Abstract
Given the criminalization of mental illness in the United States today, persons with mental health diagnoses, particularly those with posttraumatic stress disorder (PTSD), are disproportionately involved in the criminal legal system. Despite higher rates of PTSD in jails compared with other correctional settings, research on the lived experiences of individuals with PTSD incarcerated in jails is limited. Using a phenomenological approach, this study examined individuals with PTSD who were formerly incarcerated in jail, focusing on how jail incarceration may impact the healing process. Findings from this study highlight both barriers and facilitators to healing, providing a deeper understanding of how to better support the healing process for individuals with PTSD and underscoring the need for trauma-informed interventions and policies in jails.
Background
Posttraumatic stress disorder (PTSD) is a diagnosable mental health condition that can develop in individuals following exposure to traumatic events, leading to significant and persistent impairment and distress, often long after the event has passed (American Psychiatric Association, 2013). While 3.6% of the general population has a PTSD diagnosis, PTSD is notably more prevalent among incarcerated individuals, with rates in prisons ranging from 5.6% to 57.8% (Baranyi et al., 2018; Fovet et al., 2023; Giarratano et al., 2017; Young et al., 2025) and 44% to 58% in jails (Barrett et al., 2020; Combs et al., 2019; Proctor et al., 2019). To better understand PTSD within correctional settings, it is essential to first distinguish between jails and prisons. The primary differences between jails and prisons lie in both their populations and their purpose. Prisons are long-term correctional facilities designed for individuals serving sentences of 1 year or more, typically for more serious (felony) offenses (McClain, 2021). Because of the longer duration of confinement, prisons are more likely to offer rehabilitative services such as mental health treatment; however, these services are often underfunded and inconsistently available (Hutchison, 2017). In contrast, jails are short-term, “people-processing” facilities that primarily hold individuals awaiting trial/sentencing or those serving short sentences (generally less than 1 year for misdemeanor offenses), with an average jail stay of approximately 26 days (Adler & Chen, 2023). Due to rapid turnover, limited funding, and structural constraints, jails provide far fewer rehabilitative or mental health services compared to prisons (Kolodziejczak & Sinclair, 2018).
Despite the overrepresentation of PTSD in jail populations, qualitative research on persons with PTSD in jail settings remains limited, as much of the existing literature focuses on the broader topic of trauma within prisons. While this literature may not directly apply to jail populations due to the differences between the two settings, these prior findings can serve as a starting point for understanding how jail incarceration impacts the healing process for those with PTSD. For instance, prior qualitative studies that explored trauma and the healing process within prisons highlight both barriers and facilitators to healing. Specifically, prior research identifies lack of mental health treatment as a significant obstacle, while the development of coping strategies is recognized as a key catalyst for healing (Bouw et al., 2019; Fournier et al., 2011; Kennedy & Mennicke, 2017; Kubiak et al., 2017; Vaswani & Paul, 2019).
Mental health treatment is essential to the healing process for persons with PTSD and despite the fact that both prisons and jails are legally responsible to provide mental health treatment under the Eighth Amendment's ban on “cruel and unusual” punishment ( Brown v. Plata, 2011 ; Wilper et al., 2009), there is an overwhelming lack of access to mental health treatment, psychotropic medication, programs, and other therapeutic tools while incarcerated (Hutchison, 2017; Kolodziejczak & Sinclair, 2018). This can be traumatic for persons with PTSD and exacerbate their PTSD symptoms (Bouw et al., 2019; Harner & Riley, 2013; Kennedy & Mennicke, 2017; Vaswani & Paul, 2019).
Further, when individual psychotherapy is provided in carceral settings, it is frequently affected by staffing instability, provider turnover, and institutional scheduling policies or constraints that limit continuity of care and disrupt the development of sustained therapeutic alliances (Fournier et al., 2011; Kolodziejczak & Sinclair, 2018). As a result, individuals may be forced to keep retelling their trauma narrative, which may cause further unnecessary re-experiencing of traumatic events (Segal et al., 2018). The jail setting itself is also a barrier to receiving psychotherapy, as the lack of privacy due to physical barriers makes it ineffective at providing confidential treatment. Additionally, many persons with trauma histories struggle with trust, a challenge that may be exacerbated by the power imbalance inherent in jail-based mental health care, which may be intensified when jail-based mental health providers are perceived as part of the system maintaining their detention (Segal et al., 2018). Further, prior research emphasizes that confinement exacerbates mental health symptoms, again underscoring the critical need for mental health treatment in the healing process (DeVeaux, 2013; Harner & Riley, 2013; Hutchison, 2019; Kennedy & Mennicke, 2017; Piper & Berle, 2019).
While limited access to treatment behind bars can worsen PTSD symptoms, the development of coping mechanisms can help mitigate their impact. It is important to note that some coping skills may be viewed as maladaptive; however, we must recognize that they may be survival behaviors developed in response to traumatic events—offering protection, comfort, relaxation, and relief (Kubiak et al., 2017). One of the most common coping mechanisms utilized by persons in prisons documented in previous literature is the engagement in self-injurious behaviors (Benedict, n.d.; Fournier et al., 2011; Harner & Burgess, 2011; Maschi et al., 2015; Smith, 2014; Wolff et al., 2009). This can involve injuring oneself through cutting, burning, head-banging, and even attempting suicide, and is often utilized to achieve affect regulation when an individual may be triggered or repressing their emotions related to a traumatic event (Smith, 2014). Other coping skills that may be considered maladaptive that are utilized by trauma survivors during incarceration include substance use, deviance, isolation, withdrawal, disassociation, suppressing feelings and thoughts, engaging in violent behaviors, aggression, and hoarding food (Benedict, n.d.; Bouw et al., 2019; Harner & Riley, 2013; Hutchison, 2019; Kennedy & Mennicke, 2017; Maschi et al., 2015; Williams et al., 2021; Wolff et al., 2009).
More adaptive coping skills utilized by persons with trauma histories incarcerated in prisons have also been documented. Common coping skills include prayer and attendance at religious services when available (Maschi et al., 2015; Smith, 2014; Williams et al., 2021). Prior research also suggests that prayer is utilized by individuals who lack access to mental health services during incarceration as a way to strengthen their mental health (Harner & Riley, 2013). Notably, a recent quasi-experimental study focusing specifically on jail populations found that participation in a faith-based correctional program may help reduce PTSD symptoms (Jang et al., 2024). This is consistent with the above-mentioned research among prison populations, demonstrating that faith can serve as a facilitator to healing.
Other coping skills mentioned in prior research include taking psychotropic medication when available, mindfulness, reading, calling family/friends, meditation, yoga, doing puzzles, playing chess, creating art, being of service to others, exercising, attending individual or group counseling when offered, interacting with peers, and participating in programs when available (e.g., vocational training, education classes, etc.) (Bouw et al., 2019; DeVeaux, 2013; Fournier et al., 2011; Harner & Riley, 2013; Maschi et al., 2015; Smith, 2014).
One approach to reducing barriers and enhancing healing in carceral facilities may be the adoption of a Trauma-Informed Care (TIC) model. This model provides a framework for understanding and responding to trauma through six core principles: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and consideration of cultural, historical, and gender issues (SAMHSA, 2014). Altogether, these principles aim to increase trauma awareness, train individuals to recognize and address trauma, and seek to prevent re-traumatization while fostering healing. While widely recommended for use in carceral institutions (Jewkes et al., 2019; Kubiak et al., 2017; Miller & Najavits, 2012), research on effectiveness in these settings remains limited. Existing studies, however, suggest it can improve feelings of safety, trust, and institutional culture, thereby supporting healing among individuals with PTSD (Gaber et al., 2025; Patterson et al., 2013).
Ultimately, while there is some literature available exploring barriers and facilitators to healing in prison populations, research among jail populations is again limited, with no prior qualitative studies specifically focusing on the healing process for those with PTSD incarcerated in jails. Thus, the purpose and overall aim of this study were to explore, describe, and understand what barriers and facilitators to healing individuals with PTSD experience during their jail stay. Examining these experiences is crucial, as it offers a firsthand perspective on the shortcomings of the criminal justice system in addressing the needs of those with PTSD, while simultaneously amplifying the voices of this vulnerable population.
Method
Study Design
To understand barriers and facilitators to healing individuals with PTSD experience during their jail stay, this study employed a qualitative, cross-sectional, phenomenological design. Qualitative research offers rich descriptions of a phenomenon in a way that quantitative methods cannot, and phenomenological designs, specifically, are employed to capture both the how and what of human experience (Neubauer et al., 2019). Utilizing this design enables us to hear directly from individuals with PTSD about how their time in jail influenced their healing journey, thereby deepening our understanding of the impact of jail incarceration on the healing process.
Further, this study was guided by a critical theory framework to examine how social institutions (i.e., jails) shape the experiences of individuals with PTSD, including addressing any oppression and discrimination that individuals living in carceral facilities and individuals with mental health diagnoses may face. This framework also informed the analysis and presentation of findings, centering participants’ perspectives and prioritizing their voices throughout. Additionally, a TIC model was used to guide data collection and analysis. During data collection, deliberate efforts were made to remain sensitive to participants’ trauma histories and to minimize the risk of re-traumatization. Examples of this included prioritizing participant autonomy (i.e., emphasizing participants’ right to decline to answer any questions or withdraw from the study at any point) and pacing interviews according to participants’ comfort (i.e., flexibility to pause or go back to questions as needed). Additionally, a TIC model was utilized during data analysis to help interpret and document the impact prior trauma has on one's lived experiences in jail, particularly those surrounding the healing process. These practices reflect core TIC principles such as safety, choice, and empowerment.
Ethical Reflections
The Wayne State University Institutional Review Board (Approval No. IRB-21-10-4127-B3) approved this study. The Principal Investigator obtained informed consent verbally from each participant. Next, a Research Information Sheet (specifying information about confidentiality, risks, and benefits of participating in the study) was mailed to and read to participants before the interviews began. The study sample included individuals formerly incarcerated in jail rather than those currently incarcerated due to the sensitive nature of the data being collected and the potential for emotional distress, making it ethically inappropriate to collect data in settings with limited mental health supports. Further, to prevent any potential coercion, participants were explicitly informed that their involvement in the study was not a probation requirement and that the decision to participate or not would impact their legal status. Further, given the sensitive nature of the interview topics, contact information regarding local emergency counseling services was provided to participants should they begin to experience any psychological distress. Finally, to ensure the trustworthiness and rigor of the research findings, theory triangulation, member checking, and bracketing were employed, as these validation strategies are consistent with a phenomenological approach (Padgett, 2017).
Participants and Sampling
A purposive sampling approach was employed to recruit participants currently on probation from a single state in the Midwestern United States. The PI distributed the study description to professional contacts who work with individuals on probation. Participants were recruited from five different agencies: two nonprofits, one mental health court, one drug court, and one community mental health program. Potential participants identified by agency staff (excluding direct probation officers) as having PTSD were subsequently contacted by the PI via telephone, and a screening interview was conducted. After completion of screening interviews, the final sample included nine participants. All participants had a history of jail incarceration and met criteria for PTSD prior to incarceration, as assessed during the screening interview by the PTSD checklist–civilian version (PCL-C), a standardized instrument aligned with DSM-IV diagnostic criteria (Weathers et al., 1994). Although the sample size was relatively small, data saturation was achieved. Further, prior phenomenological studies examining trauma in incarcerated populations have used similar sample sizes (e.g., n = 11 and n = 9; Williams et al., 2021; Honorato et al., 2016), which is consistent with the recommended ranges of 6–15 participants in phenomenological research to ensure depth (Creswell & Poth, 2018; Padgett, 2017).
The study sample consisted of seven females and two males, all of whom identified as White. The mean age of participants was 40.0 years, ranging from 32 to 49 years old. Two participants reported some college education; four had earned a high school diploma or GED, and three reported having a 12th-grade education or less. The number of times participants had been incarcerated in jail throughout their lifetime ranged from 1 to 30 (M = 10.5, SD = 10.1), while the number of days spent in jail during their most recent stay ranged from 5 to 90 days (M = 27.9, SD = 27.6). The number of traumatic experiences across participants’ lifespans ranged from 11 to 25 (M = 17.8, SD = 4.9), with traumatic experiences during jail incarceration ranging from 2 to 23 (M = 12.9, SD = 7.0). The composite score on the Trauma Symptom Checklist-40 (measuring current trauma symptomology) ranged from 19 to 35 (M = 24.7, SD = 5.3), with higher scores indicating greater levels of distress. Additionally, participants were incarcerated in four different jails, with three participants being held pre-trial only, two serving a sentence, and four being incarcerated in jail for both pre-trial and sentencing.
Data Collection
Data for this study was collected between 2022 and 2023 through a semi-structured interview process, with all interviews being conducted via telephone or Zoom. An interview protocol guide was developed to address the study's research questions concerning barriers and facilitators to healing experienced by individuals with PTSD during jail incarceration. The semi-structured interviews lasted about 90 min and included 14 open-ended questions, such as: How did your PTSD/trauma symptoms affect you while you were in jail? What factors made these symptoms better or worse? What treatment or services, if any, did you receive while in jail? and How do you think you were affected by your jail experiences? Interviews also included a demographic questionnaire and three standardized screening measures. Two measures assessed traumatic experiences: the Life Stressor Checklist-Revised (Wolfe et al., 1997) and the Prison Coercion Scale (Listwan et al., 2010), while the third measured current trauma symptomology: the Trauma Symptom Checklist-40 (Briere, 1996). Research has demonstrated that the Prison Coercion Scale and the Trauma Symptom Checklist-40 have strong internal consistency (α = .80 and α = .90, respectively; Elliott & Briere, 1992; Listwan et al., 2010), while the Life Stressor Checklist–Revised has shown good criterion-related validity (Wilson & Keane, 2004).
Data Analysis
A phenomenological approach guided data analysis. First, bracketing was utilized, and then the transcripts were read multiple times in an effort to get familiar with the data and to provide context for theme development. Next, horizontalization was completed through assigning value to each statement in an effort to extract units of general meaning, such as words, phrases, and significant non-verbal cues that describe the essence of meaning (Padgett, 2017). From this process, both textural (what was experienced) and structural (how it was experienced) descriptions were identified (Creswell & Poth, 2018). The research questions were then applied to these units of general meaning to determine units of relevant meaning, which are essential meanings described by participants that reflect the phenomena under study (Hycner, 1985). Once units of relevant meaning were identified, redundant ones were removed, and the process of clustering units of relevant meaning began, which involved grouping similar units of relevant meaning together based on common essence (Groenewald, 2004). These clusters were then reviewed to identify central themes, which represented the essence of the phenomenon and guided the narrative. A summary of these themes was then written. Finally, member checking was conducted by providing these summaries to participants, allowing them to provide feedback on the accuracy of the themes or any missed data (Hycner, 1985). None of the participants disagreed with the developed themes.
Results
This study aimed to identify barriers and facilitators to healing that individuals with PTSD experienced during incarceration in jail. Healing was conceptualized phenomenologically as participants’ lived experiences during jail incarceration that contributed to the exacerbation or alleviation of trauma-related psychological and physical symptoms. Three themes emerged from the data: (1) unmet basic needs and treatment needs in jail (barrier); (2) access to services in jail (facilitator); and (3) coping skills (facilitator). Participants are identified in the results with a combination of a number and a letter “F” or “M,” denoting female and male, respectively.
Barrier: Unmet Basic Needs and Treatment Needs in Jail
A key barrier to healing during jail incarceration, as highlighted by all participants, was the inability to have their basic needs (i.e., not having access to basic human necessities) and treatment needs (i.e., not receiving any form of treatment for mental illness or substance use disorders) met. To begin, all participants shared experiences of lacking basic human necessities. For example, participants shared not having access to toilet paper, feminine hygiene products (i.e., tampons, pads, etc.), undergarments, or blankets. Participants described that not having access to basic human necessities made their trauma symptoms worse, discouraging the healing process. Participant 8F shared, “You ask them for toilet paper or tampons, or something like that. They either do it or they don’t. Most times, they don’t. They don’t care.” Participant 1F also described their experience with not having access to basic necessities, stating, “A lot of the time when I went to jail I didn’t have socks or underwear or a bra…So a lot of the time I was wearing these uniforms that other people wore, but no underwear. None.” Ultimately, access to basic necessities affirms dignity and helps maintain personal agency. When these needs go unmet, individuals may experience powerlessness and further re-traumatization. Additionally, five participants described how those who are indigent suffered the most. They described having a lack of access to monetary funds in their jail account meant that they were unable to get basic necessities from the commissary. Participant 1F shared: I was indigent. So, I didn’t get, I've never gotten money put on my books in jail…like, I got literally indigent kits. So, I got a bottle of shampoo that was this big [motioned small size] for every two weeks with a bar soap and a toothbrush and that was it. And what makes it even worse is watching everybody else get food, and you know, clothing and socks.
Further, all participants shared experiences of lacking access to mental health or substance use treatment or both. Five participants described not being able to receive their mental health medication. Participant 4F recounted: While I was in jail I received no treatment and no services and they knew when they did the initial take that I had psych problems. They knew that I was seeing a psychiatrist and they would never offer me anything, or say, ‘ma’am, would you like to continue your [mental health] medication?’ Nope.
While three participants reported having access to mental health medication, they noted that obtaining it was a lengthy process. Participant 6F recounted: If you come in and you already have prescriptions, you can tell them the name of your doctors, the name of your pharmacy and stuff, and they will arrange to have your medications brought in…but it can take like one to three weeks to get and it's only the medications that you were on when you came in. So if your prescriptions are not current or you’ve not… like a lot of people that's coming into jail, they’re not seeing their doctor regularly. So, you know there's nothing [no current medication]. They don’t do like a psych eval and go ‘okay, you know, maybe we would need to put you on medications.
Like many other participants, this participant went on to describe how a lack of access to treatment, specifically medication, caused a barrier to their healing process, sharing: So there's a huge separation, like, you get that like detox from your psych meds. It's really hard…It took exactly 7 days to get my medications, Wellbutrin, Seroquel, and Trazodone. So I only got it on the last day. It did not help…Psychiatric medication sometimes, like it builds up in your system. My concern is like two out of three of those medications very strongly warn you not to stop taking them suddenly. So, I mean, I kind of like attribute some of that to why my anxiety levels were so high, like why my physical anxiety is so high.
Further, participants discussed not having access to treatment such as individual or group therapy. Participant 6F elaborated: There was a lot of like [mental health] assessments. They do all these assessments as though there were these programs and there just weren’t. Not being able to access treatment made it [trauma symptoms] worse, but also you get kind of a sense of hope when you think that you’re going to, number one there's going to be something that's going to break up your day…and that's kind of the worst thing. When you don’t know, when you just spend every day with this hope in the back of your head waiting for something to happen, and it's really hard on like the nerves and the anxiety and like, when nothing happens over and over, it's very like I don’t know, dispiriting, demoralizing. Like, so I've answered all these questions and then you’ve given me hope that you’re gonna help something and then nothing ever comes… I don’t know anybody who has ever received any kind of services while at [jail name removed]. So, I don’t really know why the assessments are happening. As far as I know, those programs don’t exist.
Likewise, other participants talked about mental health assessments acting as more of a formality than actual treatment. Participant 5F shared, “They would have a… I don’t know if you’d even call it a therapist? But somebody comes through and asks about your mental health. They just had this policy, they gotta make sure you’re mentally okay. That was it.” Participants further described how the lack of mental health services available created barriers to healing and caused an increase in PTSD symptoms. For example, Participant 8F shared, “I wish I could have at least been able to talk to somebody about mental health. It has impacted me…I think it made it [trauma symptoms] worse personally. I think a lot of my anxiety comes from that.” It is important to note that when mental health treatment did exist, there were barriers to receiving it. Participants reported jail stay length requirements and faulty kite systems (system in place for those incarcerated to be able to communicate with jail staff), were to blame. Participant 3M shared their experience of how difficult it was to access mental health services due to both of these barriers, stating: I remember sending kites talking about this is the 10th kite I’ve sent, why haven’t you responded yet. I need help. I need this, that, and the other. You know guidance. Some kind of something. Not like, not necessarily medication, you know? But like coping skills…I did get one response early on and that was telling me that I needed to be sentenced and/or been there for 90 days. And I responded with, ‘You’re telling me that I’m having these thoughts and feelings ten days into my stay, but because I haven’t been here for 90 days you can’t help me.’ That's not fair.
Further, three participants described COVID-19 as a barrier to accessing support such as group classes. Participant 6F stated, “I know that like with COVID especially, they don’t bring anybody in to do like groups or anything.” Additionally, participant 6F shared an internal barrier to receiving help, sharing, “I didn’t think I had a problem.” Participant 9M also noted stigma as a barrier to help seeking, stating, “I don’t really wanna do a whole mental health thing because I don’t…I don’t wanna be judged.” Further, participant 3M described the lack of tailored programing in place to help facilitate their growth and healing, such as anger management. They went on to share: I feel like, the whole point of jail, right, it's fundamentally to correct a certain type of behavior. Well, how are you going to correct that behavior without implementing some kind of treatment for said behavior. Right? For example, if somebody breaks into somebody's house, while they’re in jail shouldn’t you teach them why breaking into somebody's house is wrong? So why is that not part of jail? That's the question. I’m not even going to sugarcoat…I beat [name of person removed] ass…I know that given my past and given my history and given you know like the rules in the world, I know that I went about that the wrong way. Ok? So why didn’t the jail tell me why I did that?
Additionally, six participants shared that there was no access to substance use treatment. This is unfortunate, as incarceration in jail can serve as a rare opportunity to achieve sobriety. Participant 6F explained, “When you’re in jail for eight days you have a lot of time to like detox, and you know, I really kind of wanted to not go back to using when I left, but there was no substance use treatment.” Four participants did, however, share that at times there was access to 12-step programs, such as Alcoholics Anonymous, but reported that it was only offered in certain housing areas. For example, participant 9M shared: I would have been able to access meetings [but] I would have had to go back to [being housed in] the echoey part of the jail. I made a mental health judgement call that I would have been better off in the, you know, in the quieter area…that was the trade-off.
What were most striking about the lack of access to substance use treatment was participants accounts of how withdrawal was not taken seriously. Participant 1F shared: The way that they handle people coming in with drug problems is wrong…They don’t take care of them the way they should…they don’t really do a lot medication-wise. They just kind of leave you to suffer…I think that there should be a little more intense [treatment] and a little more understanding…These are people that could die from withdrawal. If they offered more support, like rehab, if it was something that was worked on and offered to people, I think that it would be better.
Additionally, when substance use disorders are left untreated, individuals often experience severe physical and psychological symptoms (i.e., anxiety, restlessness, etc.) that may overlap with or worsen PTSD symptoms.
Participants also explained how they were not able to access pharmacotherapy for substance use disorders (i.e., medications for opioid use disorder [MOUD]), often because it did not exist or because of sentence length requirements or housing/security level. For example, Participant 1F shared, “They only offer medications for substance use disorders after you’re there for a while, but not immediately.” Participant 7F shared the impact this had on their healing, stating, “If they had offered me that [MOUD], I wouldn’t have gotten out of jail and beelined it to the dope house…I [was] physically sick…my body was so ill I was like, ‘I can’t even walk right now.”
Further, two participants shared how medical services in general are poor and lacking. Participant 8F shared, “If you’re sick or not, they don’t have no medical attention much” and participant 1F stated, “When it comes to medical, you have to send a kite to be seen. If you’ve got a toothache…you could wait two to three weeks, if not longer, before you can even get a Tylenol for that.” When physical health needs go unaddressed, resulting pain, discomfort, and stress can intensify emotional dysregulation and worsen PTSD symptoms.
Additionally, participants described how they wished they had services available of any kind. For example, Participant 2F shared, “I wish they had more services. Just things to get you out in a group and something different to talk about” and participant 5F stated “I wish they had just anything, to be doing activities. I wish they would have had anything throughout the day.” Lastly, participants discussed the need for jail reform and emphasized that jails should be rehabilitative and not punitive. For example, participant 3M shared: [I have] a general overall disappointment in the legal system, specifically the correctional part of the legal system…It's consequences, consequences, consequences. That's not what life is about man…You know, jail is not a fix all for everything. It's just not. And I hate to say it, even sex offenders, like jail is not a fix all for every single problem— treatment is. Specialized treatment for individualized problems is the fix all.
Facilitators
While all participants faced barriers, they also all described experiences during their jail stay that helped to facilitate healing. Two themes emerged from the data as facilitators to healing, including: (1) access to services in jail and (2) coping skills.
Access to Services in Jail
Some participants shared how services provided to them during jail incarceration facilitated their healing; however, most participants described healing as being possible due to the services they received post-incarceration. This is because either participants were not offered services (four participants reported not being offered any type of service) or the services offered were inadequate.
However, when services were available, participants did share how these services facilitated their healing. To begin, the mental health and substance use services offered in jail to participants included assessments (offered to all participants), psychiatric medication (offered to three participants), medications for opioid use disorders (offered to one participant), group therapy (offered to two participants), twelve-step programs (offered to one participant), individual therapy (offered to two participants) and case management (offered to one participant). These participants described that access to mental health services while in jail helped facilitate restoration and healing. For example, participant 1F shared: I did do [group therapy] classes. Like we did, uh, it's called Breakout. That class helped me a lot. It's basically breaking out of your own person. So, it's more about in here and how you can better yourself. There's also another class…it was like a redirection of thinking…and anger management stuff that they teach us and things like that. Like those classes helped me change the way I viewed myself and the way that I dealt with some of my issues and how I talk to people.
Next, those with access to medications described how it helped them to manage their mental illness or substance use disorder, which facilitated healing. For example, participant 2F shared: Probably about my eighth week, the doctor gave me Buspar for my anxiety. It did help for a little bit…I went and saw the nurse, and with my anxiety level being so high, the nurse called the doctor. So once the doctor okay-ed it, they just, you know, said ‘Let's see how this works,’ and put me on a low dosage twice a day and I've been on them since.
Further, participant 1F described how a faith-based group offered to them helped them to move towards healing by providing them with connection and purpose. They shared how impactful this was, stating, “I was doing Bible studies…I always made sure I went every time…after each chapter, you get a certificate, and those certificates I still have.” Additionally, two participants reported receiving general medical services. For example, participant 2F shared: I had severe heartburn where I threw up for a while and they put me on antiacid pills…I actually had a cold shoulder, so I did x-rays in there one time…I really didn’t have any other service that I got or needed.
Consistent access to medical care can promote a sense of safety and security, which is especially important for persons with PTSD and can support overall emotional regulation and healing.
It's also important to note that participants shared how having people on the inside advocating for them helped to make services more accessible. For example, Participant 6F shared how knowing a trustee helped them: I knew people. The trustee downstairs that did the intake was a close friend of mine and he had a really good relationship with like the medical staff downstairs. So, I feel like it was, you know, that [getting my medication] may have happened because, you know, I knew somebody who was on good terms with the medical staff. There were people that came in, had the same thing, and by the time I left hadn’t received [medication].
Participant 7F described how a correctional officer advocated for them, sharing, “Just one person caring about their job. She [correctional officer] was the one that sent me to the nurse.” Lastly, participant 1F described how the chaplain helped them to access services, stating: The chaplain helped me [bypass the waiting period]. If you know about the chaplain, you’re able to do Bible studies and things like that, so this last time I was able to start Bible studies as soon as I got there…He's able to have direct contact with the Warden and be able to have things cleared. Not this last time, but the time before that, I had plastic glasses and my arms had broke off my glasses and one of my lenses was falling out. The Chaplain literally, I sent one of my lenses to the Chaplin so he could measure the lens that would fit into the readers that he had, so that way I could pop my lenses out and put them in a frame that I could actually use.
Further, participant 9M shared how the use of an electronic kite system made services more accessible, stating, “They had a tablet that floats around, I guess that they call it a digital kite…that kind of makes it a little more helpful. Makes it [requesting mental health services] accessible.”
Coping Skills
All participants depicted this theme as they shared stories of how they coped with their PTSD during incarceration, describing coping skills as a facilitator to healing. Common coping skills utilized among participants to help manage PTSD symptoms included writing and drawing. Participant 2F shared, “I would draw, just whatever would pop in my head…I’d write inspirational, just advice, so anything, and any quotes that would inspire me or get me through the day.” Additionally, Participant 9M shared, “I wanted to make some use out of the time in there and not just sit there like a dummy, so I wrote a children's story…I illustrated the story as well.” This participant went on to describe how this also facilitated their healing process, sharing, “I was actually able to use the time for good stuff…I accomplished a goal that I had set and I told my son I was gonna do, and I did it. And that was a pretty good feeling.” Another related coping skill utilized by participants was reading; however, four participants reported that they didn’t have access to books. Participant 5F shared, “They didn’t [have books]. If I did have access to books, like I would have been all about it.” Other coping skills reported among participants included singing, watching television, looking out a window, showering, and eating.
Additionally, utilizing sleep as a coping skill was frequently described by participants. Participants shared statements such as, “I’d sleep most of the day (participant 1F),” “I’d take a million naps, (participant 6F)” and “I just sleep. I get up, eat, go back to bed, sleep (participant 9M).” Exercise was another coping skill often described by participants. Participants shared comments like, “I’d walk a lot in the pod (participant 1F)” and “I’d do jumping jacks. I would go back and forth from door to door and count laps, just to maybe burn off some of my, you know energy (participant 4F).” Next, participant 4F shared how cleaning helped them cope, stating: I washed my jail clothes a lot, my uniform. I actually washed it in the sink and I would hang them…that was a coping skill. It kept me busy. I would… I asked for the guard to bring in the fresh mop water and, you know, window cleaner and stuff. I did a lot of wiping of the tables, wiped every little seat. Mopped the top, mopped the bottom, mopped the, you know, my room. Wiped the metal bunk beds. Yeah, I did a lot of cleaning, that's for sure.
Another coping skill shared by participants was leaning on one's faith. Participants 7F and 8F shared how they would “pray” during incarceration to cope with their circumstances. Others reported that having access to mental health medication helped them cope. Participant 2F shared, “I mean that [mental health medication] was something I did look forward to. Like sometimes just so I can relax…I got just a little relief of calmness once I started getting them.” Similarly, others shared how access to MOUD was beneficial for healing.
Next, all participants shared how interacting with their peers helped them to cope. Participants shared lighthearted experiences of “playing cards (participant 5F)” or “braiding hair (participant 4F),” but also shared more meaningful experiences, such as offering/receiving advice and leaning on one another for support. Participant 1F shared their experience: Being able to talk to any other ladies, because then I wasn’t in my head so much. Just because they’re in jail doesn’t make them bad people, doesn’t make them not have good advice…There was people that had murdered people there, but some of those people became really close to me. [They] were some of the kindest people I've ever met… A lot of the realizations that I had about myself, came from those women.
Participant 2F shared how stepping into a parental role gave them purpose, sharing: I got along pretty well with everybody. I was older. There was only about five of us that were over the age of thirty, so it was us five that just kind of hung together. The girls always asked us questions. Kind of felt like, I don’t know, like a mom over somebody, you know?
Additionally, participant 6F shared how their peers helped to normalize what they themselves had been through, which was important for healing. They shared: It's helpful to be in a place where people understand you. Like it felt like, you know, it wasn’t like being out in the public, in general, where people are gonna judge or look at you strangely. In jail, some people know some of the people that you know, or been to some of the places you’ve been, or they’ve experienced some of the things you’ve experienced, and that was probably the most helpful thing. It's just that, I mean, for the most part, you’re in a room full of people who kind of get where you’re coming from.
Further, participant 1F shared they relied on these friendships to access basic necessities, explaining, “Friendships in jail…I got lucky. People would give me a pair of socks, you know…they would help me when they could.” Contrastingly, participant 4F shared not engaging with peers, stating, “I just kind of wanted to lay low. Lay low in jail and just do my time and get out.”
Next, seven participants stated how being able to contact family and friends on the outside was a major coping skill that helped facilitate healing. Participant 3M explained: I would try to call my family every single day I would call, ten times a day. You know, pictures, phone calls, and letters mean everything to people in jail. That could mean the difference between your week feeling like a month and your week feeling like three days.
Likewise, another participant emphasized the importance of phone calls, describing how talking to their children served as a grounding technique and brought them a sense of relief. However, participant 5F described an unfortunate reality likely shared by others, stating, “The phone calls are most definitely a big thing, but this is the thing; I didn’t really have anybody to call.” Similarly, participant 2F shared, “I have such great family and friends that I did call quite a bit. I was very fortunate there, some people weren’t.” Contrastingly, participant 6F shared that calls didn’t help, explaining, “It was difficult…you have a 15 min time limit and it's so loud. There was kind of that disconnect. You didn’t feel super connected to the person on the other end of the line.”
Unfortunately, persons who were indigent weren’t able to utilize this coping mechanism of communicating with loved ones, which could have been significant to their healing. Participant 8F shared, “If you don’t have any money, you don’t call home at all. I never had money on my account…Being able to make a legitimately free phone call would be a thing that would definitely benefit some people.” Four other participants shared similar stories of not being able to speak with loved ones due to not having money on their jail account to make a call. Participant 3M noted an individual might be able to bypass this by making a collect call; however, shared their experience, stating, “Nine times out of ten they can’t answer because they are just as broke as I am.”
Participants also shared coping skills that may be viewed as maladaptive, such as using and dealing substances, engaging in violence, disassociating, and self-harm. As mentioned in the above literature review, many of these skills are actually survival behaviors that have been developed in response to traumatic events and provide protection, comfort, relaxation, relief, and ultimately, resilience. For example, four participants shared how their substance use helped them cope. Participant 7F recounted how using substances helped to “Seek out a way to rest that restlessness in you.” Likewise, participant 5F shared their experience with substance use, stating: I snuck stuff [substances] into jail with me…Honestly, it wasn’t on purpose…I don’t know why I did it. I shouldn’t have. It was stupid. They weren’t my drugs, so, I was trying to hold on to them for somebody else…It sounds stupid, just, to me, I’m so used to the chaos in certain things, like, to me, they’re just drugs, like, it wasn’t a big deal. And I had hung on to them too because I took some of the pills and it helped me sleep, I just wanted to sleep the stay away. I guess in a sense it was a cry out for help at the same time…I know I had a problem with addiction, but it's just like, it goes deeper than just the addiction. I don’t wanna get high. I self-medicated because it made me sociable. It made me feel normal.
Participant 3M also shared how dealing substances helped them cope, describing how selling their suboxone prescription enabled them to have a more comfortable jail stay, sharing, “I was in heaven. I had everything I needed and then some. I mean I was drinking french vanilla coffee in jail, and that's unheard of, nobody can afford that, but I could. I was living the dream.”
Next, two participants talked about engaging in violence to cope. For example, participant 3M described how fighting their abuser in jail helped them begin to heal and see things differently. They shared, “I beat him up. I wrecked his world…And you know what, even still, like, I’m sitting here thinking like this guy he might’ve deserved it, but then again, like did something happen to him when he was a kid.” Additionally, participant 5F described dissociation as a way to cope, sharing, “Spacing out. I would, I don’t know what the word to use for it, but like just going somewhere else in my head, trying to go to a positive place, or thinking of something different.”
Lastly, only one participant, 3M, described resiliency through engaging in self-harm, sharing how this was the only way they were able to get their needs met. This participant explained: I was in there [isolation] close to 30 [days] again. On my close to 30th day I found in the day room a razor blade…and I cut myself with it…I wanted attention. I need attention. I needed someone to realize that I was fucking serious and nobody would…. I need you guys to give me some attention. You’re just locking me in a box and leaving me alone that's not okay with me…So I went to that measure…And they weren’t able to stitch me up in the jail, so they sent me to the hospital. And from that day on, in that particular jail stay, they acknowledged my [mental health] needs you know, they were more attentive [after] that.
Discussion
The findings of this study contribute to the existing literature by highlighting a major barrier to healing for persons in jail with PTSD—having needs go unmet, both basic needs and treatment needs. Lack of access to basic human necessities in jail is inhumane. Common unmet basic needs identified in this study included: toilet paper, feminine hygiene products (i.e., tampons, pads, etc.), undergarments, and blankets. This study also identified a subcategory of this already vulnerable population: persons who are indigent, explaining that a lack of access to monetary funds in jail meant that they were unable to get basic necessities that could only be purchased from the commissary. Sykes (1958) research on deprivation theory in prisons explains that the deprivation of basic needs in the carceral environment is an attack on the psyche, causing distress and trauma symptomology. His theory holds that the more deprivation of basic needs experienced the more psychological distress individuals will encounter. This is concerning, as the results of this study revealed that the deprivation of basic necessities was a common occurrence, further exacerbating the trauma experienced by individuals with PTSD during jail incarceration.
Additionally, as concerns were the unmet treatment needs identified by participants. Unmet treatment needs described in this study included: lack of access to mental health and substance use treatment, group classes, therapeutic tools (e.g., books), psychiatric services, and psychotropic medications. These results confirm similar findings in prior literature describing the unmet treatment needs of persons incarcerated in prisons (Bouw et al., 2019; Fournier et al., 2011; Fuentes, 2014; Harner & Riley, 2013; Kennedy & Mennicke, 2017; Maschi et al., 2015; Vaswani & Paul, 2019). More significantly, this study emphasized the dangers of going without psychotropic medication in jail, as it can lead to withdrawal, supporting prior research findings (Casey & Bentley, 2017). It's important to recognize that there are numerous systemic barriers to accessing psychotropic medications within carceral facilities. For example, one barrier is the Medicaid Inmate Exclusion Policy. This policy prohibits carceral facilities from utilizing Medicaid funds for healthcare needs, such as psychotropic medications, ultimately leaving the burden of cost to facilities that often lack appropriate funding (Congressional Research Service, 2023). Additionally, carceral facilities that contract for-profit healthcare providers often have formulary restrictions. For example, substituting a high-cost medication for an alternative, which is not recommended with psychotropic medication, as it can cause potential risks and jeopardize continuity of care (Daniel, 2007; Pilkinton & Pilkinton, 2014). Policy reform is essential to address these systemic barriers, as they only deepen the trauma experienced behind bars.
Further, this study identified additional barriers to receiving mental health and substance use treatment inside jails including jail stay length requirements and faulty kite systems. Untreated PTSD has many consequences, including increased trauma symptomology. Further, research on carceral populations by Van Wormer and Bartollas (2021) found that untreated PTSD can lead to substance misuse and recidivism, further stressing the importance of treatment for co-occurring disorders inside jails. What is even more concerning, however, is that untreated PTSD may lead to self-injurious behavior. Smith's (2014) research on prison populations found that self-harm is often utilized as a coping mechanism to achieve affect regulation when an individual may be triggered or utilized in repressing emotions related to a traumatic event. Similarly, this study found that persons in jail with PTSD utilize self-injury as a physiological regulator and as a way to cope with trauma; however, these findings add to the body of literature as engagement in self-injurious behavior was labeled as a form of resiliency and described as the only way to get external needs met. These findings suggest that if comprehensive mental health and substance use treatment services were provided to persons in jail with PTSD, self-injurious behavior could be avoided. Unfortunately, results from this study show that receiving these treatment services is unlikely, as few participants were able to access mental health and substance use treatment services while in jail. This is similar to findings in prior literature by James and Glaze (2006) who identified that only 17.5% of persons with a mental health diagnosis detained in jail received treatment. This is highly problematic, as federal case law mandates that individuals detained in carceral facilities are entitled to receive mental health treatment (Bowring v. Godwin, 1977; Estelle v. Gamble, 1976).
While access to treatment services in jail is rare, those participants who reported receiving treatment viewed it as a facilitator to healing, documenting the importance of formal treatment services for persons with PTSD. Moving on, additional facilitators to healing identified in this study, included the use of a plethora of coping skills while in jail. Some of these coping skills included: writing, drawing, reading, eating, exercise, faith and prayer, participating in groups or programs when available, psychotropic medication or MOUD (when available), interacting with peers; being of service to others, calling family and friends, using and dealing substances, engaging in violence, and disassociating. These coping mechanisms are consistent with findings from previous literature that describe the same coping skills being utilized among persons in prisons (Benedict, n.d.; Bouw et al., 2019; DeVeaux, 2013; Fournier et al., 2011; Harner & Riley, 2013; Hutchison, 2019; Maschi et al., 2015; Smith, 2014; Williams et al., 2021). Further, other coping skills identified in this study that haven’t been mentioned elsewhere in previous literature include watching television, looking out a window, showering, sleeping, and cleaning. These potentially mundane activities were extremely meaningful for persons in jail as they helped to pass the time and keep their minds distracted from thinking about trauma.
Strengths and Limitations
This study is important as it provides a phenomenological account of the barriers and facilitators to healing those persons with PTSD who have been previously incarcerated in jails experience, which until now has not been researched. A key strength of this study is its use of a phenomenological approach, as it amplifies the voices of this vulnerable population and offers firsthand insight into the healing process for individuals with PTSD inside jail. Further, this study was designed with a critical theory framework in mind, allowing this study to bring light to injustices and call for action and change within the criminal legal system. Analysis of these participants’ stories highlights these injustices and underscores the need for policy reform within the criminal legal system.
A limitation of this study is lack of participant diversity, as the majority were women and all were Caucasian. The historical distrust of the criminal legal system within the African American community may have deterred participation in this study. Additionally, societal gender roles and stereotypes could have prevented men from sharing their lived experiences. Furthermore, since the sample consisted of people on probation, participants may have been reluctant to disclose certain details out of fear of retaliation from the criminal legal system. Lastly, the sensitive nature of survey questions may also have led some participants to withhold parts of their stories. Future research should make efforts to uncover the experiences of persons of other races and genders.
Practice and Policy Implications
This study was guided by the TIC model, which focuses on healing, empowerment, and safety by addressing the widespread impact of trauma on well-being. TIC has been widely advocated for carceral facilities to adopt, yet research on effectiveness in these settings is limited. While some scholars have raised important questions about whether prisons, given their emphasis on punishment, can ever fully implement a TIC model (Carlton & Russell, 2023; Vaswani & Paul, 2019), other studies have shown that TIC implementation in carceral settings can be successful (Gaber et al., 2025; Patterson et al., 2013). Jails may also be better positioned than prisons to support TIC implementation, as shorter lengths of stay, closer ties to local communities, and greater opportunities for collaboration with community-based services may allow for more flexible, responsive, and person-centered interventions, with a stronger orientation toward rehabilitation.
Based on this study's findings, it appears that TIC was not being implemented in the four jails where participants were housed. However, the results highlight the need for adopting a TIC model in jails. The simplest way to achieve this is through raising awareness of PTSD to reduce its impact on incarcerated individuals. This can be done through mandatory PTSD training for staff and psychoeducation for all new arrivals. Additionally, altering current carceral policies to be more trauma-informed is essential. For example, ensuring access to hygiene products should be the basic standard of care in jails. Meeting these basic needs helps preserve a sense of autonomy and respect. When they are unavailable or inconsistently provided, it can reinforce feelings of neglect, powerlessness, and dehumanization, further causing re-traumatization. Another simple TIC strategy is improving access to phone calls. When phone access is limited or costly, it can intensify feelings of distress, potentially worsening trauma symptoms. As the results show, regular, affordable communication with loved ones can provide emotional support, reduce isolation, and help maintain a sense of connection during incarceration.
Most importantly, and highlighted by participants throughout this study, treatment is the key to healing. Utilizing a TIC model would require staff to screen for trauma history during intake and would mandate that appropriate follow-up treatment, such as mental health and substance use services, be provided. However, as results from this study suggest, there is a need for federal monitoring of current policies already in place that are supposed to protect incarcerated individuals rights to mental health treatment. Because of this, it is apparent that the implementation of a TIC model within carceral facilities may only be possible with government oversight. By modeling the creation and implementation of the Prison Rape Elimination Act (PREA), it may be possible to advocate for laws that require an adaptation of a TIC model inside carceral facilities.
After numerous lawsuits surrounding the occurrence of sexual assault in carceral facilities, the Federal Bureau of Prisons (BOP) initiated PREA as a way to eliminate sexual assault within their facilities. PREA established a zero-tolerance policy for sexual assault and created a culture that supports victims. With the implementation of PREA came the creation of the National Prison Rape Elimination Commission, who was tasked with developing guidelines to eliminating sexual assault for carceral facilities to follow. Further, PREA mandated that training and technical assistance be offered to carceral facilities. Lastly, PREA created funding for state and local governments to ensure successful implementation (PREA Resource Center, 2004).
Although it may be challenging to bring forth a lawsuit regarding incarcerated persons unmet basic and treatment needs within carceral facilities, these failings have been constantly documented throughout prior literature, calling for a prompt investigation by the BOP and an accompanying policy response. While the BOP does not directly oversee local jails, its role in developing and disseminating federal correctional policies, such as PREA, demonstrates how federal standards can both influence and mandate practices within local jail systems. Like PREA, the creation of a TIC carceral policy could develop a zero-tolerance policy for inhumane treatment, through requiring implementation of a TIC model within carceral facilities. While there are safety and security issues that come with implementing a TIC model inside carceral facilities (i.e., conflict between the need for supervision to ensure safety and the individual right to privacy, etc.), prior research has found that it is possible for carceral facilities to be trauma-informed and has had a positive impact (Gaber et al., 2025; Patterson et al., 2013). A TIC commission, staffed with both corrections and mental health professionals, as well as persons with lived experiences, could create guidelines for successful implementation of a TIC model within carceral facilities without compromising safety and security. Lastly and most importantly, the creation of a successful TIC carceral policy would mandate funding to state and local governments, as well as education and training to carceral facilities, so that implementation can be efficacious. Nevertheless, until a TIC carceral policy is formally mandated, local jails should begin implementing trauma-informed practices, such as those recommended above, to improve care and reduce re-traumatization among incarcerated individuals.
Recommendations for Future Research
Future research should further explore barriers to accessing mental health and substance use treatment in jails, focusing on key issues such as jail stay length requirements and flawed kite systems, which may hinder timely care. Additionally, further investigation into the consequences of untreated PTSD in jail populations is crucial, particularly its link to self-injurious behavior, substance misuse, and recidivism. Given the study findings, future research should investigate how comprehensive mental health and substance use treatment services influence the healing process for those incarcerated with PTSD. Moreover, further investigation is required to better understand ways in which self-injurious behavior is used as a coping mechanism, and how interventions focusing on trauma and mental health treatment can mitigate these behaviors in jail populations. Additionally, future research should prioritize the inclusion of persons of color, as experiences of incarceration and PTSD are likely shaped by racial identity, structural inequality, and systemic bias. Understanding these differences is essential for capturing the full scope of how trauma is experienced and processed within carceral settings. Expanding representation in this area of research is critical; however, it also requires that future studies be intentionally designed to build trust within communities of color, given the longstanding distrust of both the criminal justice system and research institutions. Lastly, longitudinal studies tracking outcomes of those with PTSD who receive treatment during jail incarceration could provide valuable insights into the long-term benefits of receiving treatment services behind bars.
Footnotes
Ethical Statement
This study was approved by the Wayne State University Institutional Review Board (Approval No. IRB-21-10-4127-B3). All participants provided verbal informed consent prior to enrollment in the study.
Funding
The authors disclosed receipt of the following financial support for the research of this article: The study was supported by the Wayne State University Graduate School and the Wayne State University School of Social Work.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.