, women more often described forming bonds with other inmates to cope with incarceration as well as to prepare for outside life. For instance, some explained how women swapped information about resources and places to go with others struggling with reentry planning. Often this information sharing represented the way women who had “been there” provided moral support to those facing first-time releases.

The shared experience of incarceration aided women in forming supportive connections that were distinct from those with kin on the outside, or with professional service providers inside. Of her fellow inmates, one interviewee said, “I can honestly say, they can relate. They know what I’m talking about when I’m distressed. After being locked up for so long they helped me out a lot, just striving to succeed.” Another described a fellow inmate who was “more like a sister ’cause not even me and a sister have been that close.” In this way, rural women inmates may experience the prison environment as a place where they can form positive social supports among understanding peers. These supports appeared valuable when compared to taxing social or kin relationships outside prison, which, as we describe later, could threaten reentry.

Rural women prisoners’ descriptions of their incarceration thus reveal a contradictory experience. Coming from an intensely challenging socioeconomic context, these prisoners find a level of basic security and care that contrasts with their familiar subsistence, substance use, and mental distress. At the same time, they are able to form supportive relationships with peers. However, the care and support in prison is limited, sporadic, and overly reliant on powerful pharmaceuticals that may mute women’s mental health symptoms without addressing their causes. Significantly, the provision of limited and inadequate resources within such closed institutional settings has been linked to the influx of private and for-profit interests into prisons and subsequent efforts to “economize” upon the escalating costs associated with incarceration (Bondurant 2013). The ill effects of prison care thus intersect with and compound the physical and mental health—related disparities that rural women prisoners commonly face. That incarcerated women experience these limited forms of prison-based care as improvements to their well-being highlights the dire conditions to which they are accustomed. Indeed, it is little surprise that rural women prisoners face their impending release with extreme trepidation.

The “Revolving Door”: Contributions to Rural Women’s Recidivism

As women prisoners prepared to reenter rural communities, their concerns about securing food and shelter, physical and mental healthcare, substance use treatment, and healthy social supports were accentuated. Women described anxiety and uncertainty about their lives outside prison, emotions influenced by the problematic dynamics of prison-based reentry-planning services and the increasing incidence of prolonged sentences and in-house parole. Once women were released into rural areas, they faced new oppressions that intersected with the socioeconomic and health-related disparities that affected them before incarceration. In the following sections, we describe how the synergy of inadequate reentry planning, social stigma, and punitive federal and state policies set women up for reentry failure.

Our interviewees’ preparations for reentry were often frustrated by ambiguity about sentence lengths and release dates, and unproductive reentry planning. When collecting data, researchers and interviewees alike became perplexed with determining release dates. For our study, prison staff identified women eligible for release within the next six months, but sometimes these interviewees would express confusion when hearing of their imminent release. For example, when asked about her plans for release, one prisoner stated, “They give you four different out dates. They have it all messed up.” Several of the women complained that they were unsure of their release dates because their cases were caught in the system. Others claimed that they had remained in prison past their release dates due to inaction by the parole board, missing or incorrect paperwork, or inability to locate safe and drug-free housing.

Prolonged length of stay (or stays in prison beyond the expected release date) affects growing numbers of women (New Mexico Sentencing Commission 2012). Vagueness about release dates undermined formal and informal reentry planning while in prison. It made it hard for women to formulate goals and strategies for the transition prior to release and complicated basic transportation arrangements for their impending return. For some inmates in New Mexico, a trip home could take eight hours, so arranging for someone to pick them up was a challenging prospect, especially in the absence of reliable release dates. Such uncertainties were inadequately addressed through the official discharge and reentry-planning meetings that were supposed to take place between prisoners and caseworkers, mental-health and substance-use counselors, medical representatives, and in-house parole officers. Such meetings were often delayed or truncated, with little opportunity for women to ask questions or give feedback. One interviewee summarized, “Once you’re done, they just throw you out to the wolves, and they don’t care.”

Once released, most interviewees described difficulties finding jobs as known felons in rural communities. Few had work experience or training, and some had previously resorted to illicit forms of making a living. One woman explained, “Life gets hard out there. The money I make in two weeks working from nine to five is not even half the money I make in one day running the streets.” This inability to meet basic needs probably contributed to relapse and reincarceration. Another woman recalled the conditions leading her back to prison: “I’m tired of living in a place with no lights, no gas. I’m tired of selling dope. I’m tired of trying to hustle to keep a roof over my head. . . . So I started smoking crack again, and I ended up back in prison. That’s the sad thing.”

Women also faced extreme difficulties in accessing healthcare. They most commonly described struggles obtaining insurance coverage, services, and the medications they were prescribed in prison. One recently reincarcerated woman explained, “To stay on my meds is hard out there, ’cause if you don’t got a job or a medical card you can’t get your meds, and meds for mental issues are very expensive.” Several interviewees attributed their eventual return to prison to problems obtaining medications. When asked what events led to her reincarceration, one woman responded, “I couldn’t get my meds. I have chronic nightmares. I have flashbacks, hear voices. Without the meds I go crazy. So I used heroin to stop the pain and the nightmares, and I got caught, so they sent me back.” In this way, interviewees linked the scarcity of health resources in rural communities to their inability to establish successful lives outside of prison.

In addition to obstacles to treatment, the pervasiveness of alcohol and illicit drug use within rural communities was implicated in women’s recidivism. One interviewee recounted a memory of a previous release: “When I walked out these doors it was not a good experience. It felt free to be released [but] my mom picked me up and we went straight to a dope house.” In these challenging environments, women experienced multiple barriers to treatment. Stringent and often contradictory eligibility requirements for public treatment programs were known to confound even community-based providers. Women with criminal histories could be shut out of treatment, while other programs required criminalized behavior to qualify for them. For example, residential programs could require that patients be “dirty” in order to obtain a coveted bed, and some patients were only eligible for programs if they were court ordered. One woman’s parole officer struggled to get her into treatment to avoid sending her back to prison for a violation but, “None of them accepted me because I have an assault [on my record].”

Rurality profoundly influences the ability to fulfill reentry needs. In rural New Mexico, neoliberal policies and practices have largely dismantled the mental healthcare safety net. Following privatization initiatives in recent years, the state has witnessed the disintegration of its mental healthcare system (Willging and Semansky 2014). This has a major effect on returning prisoners for whom deficient provider training and scarcity of resources has been linked to participation in criminalized activities, including substance use (Kellett and Willging 2011; Willging et al. 2013). These problems are particularly acute in rural areas, where returning prisoners already have less access to the more comprehensive reentry programs found in urban areas (Scroggins and Malley 2010).

Women in rural areas with few services were forced to travel elsewhere or to do without services altogether, increasing the likelihood of parole violations for those who were mandated to take part in treatment but who lacked reliable transportation. As with clinical services in prison, women found that the few rural treatment centers available in New Mexico were beleaguered by high turnover of clinical staff, long wait lists, and limited resources. Self-help groups were unreliable or difficult to access because of distance. Even when they were available, some of the interviewees did not consider these groups to be safe venues in which to disclose their thoughts, feelings, and experiences, especially related to trauma. Accordingly, the collision of punitive policies and resource scarcity in rural areas reportedly led many women needing assistance back to prison.

Social ties on the outside were another source of concern for returning women prisoners, many of whom found it difficult to break from harmful relationships. An interviewee worried about living with her mother, who struggled with alcohol issues: “[My mother] is like, ’I can’t wait until you get out. We can just move in together.’” A second discussed the challenge of maintaining distance from friends who might contribute to relapse: “I don’t think I could find a positive crowd in [town]. Because it’s like once you’re out and everybody knows you’re out, they find out your number.”

With social networks so small and encumbered, women explained that finding stigma- and drug-free associates was difficult. Inmates worried that “normal” individuals would avoid them because of their felony status, and feared that associating with the “wrong crowd” might lead to reincarceration. One woman elaborated on this predicament: “I don’t wanna get caught for anything I wasn’t even involved in. People would be saying, ’Oh, she just got out of prison, so she might’ve done it.’ If my community finds out I got out of prison, I’m gonna be already labeled.” Stigma from serving time and connections to others who were entrenched in behaviors that women sought to avoid thus made it extremely difficult to form prosocial bonds that they could rely upon for emotional and pragmatic support.

Given their high rate of reincarceration and recounting of their personal experiences, it appears clear that upon release rural women prisoners are commonly denied even the most basic assistance in finding employment, housing, education, and healthcare. In addition to the problems posed by stigma and the economic scarcity common to rural areas, federal and state policies can also restrict returning prisoners’ access to public entitlement programs that could potentially assist them in fulfilling these needs (Freudenberg et al. 2005). At the same time, women may find themselves struggling to form supportive kin and peer relationships. Paradoxically, they are unable to maintain the supportive relationships they may have formed in prison, as parolees are typically not allowed to associate with one another.

Due to the intersection of material difficulties, the women we interviewed often pointed to the irony that prison life was “easier” for some. Yet, the descriptions presented by the women in their interviews also illustrate that their earnest and repeated attempts to access assistance and to meet the obligations of parole are frustrated by structural and institutional barriers that significantly limit their efforts to ensure their own well-being. Combined with the inadequate care that they receive during incarceration, these barriers set women up for failure on the outside.

Working Assumptions among Corrections and Mental Health Professionals

Stereotypes, prejudices, and ideologies of corrections officials and mental health providers, and within wider communities, make it possible to neglect the material disparities that rural women with incarceration histories may suffer. These ideologies often focus on specifically gendered characteristics, such as appearance and demeanor, and tend to perpetuate stereotypes of underclass femininity, including dependence in relationships and emotional instability. Parole officers, for example, may conceptualize women prisoners as “lost causes,” unable to make the choices necessary to rehabilitate themselves after prison. Other ubiquitous gendered stereotypes include the ideas that these women are irresponsible parents, dependent on social welfare, and incapable of maintaining stable relationships and avoiding victimization (Willging, Lilliott, and Kellett 2015). Such views are not limited to correctional officers in New Mexico, as they have been documented in other settings as well (Appelbaum, Hickey, and Packer 2001). While mental health providers are also susceptible to patronizing and paternalistic attitudes (Willging et al. 2015), they have been described as being less punitive or judgmental in their perceptions (Appelbaum, Hickey, and Packer 2001).

The social dynamics of small communities, where entire families may be labeled as “criminal,” reinforce these stereotypes and attitudes toward former women prisoners, engendering feelings of hopelessness and defeat among those released from prison (Willging et al. 2015). Other ethnographic research suggests that these dynamics reflect a pervasive attitude of “negativity” (Trujillo 2009) toward the poor, rural, and largely non-White areas of New Mexico. They are also fueled by the state’s history of subjection to White American imperialism and the construction of these communities as dangerous, helpless, and mired in cultures unsuitable for modern life (Kosek 2006; Sanchez 1940).

Beliefs about the inferiority of women with incarceration histories also prevail in prisons, where health and behavioral interventions portray imprisonment as the result of poor choices rather than of structural violence begetting contexts of inequality. Interventions steeped in discourses of personal responsibility assign women the duty of their own rehabilitation without providing them with sufficient material and psychological resources to facilitate successful reentry (Kellett and Willging 2011). The appropriation of these neoliberal narratives of individual responsibility by women prisoners may contribute to complications during reentry. Women’s rehabilitation becomes “up to them,” and their possible failure will also be theirs alone.

Our previous research suggests that corrections and mental health professionals may mistake the structural inequities that impede women’s life chances for innate qualities, casting them as irresponsible, helplessly victimized, and dependent on social welfare (Willging et al. 2015). Psychologists working in similar neoliberal contexts are also vulnerable to such ideologies. Although social justice is one of the core tenets of subfields such as feminist psychology (Brown 1997), multicultural counseling (Constantine et al. 2007), and community psychology (Prilleltensky and Nelson 1997; Wolff 2014), such work has yet to predominate in mainstream mental health services. For practices set in neoliberal service structures, these paradigms are less likely to shape the work of corrections officers, paraprofessionals, clinical psychologists, and psychiatrists with whom rural women prisoners may come into contact, resulting in less than ideal service provision.

Addressing Structural Violence and Intersectionality: Recommendations for Mental Health Professionals

Working effectively with rural women prisoners requires a comprehensive understanding of the interdependent nature of multiple levels of influence (e.g., gender/sexuality, race/ethnicity, and geography). Further, clinicians working within a social justice perspective recognize how contemporary systems of structural violence rooted in racism, colonialism, sexism, heterosexism, and classism facilitate and sustain the incarceration of rural women. They also become engaged in efforts to address larger societal and structural problems affecting these women. Increased integration of the concepts of structural violence and intersectionality into the everyday practice of mental health professionals is imperative to both understanding and helping rural women prisoners.

The social and psychological concerns of women described in this chapter reflect intersecting material and ideological oppressions. Structural disadvantages, including socioeconomic and health-related disparities, interact with institutional failures (notably the lack of reentry planning), the effects of systemic processes like the privatization of prison and mental health services, and a panoply of more diffused vulnerabilities common in rural areas, such as reduced availability of health and human services and transportation difficulties. Even when women leaving prison make every effort to find work, access public assistance, and get care, they are often thwarted by the intersection of these structural disadvantages.

Stigma and the cynical and prejudicial ideologies of professionals encountered in corrections and healthcare systems, and within communities, can exacerbate these oppressions, while reinforcing the notion that rural women prisoners “prefer” to be in a state of incarceration. Such ideologies burden women by uncritically drawing upon the gendered stereotypes described above. We argue that the history of colonialism also weighs on Latina and Native American prisoners in the form of prejudicial and paternalistic ideas of their cultural “backwardness” and lack of individual agency. It is the structural effects of these ideologies manifested in the unequal distribution of opportunities and resources that most concern women prisoners. At present, many mental health professionals may be ill prepared to tackle these effects.

Recommendation #1: Expand psychology’s social justice framework.

Psychologists have called for expanding graduate training in race and multicultural issues to include concern for structural violence within a social justice framework that addresses issues such as gender/sexuality, race/ethnicity, and socioeconomic status from a perspective of power and privilege as part of case conceptualization, assessment, and treatment (Ali et al. 2008; Burnes and Singh 2010; Toporek and Vaughn 2010). Psychologists in prisons and rural service systems can expand a social justice framework that considers intersectionality and the larger contexts impacting rural women prisoners by incorporating these concepts not only into their own direct work with these women but also in their training, supervision, and mentoring of correctional officials and other mental health providers.

The American Psychological Association has published guidelines for psychological treatment with lesbian, gay, and bisexual clients; transgender and gender-nonconforming people; ethnically, linguistically, and culturally diverse populations; and girls and women (American Psychological Association n.d.). These guidelines address the need to attend to the impact of adverse social, environmental, and political factors in assessing and treating marginalized populations. In line with these guidelines, by forcefully challenging stereotypes about rural women prisoners through social justice praxis, psychologists can best arm themselves, trainees, and supervisees with effective and appropriate intervention strategies.

Recommendation #2: Adopt a trauma-informed and systemic approach to women’s mental health before, during, and after incarceration.

The women quoted in this chapter discussed treatment primarily in the form of self-help and psycho-educational groups, and concerns about pharmaceuticals that render them “zombies” without addressing underlying issues. We suggest that rural women prisoners in New Mexico and probably elsewhere would benefit from a gender-responsive, trauma-informed approach implemented by mental health providers before, during, and after incarceration. This approach requires attention to the voices of rural women prisoners and system-level intervention. Service systems must be pressured to develop environments where practitioners can assess for and understand the impact of trauma and paths for recovery; recognize the signs of trauma for those involved with the system; integrate knowledge about trauma into policies, procedures, and practices; and seek to resist retraumatization (U.S. Substance Abuse and Mental Health Services Administration 2014).

Recommendation #3: Increase availability of services for women in rural areas.

Psychologists, in particular, can collaborate proactively with local, state, and federal governments for increased funding to expand the provider base within these service systems and to encourage greater utilization of existing loan-forgiveness programs to incentivize licensed mental health professionals to relocate to high-need, underserved areas. We also encourage psychologists to practice in rural areas, utilizing their unique skill sets to implement trauma-informed approaches initiated through specialized services within prisons and continued through coordination with community-based service providers. In rural communities, psychologists can take lead roles in facilitating support groups for women returnees, engaging families in the reentry process through education and direct services, and aiding women in cultivating strong social support networks that protect against substance use.

Recommendation #4: Advocate for additional training and broader systemic support for evidence-based clinical practice in rural areas.

For psychologists and other mental health providers in rural settings to wholly realize the social justice potential of a trauma-informed approach for empowerment, cultural relevance, and gender responsiveness, they may require additional training and systematic support. Seasoned psychologists can help by being vociferous in encouraging this training and support.

Rural women prisoners would benefit from integrated evidence-based, trauma-informed interventions that concertedly address substance use and prevention of relapse. Several evidence-based interventions for individuals undergoing reentry are already in extensive use in public service settings, including correctional systems and community settings (Lynch et al. 2012; Wallace, Conner, and Dass-Brailsford 2011). These models of intervention, including Seeking Safety (Najavits et al. 1998), the Addiction and Trauma Recovery Integration Model (Miller and Guidry 2001), and the Trauma Recovery and Empowerment Model (Harris 1998), combine empowerment principles with traditional clinical approaches (e.g., cognitive behavioral therapy and psycho-education) to enhance coping skills, reduce self-harm behavior, navigate relationships, and explore connections between trauma and substance use. At the same time as such interventions promote change at the individual level, there is a need to continually challenge the social circumstances that can limit the life opportunities of rural women prisoners.

In each of these approaches to clinical practice, empowerment is a core treatment component. Each recognizes that trauma survivors may have lost their capacity to speak out against past and present injustices due to years of abuse, and encourages providers to learn skills to enable survivors to exercise their own voices and advocate for themselves (U.S. Substance Abuse and Mental Health Services Administration 2014). However, it is crucial to distinguish ideas of empowerment from neoliberal perspectives that emphasize individual responsibility apart from contextual factors engendered by structural violence. Evidence-based approaches will fail unless situated within a social justice framework that considers the broader impact of structural issues such as racism, sexism, and poverty on the outcomes of women prisoners. Providers of therapeutic services to these women in rural areas may need additional support and training in (a) administering appropriate treatments; (b) recognizing and contesting how neoliberal ideologies and gendered stereotypes about criminality can subtly infuse clinical work; and (c) engaging in policy-related advocacy efforts that target structural factors causing women to fall through the cracks both within and outside of prison. Only by regarding rural women as part of a larger social ecology, in which historically entrenched power inequities work against health and safety, will mental health professionals truly provide effective and holistic intervention for this marginalized population.

Conclusion

The experiences of rural women prisoners in this chapter illustrate the double-edged quality of the “three hots and a cot” offered in prison and the harsh realities of interlocking systems of structural violence that pave paths to incarceration. In response, psychologists and other professionals must heed the voices of these women, pursuing multilevel intervention strategies to address the layered oppressions of structural violence that adversely impact them, while remaining mindful of how their own attitudes and biases might also be steeped in neoliberal logics. This chapter suggests that geography should also be included as an issue of critical concern in relation to incarcerated women. Psychologists have a responsibility to engage in social justice praxis that encompasses (a) assessment, expansion, and coordination of health and other human services in prison and rural communities; (b) ongoing examination of connections among crime, incarceration, trauma, and structural inequities, such as poverty (Travis, Western, and Redburn 2014); and (c) development of supportive environments at the system level. This chapter points to the material and ideological barriers to empowered reentry and calls for psychologists to spearhead interventions in underserved rural communities to dismantle these barriers.

Acknowledgments

This research was funded by grant R34 MH082186 from the National Institute of Mental Health. The authors wish to thank Betty A. Bennalley, MA; Pamela Brown, RN, MPH; Patricia Hokanson, MPH; and Lara Gunderson, MA, for their contributions to this research.

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