A Novel Exploration of Women’s Pathways Through Prison and the Roles of Trauma, Addiction, and Mental Health

Trauma, mental illnesses, and substance use disorders (SUD) are well-documented contributors leading to women’s incarceration; however, less is known about how these factors also influence women’s pathways through prison once incarcerated. To address this gap, we examined (1) women’s pathways to and through prison-based mental health services, (2) summarized their sociodemographic and diagnostic profiles, and (3) examined how mental health and addiction relate to indicators of within-prison functioning, intervention receipt, and recidivism. Data derived from routine administrative and treatment records of women incarcerated between January 2015 and December 2023 in the Washington Corrections Center for Women (WCCW). The full sample comprised 5775 women who entered WCCW during the study period. The majority (53.2%) of women admitted to prison in the study period had at least one mental health diagnosis requiring at least moderate mental health intervention. Substance use (62.73%), trauma-related (61.11%), and mood (47.71%) disorders were most common. Individuals with at least a diagnosis of psychosis, neurocognitive disorders, and personality disorders had greater rates of close observation stays, crisis events, and non-suicidal self-injury risk assessments. Psychosis was associated with the highest rate of crisis events, while personality disorders were associated with the highest rate of non-suicidal self-injury risk assessments. Three-year recidivism rates were highest amongst those with a diagnosis of psychosis or ADHD. Trauma-focused and substance use treatments were associated with lower rates of crisis interventions and other critical incidents in their post-treatment period, but no relationship was observed for reductions in post-release recidivism. Overwhelmingly, women enter prison with significant mental health care needs and require a high-level of care that is largely reflective of the nearly ubiquitous nature of trauma, psychological distress, and addiction. The level of care needed, in response to the varied and complicated diagnostic profile of incarcerated women (e.g., ADHD, psychosis, trauma), as well as the number of critical incidents stemming from symptoms, reflects the need for more clinical staff to expand reach along with training in a wide range of modalities.