Developing a Gender-Responsive Framework for the Delivery of Interventions That Address Criminogenic Risk Factors Among People with Serious Mental Illnesses

Background:  Gender differences have been found in the experiences, needs, and services available for men and women involved in the criminal justice system, providing a foundation for the need for gender-responsive services. However, gender differences have not been commonly examined among persons with serious mental illness (SMI), significant sub-population of adults in the criminal justice system, and this gap may particularly impact intervention delivery and efficacy with this population. This paper examines gender differences in the delivery of a cognitive behavioral intervention designed to address criminogenic risk factors among persons with SMI incarcerated in prison to determine whether this intervention adequately accommodated the needs of both men and women with SMI.

Methods: Data for this analysis was collected from the open trial phase of this study, which included three intervention cycles: two with women (n=21) and one with men (n=11). Two members of the research team used open coding techniques to analyze notes that facilitators completed after each session. Since the open trial focused on finalizing the intervention materials, these facilitators systematically documented content on service delivery and facilitation strategies throughout this phase. Additional feedback on the developing analysis was sought through member checking with intervention facilitators and peer-debriefing with the study’s team of gender-responsive experts.

Findings: Four primary themes highlighted differences in how men and women engaged in the intervention material. These themes included suppression of conflict, emotional invalidation, constrained support, and power. The first two themes applied to men and women but were expressed differently, and the remaining two were present only among women. A central feature of this intervention was that participants discussed examples of disagreements with others. Suppression described the ways in which participants suppressed conflict in these discussions. While men minimized the severity of conflict, women rarely acknowledged conflict in their lives. Power was expressed as dominance in men and disempowerment in women. Men reported purposefully engaging in conflict as a means for establishing power and respect; by contrast, women felt they lacked power because they were not taken seriously by staff or family. Invalidation involved women’s experiences of the devaluation of their needs and emotions, which resulted in negative self-judgement and difficulty asserting their needs. Constrained support described how women’s reliance on persons in and outside of prison for support limited their ability to speak for themselves when disagreements arose, such as deciding not to give needed parenting feedback out of fear that family members may cut off contact.

Conclusions/Implications: Results from this analysis indicate that incarcerated men and women with SMI may approach conflict differently. Many women in prison, including those with SMI, rely on their extended family to provide them with support and childcare while incarcerated. This reliance impacts how they manage disagreements. These findings suggest that for correctional interventions addressing conflict, the model and methods for doing so may be different for men and women with SMI. Our results indicate that the need for research and correctional interventions that address dynamics at the intersection of conflict, gender, and SMI.