Beyond “pains” and “gains”: untangling the health consequences of probation

Abstract

Background Research on the health consequences of criminal legal system contact has increasingly looked beyond imprisonment to understand how more routine forms of surveillance and punishment shape wellbeing. One of these sites is probation, the largest form of supervision in the U.S. Drawing on an interview study with 162 adults on probation in Hennepin County, MN, in 2019, we map how adults on probation understand the consequences of supervision for their health and how these self-reported health changes correlate with individual, social, and structural circumstances. Results Roughly half of participants described their health as having improved since starting probation, while the remainder were split between no change and worsened health. Examining both closed-ended survey questions and open-ended interview prompts, we find that the “gains” of supervision were correlated with substance use treatment (often mandated), reduced drug and alcohol use, increased housing and food security, and perceptions of support from their probation officer. However, these potentially health-promoting mechanisms were attenuated for many participants by the significant “pains” of supervision, including the threat of revocation, which sometimes impacted mental health. In addition, participants in the most precarious circumstances were often unable to meet the demands of supervision, resulting in further punishment. Conclusions Moving beyond the “pains” and “gains” framework, we argue that this analysis provides empirical evidence for the importance of moving social services outside of punishing criminal legal system interventions. People with criminal legal contact often come from deeply marginalized socio-economic contexts and are then expected to meet the rigorous demands of supervision with little state aid for redressing structural barriers. Access to essential services, including healthcare, food, and housing, without the threat of further criminal legal sanctions, can better prevent and respond to many of the behaviors that are currently criminalized in the U.S. legal system, including substance use.

The application of implementation science methods in correctional health intervention research: a systematic review

“…In addition to reforming the criminal-legal system to reduce these inequities, researchers can also investigate effective implementation strategies to rapidly increase access to high-quality health services that meet the health needs of people currently incarcerated and under community supervision. In this way, greater testing of dissemination and implementation strategies in criminal-legal settings can help address health inequities stemming from societal injustices of mass incarceration and the impact of criminal-legal involvement on social and economic wellbeing [62,63]. This review provides a summary of published correctional health intervention research that integrated implementation science approaches and provides a foundation to inform future studies seeking to employ implementation frameworks, strategies, and outcomes in their study designs.…”

Identifying and addressing barriers to effective substance misuse treatment in rural settings.

“…The lack of oversight of facilities such as sober living houses contributes to the recidivistic cycle of prison re-entry for formerly incarcerated individuals. Additionally, harsh penalties for substance possession are stigmatizing (Tyndall, 2019), while probation and parole policies do not allow for recidivism or relapse, which are common in OUD/SUD treatment (MacLean & Packer, 2019; Phelps et al, 2022). Child welfare policies have also resulted in a significant increase in children being placed in foster care due to parental substance misuse, with rural children (particularly infants and toddlers) being the most vulnerable (Sieger & Becker, 2020; United States Children’s Bureau, 2021).…”

“Nothing but a rope to hang yourself:” The toll of mass supervision on mental well-being

“…The lack of structural support while on community supervision often results in individuals failing to meet requirements and contributing to worse well-being, highlighting the need for policy to move support services (e.g., resources for housing) outside of the criminal legal system and into supportive community settings ( Phelps et al, 2022 ). As participants stated, providing more resources and fewer punitive requirements would ensure that individuals are able to begin achieving well-being.…”

“…Community supervision widens the net of state control in ways that likely directly affect mental well-being ( Phelps, 2013 ; Phelps et al, 2022 ). Often defined as the pains of supervision, individuals experience the stress of constant state-sanctioned surveillance and, specifically, the threat of revocation, which may affect mental well-being ( Phelps and Ruhland, 2022 ).…”

“…Yet, little work has collected first-person perspectives from those experiencing probation and parole about how this supervision has affected their mental well-being. Prior work has focused on understanding the burdens of probation itself, ( Phelps and Ruhland, 2022 ) how people experience supervision, ( Welsh, 2017 ) and its overall health consequences ( Phelps et al, 2022 ). We looked at the effects of the probation and parole environment on mental well-being to better understand the mechanisms through which this supervision affects individuals.…”