Women prisoners' perspectives of mental health treatment in US jails and prisons

Background: US jails and prisons have become the nation's largest psychiatric facilities. It is widely documented that women prisoners experience more severe psychiatric illness and use more services than male prisoners and than women in the general population. Access to quality mental health services for women in jails and prisons is a significant challenge. This paper is based on a larger study women prisoners' use of co-payments for health care. Method: This community-based participatory research project included 31 formerly incarcerated women. Focus group data were transcribed verbatim and analyzed using grounded theory. Participants' mean age was 38 years. Fourteen were White, 8 Hispanic, 6 African American, and 3 other. Their mean level of education was 12 years. They reported an average of 6 incarcerations in jail and 1 in prison. Results: Findings reveal co-payments hindered access to mental health treatment in jails and prisons. Prisoners reported having a variety of mental health problems, being charged a co-payment for psychiatric visits, experiencing long delays in seeing a psychiatrist, and receiving inadequate treatment which left many suffering with symptoms and screaming in their cells. These experiences factored into prisoners' distrust and avoidance of providers inside jails and prisons and at re-entry to the community. Such avoidance reinforced well established health disparities among formerly incarcerated women. Conclusions: Co-payments contributed to delays in receiving mental health treatment and decisions to forego treatment. Minimizing prisoners' mental disability is an important step in reintegrating them into their families and creating healthier communities.