Health service needs, use, and barriers among formerly incarcerated women survivors of sexual violence

Abstract

Background: Incarcerated women commonly report lifetime sexual violence victimization, have high rates of many physical and mental illnesses, and ultimately return to their communities with significant healthcare needs. Objective: This study qualitatively examined formerly incarcerated women sexual violence survivors’ health service utilization and perceived barriers to accessing health care–including primary care, mental health care, and substance use treatment services–three-to-five years post-release. Method: We conducted semi-structured qualitative interviews and administered self-report surveys with 65 women. Results: Interviews revealed some barriers that were consistent across healthcare service type, including health insurance coverage, healthcare costs, competing obligations, care interruptions, and intrapersonal factors; other barriers were unique to service type. Although women reported barriers to primary care engagement, most still reported engagement. However, relatively few were attending any form of specialty mental health care–ongoing psychiatric care was especially uncommon–despite that many participants were experiencing mental and/or behavioural health concerns. Very few had received evidence-based trauma therapy and treatment for sexual violence victimization specifically was rarely mentioned. Participants reported significant barriers to accessing therapy, including interpersonal factors and competing obligations that interfere with appointment attendance. Conclusions: This study reveals the need for behavioural healthcare–including treatment for sexual violence victimization–and healthcare navigation resources in the years following incarceration, as well as the need for new models of mental health care management, to improve healthcare access for this underserved population.