The Compounding Effects of Disasters and Confinement on the Mental Health of Incarcerated Women

Publication Date: 2024

Abstract

Incarcerated people are often invisible in disasters. Incarcerated women are routinely erased in studies and materials about prisons, including in emergency management and public health. To help address this gap, we explored the unique impacts of disasters on incarcerated women and gender minorities through four focus groups with thirty-six people who were formerly incarcerated in Texas women’s prisons. Research participants discussed hazard events they experienced while incarcerated, prison practices and processes during disasters, and how these events impacted their mental health during and after incarceration. Experiences with hazards and disasters have particular detrimental and lasting mental health impacts on incarcerated women and other gender minorities. Hazard risk is exacerbated by the restricted autonomy, dehumanization, and punishment of collective care that characterize daily life in prisons. Our findings have policy and practice implications for public health, emergency management, and prison management, including the need to provide the following services to incarcerated women and gender non-comforting people: (a) mental health support before, during, and after disasters which recognizes that incarcerated women and gender non-conforming people experience r stresses and trauma during acute disasters that are compounded by the daily acts of negligence and violence in prison; (b) ongoing support services including continuity of medical and healthcare services to formerly incarcerated women and gender non-conforming people; (c) stronger safeguards against sexual violence in women’s prisons (d) hazard information and resources tailored to incarcerated individuals with disabilities; (e) communications protocols and risk information programs that convey timely and accurate information during disasters and ensure incarcerated individuals can communicate with family and loved ones for emotional support and additional safety information; and (f) emergency preparedness programs that recognize the unique resilience and contributions of incarcerated women and gender non-conforming people and include them in the development of emergency plans and policies.

Introduction

Incarcerated people are highly vulnerable to disasters due to a combination of limited medical care, overcrowding, over policing, and limited access to resources, among other factors (Purdum et al., 2021¹). Incarcerated individuals are known to have a higher prevalence of chronic diseases including diabetes, hypertension, asthma, and mental health disorders (Puglisi & Wang, 2021²). While incarceration may not be the origin of these health problems, it has been known to exacerbate such conditions leading to worsening physical and mental health (Goomany & Dickson, 2015³). The overcrowding and confined nature of carceral facilities can significantly limit access to healthcare and other necessary resources.

The security classification that an incarcerated person is given can also impact their access to resources when exposed to hazards (Purdum et al., 2022⁴). Custody levels range for the general incarcerated population from 1 to 5, with each designation indicating the level of staff supervision required for the incarcerated individual. For instance, G5 stands for “close custody” in which incarcerated individuals must reside in single cells and can only work outside the security fence under armed supervision. G4 indicates “medium custody” which places individuals in a cellblock with a cellmate and allows them more freedom to move around at limited times in dayrooms and rec yard. Incarcerated people with G3 or G2 designations are allowed to live in dorm settings and are able to work more jobs, walk the unit, go to the chow hall, and attend school. Individuals with G1 designations are considered trustees who can live and work outside the fence. No matter their custody level, incarcerated people’s ability to take protective actions on their own is limited as they must rely on prison staff to facilitate access to essential services (Gaillard & Navizet, 2012⁵).

Carceral emergency planning policies and practices are marred by major shortcomings and injustices (Purdum et al, 2021; Purdum, 2019⁶). To begin, existing plans tend to focus on using incarcerated people as an emergency labor source (e.g., as firefighters) or on the risks that prisons could pose to the larger community due to escapes, riots, or protests (Purdum, 2019; McCullough 2006⁷). There is little to nothing in existing plans about protecting incarcerated people from harm or providing resources to cope with disaster impacts (Purdum et al., 2021; Purdum, 2019). The rural location and isolation of many prisons further complicates disaster preparedness and response (Gaillard & Navizet, 2012). For example, the most current guide published by the U.S. Department of Justice and National Institute of Corrections for preparing for and responding to prison emergencies recommends that prisons plan for “desert island operations” where prisons may have to operate without contact or assistance from the outside world for an extended period of time should a disaster occur (Schwartz & Barry 2005⁸). There are currently no comprehensive legal requirements that force prisons institutions at any jurisdictional level to have certain emergency plans, only guidance that institutions should develop plans for certain emergency events (Robbins, 2008⁹; Schwartz & Barry, 2005).

There are significant gaps in the existing literature on disasters and incarcerated populations, particularly in understanding the mental health impacts of disasters on incarcerated people as well as how intersecting identities such as race, gender, socioeconomic status, and disability status influence their disaster experiences. Existing studies tend to focus on the incarcerated population as a whole, overlooking the vulnerabilities experienced by incarcerated women and other gender minorities. These vulnerabilities may include existing history of trauma, sexual assault, victimization, and caregiving and familial responsibilities, which the carceral system fails to address (Karlsson & Zielinski, 2020¹⁰). Transgender Individuals assigned male at birth in women's prisons face heightened vulnerability due to potential discrimination, lack of continuous medical care, and increased risk of violence and harm (Rodgers et al., 2017¹¹). Research has shed light on the ways disasters disproportionately harm the mental health of vulnerable populations—including women, other other gender minorities, children, and older adults (Enarson & Morrow, 1998¹²; First et al., 2017¹³). There is a lack of research, however, on the long-term ways that disasters affect the mental health of incarcerated women and other gender minorities even after the completion of their sentences.

Addressing these gaps requires intersectional approaches that consider the multifaceted identities and experiences of incarcerated women and other gender minorities to develop more effective mental health support and disaster response strategies. Women have different needs in disasters and have been shown to navigate recovery differently than men (Akerkar & Fordham, 2017¹⁴). This study seeks to address existing gaps in literature by focusing on incarcerated women and other gender minorities’ experiences with evacuation efforts and related decisions in disasters. Incarcerated women and other gender minorities are routinely ignored in research efforts as the experiences of incarcerated men are often treated as the default incarcerated experience. Braithwaite et al. (2005¹⁵) described prisons as spaces “created by males for males in which the diverse needs of women are forgotten and neglected” (p. 1680). Through focus groups with individuals formerly incarcerated in Texas state facilities who had experienced disasters and evacuation processes during their incarceration, this study aims to explore how carceral processes, policies, and contexts shape the mental health impacts of disasters on incarcerated women and other gender minorities.

Literature Review

Disaster Planning and Response for Carceral Facilities

Incarcerated people are isolated both geographically and socially (Gaillard & Navizet, 2012). Prisons have intentionally been placed in rural communities due to the low cost of land and to isolate prisons from highly populated urban areas in the name of public safety (Freeman, 1996¹⁶). Most prisons in the United States were built without duly considering their proximity to natural or technological hazards (McCullough, 2006). Furthermore, their stigmatization and isolation from the general community leads to them having restricted access to emergency resources (Gaillard & Navizet, 2012). Prisons and incarcerated people are perceived by decision-makers as disconnected from the host community, so the needs and experiences of incarcerated people during disasters are not prioritized within the community at large (Dement, 2023¹⁷).

That said, previous research by this team has shown that prisons and corrections officials engage with local emergency response agencies—including fire departments, emergency medical services (EMS), emergency management, and public works—for disaster response and recovery operations (Purdum, 2020¹⁸, 2023¹⁹). Evacuation has emerged from our investigations as an issue urgently needing more research and policy attention because of the ways it puts incarcerated people at undue risk. This is owed in part to the fact that the carceral system relies on local agencies and organizations to assist in response and evacuation, overburdening systems with limited capacities that are already strained by the demands of other residents. As evacuations become more frequent in the era of climate change and increased frequency of disasters, emergency response and correctional officials are under heightened scrutiny when deciding whether or not to evacuate incarcerated people (Purdum, 2019). In 2017, for example, the state of Florida initiated their largest evacuation of prisons in the state’s history and evacuated approximately 7,000 incarcerated people in the days before Hurricane Irma made landfall. The next year, the state chose not to evacuate incarcerated people in the days leading up to Hurricane Michael. Only after the storm made landfall and facilities were seriously damaged did the state evacuate prisons. Reports described incarcerated people trapped in “chaotic and deteriorating conditions, including destroyed dormitories, power outages, and limited supplies of food and water” (Sacks, 2018²⁰).

Evacuating Incarcerated Women and Other Gender Minorities

When prisons evacuate, they send their incarcerated people to similar facilities that meet their specific security and medical needs. There are significantly fewer women’s prisons in the United States than those for men, leading to very small set of options for evacuation locations. Prison officials have acknowledged that incarcerated women have different needs than men during prison evacuations (Wilson, 2020²¹). Yet, it remains unclear what those needs are because the voices of incarcerated women and other gender minorities are overlooked in news media coverage in favor of institutional voices.

Similar to what is seen with residents of rural communities, increased mental health challenges may be faced by incarcerated people during and after disaster, especially among women. Existing research suggests that women in prison often have higher rates of mental health disorders compared to incarcerated men (Maruschak et al., 2021²²; Edison & Haynie, 2023²³). Incarcerated women often have a history of trauma and victimization, including experiences of physical or sexual abuse and domestic violence (Karlsson & Zielinski, 2020). For mothers, mental health issues can be exacerbated by separation from their children. Social networks developed in prisons play a crucial role in providing emotional support, fostering connections, aiding in rehabilitation, and improving mental health outcomes (Edison & Haynie, 2023). Evacuating prisons can result in relocation away from these social networks, children, family, and friends.

Incarcerated evacuees are typically evacuated to gymnasiums or other open spaces that serve as shelters, places which are often disconnected and isolated from resources needed to meet their basic needs and address mental health challenges associated with evacuation. Reports have shown that communication is a challenge during evacuations, for example, because the receiving facility may not have telephones available for the evacuees to contact their loved ones (Purdum, 2020). Incarcerated evacuees have also reported lacking access to basic resources such as potable water, food, medical care, clean clothing, and bedding (Wilson, 2020; McDonald, 2018²⁴; “Officials break ground”, 2022²⁵). Incarcerated people instructed to “shelter in place” during disasters, rather than evacuate, have also faced serious risks as the prisons where they are left can be cut off from resources for multiple days and exposed to direct hazard impacts.

Regarding mental health impacts of disasters, research shows that disasters and evacuation can trigger acute stress reactions or lead to the development of post-traumatic stress disorder (Neria et al., 2008²⁶; Lee et al., 2020²⁷). Evidence also suggests that women have a heightened risk of negative mental health outcomes following disasters (Bromet & Havenaar, 2002²⁸). A lack of access to resources or mental health support can exacerbate these challenges. Understanding and addressing mental health during disasters is vital for both individual and community capacity and resilience building.

Large scale disaster-related evacuations of women’s prisons have happened around the country. In 2016, the Louisiana Correctional Institute for Women was evacuated because of concern about potential flooding. News reports stated, “in the weeks after the flood, the rainwater inundated the prison and destroyed the facility” (“Officials break ground”, 2022). Texas has a history of prison evacuation due to hurricanes and flooding events. There are currently 15 state facilities housing incarcerated women and other gender minorities in Texas. Incarcerated women spoke to news outlets about the significant impacts to their health and safety by not being evacuated during Hurricane Harvey even though similarly impacted men’s prisons were evacuated (McDonald, 2018).

Research Questions

This study focused on formerly incarcerated women and other gender minorities in Texas who had experienced prison evacuations. We sought to explore the challenges they faced and elevate their perspectives. Working with our community partner, Lioness Justice Impacted Women’s Alliance, we identified four research questions to guide the study:

1. How do incarcerated women and other gender minorities in women’s prisons experience disasters?
2. How do their disaster experiences impact their health?
3. What role do carceral processes, policies, culture, and environment play in shaping hazard risk in prison contexts?
4. How do incarcerated women and other gender minorities cope with disaster impacts?

Research Design

We used qualitative methods to explore how incarcerated women and other gender minorities experience disasters. We chose focus groups with formerly incarcerated women and other gender minorities as our primary data collection method. In addition to providing rich data, existing literature shows that focus groups also provide participants with an opportunity to connect with others and experience feelings of social support and empowerment (Peek & Fothergill, 2009²⁹). By employing qualitative methods, we aimed to unravel the intricate interactions between rural locations, limited resources, and disaster related protocols and procedures. By engaging formerly incarcerated women and other gender minorities, we sought to understand the unique challenges and barriers encountered during disasters. Additionally, we investigated the repercussions of these experiences on the mental health of incarcerated women and other gender minorities, acknowledging the potential trauma and stress induced by disasters.

Research Team: Partnership Between Researchers and Local Collaborators

Our transdisciplinary team is composed of experts in public health, urban planning, transportation, and individuals with lived experience in the Texas state carceral system. Lioness Justice Impacted Women’s Alliance (“Lioness”) is an organization led by currently and formerly incarcerated girls and women in Texas with the purpose of ending the incarceration and systematic devaluing of the girls and women within the criminal legal system. Through radical advocacy, education, community engagement, grassroots organizing, and legislative action, Lioness works to achieve a society where girls and women are spiritually, emotionally, mentally, and physically free from all forms of violence and harm in the criminal legal system. Lioness is a membership organization, open to anyone who identifies as a current or formerly incarcerated girl, woman, or gender-expansive person. There are no membership fees or other requirements (Lioness Justice Impacted Women’s Alliance, n.d.³⁰).

A team of Texas A&M researchers has worked closely with Lioness members for approximately two years. Our collaborative work includes collectively presenting a panel, “Centering the Needs of Incarcerated People in Disaster Risk Reduction,” at the 48th Natural Hazards Workshop. Lioness members have also engaged with Texas A&M students through research and on-campus presentations.

On this project, Lioness members were co-collaborators from the start, playing an integral role in establishing and maintaining trust with research participants, providing cultural insights, and ensuring that the research aligned with the needs and priorities of the community. Lioness members led participant recruitment and assisted with developing focus group questions. Focus groups were moderated by Lioness staff with support from the Texas A&M faculty and students. Lioness-trained peer support staff participated during the focus groups to provide emotional support and ensure a safe environment. Lioness staff also assisted in the data analysis, development of the final report, and will be directly involved in future peer-reviewed journal articles, policy briefs, support documents for current and formerly incarcerated people, and other project outcomes.

Focus Groups

Focus Group Recruitment and Selection Criteria

One primary mission of Lioness is fostering ongoing connection among and support for formerly incarcerated women and other gender minorities, including participants in this study. Thus, leaders within the organization led the recruitment and leveraged their extensive networks and existing relationships and trust with potential participants. The Lioness leadership team identified members of their organization who have experienced disaster and hazard events in Texas, including but not limited to hurricanes and flooding (two of the most common hazards in Texas), and recruited research participants in various ways, including sending invitations via email, through direct contact during interactions with members, and with flyers posted at transitional housing where formerly incarcerated women live. As discussed above, Lioness is focused on the Texas criminal legal system and thus focus groups were all conducted in Texas and focused on participants’ experiences during hazards and disasters in Texas facilities.

The selection criteria, which were outlined on the recruitment materials, were that participants be 18 years of age or older and “a formerly incarcerated individual who has experience with hazards/disasters while incarcerated in a women’s facility.” The recruitment materials also explained that the goal of the focus groups was to hear participants’ “experiences with hazard/disaster evacuations and health outcomes as incarcerated women.” All participants volunteered either through the contact information provided on the recruitment flyers or via direct communication with the Lioness research team members. All participants had been incarcerated in Texas facilities. To ensure the confidentiality of the participants and their anonymity in any documentation of the project, we did not collect demographics or specific incarceration information from them, including reason or duration of incarceration or the specific facility or facilities at which they were incarcerated.

Focus Group Guide

Our research questions and focus group guide were co-developed with formerly incarcerated women who lead Lioness. The guide had nine categories of questions: experiences with evacuation, communication, punishment, healthcare resources, disability and chronic illness, mental health, race and gender, and an understanding of the needs and wants of incarcerated women and other gender minorities related to evacuations. (The full focus group guide is available in the Appendix.)

Protection and Care for Participants

Due to the focus groups' sensitive nature and the participants' vulnerability, our team wanted to keep the groups small, and limited participation to 10 or fewer people per group. Prior to the start of the focus group, all potential participants received a clear and comprehensive explanation of the research objectives, methods, and potential risks and benefits. This information was provided to each potential participant via handout and discussed verbally before the start of each session. They were informed that their participation was entirely voluntary and that they had the right to decline to participate or withdraw from the focus group at any time during its duration without any consequences. Participants were also told their comments would be anonymous and not be linked to their names in the transcripts.

This research design was co-developed with Lioness, ensuring that each part of the process was completed with the greatest likelihood of minimizing risk to this already vulnerable population. The research team included a trained peer support specialist with lived experience. This individual provided support and coping strategies during and after the focus groups. Additional information about support services was provided to participants at the end of each focus group. This study was approved by Texas A&M University Institutional Review Board (STUDY2023-0034).

Focus Group Sample, Setting, and Other Details

We conducted four focus groups, each with eight to 10 participants, between February and April 2024. A total of 35 formerly incarcerated women and one person identifying as non-gender conforming participated. Three focus groups took place in person in the cities of Bryan/College Station, Austin, and Weatherford, TX; one was held over Zoom. Table 1 describes the focus group sample for each of the four focus groups. All participants experienced at least one hazard or disaster and multiple participants experienced an evacuation while incarcerated.

Table 1. Focus Group Sample

All sessions were recorded using audio recorders. A Lioness-trained peer support person participated in the focus groups to provide a trusted and relatable presence, fostering a more comfortable and empathetic environment to share experiences. To facilitate ease of participation and alleviate barriers, participants in the in-person focus groups were provided with food, childcare services, and received $75 for participation (including travel to and from the focus groups) in the focus group sessions. Participants in the online focus group were sent $75 via the online money transfer platforms of their choice for food the evening of the focus group.

Data Analysis Procedures

Following each focus group session, we transcribed the recordings manually, ensuring accuracy and capturing the nuances of participants' experiences and perspectives. Thematic analysis was used to identify recurring themes and patterns related to the challenges faced in women's prisons. We also explored the physical, emotional, and psychological toll of these evacuation experiences on the health of incarcerated women and other gender minorities.

Findings

Broad Hazard Exposure Compounded by Systemic Neglect in Prison

Our findings revealed that participants were exposed to a variety of hazards that have been reviewed in disaster literature relating to prisons and incarcerated people such as extreme temperatures (heat and cold), flooding, hurricanes, structure fires, tornados, winter storms, vermin infestations, and the COVID-19 pandemic. However, as Table 2 shows, incarcerated participants described additional hazards as important to address in terms of protecting their physical and mental health including ongoing mental health crises, sexual violence, interpersonal violence, and violence from staff. This was an important finding in that when discussing disasters, incarcerated participants described hazards more broadly in terms of the unique threats within the carceral environment that threatened their health and safety.

Table 2. Hazard Events Experienced By Participants While Incarcerated

Throughout the focus groups, participants emphasized that their hazard event experiences while incarcerated did not feel that different from the dangerous and harmful conditions that they experienced every day in prison. Systemic failures made neglect and violence a routine aspect of prison life and exposed them to crumbling infrastructure, physical and sexual violence, sexual harassment, unattended mental health crises, and much more. Participants frequently described every day in prison as if it were an ongoing disaster. As one formerly incarcerated woman stated:

To us disasters are not just tornados and fires [which we had plenty of those] but the disasters on the unit like COVID or illness or disease or vermin, the infrastructure, the conditions, the confinement, the heat… So as all this stuff is happening.

Incarcerated People’s Loss of Autonomy Intensifies During Disasters

Limited Ability to Take Protective Actions

Many traditional emergency management frameworks assume people are able to take personal responsibility for protective actions. Incarcerated people lose much of their autonomy due to their incarceration—disasters intensify that loss of autonomy in multiple ways (Purdum, 2019). Principally, incarcerated people lose their ability to protect themselves by fleeing from sites of danger. Focus group interviews revealed in detail that the severe restrictions on incarcerated individual’s autonomy creates significant risk for their health and safety in hazard contexts. For example, participants across focus groups described experiences with fires in their cells and the terror of not being able to get out to save themselves. One participant described how she and others were left in their dormitory as it filled with smoke from an electrical fire until the fire department arrived and ordered the staff to evacuate the women:

It was a fire… They didn't evacuate us for the fire until the fire department came. And the fire department came. Those men came in and the dorm is full of smoke…I'm in my cell and it's here... We're covering our mouth and the firemen come in with all the ranking officers… and the firemen said, "Why are they still in their cells?" And that's when whoever the ranking officer said, “Get them out, get them to the gym.” And that's when they decided to evacuate us. We would have just died.

One participant described the intense fear and anxiety she experienced when a small wildfire erupted nearby her unit, knowing that she was powerless if it were to overtake the prison. Other participants in the focus group affirmed her experiences as they too had felt that intense fear and anxiety, wondering if they would live or die, especially around unit fires:

Participant 1: There was a field fire right next to our unit. And we just sat there watching it burn, you know… and come closer… I remember seeing it and I was like the fire is gonna get really close…

Participant 2: It’s scary.

Participant 1: And then about an hour or two before the fire department came, but it was really close to the unit. And I'm just… Just sitting there feeling that this could be the end and just being helpless in it. You know there's nothing I can do. I can't run out. You know, I can't. We can't call for help. We just gotta take it.

Participant 3: Wondering if cinder blocks burn? Like do cinder blocks burn? Yeah.

Participants described particular fear and anxiety around hurricanes and whether or not they would be evacuated by the administration. One participant described the trauma of experiencing a failed evacuation of her unit where the prison prepared the women to be evacuated but then changed their minds leaving the women to ride out the storm in their unit:

There’s a hurricane coming and we see on the news that people are evacuating. The major… She came in and she handed out chain bags and she said you need to pack light, pack whatever is the most important thing in your box and we’re evacuating… We’re like, where are we going? This is so wild. I’ve been gone for 10 years and I’m fixin to evacuate. Like, this is so crazy to me. She came in. You know as a major she leaves at like 5 o’clock or whatever and she came in towards the end of the day and she just almost had tears in her eyes. She had this sadness and she said ahh we all were in the day room with like 52 ladies so she said, ‘Ladies, I’m so sorry they are not evacuating.’ … I remember thinking holy shit I’ve been gone from my family for this long and we are fixing to get [hit] by a damn hurricane…like we’re not leaving? We had been seeing vans… We just knew we were leaving. I just remember that feeling of yeah…they didn’t know what to do with us. They didn’t have anywhere for us to go and they wanted to evacuate us. And so it was…it was pretty crazy…it was pretty crazy. It felt ugly…

Limited Access to Hazard Risk Information

Prison administrators and staff often do not share timely and accurate information with incarcerated individuals in emergencies and disasters (McCullough, 2006). Participants in our study described experiencing restricted access to relevant emergency information while incarcerated. They are allowed limited phone call access to persons on the outside while cellphones are designated as contraband. Access to the internet is strictly prohibited (Zoukis, 2016³¹). Multiple participants described prison administrators and staff withholding information during disaster events and other crises. This withholding of information was traumatic in that it caused significant fear. One incarcerated woman described how during the pandemic, staff did not tell anyone in her unit anything about the pandemic:

They were keeping it a secret, and the unknown is what's scary. And knowing that people were dying and how bad it was, they were talking about, like, out here in the world, I just couldn't think, but it helped to think about my family. They're fighting for toilet paper, fighting for water, fighting for, I'm like, what is going on? And the laws [guards] weren't trying to give us peace of mind, nothing. They were just, I don't know, keeping us in the dark… I think that if they would have just been more open and upfront in telling us, like, they could have contained it a little bit more, or maybe the inmates wouldn't have been so scared.

Another participant reflected that the systemic refusal by prison officials and guards to share accurate and timely hazard risk information—whether it be about extreme heat, hurricanes, or the pandemic—was another way to reinforce the social hierarchy within the prison and make incarcerated people feel dominated and helpless.

Well, ‘cause there’s the fear of the unknown. If you at least let me know what I’m dealing with I can make a plan. We can make a plan with each other… To me, it was another way of [having] power over us, to let us know how helpless and out of control our lives were, and to be dismissed.

Incarcerated women described how in a disaster, the prison adminstration may intentionally cut off access to information and the outside world. For example, one participant described how when preparing for an evacuation, her prison’s televisions and phones were shut down.

So, they cut the TVs off, they cut the phones off and we packed up with our chain bags and we sat there for hours and we’re just waiting and we’re not knowing, and we are not seeing the news and we see the weather is ugly outside.

In response to discussing how prisons would do this during emergencies, another participant described experiencing a similar situation while she was incarcerated at a county jail impacted by severe winter weather.

I just remember… there was no water for the last 2 days I was there and the pipelines were frozen… We had no water for 2 days, the phones were cut off like you said. So, we couldn’t contact the outside, like our families, to let them know, “hey we’re dying in here, we’re actually not ok.”

Abandonment and Neglect

Multiple participants described the ways the prison system neglected and abandoned them during hazard events. This included incidents when prison staff deliberately left incarcerated women and other gender minorities in harm’s way without any way to protect themselves. Several participants, for example, mentioned being abandoned by staff during a tornado. The staff members fled their posts to find a safer place to shelter, leaving the incarcerated women and other gender minorities for whom they were responsible unable to do anything except cover themselves with their mattresses. As one woman recounted:

We had a really, really scary bad tornado… And I remember hearing the sirens go off in town… And I remember the Warden screaming over the walkie talkie, “Get those women under their beds now!” … and the [guard] was in the picket [guard post] and she ran. She left! She left the picket! She said, “I'm not doing this shit.” Like she left us. And I remember just like burying myself underneath the metal bed with my mattress. And just hearing the weather outside and being absolutely terrified… I can distinctly remember all of the feelings and the way the staff kind of abandoned us… just pure panic at that point.

Multiple participants described how disaster events caused shortages in prison staff that left incarcerated women and other gender minorities without access to basic necessities or ways to care for themselves. During the Winter Storm Uri in 2021, for example, the participants described being largely left to suffer the life-threatening cold without support or care from the prison system. As one participant said:

During like the ice storm… we was left to fend for ourselves… due to like, shortage of officers and stuff… It's like basically, fend for yourself if you weren't one of the fortunate ones who had like extra blankets and stuff. And it became… what do we do now? … We're kind of helpless… When you're housed, everything is being brought to you. It's not like you could just go out and try to hustle it or fend for ourselves… it was kind of like a fearful experience... They treat us like animals… Like, we're not human beings and it's like another world where it's like they actually just forget.

During Winter Storm Uri, 32 prisons lost power and had to rely on generators, and 33 facilities experienced low water or lost external water sources, relying on backup supplies (Moritz-Rabison, 2021³²). These conditions may have exposed incarcerated individuals to life-threatening temperatures while short staffing resulted in minimal access to resources such as blankets. Lack of access to water may have led to dehydration and unsanitary living conditions, as toilets could not be flushed, and there was no access to clean water for drinking or hygiene.

Gendered Dehumanization and Trauma

Participants described how their experiences while incarcerated in women’s prisons were uniquely gendered. This has significant impacts on how they are impacted by hazards while incarcerated. One participant described how they were forced to strip naked for a security search before they could be loaded onto the evacuation bus.

Participant 1: I think the most traumatic experience I had, well one of the most traumatic experiences I had was when they told us at midnight to get up and pack all of your shit. They had cut the phones off, it’s pouring down raining. It was like a tsunami was coming through. Then all of a sudden the officers just come in the dorm, the lights is off, the phones is off, everything is off and they just start calling out bed numbers…. So they calling all these people to go to the day room, “pack all of your stuff.”... So everybody is asking where we going? Where am I going?... “Ain’t your business just pack your shit and get in the day room!” I was like, what the hell? It’s dark outside, it’s pouring down raining… You don’t know where you’re going and it’s about to get soaked. They don’t give you anything to cover up and I’m like what the hell is going on. You go through the strip shack, they make you get naked, go out, get on a bus and we still don’t know where we going.

Participant 2: They made you get naked?

Participant 1: Yeah. Stripping going through.

Strip searches are regularly conducted in prisons on all incarcerated individuals, but this instance was singled out by participants as a particularly socially and psychologically violent occurrence to hear that a woman had been forcibly strip searched in the midst of an emergency significant enough to warrant an evacuation. Previous research has described how security protocols in prisons can deter efforts to protect the life and safety of incarcerated people and staff during disasters (Gaillard & Navizet, 2012). However, security measures during disasters also inflict trauma, as strip searches in the carceral environment have been described as “state-inflicted sexual assault” as they do not require consent and any incarcerated individual who resists can face punishment and other negative consequences (Hutchison, 2020³³; VanNatta, 2010³⁴).

Another participant described traumatic experiences of being evacuated from her coastal prison to a men’s prison unit along with other incarcerated pregnant women leading up to Hurricane Rita. Not only did she experience medical neglect when she went into labor, but she and the other incarcerated women were sexualized by staff and incarcerated men:

I was at [a women’s] unit. There was a hurricane coming towards Galveston. Nine months pregnant, 2 days past my due date. They shipped us to [a men’s unit]. [They] did not know we were coming. There were men everywhere and they brought us down the halls and told them to turn around and they didn’t. It was awful. We were there for 4 days. It was Rita, the hurricane hit Louisiana. It didn’t even hit us but they thought it was gonna hit Galveston until the last minute. God they were nasty. They didn’t bring us food to the dorm where we were at. They took us first and marched us through all of those men. I’m shaking all over. They made them stand outside the chow hall and watch us eat…a bunch of pregnant women. We got back…we finally went back to the unit and the hospital […] had been closed too. I got back and they got us back to our rooms and we laid down and I went into labor and my water broke. And it was count time and they didn’t have us all unloaded. And I was there what like 4 hours before an ambulance finally came and got me.

Evacuation is meant to be an action that protects people. However, as in the example described above, without consideration for the vulnerabilities of incarcerated women and gender minorities who experience high rates of sexual violence while incarcerated, emergency management processes may inflict further trauma and make vulnerable populations at further risk.

Enduring Impact

Participants described these experiences as having lasting impacts on their mental and physical health as well as social cohesion and ability to build relationships and connections to family and friends after leaving prison. Multiple interviewees, for example, mentioned that the neglect and trauma that they experienced in prison left them with feelings of constantly being on edge and hypervigilant about their surroundings. As one interviewee said:

I think that when we are constantly, you know, trying to survive every day. Whether it’s a hurricane, or a tornado, or it’s the fucking gross male staff that’s on third shift. It was every day surviving something, and once your brain clicks into that it won’t turn off. Like… it’s that hypervigilance that… some shits about to happen, some danger is here and nobody’s going to protect us but ourselves. I can’t… I live constantly out here with the struggle of that.

Other participants talked about the repercussions for their mental health and their families of not having resources once they left prison to cope with the trauma they experienced when they were inside. The quote below shows how one formerly incarcerated woman needed to disconnect emotionally from her environment while in prison, but that doing so has led to her remaining disconnected emotionally once she re-entered her community, inhibiting relationships and how she regulates her emotional state:

Looking back on some of this stuff… There’s a part of me that’s disassociated from it… like I survived it with just blocking it out… Not having any feeling about it, using a lot of dark humor, that helped me get through. But I’ve noticed the things that I do out here, making connections to those really difficult moments in prison when this stuff happens and how it has affected the way that I leave and deal with my emotions out here.

Resilience Through Care and Community

Prison rules and guard biases prevented incarcerated women and other gender minorities from caring for one another in their day-to-day social interactions in prison as well as during hazard events. Multiple participants described how physical contact and affection among incarcerated women and other gender minorities was constantly sexualized by staff and strictly punished. According to advocacy organizations, this is a common experience among incarcerated persons as policies that are intended to penalize non-consensual touching are weaponized or misused by prison staff against consensual or platonic touch (California Coalition for Women Prisoners, 2021³⁵). One participant, for example, described how women would get in trouble for lying down together to keep warm in freezing temperatures, “I couldn't sleep. Everybody was shivering … I remember some of our friends got caught because they would, like, lie with each other to keep warm. But it was terrible.” Regardless of the risk of a disciplinary case (which, for example, could prevent women from making parole or losing visitation rights with their children), women still took risks to care for one another. One participant described how she gave her blanket that was in better condition to another incarcerated woman during the harsh winter months. She also received socks from another incarcerated woman who had bought socks to share with her and others in their unit so they could stay warm, despite the fact that she could get written up for sharing resources with another incarcerated individual:

Some people's blankets had holes. Like it wasn’t even like you could even cover them enough. And I remember trading mine with another person… She needed it more than me… Another friend of mine bought me socks. She's like, you know what? Just don't say nothing. I'm gonna get you some socks. [She] bought a lot of socks, and she gave me [some socks to put] on my arms.

Participants described how this dedication to caring for one another continues on after they are released, and that caring for one another is an important part of their recovery. One participant described how she began working towards healing from the trauma she endured while incarcerated after she was released and how important supporting other incarcerated and formerly incarcerated women is for her recovery:

It affected my mental health in the sense that I realized I need therapy, and I have actively been on that journey for 6 months now, seeing a therapist. So… like things that I said I needed, I actually have worked towards doing, you know? So, it affected my mental health in a tremendous way. I wanted to be able to help other women that are experiencing what I experienced and worse, you know? Ummm, that’s me personally.

Conclusions

Public Health Implications

Findings from this study have notable public health and emergency management practice and policy implications. The first set of implications regard the mental health of incarcerated and formerly incarcerated women and their need for mental health support services before, during, and after disasters. The stresses and trauma that incarcerated women experience during acute disasters are compounded by the daily acts of negligence and violence they are subjected to during their confinement. These compounded traumas exacerbate pre-existing physical and mental health conditions and lead to long-term psychological distress. The long-term mental health impacts felt by incarcerated women persist long after their release, manifesting as fear, anxiety, isolation, and lack of trust. The findings in this report underscore the need for policy changes that prioritize adding mental health services to emergency planning, response, and recovery operations in prisons. Trained mental health staff should be made available to incarcerated people before, during, and after disasters. Mental health programs should be designed so that they consider the gendered experiences of incarcerated women and gender non-conforming people. Additionally, this study highlights that mental health support services should continue even after release to address the lingering effects of incarceration and disaster experiences.

The second set of public health implications from our research regards the lack of risk communication with incarcerated people during disasters. Incarcerated individuals are often isolated from critical information that can be lifesaving in times of disaster or crisis. Addressing this issue requires a concerted effort to establish reliable and accessible channels of communication, ensuring that incarcerated populations receive timely and accurate information during disasters to protect their health and safety. This includes regular communication from prison staff to provide timely and accurate information and updates about the nature and severity of the disaster. In addition, staff need to be trained to relay this information clearly and efficiently to the incarcerated population. Moreover, ensuring that incarcerated individuals have access to external communications with family and loved ones is crucial, as it can provide emotional support and additional safety information. By establishing robust communication protocols that encompass internal coordination and external connectivity, correctional facilities can significantly improve the safety and well-being of incarcerated individuals during disasters.

The third set of public health implications from our study concern our findings that incarcerated people are denied opportunities to protect themselves and others during hazard events and often punished for doing so. Incarcerated individuals frequently lack access to basic protective measures, such as adequate shelter, water, and sanitation, during hazard events. When they attempt to take self-protective actions, such as seeking respite or sharing resources, they are often met with punitive responses from facility staff. This not only undermines their immediate safety and health, but also fosters an environment of fear, anxiety, and mistrust. Additionally, the lack of ability to provide peer-to-peer support limits the establishment of community resilience within the incarcerated population. Addressing these issues requires systemic changes to empower incarcerated individuals with the knowledge, resources, and agency to safeguard their health and that of others during hazard events.

The fourth set of implications from our study regard our finding that incarcerated people are neglected or abandoned during hazard events as a result of staff shortages or staff shirking their responsibilities to protect themselves from the hazard. During disasters and hazard events, correctional facilities often experience severe staff shortages, because staff are unable to reach the facility, abandon their posts, or choose to prioritize their own safety over that of incarcerated persons. This lack of personnel leaves incarcerated individuals without adequate supervision or assistance and with limited access to resources, exacerbating their vulnerability and risk of harm. Additionally, the structural limitations within correctional facilities can hinder the implementation of emergency protocols, further endangering the lives of those incarcerated.

The fifth set of implications regards the resilience of incarcerated women and gender non-conforming people. Our findings showed incarcerated women and gender non-conforming people resisting dehumanization and punishment to care for one another both while incarcerated and upon release, demonstrating their deep resilience and commitment to collective care. Despite facing harsh and often discriminatory conditions, these individuals forged strong support networks, providing emotional, mental, and physical care to each other. Their acts of solidarity and support for each other include sharing limited resources, advocating for better conditions, and offering protection and comfort during crises. This resilience not only highlights their strength and resourcefulness but also underscores the need for policies and programs that recognize and support the unique needs and contributions of incarcerated women and gender non-conforming people, while including them in the development of such plans and policies.

Based on discussions amongst our focus group participants, this study also has implications for the need for policies and programs that ensure ongoing support services including continuity of medical and healthcare services, stronger safeguards against sexual violence, and access to disability-specific resources such as tailored notification and communication methods for individuals with physical, cognitive, and mental health disabilities to ensure equitable and safe response and recovery efforts. Entities developing and implementing programs and providing the aforementioned resources should ensure that this work is done with an intersectional approach, thereby considering the intersecting identities (race, gender, sexuality, disability, language, culture) of the population.

Results from the study also highlight the need for increased cross agency collaboration among partners including corrections, public health, behavioral health, emergency management, emergency medical services, law enforcement and health care providers. While this is a case study focusing on women’s prisons in Texas, our findings have implications for carceral facilities in other locations as well as for understanding the mental health impacts of disasters and evacuation processes on other institutionalized populations including hospitals, nursing homes, and schools.

Limitations

This study was originally designed to explore the evacuation experiences of incarcerated women and other gender minorities during disasters. Because this is one of the only studies of the hazard and disaster experiences of formerly incarcerated women and other gender minorities, we chose to follow an emergent, open approach to the focus group discussions rather than trying to redirect or constrain participants to a narrower focus on evacuation. This led to rich discussions of the hazards that our participants were exposed to as well as meaningful conversations about the ways that incarceration is a daily, ongoing, often compounding array of disasters for those impacted by the system. For these reasons, our focus groups did not generate the rich, qualitative data on evacuations that we initially expected, and the focus of our study and this report shifted to a broader examination of hazards in prisons and their mental health effects.

Another challenge was building trust with participants. Even though our research team included formerly incarcerated women and other gender minorities, participants at times expressed feeling fearful talking about their vulnerable experiences. Thus, we did not ask participants about specific demographics questions such as their age, race, time served, or security status while incarcerated. These characteristics or social identities arose naturally in the focus groups, reflecting the importance of understanding intersectionality in understanding the full experience of incarcerated women. Understanding the intersecting effects of race with other incarceration experiences is difficult from the official data, however, as the Texas Department of Criminal Justice limits racial identities in the prison system to one race and erases multi-racial identities (Purdum et al., 2022). Building trust was essential among participants who expressed hesitation in sharing their vulnerable stories with academics. More trust must be built with such communities to be able to more confidently speak to the role that such demographics play in disaster experiences. Future work should explore the barriers to participating in this type of research and how to approach it, to ensure a greater variety of perspectives.

Finally, as discussed in the methods section, we cannot tie particular experiences or quotes to specific facilities or time periods. We decided that ensuring the confidentiality of the participants and their anonymity in any documentation of the project was more important than gathering demographic data or specifics about participants’ incarcerations outside of what they shared about their experiences. Thus, our findings should be viewed in the larger context of incarceration and not specific to any one facility.

Future Research Directions

The study will produce several outputs that will contribute to the knowledge base on the women’s prisons and mental health impacts of disasters and confinement. We plan to publish our research findings in several peer-reviewed journals in the fields of disaster planning and emergency management, public health, or behavioral health. Our community partner will coauthor or review any academic materials we submit for feedback. This team has a history of publishing with community partners, including formerly incarcerated people and others impacted by the legal system. Research findings will be presented at conferences and workshops including the 49th Annual Natural Hazards Workshop. We will create policy briefs summarizing key findings and recommendations to be shared with relevant community and non-profit organizations, and local and state public health, behavioral health, and emergency management agencies. With leadership and guidance from Lioness, we will develop a guide for currently incarcerated women and other gender minorities for understanding and preparing for disaster and hazard situations. We will work with Lioness to distribute to their membership as well as other currently and formerly incarcerated individuals and families. It is the goal of the research team to continue to explore this area of study through the submission of a National Institute of Health (NIH) Exploratory /Developmental Research Grant (R21) and eventually an NIH Research Project Grant (R01).

Acknowledgments. Thank you to the members of Lioness Justice Impacted Women’s Alliance and their network, without whom this project could not have been completed.

References