Issues in Mental Health Nursing, 35:979–982, 2014 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2013.873103
COMMENTS, CRITIQUE, AND INSPIRATION COLUMN
Nearly Invisible: The Psychosocial and Health Needs of Women with Male Partners in Prison Cheryl L. Cooke, PhD, MN, RN University of Washington Bothell, Nursing and Health Studies, Bothell, USA
Edited by Mona Shattell, PhD, RN, FAAN DePaul University, Chicago, Illinois, USA Very little research has been conducted investigating the health status and social needs of women with incarcerated male partners, despite the large number of men from underserved communities who are currently incarcerated. Research with women who have incarcerated male partners has primarily focused on communicable disease risk and family interactions. Women with incarcerated partners are often mothering children who are at risk for early and repeated incarceration, behavioral problems, and poverty. Gaining a better understanding of the health and social needs, and the resources use of these women and their children may lead to developing policies and programs that help them better manage their health, as well as aid in strengthening their family relationships.
Women have always been involved with, married to, or parenting with men who are incarcerated in prisons and jails. Unfortunately, as nursing and healthcare professionals, we do not know much about these women. What we do know is that the diversity of women who have to manage their lives and families once their partner has gone to prison, is extensive. We have seen representations of them in film, such as Halle Berry’s Oscarwinning portrayal of a woman with an incarcerated partner in Monster’s Ball (2001). As researchers and healthcare workers, we may have met them when visiting a shelter to collect data, or have cared for them in the emergency room. Along with the cases of famous women who have an incarcerated partner, such as Ruth Madoff (Browning, 2009), there is an untold number of women in the USA whose husbands, partners, and co-parents are incarcerated men (Comfort, 2002). This paper examines the current literature on women with incarcerated partners and considers the psychosocial health and policy implications for conducting research with this population. Women with partners in prison are a part of the US population who are involved with the criminal justice system, to which little Address correspondence to Cheryl L. Cooke, University of Washington Bothell, Nursing and Health Studies, Box 358532, Bothell, 98011-8532 Washington, USA. E-mail: [email protected]
positive attention is paid. The social costs for women with incarcerated partners has been referred to as a secondary prisonization (Comfort, 2003), an unintended or collateral consequence to having a large number of individuals behind bars (Tonry, 1995). Many of these women are mothers to the more than 7.4 million children (Mumola, 2006) with incarcerated fathers. Historically, about half of men in prison describe themselves as married (Carson & Sabol, 2012). The numbers of individuals incarcerated in the USA are astounding; nearly 1.6 million individuals are living in prisons and jails (Glaze & Parks 2012), while almost 7 million adults are currently involved in the criminal justice system through community supervision programs. These statistics do not include the number of adolescents who may be subject to incarceration or supervision (Carson & Sabol, 2012). The numbers imply that a large population of children is at risk for early and/or repeated incarceration, following in the footsteps of their fathers. Literature about the children of incarcerated parents is growing, and with it, attention to their functioning, challenges, and educational needs. Conducting research with the mothers of these children provides an opportunity to assess, develop and evaluate both individual and family-level interventions. By understanding who women with incarcerated partners are, what their daily challenges in life may be, and how they manage their health, families, and relationships with their male partners, we can uncover the unmet needs, challenges, and possibly, even their successes in these areas. The experiences that women with incarcerated partners have in negotiating a number of institutions that support disenfranchised and troubled populations (e.g., state and federal social services organizations, healthcare service providers, K-12 education providers), can provide a rich source of information on the utilization and effectiveness of systems-level interactions. This paper describes what is formally known about this population of women, and where gaps exist in healthcare workers’ and researchers’ knowledge of their lives. I conclude with a call for expanding research efforts with a population that is often considered guilty by association, and as such, is stigmatized and neglected. While these two issues are sufficient to warrant further investigation of this group, we should also know more
979
980
C. L. COOKE
about their use of public resources in the form of uncompensated care and social programs (e.g., TANF, school lunch programs, community mental health services), which may ultimately lead to targeted interventions with these families.
RESEARCH ON WOMEN WITH INCARCERATED MALE PARTNERS Few studies have focused on the health of women with incarcerated partners. While there has been research conducted directly with these women, it has been primarily focused on their risk for developing HIV (Comfort, Grinstead, Faigeles, & Zack, 2004; Grinstead et al., 2005); family interactions during visitation (Comfort, 2002, 2003; Tewksbury & Demichele, 2005); or personal accounts by women whose husbands have been incarcerated (Girshick, 1996; Fishman, 2004; Comfort, 2008). These studies use small sample sizes and qualitative methods. Often, the focus of this research has been on the regulation of women’s bodies, their sexual relationships, and risk for communicable disease. Although small in number, the findings of these studies are important. For example, we know that men leaving prison often have unprotected sex with their female partners (Grinstead et al., 2005). Women often are not aware that they are at risk for HIV and hepatitis C through sexual contact with their incarcerated partners (Comfort et al., 2004). Comfort (2002, 2008) has explored how incarceration affects the intimate lives and relationships women have with their incarcerated partners. Her findings show how the prison, with its mission of custody and safety, regulates women’s bodies, intimate relationships, and sexual decision-making (Comfort, 2002). She offers a complex analysis suggesting, in part, that prison, while complicating family relations, may also provide some relief from these challenges for families who deal with offenders who are frequently cycling in and out of the system. Other studies have explored the concept of family and place and how attempts to stay connected to the incarcerated man are defined and limited by his participation in the criminal justice system (Comfort, 2002). Still other data on women with incarcerated partners comes from narratives by women whose husbands are incarcerated. These narratives provide a focused view of life on the outside for women and their children (Girshick, 1996; Fishman, 2004; Cooke, 2007; Comfort, 2008). They also provide information related to maintaining relationships with a partner, dealing with financial struggles, and how prison policies affect family functioning. Families often become the source of financial and emotional support for offenders. These narratives describe the shame and frustration of not only having a family member who is incarcerated but one who may return to prison many times. Recent data about the mental health of women with incarcerated partners suggests an association between having a male partner in prison and the risk for maternal depression (Wildeman, Schnittker, & Turney, 2012). This study is important for identifying the risk for depression in this population. However, it provides an estimation of disease based on a larger dataset
(e.g., Fragile Families Study), one not specifically drawn from a population of women with incarcerated partners. My own research with women who have incarcerated partners has found that they are intensely interested in knowing how to improve and maintain their health, as well as understanding more about how to manage and sustain relationships with their incarcerated partners (Cooke, 2007). Women wanted to know more about their health and how stressors related to the incarceration of their partner affected their current health state. While this research has given us some insight, few studies have been aimed at examining specific health problems, both immediate and chronic, or developing and evaluating interventions that can strengthen these women, their children, and their families both during and after their experiences with the criminal justice system. Finally, we know that approximately 90% of children whose fathers are in prison live with their mothers (Hairston, 1995; Mumola, 2000) and that children with incarcerated parents are at risk for repeated incarceration themselves (Wildeman & Western, 2010). It has been documented that boys respond to incarceration by showing an increase in externalizing behaviors such as aggression, attention problems (Geller, Garfinkel, Cooper, & Mincy, 2009; Geller, Cooper, Garfinkel, Schwartz-Soicher, & Mincy, 2012), and acting out (Wildeman, 2010). In their meta-analysis on parental incarceration and child outcomes, Murray and colleagues report that parental incarceration is associated with later antisocial behavior in children (Murray, Farrington, & Sekol, 2012). This information is important as it supports the need for an upstream approach to intervening with these women regarding short-term and chronic health conditions, stress-related illness, and parenting issues, all of which may influence family function and stability. In sum, the literature does not provide a clear picture of the health and social needs of this population of women. Illustrating just how marginalized this population is, is the fact that we have a better developed literature on the health of women who are in prison than we do on women who are not, but are dealing with an incarcerated spouse or partner. Women who have been incarcerated are a well-studied group (Anderson, Rosay, & Saum, 2002; Zaitzow, 2001). In fact, substantive data demonstrates that health disparities nearly disappear in prison (Rosen, Wohl, Schoenbach, 2011; Spaulding et al., 2011). However, since the female partners of incarcerated men do not receive their health care within the criminal justice system, they do not benefit from this finding. WHAT WE CAN LEARN Research Priorities and Policy Implications Because there are no large epidemiological studies of women with incarcerated partners (male or female), we have no reliable demographics on their numbers. African-American men are twice as likely as Latinos to be incarcerated at some point in their lifetime, and compared with White men, they have nearly six times the risk (Bonczar & Beck, 1997). We also know that
PSYCHOSOCIAL AND HEALTH NEEDS OF WOMEN WITH MALE PARTNERS IN PRISON
the majority of families who are dealing with incarceration are from low-income backgrounds, are poorly educated and are young (Arditti, Lambert-Shute, & Joest, 2003; Arditti, 2005; Geller et al., 2009). If we argue that people largely partner within similar social locations, this would suggest that this group of women are mostly women of color, who come from economically disadvantaged communities. Thus, rather than using deductions based on relational estimates, a necessary starting point is to develop a detailed profile of this population. Doing so allows us to gauge the breadth of the population who are currently associated with, and possibly, parenting, with men in prison. Further, it indicates the need for immediate investigation of their living conditions, their physical and psychosocial healthcare needs and how these conditions contribute to parenting strengths or challenges. Understanding this may influence patterns of early and/or intergenerational incarceration, school success, and behavioral patterns in their children. Understanding who the women with incarcerated partners are, is important because we then have the opportunity to examine the psychosocial effects of having a husband or boyfriend in prison, the impact of short- to long-term loss of a partner in terms of parenting, and the chance to identify strengths and challenges for women who are attempting to keep their children out of the criminal justice system. We can also learn about the biopsychosocial effects on both children and their mothers living in conditions associated with having an incarcerated partner. Finally, since incarceration is a family affair, understanding whom, if anyone, these women and their children and children utilize as support systems is necessary. A better understanding of these families’ dynamics may provide opportunities to develop and evaluate psychosocial intervention in an effort to increase family stability and prevent early intergenerational incarceration of their children. A second useful step would be individual assessment and analysis of these women for at least three reasons: first, it is a way to assess the health and safety of these women; second, it allows the identification of children who may be at risk for early or intergenerational incarceration, school and behavioral problems (Arditti et al., 2003; Arditti, 2005), or who may need assistance in coping with loss and family disruption related to the incarceration of their fathers; and third, it can support the creation of relevant social service programs that are geared to improving the lives of these women and their children, such as stable housing, food security, access to individual and family mental health treatment, and family support and/or mentoring services. There are both practical and moral imperatives to identify and assist these women and their families. Engaging women who have incarcerated partners in research ventures, particularly those using a participatory methodology and originating from a biopsychosocial perspective, will provide data on the life course and psychosocial diagnoses affecting of a novel population. In general, these women are from economically disadvantaged groups who will benefit from the identification of their social resource utilization. For example, identifying their level of resource utilization helps us understand the situations when
981
they may be using Temporary Assistance to Needy Families (TANF) or other social welfare programs, when their children may be participating in school lunch programs, and what their behavioral health services utilization is. We can also determine how they access and utilize healthcare services and the total expenditures associated with this use, with an eye toward assuring that resources are available for families that need them the most. However, this research agenda should not merely focus on ‘cost’ so much as be seen as an opportunity for support and prevention. For example, by assisting women who have incarcerated partners (e.g., by treating issues of depression and anxiety), we improve their health and ability to support their families. Additionally, research with these women may uncover ways to support children of incarcerated men to improve their school success, diminish behavioral problems, and reduce the risk for intergenerational incarceration. Conducting this research is not without its challenges. These families are transient; as their relative is transferred both in and out of state to different prisons when the need arises, the family may follow him. At times, it can be difficult to find these families. Having a family member in prison marks the family with a social scar that they may be unwilling to publicly display. Many individuals in prison are from ethnic groups and also have lower levels of education, and therefore, may be less familiar with, unaware of the benefits of, and unwilling to participate in health-related research. These women are often very stressed as a result of managing a family with exhaustive struggles in multiple locations and their time to participate in academic research may be limited. Finally, they may feel stigmatized by others who question their decision-making with regard to beginning and/or remaining in a relationship with an incarcerated man, which may lead to lower levels of participation in research efforts. As psychiatric providers who are committed to fostering a culture of rehabilitation and optimal health, we must support these women, so that they can succeed without dependence on the incarcerated man. Policies that privilege cost-cutting over providing access to services have eroded an already precarious safety net system, and the restoration of the services that have been lost seems like a difficult, if not impossible, task. Therefore, advocating with community leaders, other providers, and policymakers helps to change the discourse on who these women and their families are, and why these services are necessary. Finally, as psychiatric healthcare providers, we support them because, morally, it is the right thing to do. We also support them because these benefits in turn affect their children, who, despite what their fathers may have done, need this support in order to help them become highly functioning members of society. When we identify a population in need of health services and provide early intervention and treatment, we begin to limit the burden they exact on society and increase their capacity to participate in and contribute to our communities (Li, Zhang, Barker, Chowdhury, & Zhang, 2010; Simon et al., 2001). Finally, we begin to secure a stable home life for these children, lessening the chance of them entering the criminal justice system.
982
C. L. COOKE
ACKNOWLEDGEMENTS The author expresses sincere thanks to the following review¨ ers: Dr. Ozlem Sensoy, Jasper Scott-Weis, the UWB NHS Summer Reading Group, and the external reviewers for their careful review of the manuscript. Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES Anderson, T. L., Rosay, A. B., & Saum, C. (2002). The impact of drug use and crime involvement on health problems among female drug offenders. Prison Journal, 82(1), 50–68. Arditti, J. A., Lambert-Shute, J., & Joest, K. (2003). Saturday morning at the jail: Implications of incarceration for families and children. Family Relations: Interdisciplinary Journal of Applied Family Studies, 52(3), 195–204. Arditti, J. A. (2005). Families and incarceration: An ecological approach. Families in Society, 86(2), 251–60. Retrieved from http://ovidsp.ovid.com/ovid web.cgi?T=JSandNEWS=NandPAGE=fulltextandAN=52280andD=swab. Bonczar, T. P. & Beck, A. J. (1997). Lifetime likelihood of going to state or federal prison. Washington DC: US Department of Justice, Bureau of Justice Statistics. Browning, L. (2009). The loneliest woman in New York. New York Times (June 14, 2009). Carson, E. A. & Sabol, W. J. (2012). Prisoners in 2011. (Government No. NCJ 239808). Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Comfort, M. (2002). Papa’s house: The prison as domestic and social satellite. Ethnography, 3(4), 467–99. Comfort, M. (2003). In the tube at San Quentin: The ‘secondary prisonization’ of women visiting inmates. Journal of Contemporary Ethnography, 32(1), 77–107. Comfort, M., Grinstead, O., Faigeles, B., & Zack, B. (2004). Reducing HIV risk among women visiting their incarcerated male partners. Criminal Justice Behavior, 3(2), 45–48. Comfort, M. (2008). Doing time together: Love and family in the shadow of the prison. Chicago: University of Chicago Press. Cooke, C. L. (2007). Social and environmental factors: interviews of women with incarcerated partners. Family and Community Health, 30(2), S17–S22. Fishman, L. T. (2004). AIDS, violence and matters of respect: Family and peer relations of African-American and Latino convicted felons. In C. T. M. Coston (Ed.), Victimizing vulnerable groups: images of uniquely high-risk crime targets (pp. 140–171). Westport, CT: Praeger. Geller, A., Cooper, C., Garfinkel, I., Schwartz-Soicher, O., & Mincy, R. (2012). Beyond absenteeism: Father incarceration and child development. Demography, 49(1), 49–76.
Geller, A., Garfinkel, I., Cooper, C. E., & Mincy, R. B. (2009). Parental incarceration and child well-being: Implications for urban families. Social Science Quarterly, 90(5), 1186–1202. Girshick, L. B. (1996). Soledad women: wives of prisoners speak out. Westport, CT: Praeger. Glaze, L. E. & Parks, E. (2012). Correctional populations in the United States, 2011. (No. NCJ 239972). Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Grinstead, O. A., Faigeles, B., Comfort, M., Seal, D., Nealey-Moore, J., Belcher, L., et al. (2005). HIV, STD, and hepatitis risk to primary female partners of men being released from prison. Women and Health, 41(2), 63–80. Hairston, C. F. (1995). Fathers in prison. In K. Gabel & D. Johnston (Eds.) Children of incarcerated parents. New York: Lexington Books. Li, R., Zhang, P., Barker, L. E., Chowdhury, F. M., & Zhang, X. (2010). Costeffectiveness of interventions to prevent and control diabetes mellitus: A systematic review. Diabetes Care, 33(8), 1872–1894. Mumola, C. (2006). Children of parents in the criminal justice system: Children at risk. Presented at the NIDA Research Meeting, North Bethesda, MD. Mumola, C. J. (2000). Incarcerated parents and their children. (NCJ 182335). Washington DC: US Department of Justice, Office of Justice Programs. Murray, J., Farrington, D. P., & Sekol, I. (2012). Children’s antisocial behavior, mental health, drug use, and educational performance after parental incarceration: A systematic review and meta-analysis. Psychological Bulletin, 138(2), 175–210. Rosen, D. L., Wohl, D. A., Schoenbach, V. J. (2011). All-cause and causespecific mortality among black and white North Carolina state prisoners, 1995–2005. Annals of Epidemiology, 21(10), 719–725. Simon, G. E., Manning, W. G., Katzelnick, D. J., Pearson, S. D., Henk, H. J., & Helstad, C. S. (2001). Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Archives of General Psychiatry, 58(2), 181–187. Spaulding, A.C., Seals, R.M., McCallum, V.A., Perez, S.D., Brzozowski, A. K., & Steenland, N.K. (2011). Prisoner survival inside and outside the institution: Implications for healthcare planning. American Journal of Epidemiology, 173(5), 479–487. Tewksbury, R. & Demichele, M. (2005). Going to prison: A prison visitation program. Prison Journal, 85(3), 292–310. Tonry, M. H. (1995). Malign neglect: Race, crime, and punishment in America. New York: Oxford University Press. Wildeman, C. & Western, B. (2010). Incarceration in fragile families. The future of children/Center for the Future of Children, the David and Lucile Packard Foundation, 20(2), 157–177. Wildeman, C. (2010). Paternal incarceration and children’s physically aggressive behaviors: Evidence from the fragile families and child wellbeing study. Social Forces, 89(1), 285–309. Wildeman, C., Schnittker, J., & Turney, K. (2012). Despair by association? The mental health of mothers with children by recently incarcerated fathers. American Sociological Review, 77(2), 216–243. Zaitzow, B. H. (2001). Whose problem is it anyway? Women prisoners and HIV/AIDS. International Journal of Offender Therapy and Comparative Criminology, 45(6), 673–690.
Copyright of Issues in Mental Health Nursing is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
COMMENTS, CRITIQUE, AND INSPIRATION COLUMN
Nearly Invisible: The Psychosocial and Health Needs of Women with Male Partners in Prison Cheryl L. Cooke, PhD, MN, RN University of Washington Bothell, Nursing and Health Studies, Bothell, USA
Edited by Mona Shattell, PhD, RN, FAAN DePaul University, Chicago, Illinois, USA Very little research has been conducted investigating the health status and social needs of women with incarcerated male partners, despite the large number of men from underserved communities who are currently incarcerated. Research with women who have incarcerated male partners has primarily focused on communicable disease risk and family interactions. Women with incarcerated partners are often mothering children who are at risk for early and repeated incarceration, behavioral problems, and poverty. Gaining a better understanding of the health and social needs, and the resources use of these women and their children may lead to developing policies and programs that help them better manage their health, as well as aid in strengthening their family relationships.
Women have always been involved with, married to, or parenting with men who are incarcerated in prisons and jails. Unfortunately, as nursing and healthcare professionals, we do not know much about these women. What we do know is that the diversity of women who have to manage their lives and families once their partner has gone to prison, is extensive. We have seen representations of them in film, such as Halle Berry’s Oscarwinning portrayal of a woman with an incarcerated partner in Monster’s Ball (2001). As researchers and healthcare workers, we may have met them when visiting a shelter to collect data, or have cared for them in the emergency room. Along with the cases of famous women who have an incarcerated partner, such as Ruth Madoff (Browning, 2009), there is an untold number of women in the USA whose husbands, partners, and co-parents are incarcerated men (Comfort, 2002). This paper examines the current literature on women with incarcerated partners and considers the psychosocial health and policy implications for conducting research with this population. Women with partners in prison are a part of the US population who are involved with the criminal justice system, to which little Address correspondence to Cheryl L. Cooke, University of Washington Bothell, Nursing and Health Studies, Box 358532, Bothell, 98011-8532 Washington, USA. E-mail: [email protected]
positive attention is paid. The social costs for women with incarcerated partners has been referred to as a secondary prisonization (Comfort, 2003), an unintended or collateral consequence to having a large number of individuals behind bars (Tonry, 1995). Many of these women are mothers to the more than 7.4 million children (Mumola, 2006) with incarcerated fathers. Historically, about half of men in prison describe themselves as married (Carson & Sabol, 2012). The numbers of individuals incarcerated in the USA are astounding; nearly 1.6 million individuals are living in prisons and jails (Glaze & Parks 2012), while almost 7 million adults are currently involved in the criminal justice system through community supervision programs. These statistics do not include the number of adolescents who may be subject to incarceration or supervision (Carson & Sabol, 2012). The numbers imply that a large population of children is at risk for early and/or repeated incarceration, following in the footsteps of their fathers. Literature about the children of incarcerated parents is growing, and with it, attention to their functioning, challenges, and educational needs. Conducting research with the mothers of these children provides an opportunity to assess, develop and evaluate both individual and family-level interventions. By understanding who women with incarcerated partners are, what their daily challenges in life may be, and how they manage their health, families, and relationships with their male partners, we can uncover the unmet needs, challenges, and possibly, even their successes in these areas. The experiences that women with incarcerated partners have in negotiating a number of institutions that support disenfranchised and troubled populations (e.g., state and federal social services organizations, healthcare service providers, K-12 education providers), can provide a rich source of information on the utilization and effectiveness of systems-level interactions. This paper describes what is formally known about this population of women, and where gaps exist in healthcare workers’ and researchers’ knowledge of their lives. I conclude with a call for expanding research efforts with a population that is often considered guilty by association, and as such, is stigmatized and neglected. While these two issues are sufficient to warrant further investigation of this group, we should also know more
979
980
C. L. COOKE
about their use of public resources in the form of uncompensated care and social programs (e.g., TANF, school lunch programs, community mental health services), which may ultimately lead to targeted interventions with these families.
RESEARCH ON WOMEN WITH INCARCERATED MALE PARTNERS Few studies have focused on the health of women with incarcerated partners. While there has been research conducted directly with these women, it has been primarily focused on their risk for developing HIV (Comfort, Grinstead, Faigeles, & Zack, 2004; Grinstead et al., 2005); family interactions during visitation (Comfort, 2002, 2003; Tewksbury & Demichele, 2005); or personal accounts by women whose husbands have been incarcerated (Girshick, 1996; Fishman, 2004; Comfort, 2008). These studies use small sample sizes and qualitative methods. Often, the focus of this research has been on the regulation of women’s bodies, their sexual relationships, and risk for communicable disease. Although small in number, the findings of these studies are important. For example, we know that men leaving prison often have unprotected sex with their female partners (Grinstead et al., 2005). Women often are not aware that they are at risk for HIV and hepatitis C through sexual contact with their incarcerated partners (Comfort et al., 2004). Comfort (2002, 2008) has explored how incarceration affects the intimate lives and relationships women have with their incarcerated partners. Her findings show how the prison, with its mission of custody and safety, regulates women’s bodies, intimate relationships, and sexual decision-making (Comfort, 2002). She offers a complex analysis suggesting, in part, that prison, while complicating family relations, may also provide some relief from these challenges for families who deal with offenders who are frequently cycling in and out of the system. Other studies have explored the concept of family and place and how attempts to stay connected to the incarcerated man are defined and limited by his participation in the criminal justice system (Comfort, 2002). Still other data on women with incarcerated partners comes from narratives by women whose husbands are incarcerated. These narratives provide a focused view of life on the outside for women and their children (Girshick, 1996; Fishman, 2004; Cooke, 2007; Comfort, 2008). They also provide information related to maintaining relationships with a partner, dealing with financial struggles, and how prison policies affect family functioning. Families often become the source of financial and emotional support for offenders. These narratives describe the shame and frustration of not only having a family member who is incarcerated but one who may return to prison many times. Recent data about the mental health of women with incarcerated partners suggests an association between having a male partner in prison and the risk for maternal depression (Wildeman, Schnittker, & Turney, 2012). This study is important for identifying the risk for depression in this population. However, it provides an estimation of disease based on a larger dataset
(e.g., Fragile Families Study), one not specifically drawn from a population of women with incarcerated partners. My own research with women who have incarcerated partners has found that they are intensely interested in knowing how to improve and maintain their health, as well as understanding more about how to manage and sustain relationships with their incarcerated partners (Cooke, 2007). Women wanted to know more about their health and how stressors related to the incarceration of their partner affected their current health state. While this research has given us some insight, few studies have been aimed at examining specific health problems, both immediate and chronic, or developing and evaluating interventions that can strengthen these women, their children, and their families both during and after their experiences with the criminal justice system. Finally, we know that approximately 90% of children whose fathers are in prison live with their mothers (Hairston, 1995; Mumola, 2000) and that children with incarcerated parents are at risk for repeated incarceration themselves (Wildeman & Western, 2010). It has been documented that boys respond to incarceration by showing an increase in externalizing behaviors such as aggression, attention problems (Geller, Garfinkel, Cooper, & Mincy, 2009; Geller, Cooper, Garfinkel, Schwartz-Soicher, & Mincy, 2012), and acting out (Wildeman, 2010). In their meta-analysis on parental incarceration and child outcomes, Murray and colleagues report that parental incarceration is associated with later antisocial behavior in children (Murray, Farrington, & Sekol, 2012). This information is important as it supports the need for an upstream approach to intervening with these women regarding short-term and chronic health conditions, stress-related illness, and parenting issues, all of which may influence family function and stability. In sum, the literature does not provide a clear picture of the health and social needs of this population of women. Illustrating just how marginalized this population is, is the fact that we have a better developed literature on the health of women who are in prison than we do on women who are not, but are dealing with an incarcerated spouse or partner. Women who have been incarcerated are a well-studied group (Anderson, Rosay, & Saum, 2002; Zaitzow, 2001). In fact, substantive data demonstrates that health disparities nearly disappear in prison (Rosen, Wohl, Schoenbach, 2011; Spaulding et al., 2011). However, since the female partners of incarcerated men do not receive their health care within the criminal justice system, they do not benefit from this finding. WHAT WE CAN LEARN Research Priorities and Policy Implications Because there are no large epidemiological studies of women with incarcerated partners (male or female), we have no reliable demographics on their numbers. African-American men are twice as likely as Latinos to be incarcerated at some point in their lifetime, and compared with White men, they have nearly six times the risk (Bonczar & Beck, 1997). We also know that
PSYCHOSOCIAL AND HEALTH NEEDS OF WOMEN WITH MALE PARTNERS IN PRISON
the majority of families who are dealing with incarceration are from low-income backgrounds, are poorly educated and are young (Arditti, Lambert-Shute, & Joest, 2003; Arditti, 2005; Geller et al., 2009). If we argue that people largely partner within similar social locations, this would suggest that this group of women are mostly women of color, who come from economically disadvantaged communities. Thus, rather than using deductions based on relational estimates, a necessary starting point is to develop a detailed profile of this population. Doing so allows us to gauge the breadth of the population who are currently associated with, and possibly, parenting, with men in prison. Further, it indicates the need for immediate investigation of their living conditions, their physical and psychosocial healthcare needs and how these conditions contribute to parenting strengths or challenges. Understanding this may influence patterns of early and/or intergenerational incarceration, school success, and behavioral patterns in their children. Understanding who the women with incarcerated partners are, is important because we then have the opportunity to examine the psychosocial effects of having a husband or boyfriend in prison, the impact of short- to long-term loss of a partner in terms of parenting, and the chance to identify strengths and challenges for women who are attempting to keep their children out of the criminal justice system. We can also learn about the biopsychosocial effects on both children and their mothers living in conditions associated with having an incarcerated partner. Finally, since incarceration is a family affair, understanding whom, if anyone, these women and their children and children utilize as support systems is necessary. A better understanding of these families’ dynamics may provide opportunities to develop and evaluate psychosocial intervention in an effort to increase family stability and prevent early intergenerational incarceration of their children. A second useful step would be individual assessment and analysis of these women for at least three reasons: first, it is a way to assess the health and safety of these women; second, it allows the identification of children who may be at risk for early or intergenerational incarceration, school and behavioral problems (Arditti et al., 2003; Arditti, 2005), or who may need assistance in coping with loss and family disruption related to the incarceration of their fathers; and third, it can support the creation of relevant social service programs that are geared to improving the lives of these women and their children, such as stable housing, food security, access to individual and family mental health treatment, and family support and/or mentoring services. There are both practical and moral imperatives to identify and assist these women and their families. Engaging women who have incarcerated partners in research ventures, particularly those using a participatory methodology and originating from a biopsychosocial perspective, will provide data on the life course and psychosocial diagnoses affecting of a novel population. In general, these women are from economically disadvantaged groups who will benefit from the identification of their social resource utilization. For example, identifying their level of resource utilization helps us understand the situations when
981
they may be using Temporary Assistance to Needy Families (TANF) or other social welfare programs, when their children may be participating in school lunch programs, and what their behavioral health services utilization is. We can also determine how they access and utilize healthcare services and the total expenditures associated with this use, with an eye toward assuring that resources are available for families that need them the most. However, this research agenda should not merely focus on ‘cost’ so much as be seen as an opportunity for support and prevention. For example, by assisting women who have incarcerated partners (e.g., by treating issues of depression and anxiety), we improve their health and ability to support their families. Additionally, research with these women may uncover ways to support children of incarcerated men to improve their school success, diminish behavioral problems, and reduce the risk for intergenerational incarceration. Conducting this research is not without its challenges. These families are transient; as their relative is transferred both in and out of state to different prisons when the need arises, the family may follow him. At times, it can be difficult to find these families. Having a family member in prison marks the family with a social scar that they may be unwilling to publicly display. Many individuals in prison are from ethnic groups and also have lower levels of education, and therefore, may be less familiar with, unaware of the benefits of, and unwilling to participate in health-related research. These women are often very stressed as a result of managing a family with exhaustive struggles in multiple locations and their time to participate in academic research may be limited. Finally, they may feel stigmatized by others who question their decision-making with regard to beginning and/or remaining in a relationship with an incarcerated man, which may lead to lower levels of participation in research efforts. As psychiatric providers who are committed to fostering a culture of rehabilitation and optimal health, we must support these women, so that they can succeed without dependence on the incarcerated man. Policies that privilege cost-cutting over providing access to services have eroded an already precarious safety net system, and the restoration of the services that have been lost seems like a difficult, if not impossible, task. Therefore, advocating with community leaders, other providers, and policymakers helps to change the discourse on who these women and their families are, and why these services are necessary. Finally, as psychiatric healthcare providers, we support them because, morally, it is the right thing to do. We also support them because these benefits in turn affect their children, who, despite what their fathers may have done, need this support in order to help them become highly functioning members of society. When we identify a population in need of health services and provide early intervention and treatment, we begin to limit the burden they exact on society and increase their capacity to participate in and contribute to our communities (Li, Zhang, Barker, Chowdhury, & Zhang, 2010; Simon et al., 2001). Finally, we begin to secure a stable home life for these children, lessening the chance of them entering the criminal justice system.
982
C. L. COOKE
ACKNOWLEDGEMENTS The author expresses sincere thanks to the following review¨ ers: Dr. Ozlem Sensoy, Jasper Scott-Weis, the UWB NHS Summer Reading Group, and the external reviewers for their careful review of the manuscript. Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES Anderson, T. L., Rosay, A. B., & Saum, C. (2002). The impact of drug use and crime involvement on health problems among female drug offenders. Prison Journal, 82(1), 50–68. Arditti, J. A., Lambert-Shute, J., & Joest, K. (2003). Saturday morning at the jail: Implications of incarceration for families and children. Family Relations: Interdisciplinary Journal of Applied Family Studies, 52(3), 195–204. Arditti, J. A. (2005). Families and incarceration: An ecological approach. Families in Society, 86(2), 251–60. Retrieved from http://ovidsp.ovid.com/ovid web.cgi?T=JSandNEWS=NandPAGE=fulltextandAN=52280andD=swab. Bonczar, T. P. & Beck, A. J. (1997). Lifetime likelihood of going to state or federal prison. Washington DC: US Department of Justice, Bureau of Justice Statistics. Browning, L. (2009). The loneliest woman in New York. New York Times (June 14, 2009). Carson, E. A. & Sabol, W. J. (2012). Prisoners in 2011. (Government No. NCJ 239808). Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Comfort, M. (2002). Papa’s house: The prison as domestic and social satellite. Ethnography, 3(4), 467–99. Comfort, M. (2003). In the tube at San Quentin: The ‘secondary prisonization’ of women visiting inmates. Journal of Contemporary Ethnography, 32(1), 77–107. Comfort, M., Grinstead, O., Faigeles, B., & Zack, B. (2004). Reducing HIV risk among women visiting their incarcerated male partners. Criminal Justice Behavior, 3(2), 45–48. Comfort, M. (2008). Doing time together: Love and family in the shadow of the prison. Chicago: University of Chicago Press. Cooke, C. L. (2007). Social and environmental factors: interviews of women with incarcerated partners. Family and Community Health, 30(2), S17–S22. Fishman, L. T. (2004). AIDS, violence and matters of respect: Family and peer relations of African-American and Latino convicted felons. In C. T. M. Coston (Ed.), Victimizing vulnerable groups: images of uniquely high-risk crime targets (pp. 140–171). Westport, CT: Praeger. Geller, A., Cooper, C., Garfinkel, I., Schwartz-Soicher, O., & Mincy, R. (2012). Beyond absenteeism: Father incarceration and child development. Demography, 49(1), 49–76.
Geller, A., Garfinkel, I., Cooper, C. E., & Mincy, R. B. (2009). Parental incarceration and child well-being: Implications for urban families. Social Science Quarterly, 90(5), 1186–1202. Girshick, L. B. (1996). Soledad women: wives of prisoners speak out. Westport, CT: Praeger. Glaze, L. E. & Parks, E. (2012). Correctional populations in the United States, 2011. (No. NCJ 239972). Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Grinstead, O. A., Faigeles, B., Comfort, M., Seal, D., Nealey-Moore, J., Belcher, L., et al. (2005). HIV, STD, and hepatitis risk to primary female partners of men being released from prison. Women and Health, 41(2), 63–80. Hairston, C. F. (1995). Fathers in prison. In K. Gabel & D. Johnston (Eds.) Children of incarcerated parents. New York: Lexington Books. Li, R., Zhang, P., Barker, L. E., Chowdhury, F. M., & Zhang, X. (2010). Costeffectiveness of interventions to prevent and control diabetes mellitus: A systematic review. Diabetes Care, 33(8), 1872–1894. Mumola, C. (2006). Children of parents in the criminal justice system: Children at risk. Presented at the NIDA Research Meeting, North Bethesda, MD. Mumola, C. J. (2000). Incarcerated parents and their children. (NCJ 182335). Washington DC: US Department of Justice, Office of Justice Programs. Murray, J., Farrington, D. P., & Sekol, I. (2012). Children’s antisocial behavior, mental health, drug use, and educational performance after parental incarceration: A systematic review and meta-analysis. Psychological Bulletin, 138(2), 175–210. Rosen, D. L., Wohl, D. A., Schoenbach, V. J. (2011). All-cause and causespecific mortality among black and white North Carolina state prisoners, 1995–2005. Annals of Epidemiology, 21(10), 719–725. Simon, G. E., Manning, W. G., Katzelnick, D. J., Pearson, S. D., Henk, H. J., & Helstad, C. S. (2001). Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Archives of General Psychiatry, 58(2), 181–187. Spaulding, A.C., Seals, R.M., McCallum, V.A., Perez, S.D., Brzozowski, A. K., & Steenland, N.K. (2011). Prisoner survival inside and outside the institution: Implications for healthcare planning. American Journal of Epidemiology, 173(5), 479–487. Tewksbury, R. & Demichele, M. (2005). Going to prison: A prison visitation program. Prison Journal, 85(3), 292–310. Tonry, M. H. (1995). Malign neglect: Race, crime, and punishment in America. New York: Oxford University Press. Wildeman, C. & Western, B. (2010). Incarceration in fragile families. The future of children/Center for the Future of Children, the David and Lucile Packard Foundation, 20(2), 157–177. Wildeman, C. (2010). Paternal incarceration and children’s physically aggressive behaviors: Evidence from the fragile families and child wellbeing study. Social Forces, 89(1), 285–309. Wildeman, C., Schnittker, J., & Turney, K. (2012). Despair by association? The mental health of mothers with children by recently incarcerated fathers. American Sociological Review, 77(2), 216–243. Zaitzow, B. H. (2001). Whose problem is it anyway? Women prisoners and HIV/AIDS. International Journal of Offender Therapy and Comparative Criminology, 45(6), 673–690.
Copyright of Issues in Mental Health Nursing is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
