Member Spotlight - Dr. Patricia Janssen

Could you tell us something about recidivism and the observations of your research on the drivers of reincarceration amongst women?

We recruited 400 women to follow up after they left prison, and we were able to stay in touch with 100 of them over time. We collected very detailed data about their lifestyles, families, reasons for incarceration, drug use, health, etc. When we looked at all those considerations, one by one, and then together we found that access to basic primary health care, for example a family doctor or dentist, was one of the most important factors for successful re-integration after prison release. This is important because primary health care falls within the healthcare sector, and it's something that we should be able to give everyone. People coming out of prison don't have their prescriptions filled and often don't have their medical insurance cards with them anymore. Many have chronic health problems that have been neglected in prison and they are ill and hurting. People using crack have damaged teeth from the crack pipes and dental pain becomes a reason for them to seek narcotics when what they really needed was access to a dentist.


What in your opinion would be a game-changer to reduce reincarceration among women?

In addition to the provision of primary health care, dealing with trauma would definitely be a game changer. Participation in the drug trade is one of the reasons that people are sent back to prison but very often it’s about survival - that is the only way they can make money. As well they are using because of underlying trauma and psychological pain. Most of these women have histories of neglect and abuse going back to when they were preschoolers. There is no point in trying to treat addiction unless you treat their trauma. In other words, if you can treat the trauma, you can treat the addiction; if you can treat the addiction, you're treating the crime; if you're avoiding the crime, then you can get someone in stable housing and start talking about personal growth, including education and health.


Do we have enough research on pregnancy and delivery outcomes in prison?

Absolutely not. In Canada, we don't even know how many children have mothers in prison. We have almost no data at all. There is more data in the U.S.

Are there any specific factors in this group that would put them at a higher risk for maternal or perinatal complications?

Yes. These are people that have lived on the street and neglected primary health care. For example, lack of screening for cervical or breast cancer, chronic hypertension, poorly managed diabetes, untreated infections, etc. So, they start pregnancy having not had good health their entire life. In addition, some of them enter the pregnant state still using various drugs and alcohol, not eating, or sleeping well. All these factors put them at a higher risk for maternal and perinatal complications.


Is there any research that you would like to conduct regarding pregnancy and labor management in women who are incarcerated?

One of the important aspects of pregnancy is to realize that this is a time when women are receptive to change and they really want to keep their baby, rather than have their baby taken away from them. BC Women's Hospital has made huge contributions in this area through the chemical dependency module where pregnant women using drugs have a choice of withdrawing or reducing their drug use under supervision without any judgement. This isn’t necessarily a population that have been incarcerated but certainly many of them have. The goal is to give women the kind of care and respect that any person deserves, to support them and make things easier for them. What we have learned through the support offered at BC Women’s was that women responded well to treatment in a stable and safe environment and family members started to come back into those their lives. This was especially important for women who were not able to look after their babies themselves, because the babies still went home with a family member - a sister, an aunt, a grandparent. The baby went back into the family with some hope that the mother and child relationship would grow over time.

Related to that, I have a graduate student, Esteban Valencia, who is currently doing what I think will be very important research. Recently in our provincial prisons, the provision of medical health services provided by individually contracted doctors was replaced by the Provincial Health Services Authority (PHSA). In the old system, the contracted doctors were not necessarily linked with other resources outside the prison and therefore detailed follow-up of individuals after release from prison was out of their scope. Sentences in provincial prisons are short - two years less a day. Often, they are only two or three months long, and so women don't get a chance to really benefit from programs.  So, there must be very robust follow-up for people coming out for programs for them to be impactful. Involvement of the PHSA is very important because it means that appropriate discharge planning can be done, and women being released can be connected with resources that they will follow up with after their release. Our current research is going to focus on the longer-term health status of women released from prison, before and after the transfer of health care in prison to the Provincial Health Services Authority. We will be looking at how they reintegrate into the community, whether they retained custody of their children, whether they reconnected with their children, etc.


How long should women be followed-up after release from prison?

Well, it should be indefinite - as long as they need it. How long does it take to recover from trauma? It takes a lifetime. Currently, some of the treatments for cognitive behavioral therapy are one-on-one, they take a long time, and are expensive. We don't have the resources and we don't even have the people to provide that level of care. But if you think about the cost to society - it's always going to be cheaper to help someone than to have them revolve in and out of prison. Besides, the effects are intergenerational. So, by helping a mother we are affecting the lives of her children and her children's children.

How easy or difficult do you think it would be to follow-up with the women in your research after their release from prison?

Well, we haven't really tried it with a population of women that have had proper follow-up as soon as they leave prison. When women come out of prison, they are given a garbage bag to put their clothes in and a taxi voucher to be dumped at the bus stop. At that point they don't even know where to go. Their families don't necessarily want them back and they have nowhere to live and have no income. They may not have their ID cards with them. It also needs to be stated that Indigenous women comprise about 5% of the pregnant population and 50% of the women in jail. So, we need to work with Indigenous helpers to address societal issues that go way beyond just health.

I would say that people go to prison when our health care system and our social services network have failed them - and they are failed before they even go into high school. We see children in the health care system when they come for immunizations as infants, and then it's a black hole from there until they get into kindergarten or elementary school.  This is complicated by the fact that British Columbia covers a vast rural area where it's very difficult for public health to keep tabs on at-risk families. A lot of Indigenous people live in places where they don't have internet or reliable road access in the winter. How are you supposed to know if a mother is not coping well or if she or her children are being abused, and how are we going to help them?

Your research on the use of peer health mentorship (PHM) for the Unlocking the Gates (UTG) program showed that PHM expertise has a role in improving the health and well-being of people leaving prison during COVID-19. Is a similar program available for pregnant women released from prison?

There isn’t a follow-up program specifically for pregnant women.  There was a program in BC where women could have their babies with them in prison and that is a model that takes place all over the world. This program was an eye-opener for many women in prison since most of them had never seen a baby cared for properly. So, when they saw women with their babies getting support and guidance for how to be a mother, they felt motivated to go out and search for their children after release and try to renew their relationships with their family.

Women don't deliver babies in prison ever. If they go into labor or need medical attention, they come into hospital to have their babies; but they are sometimes shackled to the bed when they're in hospital - and sometimes even in labor. It's an extremely humiliating and horrifying experience for them. Also, they're going through labor not knowing if their baby will be taken away from them immediately when it's born. So, it's quite unbelievable how we treat women – these are women who have not committed serious crimes. They are in provincial prison for things like being in the drug trade, theft under $5,000, breach of their parole conditions, etc. What is the purpose of such treatment? As a society do we need to be protected from these women? I don't think so.

As founder of the SmartMom program, do you think it has a role to play with pregnant women being released from prison?

I think SmartMom has a role to play, but the question is whether they can access some of the things that they need. For example, the program tells women when they need to go to appointments for key screening tests, etc. But how are they supposed to do what the program recommends if they don't have a doctor, a car, bus money, can't afford prenatal vitamins, etc.? It recommends exercise, but do they have anywhere to exercise? There's a lot of information about food and calcium, but can they afford to buy milk? Sometimes a lot of women have phones but then they can't pay the bill for the phone. So, SmartMom isn’t enough. They would need help and support to follow the guidelines in the program.

What inspired you to become a part of the THJRC?

I believe that the women that we serve are not defined by the fact that they've been in prison. These are the same women that live in poverty, that work in the sex trade, but may not have been in prison. They're all people who have been disadvantaged since youth, and they expose the cracks in our society. They are the people that fell through the cracks, whether they get in prison or not. As a labor and delivery nurse, I have worked for 25 years with people who had no one to advocate for them. As an example, the first paper that I published on the topic of women coming out of prison, I received hate mail - frightening hate mail - from the public who simply wanted these women to be put out of sight forever. This just galvanizes me to work harder. We need to deal with these misguided understandings of what these women are about. This could happen to lots of people, including someone in our family. We simply can't take a ‘we-they’ approach. These people are part of our surroundings, our culture, our society, and we're stronger as a group if we take care of them and help them and understand how they got where they are.

First Nations land acknowledegement

We acknowledge that the UBC Point Grey campus is situated on the traditional, ancestral, and unceded territory of the xʷməθkʷəy̓əm.

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