"No One--No One Has Ever Asked Me What I Need": Experiences of Service-Based Coercion in Mental Health, Substance Use, and Victimization Services Among Women with Criminal Conviction Histories

Background and Purpose: More than 975,000 women are under the supervision of the criminal legal system in the United States and millions of women are living in the community with the ongoing impacts of a history of involvement in the criminal legal system. Women in this population report high levels of victimization, including intimate partner violence and sexual assault, as well as heightened rates of behavioral health concerns such as post-traumatic stress disorder, depression, disordered substance use, and suicidal ideation or death by suicide. Despite these concerns, women with criminal conviction histories have low rates of receiving services related to behavioral health or victimization. These gaps in services may be related to collateral consequences, or the exclusion from resources based on a criminal conviction, in which the stigma of having a criminal conviction impacts women’s ability to seek or receive services, as well as how they are treated when engaging services. Within scholarship related to women’s help-seeking and help-attainment processes, there is limited attention given to women with histories of conviction. Therefore, this study aims to examine women’s processes and trajectories of seeking and receiving behavioral health and/or victimization services.

Methods: We conducted semi-structured interviews with a racially diverse sample of 35 women, drawn from a larger sample of 400 women who completed a survey during a previous phase of this explanatory sequential mixed-methods study. Women were aged 25 or older, resided in Illinois, and had experienced at least one criminal conviction during adulthood. Interviews took place virtually and were recorded with consent. Interviews aimed to understand both women’s trajectories for seeking services and their experiences of receiving services, including how they perceived a criminal conviction impacting their service attainment and treatment while receiving services. Interviews lasted between one and two hours, and interviewees were compensated for their time. We utilized a flexible coding process to ensure rigorous and transparent coding and analysis of interviews for a thematic analysis.

Findings: A persistent dynamic across women’s accounts was the experience of carceral coercion, or coercion rooted in dynamics of punishment and control, in decisions and trajectories regarding mental health treatment, substance use treatment, and victimization services. We identified themes related to the dynamics of carceral coercion in services, including 1) surveillance and control embedded in programmatic requirements; 2) programmatic control of pathways to needed tangible resources; 3) direct violations of autonomy; and 4) linguistic practices of redemption and rehabilitation. Women experienced consequences of service-based coercion, engaged in resistance strategies, and navigated contradictory interplays of assistance within service-based coercion.

Implications: The study’s findings have implications for social work research, policy, and practice, especially within the domains of improving access to and the quality of care offered within behavioral health and victimization services. These findings also contribute to theories of help-seeking and help-attainment that often do not include dynamics of coercion for this population of women, as well as have implications for conceptualizations of collateral consequences.