When I was incarcerated at age 14, I struggled with the trauma of an abusive relationship and the ensuing consequences on my mental health. I wasn’t equipped to process these experiences, much less understand how they influenced my role in the death of my mother, who my then-boyfriend killed.
In jail, my already fraught mental health continued to deteriorate. I developed an eating disorder, struggled with self-harm and attempted suicide. I needed help. But the only intervention the jail could provide were cocktails of psychotropic drugs and isolation.
As one of our country’s most traumatized and psychiatrically vulnerable populations, incarcerated women need access to ongoing, individual therapy. Therapy is an essential tool for addressing many of the root causes of incarceration: trauma, mental illness and addiction. Effective individual therapy can help cultivate one’s self-worth and lead to holistic well-being and positive behavior change, making prisons and communities safer for everyone.
I know how transformative this kind of therapy can be for incarcerated women. Once I transferred from jail to a state prison, I benefited from it.
‘Essential for incarcerated women’
For nearly three years, I met in 50-minute sessions twice a week with John, a former psychologist at State Correctional Institution Muncy, the prison in Pennsylvania where I am incarcerated. Offering individual therapy sessions was beyond John’s job duties. Staff psychologists are not required to offer individual therapy sessions. He chose to do so voluntarily.
“I believe individual therapy is essential for incarcerated women,” said John, in a video interview. He has since retired but maintains connections with former clients via the Pennsylvania Prison Society. “Their previous environments and the prison environment are typically not conducive to trusting relationships. Being able to establish this type of relationship with an individual therapist can provide the basis for extending this capacity into the general population.”
My sessions with John, whose real name I’m concealing so as not to jeopardize his ability to keep providing mental health support to incarcerated people, helped me understand that I was a victim of abuse. He showed me how trauma influenced the decisions I made prior to incarceration and while in prison.
A survey of 197 women serving life without parole in Pennsylvania found that 81% had suffered physical or sexual abuse before going to prison. This is consistent with other studies, which show that anywhere from 50% to 90% of incarcerated women have been victims of abuse before coming to prison.
An overwhelming caseload
There are currently 17 psychology support staff members at Muncy, which has a population of about 1,100 people. Psychology staff are typically assigned at least two housing units, giving them a caseload that ranges from 50 to 130 people.
Psychology staff members are required to meet with people on their caseload for a brief check-in once every 30 days, and they are asked to administer evaluations, complete paperwork such as treatment plans, and facilitate mental health groups.
It’s true that other forms of mental health treatment are widely available in prisons, via psychoeducational groups and programs. But these offerings are insufficient relative to the profound need. Most groups are limited by staff availability, have long waiting lists, and last an average of 12 weeks. Many women don’t feel comfortable opening up about their personal experiences in a group setting, and by the time some do begin to trust their peers, the group or program has ended.
“Individual therapy is vastly different from the psychoeducational groups offered in many prisons,” John said.
The development of a so-called treatment plan is what the department considers individualized care. With a staff psychologist, the incarcerated person creates goals and lists actions that can be taken to realize them. These plans may sound helpful in theory, but very little is done by staff to ensure that they are being followed. Self-reported progress or setbacks are documented, but few tools are offered in support beyond printouts and coloring pages.
But prisons don’t just fail to meaningfully address the trauma of the people they confine; they frequently compound it, dooming many to continue the same destructive patterns that led to their incarceration.
I have known women who were victims of intimate partner violence on the outside who became ensnared in abusive relationships while inside. And women whose unresolved childhood trauma drove them to continue addictions started on the street, by illicitly buying Suboxone or pain medications like gabapentin. I worry about the trajectories of these women upon their release because untreated trauma doesn’t stay static; it drives ongoing harm both inside and outside of prison.
When the feds mandated better care
In 2013, the federal government found that there were too many people in Pennsylvania with serious mental illnesses in isolation, and that the mental health treatment being offered was inadequate, violating the Americans with Disabilities Act.
As a result, the entire state prison system was subjected to a monitoring period from 2013 to 2016. Under the watchful eye of the federal government, the department hired additional psychology staff members in state prisons throughout the Commonwealth, giving psychologists like John smaller caseloads and enabling them to offer more voluntary treatments like one-on-one therapy.
But after the federal watch ended in 2017 and funding was cut, the volume of psychology staff shrank through attrition. This staff shortage meant that remaining psychologists had to once again assume larger caseloads and spend more time on department-mandated responsibilities like paperwork and check-ins, according to John.
In 2019, John was asked to cease all voluntary treatment he was offering, including individual therapy and therapeutic groups, due to this loss of staff.
In an attempt to fill these gaps in care, the Pennsylvania Department of Corrections relies on insufficient peer-based interventions through a certified peer specialist program.
“I’m there to give support so that you don’t feel alone, but we are not therapists or psychologists,” said Della Meyers, a peer specialist at Muncy. “We might be able to talk about our shared experiences and coping skills, but we aren’t equipped to help a person truly deal with the things they’ve experienced.”
The existing level of care clearly isn’t working.
According to a 2022 Pennsylvania DOC recidivism report, about two-thirds of people released from prison are rearrested or reincarcerated within three years.
If rehabilitation is indeed one of the aims of incarceration, then that must include trauma-informed treatment and access to individualized mental healthcare. We all lose when the root causes of incarceration fail to be addressed.
