Social Determinants of Incarceration: Pathways to Prison and Prevention

Background & Purpose: This study aimed to uncover the social determinants of incarceration, as related to the pathways to prison shaped by substance use, mental illness, and trauma.  This phenomenological qualitative study allowed for participants to give an in-depth account of their own pathway to prison, while simultaneously providing suggestions for possible policy and programmatic opportunities for prevention and rehabilitation.

Methods: Thirty in-depth, semi-structured interviews were conducted with newly incarcerated adults.  The sample frame included criminally sentenced, English-speaking adults held in the Massachusetts Department of Correction.  Two-stage random stratified sampling was utilized.  In the first stage prisons were selected, and prisoners were sampled in the second stage.  The two included prisons were the gender-specific intake facilities.  The separation of facility by gender allowed for stratification by gender through selection of an equal number of participants from each facility.  Stratification based on the presence of a mental health diagnosis was also utilized to ensure a gender balanced representation of participants with mental health disorders.  This was necessary because the rate of mental health diagnoses within the male and female populations was very different (30% for males versus 70% for females).  Within each of the selected prisons, prisoners were randomly sampled.  The overall response rate was 67%.  Interviews lasted approximately one hour and included open-ended questions about the social determinant related pathways to prison, with an emphasis on the role of mental illness, substance use, and trauma.  Participants were also asked a variation of the “miracle question” relating to what could have prevented their incarceration.  A short demographic questionnaire, and the Adverse Childhood Experiences Questionnaire were also administered.  Interviews were coded thematically using ATLAS.ti 7, utilizing an inductive qualitative analytic approach.

Findings: Data analysis revealed the importance of multiple social determinants of incarceration.  Overarching themes across gender were the importance of family relationships and accessing basic needs, such as housing, dental, medical, substance use, and mental health care.  Participants described how a lack of ability to meet these needs sometimes led directly to their incarceration.  However, some reported an indirect relationship, whereby their inability to meet basic needs reduced their ability to obtain employment, which led to incarceration.  Participants who had received services reported difficulty with cross-system communication, which sometimes also indirectly led to incarceration.  Males described toxic masculinity, and a greater impact of social isolation, while females more frequently described the role of unhealthily intimate partner relationships.  Proposed policy and program levers for change included the importance of early intervention for substance use and adverse childhood experiences.  Additionally, interviewees called for increased access to behavioral health/medical/dental care, more individualized cross-system services, and increased services for domestic violence victims, especially in rural areas. 

Conclusion & Implications: Findings highlight opportunities for enhancing cross-system preventive and rehabilitative policies and programs to reduce rates of incarceration.  These activities could be targeted to the social determinants of incarceration identified by the participants.  Looking forward, policy efforts to create incentives to improve inter-system collaboration could be helpful in addressing these individual needs on a systemic level.