9 Arresting Facts About Conjugal Visits

By suzanne raga | sep 6, 2015.

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They're not nearly as common as pop culture might lead you to believe.

1. ONLY FOUR STATES STILL ALLOW CONJUGAL VISITS.

In the United States, conjugal visits occur only in state prisons, not federal prisons. In the early 1990s, 17 states had active conjugal visit programs. As of 2015, though, California, New York, Connecticut, and Washington are the only states that still allow conjugal visits . Two other states that recently had conjugal visit policies in place— Mississippi and New Mexico—stopped allowing the visits as of February 1, 2014 and May 1, 2014, respectively.

2. THE PHRASE "CONJUGAL VISIT" IS ACTUALLY A MISNOMER.

Today, conjugal visits are called extended family visits (or, alternately, family reunion visits). The official reason for these extended family visits is three-fold: to maintain a connection between the prisoner and his family, to reduce recidivism , and to provide an incentive for good behavior. States no longer use the phrase “conjugal visit” to emphasize the program’s inclusion of all family members, rather than just the prisoner’s spouse/partner.

3. LIKE HOTELS, PRISONS THAT FACILITATE EXTENDED FAMILY VISITS PROVIDE TOILETRIES FOR THEIR GUESTS.

In the United States, prisons have special facilities (cabins, trailers, or apartment-style housing) dedicated just to extended family visits. Some prisons provide towels, sheets, toiletries, condoms, and lube to their inmates. Other prisons provide two-bedroom apartments with a living and dining room, DVD player, TV, and games like Jenga and dominoes. Depending on the state and the specific prison’s rules, visitors may be allowed to bring groceries and prepared food to the visit.

4. BOTH PRISONERS & THEIR VISITORS MUST FULFILL CERTAIN REQUIREMENTS TO GET PERMISSION FOR A VISIT.

The specific rules pertaining to extended family visits vary from state to state. Most visits in California, Connecticut, New York, and Washington occur only in minimum to medium security prisons, and inmates must have a record of good behavior and a record of clean health. A spouse who visits their husband/wife inmate must pass a background check, body search, and be registered with the prison’s visitor list.

5. CONJUGAL VISITS ORIGINATED IN MISSISSIPPI NEARLY 100 YEARS AGO.

In 1918, the first conjugal visits occurred at a labor camp called Parchman Farm (also called Mississippi State Penitentiary). The warden, James Parchman, wanted to encourage the African-American male prisoners to work harder, so he paid prostitutes to come and have sex with the inmates each Sunday. In the 1930s, Parchman Farm began letting white male prisoners engage in this program, and female inmates were invited to participate in 1972.

6. PRISONERS IN INDIA HAVE THE LEGAL RIGHT, NOT PRIVILEGE, TO BEAR CHILDREN.

In 2015, India’s government passed legislation stating that conjugal visits are a right , not a privilege, for married inmates. These inmates are also entitled, if they wish, to give their sperm to their spouse for artificial insemination. Interestingly, in 2014, prison officials in New Mexico cited the birth of children to fathers who were incarcerated as a big contributing factor (besides economic reasons) to end conjugal visits in the state.

7. PRISONS IN SAUDI ARABIA ARE SURPRISINGLY (ABSURDLY!) LIBERAL, LAX, & GENEROUS.

In Saudi Arabia, male inmates can have one conjugal visit each month. But that rule applies to each spouse, so men with multiple wives can have multiple visits each month! The Saudi government helps inmates’ families with money each month for housing, food, and education, and the government also pays for the travel (airfare and hotel) expenses that inmates’ family members incur to visit the prison. And, if the prisoner wants to attend a family wedding or funeral, he's given up to $2600 to give as a gift . The Washington Post reported that the Saudi government spent $35 million on these prisoner perks in 2014.

8. IN 2010, A GERMAN PRISONER USED HIS UNSUPERVISED CONJUGAL VISIT TO MURDER HIS VISITOR.

In April 2010, a 50-year-old inmate killed his 46-year-old girlfriend during a conjugal visit in a German prison. After sending him letters in prison, she became his girlfriend and participated regularly in six-hour unsupervised visits with him. The inmate, Klaus-Dieter H., had been imprisoned for nearly two decades for the rape and murder of a child. Unfortunately, he stabbed his girlfriend with a steak knife and strangled her during one of those visits. Because this incident came on the heels of a few other instances of slack security at German prisons (including prisoner beatings and escapes), many outraged Germans criticized prison authorities and the justice minister, Roswitha Müller-Piepenkötter. Ultimately, German prisons beefed up security and implemented stricter rules for conjugal visits, increasing the restrictions on which prisoners are allowed to have the visits.

9. BRAZIL'S CONJUGAL VISIT POLICY IS QUITE SEXIST.

In Brazil, both straight and gay male inmates can receive visitors , but female inmates rarely get the privilege of participating in conjugal visits. Unfortunately, discriminatory policies are probably the least of the female inmates’ worries: Brazil’s prison cells are overcrowded, filthy, unsanitary, and dangerous. Women in prison who are pregnant do not have access to medical care, and many female inmates are confined to isolation units without cause.

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Peru allows Natalee Holloway's killer multiple conjugal visits for his mental health, rehabilitation

Peru's prison population has a constitutional right to conjugal visits, official says.

Michael Ruiz

Beth Holloway believes Joran van der Sloot's confession of murdering her daughter was 'corroborated'

Beth Holloway believes that Joran van der Sloot's confession to murdering his daughter in Aruba is corroborated.

Joran van der Sloot, who murdered Alabama teen Natalee Holloway when she refused his sexual advances and then killed Peru business heiress Stefany Flores exactly five years later, is currently seeing up to three women in conjugal visits in his Peruvian prison.

A Peruvian official with knowledge of the situation told Fox News Digital that every inmate's right to conjugal visits is protected by the country's constitution.

"That Joran van ser Sloot is having free rein to have sexual encounters [is] nothing strange," he said. "Within the intraprison environment, the inmate's sexual relationship is important for his rehabilitation and resocialization."

NATALEE HOLLOWAY SUSPECT JORAN VAN DER SLOOT GETTING DIVORCED AFTER PRISON DRUG SMUGGLING SCANDAL

Joran van der Sloot is surrounded by armed guards.

Joran van der Sloot, center, smiles as he prepares to leave the airport in Lima, Peru, on Thursday, June 8, 2023. (Col. Carlos López Aeda for Fox News Digital)

"So much so that the intimate or conjugal visit is part of the sexual rights of every inmate, which is why it must be conceived as a right due to its implication, one that does not have to be limited, much less linked to any conditioning element for its concession, and that it will have its manifestation of a constitutional right, since it is part of the development of the human person," the official added.

In the United States, only California, Connecticut, New York and Washington currently allow conjugal visits for inmates – as a privilege and not a right, according to David Gelman, a New Jersey-based defense attorney and former prosecutor.

"It’s a slap in the face to the United States judicial system," he told Fox News Digital. "He should be in a federal facility, not in Peru enjoying leisure and women, multiple women."

Natalee Holloway and friends pose in a 2005 Spring Break photo

Natalee Hollway, center, went missing during a spring break trip in 2005 and was never found. Last year, the prime suspect in her disappearance, Joran van der Sloot, admitted to killing her as part of a plea deal after he extorted her mother for information on the case. (FBI)

The federal prison system, which van der Sloot avoided as part of his plea deal on extortion charges, does not allow them. And that was a likely factor in his decision to plead guilty, Gelman said.

"He took this deal in the United States knowing he would probably never see the inside of a federal cell in the United States of America -- for this exact reason," he said.

This is a slap in the face, and it’s just sticking the dagger in the heart of the Holloway family. They’ve been through so much with this individual – and calling him an individual is being a little nice. — David Gelman, former prosecutor

COURT RELEASES RECORDING OF JORAN VAN DER SLOOT'S NATALEE HOLLOWAY CONFESSION

Van der Sloot murdered Flores in 2010 and pleaded guilty but refused to fess up in Holloway's case for nearly 20 years. He claimed he killed her in a fit of anger after she learned about his connection to Holloway's disappearance. They met in her father's casino in Lima, and he beat her to death in his hotel room the following morning. 

ARUBA CONSIDERS NEW CHARGES IN NATALEE HOLLOWAY MURDER AFTER SUSPECT'S SURPRISE CONFESSION IN US PLEA DEAL

He finally admitted in October to killing her with a cinder block on an Aruba beach as part of a plea deal for an extortion case in which he tried to shake down the victim's mother for $250,000.

Leidy Figueroa is pictured wearing a wedding dress and holding flowers

File photo of Leidy Figueroa in a wedding dress. The Peruvian national married Joran van der Sloot, who was convicted in the killing of fellow Peruvian Stephany Flores. (Splash News/Shutterstock)

JORAN VAN DER SLOOT'S WHIRLWIND PLEA DEAL: ‘HE WON THE GAME,’ BUT FAMILY ACCEPTS CLOSURE

Despite a documented history of murdering women, van der Sloot got married in prison to Leidy Figueroa in 2014 while serving a 28-year sentence for Flores' death. 

Figueroa was seven months pregnant when they tied the knot. His Lima-based lawyer, Maximo Altez, told Fox News Digital in May 2023 that she was divorcing him after he had years tacked on to his sentence for smuggling drugs into the prison with the help of another girlfriend, Eva Pacohuanaco.

Joran van der Sloot bends over to sign paperwork

Joran van der Sloot signing papers at Peru's mountaintop Challapalca Prison, where he was being held previously. (APTN)

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"He’s a player, and has always been a player," his childhood friend, Cas Arends, told the New York Post . "Women have always been attracted to him for some reason."

Armando Regil Velasco contributed to this report.

Michael Ruiz is a reporter for Fox News Digital. Story tips can be sent to [email protected] and on Twitter: @mikerreports

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Pros and Cons of Conjugal Visits

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The reach of human rights does not end at the prison gates. After all, the primary goal of a healthy corrections system is the rehabilitation and successful reintegration of inmates into society.

That said, some rights remain controversial among legislators, prison reform advocates, and concerned citizens.

One such right is the right to conjugal visits . Some consider a marital visitation program as an inmate’s privilege. Others think it is an extension of their fundamental human rights.

The United States criminal justice system believes that conjugal visitation is a privilege to offenders and a right of their spouses.

Even though conjugal visitations play a crucial role in the lives of inmates and their loved ones, very few incarcerated persons can access them.

Say you or your spouse is in a correctional institution. In that case, you may find the sections below regarding conjugal visitation helpful in understanding the potential benefits and drawbacks of such visits for you and your family.

Additionally, you may learn more about the rules and procedures of conjugal visits. Our online site, LookUpInmate.org , contains detailed information regarding the state’s provisions for married inmates.

We also offer a free search tool to locate inmates in correctional facilities in the U.S.

Pros of Conjugal Visits

Generally, arguments favoring conjugal prison visits hinge on the program’s practical benefits to the inmates, their spouses, and prison facilities. Below are 11 potential advantages of conjugal visits.

Conjugal Visits Encourage Good Behavior

Whether an inmate receives a conjugal visit often depends on how well they behave in the penitentiary.

Prison governors use a “carrot and stick” (reward and punishment) approach to regulate inmates’ behavior.

Conjugal visits are one such carrot to keep incarcerated people following the facility’s rules. An inmate who misbehaves will likely not have in-person contact with their family.

The extended family visit is an effective motivator. Inmates have something to anticipate. After visits, they are more stable mentally. Their families also give moral support and help them stay on track.

Conjugal Visits Strengthen Familial Bonds

One of the most difficult challenges inmates face is their families falling apart. They will likely recidivate (reoffend) without solid social support when they get out.

Conjugal visits let offenders spend time with their spouses, hopefully keeping their marriages intact. Spending time together is particularly important in families with children.

The benefits do not only extend to the inmate. Studies show that conjugal visits support family cohesion.

Conjugal Visits Make Prison Life Safer

Most long-term prison inmates seek ways to gain privileges like conjugal visits. Consequently, they must refrain from harassing other prisoners, getting into fights, provoking violence, selling drugs, and other criminal activities.

Research from Florida International University indicated that prison systems allowing conjugal visits have fewer rapes and sexual assaults than those prohibiting such visits.

Reduced sex crimes have the extra benefit of decreasing the transmission of STDs (sexually transmitted diseases), like HIV (human immunodeficiency virus) and HIV’s late-stage form, AIDS (acquired immunodeficiency syndrome).

Conjugal Visits Results in Fewer Repeat Offenders

Since inmates can preserve family ties, they are likelier to live a healthy family life after release.

One study from the Journal of Criminal Justice showed that receiving visitation led to a 26% decrease in recidivism.

Visits with family strengthen bonds and give incarcerated individuals a reason to live after their release.

Conjugal Visits Offer Much-Needed Privacy

One of the most frustrating aspects of correctional facilities is the lack of privacy. In most cases, inmates must sleep and share the bathroom with their cellmates. Sometimes, they even shower in front of the correctional officers. Cameras and guards constantly observe their movements.

Spending time alone with your spouse, even briefly, might help improve inmates’ emotional and mental health.

Conjugal Visits Reduce Sexual Violence

Sexual violence includes various forms of abuse, such as rape, harassment, and sexual assault .

As shown above, conjugal visits can help reduce sexual violence in the prison setting. The states that do not allow conjugal visitation have a high sexual violence incidence rate.

In contrast, the region that allows conjugal visits has a lower rate of sexual crimes .

These outcomes suggest that conjugal and family visits can help reduce sex offenses in prison and the community.

Conjugal Visits Reduce the Risk of Sexually Transmitted Diseases

One of the most notable benefits of conjugal visits is protection from STDs, including HIV, chlamydia, and genital herpes.

Engaging in sexual relations with multiple partners can increase the chances of acquiring infectious diseases like HIV.

Conjugal Visits Reduce Recidivism

Recidivism refers to the tendency of the offender to repeat a crime. As mentioned above, conjugal visits help reduce the recidivism rate.

A simple explanation is that extended family visits remind the inmate that there’s life awaiting them beyond the prison bars.

These in-person meetings reinforce in their minds the thought that committing another crime is not worth sacrificing time with family.

Conjugal Visits Can Also Include Other Family Members

Visits do not just affect couples. Family visits also let inmates spend time with their children in less crowded areas. In some cases, grandparents, siblings, and cousins can all participate.

You’re Not Only Punishing Prisoners

Inmates aren’t the only ones who suffer from the lack of conjugal visits. Institutions that prohibit this type of visit as a punishment are also punishing the inmates’ spouses and children who did nothing wrong.

Some argue that this prohibition removes the inmate’s and their spouse’s reproductive rights.

Inmates Are Allowed to Keep Their Roles As Husbands or Wives

This advantage is critical for the family’s well-being. Prison can end the male inmate’s identity as a husband or the female inmate’s identity as a wife.

Conjugal visits help preserve the familial structure and stability of the incarcerated person and their spouse.

By recognizing and affirming their marital roles, conjugal visits contribute to rehabilitation by fostering responsibility, commitment, and accountability among inmates. This outcome can aid the inmate’s successful reintegration into society after release.

Cons of Conjugal Visits

Arguments against conjugal visitations often highlight the prison system’s lack of the budget and security level to facilitate this type of visit.

Below are nine potential drawbacks of conjugal visits.

There Are Some Safety Concerns

Although conjugal visits are a family affair, they can be relatively unsafe due to the lack of supervision in the visitation area. Still, some argue that criminal cases happening during visits are rare and should not drive public policy.

Conjugal Visits Are a Source of Contraband

People coming in from the outside to see their loved ones might smuggle illegal items, including drugs or concealed weapons.

That said, tight security often makes it difficult for inmates to smuggle items. While some facilities do not check visitors during visits, they might still subject the offenders to strip-search and drug tests.

Visits Are Not Entirely ‘Private’

Even though conjugal visits are primarily private, it does not mean daily prison routines do not take place. For example, prisoners must respond to routine ‘call-outs’ at their scheduled time. Guards checking in can also quickly ruin the mood if things get intimate.

Carrying Prohibited Items Poses a Risk

As indicated above, visits could be a risk for illicit activity. Visitors can bring illegal or banned items, including narcotics and weapons, guns, and other sharp objects that could injure fellow inmates.

Possible Escape Attempts

Officials cite escape attempts as one primary reason to end conjugal visits. They argue that some inmates take the opportunity to make escape plans. Consequently, some jurisdictions have discontinued the practice.

Risk of STDs

Though visits tend to decrease sexual violence, STDs remain a concern for some whenever sex is involved. These critics think inmates might bring STDs into prison with them.

Risk of Increased Cases of Pregnant Women and More Major Single Parents

Female inmates or visitors can become pregnant even after being supplied with contraceptives. This scenario can result in another single mother if the father is incarcerated for life.

The Programs Are Expensive

Many of the issues with conjugal visits are likely deflections from the most probable reason facilities end the program: lack of funds.

Several states have shut down these programs due to their high costs. Private spaces consume a lot of resources and space. The impulse to remove these programs may result from many prisons operating on low budgets.

What Is a Conjugal Visit?

Simply put, conjugal visitation refers to the visit by the husband or wife for a scheduled period to their incarcerated husband or wife. During this time, the couple receives limited privacy. Usually, this private moment involves sexual relations.

Inmates and visitors must submit applications to the prison system authorities to arrange an extended family or conjugal visit.

Here are the typical rules regarding such visitations:

  • The requesting inmate should have a decent prison record and no violent offenses.
  • Extended family visits often do not apply to inmates confined to low-security facilities.
  • Institutions do not allow convicted individuals who received sentences for child abuse or domestic violence conjugal visits.

Additionally, state or federal prisons determine eligible visitors. The visitor is usually a family member, has a record of inmate visitation to the facility (or a legitimate reason for not doing so), and must pass a background check.

Conjugal Visit : An Emerging Human Right

As indicated above, many people today view spousal visitation as an extension of the spouse’s conjugal rights.

While the visitation program is technically not a right, many countries today allow inmates extended, in-person contact with their loved ones.

Aside from the U.S., countries that allow conjugal visits may include the following:

  • Saudi Arabia

However, countries allowing conjugal visitations are rare, and most do not welcome extended family visits.

The U.S. is not the only country becoming more restrictive regarding conjugal visits. Northern Island and Great Britain have also restricted such visits.

That said, these countries permit home visits, emphasizing contact with the outside world to which the inmate will eventually return.

In addition, authorities often grant home visits to inmates with a few weeks to a few months remaining of a long sentence.

Meanwhile, countries like Germany allow conjugal visits following an extensive screening process.

Sex, Love, and Marriage Behind Bars

As expected, conjugal visits provoke discussion around the complex relationship of sex, love, and marriage behind bars.

Advocates argue that these visits can improve bonds between inmates and reduce recidivism rates, allowing them to develop stronger bonds.

In contrast, critics express concerns regarding the potential for exploitation, security threats, and the cost of facilitating intimate encounters for incarcerated persons.

Excellent institutions find the intricate balance between human rights, rehabilitation initiatives, and the practical realities of managing correctional systems.

Some incarcerated individuals use the metaphor of “heaven” to depict the profound sense of ease and happiness they encounter when they can physically reconnect with their spouse during conjugal visits.

The joy of companionship, intimacy, and touch with the opposite sex is so rare that inmates go to great lengths to avoid conflict and bad encounters.

Their Dark Origins

Conjugal visits may have originated in 1918 at Parchman Farm, a boot camp in Mississippi .

Such visitations were a haphazard, paternalistic reward system for Black prisoners. Specifically, these visits mean these people may have sexual intercourse on a given Sunday in exchange for their hard work in prison.

This way, the concept of conjugal visits derives from racist premises.

For instance, prison administrators believed allowing Black individuals to participate in lawful sexual activities would increase their productivity.

The officers also believed Black men had higher sex drives than white men. Consequently, buses packed with women arrived every weekend to get intimate with the Black offenders.

Authorities used conjugal visits to “support” Black inmates through a six-day workweek of physically and mentally demanding work.

However, due to various advocacy groups, conjugal visits now last longer with the family.

Even the Parchman Farm improved during the 1960s. For example, institutions allowed frequent visits, initiated furlough programs, and built cabins so inmates could spend time alone with their spouses.

A Misconception With Conjugal Visits

Conjugal visits are more than just sexual encounters and “family visits,” meaning children can stay overnight.

For instance, a spouse or partner in Connecticut cannot enter the facility without the inmate’s child.

In the state, approximately a third of lengthy visits are between spouses.

Are Conjugal Visits Beneficial?

The answer to this question depends on what factor you emphasize. If the prison system is not corrupt and the inmate complies with visitation conditions, the program will likely produce favorable outcomes.

Overall, research is still ongoing regarding the effectiveness of conjugal visits.

How Many States Still Allow Conjugal Visits? What States in the U.S. Allow Conjugal Visits?

Today, only four states have rules that allow extended visits: New York, Washington, California, and Connecticut.

However, each state in the United States has various rules regarding conjugal visitations, or “extended family visits.”

A 1981 report stated that the following states were the only regions in the U.S. that had conjugal visitation programs for inmates:

  • South Carolina
  • Mississippi

Following the report, various states changed their position regarding conjugal visits. For instance, at the beginning of 2000, South Carolina and Minnesota were off the list, and New Mexico and Connecticut had extended visitation policies.

However, despite being the first state to initiate conjugal visitation programs in the U.S., the Department of Corrections in Mississippi ended the privilege in 2016.

Do You Get Conjugal Visits on Death Row?

Death row inmates have no right to conjugal visits, even in states that do it for other convicts.

For example, California ’s state prisons only allow “condemned” (incarcerated people on death row) visits using a secured booth and always require the incarcerated individual to be escorted and handcuffed.

Some of these incarcerated persons on death row may only receive non-contact visits.

1. Conjugal Visitation: Prisoner’s Privilege or Spouse’s Right https://www.ojp.gov/ncjrs/virtual-library/abstracts/conjugal-visitation-prisoners-privilege-or-spouses-right 2. Benefits and risks of conjugal visits in prison: A systematic literature review https://onlinelibrary.wiley.com/doi/full/10.1002/cbm.2215 3. Research Finds that Conjugal Visits Correlate with Fewer Sexual Assaults https://www.prisonlegalnews.org/news/2014/may/19/research-finds-conjugal-visits-correlate-fewer-sexual-assaults/ 4. The effect of prison visitation on reentry success: A meta-analysis https://www.sciencedirect.com/science/article/abs/pii/S0047235216300575 5. Evolution of Conjugal Visiting in Mississippi https://www.ojp.gov/ncjrs/virtual-library/abstracts/evolution-conjugal-visiting-mississippi 6. Conjugal Visits https://www.themarshallproject.org/2015/02/11/conjugal-visits 7. This Couple Wants You to Know That Conjugal Visits are Only Legal in 4 States https://scalawagmagazine.org/2022/06/conjugal-visits/ 8. Conjugal Visitation in American Prisons Today https://www.ojp.gov/ncjrs/virtual-library/abstracts/conjugal-visitation-american-prisons-today 9. Mississippi First to Begin Conjugal Visits, Latest to End Them https://www.prisonlegalnews.org/news/2016/jan/11/mississippi-first-begin-conjugal-visits-latest-end-them/ 10. Types of Visits https://www.cdcr.ca.gov/visitors/types-of-visits/

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conjugal visits and recidivism

17 Jun 2023, Prisons , by

Discover the impact of conjugal visits on recidivism rates in this insightful article.

conjugal visits and recidivism - Inmate Lookup

The practice of conjugal visitation in correctional facilities has been a topic of controversy and debate in recent years. While some argue that allowing inmates to have intimate visits with their partners is a privilege they do not deserve, others argue that it can have significant positive impacts on their behavior and rehabilitation, ultimately leading to reduced recidivism rates.

The history of conjugal visits in correctional facilities

The concept of conjugal visits dates back to the early 1900s, when they were first introduced in Germany. The idea was to allow inmates to maintain a sense of connection with their families and partners, as these relationships were seen as vital in promoting their rehabilitation. The practice was then adopted by the United States in the 1930s. At the time, conjugal visits were only allowed in female prisons, but this changed in the 1960s, when male prisons started implementing them as well. Today, conjugal visits are available in some form in many countries around the world.

Despite the benefits of conjugal visits, there has been controversy surrounding their implementation. Some argue that allowing inmates to have sexual contact with their partners is inappropriate and sends the wrong message about the consequences of criminal behavior. Others argue that the visits can be a source of contraband and pose a security risk to the facility.

However, studies have shown that conjugal visits can have positive effects on inmate behavior and mental health. Inmates who are able to maintain healthy relationships with their partners are less likely to engage in violent or disruptive behavior while incarcerated. Additionally, the visits can provide a sense of hope and motivation for inmates to work towards rehabilitation and reintegration into society.

The benefits of conjugal visits for inmates

Proponents of conjugal visitation programs argue that they have a number of benefits for inmates. One major advantage is that they can help to maintain family connections, which is important for both the inmate and their partner and children. This can reduce stress and improve mental health, which in turn can have a positive impact on their behavior and rehabilitation. In addition, conjugal visits have been shown to increase inmate morale and decrease incidents of violence within prisons.

Another benefit of conjugal visits is that they can help to reduce recidivism rates. Inmates who are able to maintain strong family ties and relationships are more likely to successfully reintegrate into society upon release. This is because they have a support system in place that can help them to find employment, housing, and other resources that are necessary for a successful transition back into the community.

Furthermore, conjugal visits can also have a positive impact on the families of inmates. By allowing them to spend time together in a private setting, conjugal visits can help to strengthen relationships and improve communication between partners and children. This can be especially important for children, who may be struggling to cope with the absence of a parent. By maintaining a connection with their incarcerated parent, children may be less likely to engage in risky behaviors or develop mental health issues.

The impact of conjugal visits on inmate behavior and rehabilitation

Studies have shown that conjugal visits can have a positive impact on inmate behavior and rehabilitation. For example, one study from 2013 found that inmates who participated in conjugal visitation programs had a lower rate of violent incidents, were more likely to participate in educational and vocational programs, and were less likely to be placed in solitary confinement. Another study from 2014 found that inmates who had access to conjugal visits had lower rates of misconduct and disciplinary infractions than those who did not.

However, there are also concerns about the potential negative effects of conjugal visits. Some critics argue that allowing inmates to have intimate contact with their partners can lead to the spread of sexually transmitted infections and unwanted pregnancies. Additionally, there are concerns about the potential for abuse or exploitation of the visiting partner, particularly in cases where there is a power imbalance in the relationship.

Despite these concerns, many correctional facilities continue to offer conjugal visitation programs as a way to promote positive behavior and maintain family connections for inmates. Some facilities have implemented strict guidelines and protocols to ensure the safety and well-being of all parties involved, including mandatory testing for sexually transmitted infections and limits on the frequency and duration of visits.

The correlation between conjugal visits and reduced recidivism rates

Perhaps the most significant benefit of conjugal visits is their potential to reduce recidivism rates. Studies have consistently found a correlation between access to conjugal visits and reduced rates of reoffending. For example, a study from 2017 found that inmates who had access to conjugal visits had a 27% lower chance of returning to prison than those who did not. This suggests that allowing inmates to maintain intimate relationships with their partners can have a significant impact on their ability to reintegrate into society and lead successful lives after release.

Furthermore, conjugal visits have been shown to have positive effects on the mental health and well-being of inmates. Being able to maintain a healthy and intimate relationship with a partner can provide emotional support and a sense of connection, which can be particularly important for those who are incarcerated for long periods of time. This can also lead to improved behavior and a more positive attitude towards rehabilitation programs, ultimately contributing to a reduction in recidivism rates.

The role of conjugal visits in maintaining family connections and reducing prisoner stress

In addition to their impact on recidivism rates, conjugal visits play an important role in maintaining family connections and reducing prisoner stress. Being separated from their families and partners can be incredibly stressful for inmates, and can lead to a range of mental health issues. By allowing them to maintain intimate relationships and physical contact with their loved ones, conjugal visits can help to alleviate this stress and improve their mental well-being.

Furthermore, conjugal visits can also have a positive impact on the families of inmates. These visits provide an opportunity for families to spend quality time together and maintain their relationships, despite the challenges of incarceration. This can be especially important for children of inmates, who may struggle with the absence of a parent. By allowing them to have regular contact with their incarcerated parent, conjugal visits can help to mitigate the negative effects of parental separation.

It is worth noting, however, that not all prisons offer conjugal visits, and there are often strict rules and regulations surrounding them. In some cases, visits may only be allowed for married couples, or for inmates who have demonstrated good behavior. Additionally, visits may be limited in duration and frequency. Despite these limitations, many advocates argue that conjugal visits are an important aspect of maintaining family connections and promoting the well-being of both inmates and their loved ones.

The legal and ethical considerations surrounding conjugal visits

Despite the potential benefits of conjugal visits, there are also a number of legal and ethical considerations that must be taken into account. For example, there is concern that allowing intimate visits could lead to inappropriate behavior or sexual assaults. As a result, many facilities have stringent rules and regulations in place to ensure that visits are safe and consensual for both parties.

In addition to safety concerns, there are also legal considerations surrounding conjugal visits. In some states, conjugal visits are not allowed at all, while in others, they are only permitted for married couples. There may also be restrictions on the frequency and duration of visits, as well as requirements for background checks and health screenings. Ethically, there are debates about whether conjugal visits should be offered as a privilege or a right for inmates, and whether they contribute to rehabilitation and successful reentry into society. These complex issues require careful consideration and balancing of various factors.

The potential risks and drawbacks of implementing conjugal visitation programs

In addition to the legal and ethical considerations, there are also potential risks and drawbacks associated with implementing conjugal visitation programs. For example, some argue that they can create jealousy and conflict among inmates who do not have partners or who are not eligible for visits. Others worry that they can lead to increased expenses and logistical challenges for correctional facilities.

Another potential risk of conjugal visitation programs is the possibility of sexual misconduct or abuse. While these programs are intended to provide a safe and controlled environment for intimate visits, there have been instances where inmates have taken advantage of the situation to coerce or assault their partners. This can lead to legal and financial liabilities for correctional facilities, as well as emotional trauma for the victims.

Furthermore, some argue that conjugal visitation programs can perpetuate gender and sexuality inequalities. In many cases, these programs are only available to heterosexual couples, leaving LGBTQ+ inmates without the same opportunities for intimacy and connection. This can further marginalize already vulnerable populations within the prison system.

Comparative analysis: How conjugal visits differ across countries and states

Conjugal visitation programs can vary significantly across different countries and states. For example, some countries allow visits of several days, while others only allow for a few hours. Similarly, some states in the US do not allow conjugal visits at all, while others have stringent regulations in place that make them difficult to access. Understanding how these programs differ can provide valuable insight into their effectiveness and potential drawbacks.

In addition to the duration and availability of conjugal visits, the rules and regulations surrounding them can also vary greatly. For instance, some countries require that the couple be legally married, while others allow for unmarried partners to participate. Some states in the US require that the couple have a history of good behavior and a stable relationship, while others do not have any such requirements.

Furthermore, the benefits of conjugal visitation programs can also differ depending on the country or state. In some cases, these programs have been shown to reduce violence and improve inmate behavior. However, in other cases, they have been criticized for being too lenient and potentially leading to the smuggling of contraband into prisons.

Examining the impact of COVID-19 on the practice of conjugal visitation

The COVID-19 pandemic has had a significant impact on correctional facilities around the world, and conjugal visitation programs have not been immune to these effects. Many facilities have suspended visits altogether in an effort to prevent the spread of the virus. However, this has raised questions about the impact on inmate mental health, and whether these programs will be able to resume once the pandemic is over.

Furthermore, the suspension of conjugal visitation programs has also had an impact on the families of inmates. For many families, these visits were the only opportunity to maintain a physical connection with their loved ones in prison. The suspension of these programs has caused additional stress and anxiety for families, who are already dealing with the challenges of having a family member incarcerated. It remains to be seen how these families will be supported during this time, and what measures will be put in place to ensure that they can maintain contact with their loved ones in a safe and healthy way.

Overcoming the stigma associated with conjugal visitation programs

Despite the potential benefits of conjugal visitation programs, there is still a significant stigma associated with them. Many people view them as a privilege that inmates do not deserve, or worry that they could lead to inappropriate behavior. However, by educating the public about the potential benefits of these programs and the safeguards that are in place to ensure their safety, it may be possible to overcome this stigma.

One potential benefit of conjugal visitation programs is that they can improve the mental health and well-being of inmates. Studies have shown that maintaining close relationships with loved ones can reduce stress and anxiety, and improve overall mental health. Additionally, these programs can help to reduce recidivism rates by providing inmates with a sense of hope and motivation to stay out of trouble once they are released. By recognizing these benefits and working to address concerns about safety and appropriateness, we can begin to shift the conversation around conjugal visitation programs and work towards a more compassionate and effective criminal justice system.

Future directions for research on conjugal visitation and its relationship with recidivism

Although there have been many studies examining the relationship between conjugal visitation and recidivism, there is still much to be learned about how these programs work and how they can be improved. Future research could explore topics such as the optimal duration and frequency of visits, the role of family support networks in reducing recidivism, and the impact of different types of visitation programs on inmate behavior and well-being.

Additionally, future research could also investigate the potential benefits of conjugal visitation programs for the families of inmates, such as improved family relationships and reduced stress and anxiety. It would also be valuable to examine the effectiveness of conjugal visitation programs in reducing recidivism rates among different populations, such as female inmates or those with mental health issues. By further exploring these areas, we can gain a better understanding of the potential benefits and limitations of conjugal visitation programs and how they can be optimized to promote successful reentry and reduce recidivism.

A look at alternative forms of family contact for inmates who do not have access to conjugal visits

While conjugal visits can have significant benefits for inmates, not all facilities offer these programs, and not all inmates are eligible for them. As a result, it is important to explore alternative forms of family contact that can provide similar benefits. This might include video conferencing, phone calls, or in-person visits with children or other family members.

In conclusion, while conjugal visitation programs are not without their drawbacks and challenges, there is a growing body of evidence to support their effectiveness in reducing recidivism rates and promoting inmate rehabilitation. By considering the legal, ethical, and logistical issues associated with these programs, and continuing to research their impact, we can work towards implementing conjugal visitation programs that are safe and effective for all parties involved.

However, it is important to note that alternative forms of family contact can also have their own benefits. For example, video conferencing can allow for more frequent and convenient communication between inmates and their families, especially if they live far away. Phone calls can provide a sense of emotional support and connection, while in-person visits with children can help maintain family bonds and provide a sense of normalcy for the child.

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Behind Bars but Connected to Family: Evidence for the Benefits of Family Contact During Incarceration

Johanna b. folk.

a George Mason University

Jeffrey Stuewig

Debra mashek.

b Harvey Mudd College

June P. Tangney

Jessica grossmann, associated data.

Incarceration separates individuals from their families and communities, strictly limiting and controlling contact with the outside world. Despite these barriers, those who maintain contact with their families during incarceration tend to function more adaptively post-release. Within a longitudinal framework, the current study examines mechanisms (i.e., family connectedness, post-release planning) by which contact with family during incarceration may impact post-release functioning (i.e., recidivism, substance misuse, mental illness, community functioning), considering differences between type of contact (visits, phone calls, letters) and whether it occurred in a jail or prison setting. Participants included 507 adults incarcerated in a local jail ( M age = 32 years, SD = 10 years; 70% male; 44.3% Black, 36.4% White; 59.5% parents). Structural equation modeling results demonstrated having more frequent contact with family during incarceration predicts increases in family connectedness, which in turn predicts better mental health during the first year post-release. Although not related to frequency of contact, making plans for post-release predicted adaptive community functioning during the first year post-release. There were no differences in the overall model based on type of contact or incarceration in a jail versus prison setting. These findings suggest maintaining contact with family during incarceration can facilitate more psychologically healthy adjustment during the stressful process of re-entering society. Furthermore, incarcerated individuals should be encouraged to make plans for post-release while still incarcerated either independently or in collaboration with family.

Incarceration separates individuals from their families and communities, strictly controlling, monitoring, and limiting contact with the outside world. Research demonstrates predominately beneficial effects of family contact during incarceration, but the existing body of evidence is small, lacks consistency in operational definitions of contact and outcomes, lacks exploration of explanatory mechanisms, and relies predominately on single sex and prison samples. Within a longitudinal framework, the current study examines mechanisms by which family contact during incarceration impacts post-release functioning, considering differences between type of contact and correctional setting.

Contact with Family during Incarceration

Research suggests maintaining family ties during incarceration facilitates positive post-release functioning. Individuals who have family contact during incarceration are less likely to recidivate ( Bales & Mears, 2008 ; Barrick, Lattimore, & Visher, 2014 ; De Claire & Dixon, 2015 ; Duwe & Clark, 2013 ; Mears, Cochran, Siennick, & Bales, 2012 ), more likely to have and secure opportunities for post-release employment ( Liu et al., 2016 ; Visher, Bakken, & Gunter, 2013 ), less likely to be depressed ( De Claire & Dixon, 2015 ), and more likely to be involved with their children post-release, which is related to less depression ( Visher, 2013 ) and substance use ( Visher et al., 2013 ). But these beneficial effects are not universal. Some evidence suggests differential effects for different forms of contact (e.g., visits, phone call, letter) and contexts (e.g, jail, prison); the nature of the contact may be qualitatively different and impacted by different barriers, resulting in differential effects on psychological and behavioral outcomes.

Visitation.

Most research has focused on in-person visits ( De Claire & Dixon, 2015 ) and suggests a strong relationship between visitation and positive post-release outcomes. Of note, in a study of 7,000 individuals incarcerated in state prison for at least 12 months, receiving visits from a significant other, relative, or friend significantly reduced the odds of recidivism within the first two years of release; conversely, receiving more visits from one’s children predicted an increased risk of recidivism during the first two years post-release ( Bales & Mears, 2008 ). The odds of recidivism were 30.7% lower for those visited at least once during the year before release compared to those not visited, and increased frequency of visitation reduced the odds of recidivism ( Bales & Mears, 2008 ).

Visitation also protects against attenuation of social ties and increases the likelihood of having post-release employment opportunities. In a study of 414 males incarcerated in state prison, those who received more frequent visits and visits by more people perceived less weakening in their bonds with family and friends during incarceration; those who received more visits by children and other family were more likely to report having a post-release employment opportunity ( Liu et al., 2016 ). It is possible visits with family help incarcerated individuals feel more connected and enhance their confidence in capitalizing on employment opportunities, which family members may facilitate.

Although these findings support the notion that contact improves post-release outcomes, these studies did not evaluate contact other than visits, so it is unclear whether contact through phone or letters produces similar effects. In addition, data were collected concurrently (not longitudinally) and did not allow for examination of changes in social bonds and their association with post-release functioning.

Different effects based on type of contact.

Few studies have considered the impact of different forms of contact on post-release outcomes. A study of 319 men incarcerated in prison considered the impact of receiving visits or mail from one’s children on post-release recidivism, substance use, depression, and employment ( Visher et al., 2013 ). Receiving visits or letters during incarceration (examined as a single categorical variable) predicted more father-child involvement immediately following release, which predicted working more hours at one’s job per week, and marginally less criminal activity and less substance use; there was no effect of involvement on post-release depression. Thus, visitation and mail contact may positively impact post-release experiences. Other research has examined phone contact. In a study of 255 high-risk incarcerated women, more frequent family contact during incarceration via phone was associated with a reduced likelihood of reincarceration within five years post-release ( Barrick et al., 2014 ); receiving visits and mail contact were unrelated to recidivism.

Different effects of contact in jail versus prison.

To the authors’ knowledge, research on how family contact during incarceration impacts post-release outcomes has been conducted solely in prisons. Whereas prisons typically hold individuals with sentences longer than one year and are operated at the state or federal level, jails are locally operated facilities that hold individuals awaiting trial or sentencing or sentenced to one year or less. Research on contact in jails has focused on the experience of visitation and how contact affects children of incarcerated parents ( Poehlmann, Dallaire, Loper, & Shear, 2010 ).

It is possible that in jails, different barriers may alter the impact of contact on post-release outcomes. Of note, jails are typically located close to incarcerated persons’ families, but prisons are often more than 100 miles away ( Poehlmann, et al., 2010 ); visiting prison therefore requires additional resources such as time, money, and transportation, which may result in less frequent visitation or may make visitation less viable for families with limited financial resources. As such, having fewer visits from family members while incarcerated in prison may not reflect an incarcerated individual’s connection with family, but rather whether the family has the resources (e.g., transportation, child care, schedule flexibility) to make the trip to the prison. Whether relationships between types of contact with family and post-release outcomes generalize between prison and jail settings remains an open question.

In sum, most evidence suggests maintaining contact with one’s family during incarceration in prison facilitates positive adjustment post-release. But does the impact of contact with family on post-release outcomes generalize to jails? And why is contact beneficial? We consider two possible mediating factors between contact and post-release outcomes: family connectedness and making post-release plans.

Social Relationships and Post-Release Functioning

Social connections “influence the type of people we are, the things we do, the attitudes and values we hold, and the way we perceive and react to people around us” ( Hogg, 2003 , p. 462). In community samples, social connectedness is related to desirable emotional outcomes such as less trait anxiety ( Lee & Robbins, 2000 ), perceived stress in daily life ( Lee, Keough, & Sexton, 2002 ), and psychological distress ( Cohen & Wills, 1985 ). Social connectedness is also related to less dysfunctional interpersonal behaviors such as being domineering and standoffish ( Lee, Draper, & Lee, 2001 ) and to substance use ( Sale, Sambrano, Springer, & Turner, 2003 ). It is likely these effects generalize to incarcerated individuals.

Theories in criminology (social bond; Hirschi, 1969 ) and psychology (e.g., self-expansion; c.f. Aron, Lewandowski, Mashek, & Aron, 2013 ) suggest prosocial conforming behavior (e.g., desistance from criminal activity) results from attachment to conventional others. For example, relationships with conventional others can provide social and economic support during the reintegration process ( Petersilia, 2003 ; Visher & Travis, 2011 ); these relationships impose social obligations, time constraints, and informal supervision ( Sampson & Laub, 1990 ), and help incarcerated individuals maintain optimism about life and their ability to secure opportunities upon release ( Visher & O’Connell, 2012 ). Furthermore, the self-expansion model asserts that connectedness leads individuals to adopt the resources, perspectives, and identities of others ( Aron et al., 2013 ). By extension, connectedness with conventional others promotes adaptive post-release functioning ( Folk, Mashek, Tangney, Stuewig, & Moore, 2016 ).

Family Connectedness

Families are a key source of support for many incarcerated individuals ( Luther, Reichert, Holloway, Roth, & Aalsma, 2011 ) and strong family relationships can prevent criminal behavior ( Sampson & Laub, 2003 ). Family support is related to less recidivism ( Brown, St. Amand, & Zamble, 2009 ; Shinkfield & Graffam, 2009 ) and substance use ( Staton-Tindall, Royse, & Leukefeld, 2007 ). Given the impact of family connectedness on post-release functioning, it is important to understand factors that enhance family connectedness, including family contact through various mediums.

It is important to consider that initial level of family connectedness may impact how frequently family contact occurs during incarceration. Individuals who are more connected to their family at the start of incarceration may have more frequent family contact than those who are less connected. Although incarceration may serve as a time to reestablish connections with one’s family, it seems less likely an individual who completely disconnected from family prior to incarceration will receive frequent contact.

Planning for Post-Release

On a practical level, families may facilitate proactive post-release planning. The re-entry experience is a key transition, yet it is often fraught with uncertainty. Many individuals on the verge of release do not know where they will be living ( McLean, Robarge, & Sherman, 2006 ), working, or how they will financially support themselves. Making plans prior to release may facilitate reentry and set offenders on a path to conventional living at the onset of re-entry.

Families may act as facilitators of successful reentry, assisting with housing, employment, and finances. Individuals incarcerated in prison often rely heavily on family support during reentry ( Naser & La Vigne, 2006 ). In a study of 413 men interviewed 2-3 months after release from state prison, 86% reported they were currently living with at least one family member and 73% of those who looked for a job talked to family as a means of finding employment ( Naser & La Vigne, 2006 ).

Maintaining contact with one’s family during incarceration may facilitate post-release planning. It is challenging to explore opportunities during incarceration due to limited contact with the outside world, and, depending upon one’s charges, returning to prior living situations and jobs may not be possible. Contact provide opportunities for family members to facilitate efforts toward post-release planning.

Current Study

The primary aims of the current longitudinal study are to determine whether: 1) having contact with one’s family during incarceration increases family connectedness; 2) family connectedness and/or post-release planning mediate the relationship between contact and both adaptive (i.e., community functioning) and maladaptive (i.e., recidivism, substance misuse, mental illness) post-release outcomes; 3) these relationships differ based on whether one is incarcerated in jail or prison; and 4) these relationships differ based on type of contact.

Having more family contact during incarceration is hypothesized to promote adaptive functioning post-release. Specifically, in accordance with the literature, higher levels of contact are expected to predict lower rates of recidivism, fewer symptoms of substance dependence and mental illness, and higher levels of community adjustment (e.g., legal employment, residential stability). Full mediation of these effects by pre-release family connectedness and post-release planning is expected. Based upon literature on social connectedness in community populations (e.g., Lee & Robbins, 2000 ; Sale et al., 2003 ), higher levels of family connectedness just prior to release are anticipated to mediate the effects of contact on post-release outcomes. Further, higher levels of family connectedness at the onset of incarceration are expected to predict more family contact during incarceration, which in turn is expected to predict increased family connectedness. Regarding post-release plans, individuals who have more contact with family are expected to make more plans for post-release housing, employment, and continued education; having such plans is expected to mediate the effect of contact on post-release outcomes.

The generalizability of models to both jail and prison incarceration, as well as across different types of contact, will be examined. The authors are unaware of research on this subject focusing on individuals in jail; the current sample includes individuals in a local suburban jail, some of who were transferred to prison. It is possible different types of contact (visits, phone calls, letters) will differentially impact post-release outcomes through these mediators. Each form of contact presents unique challenges ( Folk, Nichols, Dallaire, & Loper, 2012 ), as well as opportunities (e.g., letter writing allows time to think before responding, potentially inhibiting emotional reactivity and allowing for thoughtful planning). Of note, since phone contact can typically occur any day and multiple times per week, it may be more strongly related to these mediators because incarcerated individuals can be more involved in the day-to-day functioning of the family, compared with the non-real time interactions through letter writing.

The current study adds to the literature in several ways. Most research has studied single-sex samples of individuals incarcerated in prison and considered only one type of contact; this limits the generalizability of results and ignores the potential for different effects based upon the type of contact (e.g., Barrick et al., 2014 ). The current sample includes men and women incarcerated in both jail and prison assesses contact through visits, phone calls, and letters. Secondary analyses include examination of gender and race differences in the model.

Participants and Procedure

Participants were 507 pre- and post-trial individuals held on felony charges in a suburban county jail who participated in a larger longitudinal study ( Tangney, Mashek, & Stuewig, 2007 ). The primary goal of the parent study was to examine the implications of moral emotions and cognitions for post-release recidivism, substance misuse, and HIV risk behavior. At enrollment, participants were on average 32 years old ( SD = 10, range 18 to 69), male (70%), had completed 11.77 years of education ( SD = 2.25, range 0 to 19), and were diverse in race and ethnicity (44.3% Black, 36.4% White, 8.7% Hispanic, 3.0% Asian, 4.1% “Mixed,” and 3.4% “Other’). Most participants had never been married (57.6%), were divorced or separated (23.3%), or were legally married (13.8%). Over half of participants (59.5%) had children ( range = 0 to 7 children; age range = <1 to 50 years old), and 52.5% had minor age children.

Participants were recruited for baseline assessment shortly after assignment to the jail’s medium and maximum security “general population” (Time 1). Because a key interest of the parent project was the effectiveness of short-term interventions with relatively serious offenders, selection criteria were developed to identify incoming individuals likely to serve at least four months (i.e., long enough to complete the 4-6 session baseline assessment and have the opportunity to request and engage in jail programs and services). Individuals fitting this profile were sentenced to 4 months or more or arrested and held on at least one felony charge other than a probation violation, with no bond or >$7,000 bond.

Participants were arrested for a broad range of felony offenses and incarcerated for an average of 10.5 months ( SD = 10.9 months) at the county jail, with 205 participants serving additional time at other facilities ( M = 17.2 months, SD = 19.0 months), typically state prisons. Participants were re-interviewed prior to release from the host jail or prior to release following transfer to another facility (Time 2) and approximately one year following release (Time 3). Participants received honoraria of $15-18 at baseline (Time 1), $25 at pre-release and post-transfer pre-release (Time 2), and $50 at the one-year follow-up (Time 3). All procedures were approved by the George Mason University Institutional Review Board.

Of the 508 participants originally enrolled in the longitudinal study, one participant did not have valid data on any construct of interest for the current study, leaving a sample of 507. Data on Time 1 (T1) variables of interest are available for 449 participants; the rest are missing due to validity concerns and incomplete interviews. At Time 2 (T2), we re-interviewed 163 of the 220 (74%) individuals eligible for a pre-release interview and 123 of the 190 (65%) eligible for a post-transfer-pre-release interview. At Time 3 (T3), we re-interviewed 370 of 478 (77%) eligible for one year post release interview. Attrition analyses compared eligible individuals who were re-interviewed vs. those who were not (not found, refused, withdrew) across demographics, mental health, psychological, criminality, and substance dependence. There were few differences at p < .05 on 34 background variables tested at each timepoint. Missed individuals tended to be younger (T2 and T3), Spanish-only speakers (T3), and reported more symptoms of paranoia (T2). Using a Benjamini-Hochberg ( B-H; 1995 ) correction to control for the false discovery rate, no significant differences were found for the time points analyzed in the current study.

Onset of incarceration (Time 1).

Demographics..

Participants self-reported a wide range of demographic characteristics including sex, age, race, and educational attainment.

Family connectedness.

Connectedness to ones’ family was measured using the Inclusion of Community in Self (ICS) scale ( Mashek, Cannaday, & Tangney, 2007 ; supplemental material ), a single-pictorial measure consisting of six pairs of overlapping circles, with each pair of same–sized circles overlapping slightly more than the preceding pair. For this administration, participants were asked about their relationships to various targets, including the community at large, the criminal community, and their current family. For the family item, participants were told the circle on the left of each pair represented themselves, while the circle on the right represented their “current family.” The directions asked participants to “circle the picture that best describes your relationship with your current.” The instructions also included a phrase indicating that current family referred to “everyone in your family now, like your spouse or your kids, as well as your other living relatives (for example, parents and siblings).” Responses were coded on a scale from 1 (the circles with no overlap) to 6 (the circles with substantial overlap). The ICS is an explicit derivation of the Inclusion of Other in Self (IOS) Scale ( Aron, Aron, & Smollan, 1992 ), which demonstrates test-retest, discriminant, predictive, and convergent validity. The family connectedness item has yet to be used in published research, but other ICS items have demonstrated test-retest, discriminant, predictive, and convergent validity ( Folk et al., 2016 ; Mashek et al., 2007 ).

Pre-release or post-transfer pre-release (Time 2).

Family connectedness was assessed using the ICS ( Mashek et al., 2007 ), as described above.

Contact with family.

Participants reported how often they had contact with various family members (spouse/significant other, parent(s), children under the age of 18, children 18 years and older, other/extended family members) during the current incarceration and the type of contact (in person visitation, phone calls, letters) that occurred. For those transferred to prison, contact reflects that which occurred in the transfer facility. Responses were rated on a 7-point scale: 0 ( never ), 1 ( once ), 2 ( less than once per month ), 3 ( once per month ), 4 ( two or three times per month ), 5 ( once per week ), 6 ( a few times per week ), and 7 ( every day ) and collapsed across family members to create an average frequency of in person visits ( M = 1.30, SD = 1.29), phone contact ( M = 2.72, SD = 1.62), and letter contact ( M = 1.87, SD = 1.35). The mean of these three variables was used to represent overall frequency of contact.

Post-release plans.

Participants reported whether they had plans following release by responding to the following questions: “Do you know where you are going to live after your release?,” “Do you have a plan for supporting yourself after release?,” “Do you have a job lined up?,” and “Do you have any plans for continued education after your release?” Response options were 0 ( no ), 1 ( yes ). The mean of these four items was used to represent post-release plans.

One year post-release (Time 3).

Recidivism was assessed using self-report and official records. Participants reported whether they were arrested for any of 16 types of crime (i.e., theft, robbery, assault, murder, domestic violence, weapons offenses, major driving offenses, prostitution, drug offenses, sex offenses, fraud, kidnapping, arson, resisting arrest, miscellaneous, other) during the first year post-release. To assess undetected offenses, participants reported whether they had committed, but were not caught for, any of the same 16 types of crime. Official National Crime Information Center records of arrests in the first year post-release were also collected; 119 charge codes found on official records were categorized into the 16 crime types used for the self-report variables. To capture criminal versatility in these three sources, three variables were created to reflect the number of types of crimes (0-16) people were arrested for (official and self-reported arrests) and reported committing (self-reported offenses). Versatility - the number of different types of crimes - was employed rather than frequency of arrest/offense because type of crime is confounded with frequency (e.g., illegal substance use vs. violent offenses). Also, versatility indices exhibit higher reliability than frequency scales, have a higher correlation with official reports of delinquency than other measures formed from self-reports ( Hindelang et al., 1979 , 1981 ), and have greater predictive validity than frequency and weighted frequency scales ( Farrington, 1973 ). Technical violations (e.g., violations of the conditions of probation or parole) were not included in the versatility variables because they represent infractions such as missed appointments, failed drug tests, etc.

Mental health symptoms.

A shortened version of the Personality Assessment Inventory (PAI; Morey, 1991 ) was used to assess depression, anxiety, stress, and borderline personality disorder symptoms. Responses ranged from 1 ( false, not at all true ) to 4 ( very true ). The PAI uses T-scores (standardized scores with M of 50 and SD of 10) based on a census-based normative sample; alphas were .85 for depression (24 items), .89 for anxiety (24 items), .74 for stress (8 items), and .88 for borderline features (24 items).

Substance dependence.

The Texas Christian University: Correctional Residential Treatment Form, Initial Assessment (TCU-CRTF; Simpson & Knight, 1998 ) was used to assess symptoms of dependency on alcohol (17 items), marijuana (8 items), cocaine (14 items), and opiates (18 items) during the first year post-release. Participants rated the frequency with which they experienced symptoms of substance dependence on each substance in the domains specified by the DSM-IV-TR ( American Psychiatric Association, 2000 ). Item responses ranged from 0 ( never ) to 4 ( 7 or more times ). For domains with multiple items (e.g., different withdrawal symptoms), responses were averaged within that domain and a total score was computed by taking the mean across the seven domains (six in the case of marijuana because withdrawal is not considered part of the criteria). Each scale had acceptable reliability (alcohol, α = .93; marijuana, α = .87; opiates, α = .98; cocaine, α = .98). Given the similarities between cocaine and opiates (illegal, highly addictive) and the low rate of opiate use in our sample, opiates and cocaine were combined into a category of “hard drugs.” Frequency of dependence symptoms related to cocaine/opiate use was defined as the higher of the two ratings for either cocaine or opiates.

Employment.

Participants self-reported whether they were unemployed, or had odd jobs, part-time, or full-time employment; if employed, follow-up questions assessed length of employment. Of those who reported employment status ( n = 332), the majority (67.8%) had full-time employment during the year after release. A continuous variable ( total hours employed ) was created to represent the amount of employment in the first year post-release. Based on the typical workweek for an average individual living in the U.S., the response “ yes, held full-time jobs (35 hours or more per week )” was coded as 40 hours. The response “ yes, held part-time jobs (35 hours or less per week )” was coded as 20 hours. The response “ yes, did odd jobs (occasional or irregular work) “ was coded as 5 hours. Number of hours employed per week was multiplied by the number of weeks employed during the year after release to determine total hours employed .

Community functioning.

A community functioning index was created to assess the degree to which participants were functioning in, and contributing to, the community adaptively. We were specifically interested in identifying prosocial forms of community functioning, which is not merely the opposite of poor outcomes such as re-arrest and reincarceration; it represents a distinct source of variance ( Moore, Stuewig, & Tangney, 2016 ). Eight items were selected from a detailed demographic questionnaire completed at one-year post-release, with each coded as adaptive (1) or non-adaptive (0). Coding was based on prior theory and research, not value judgments, and this index has been used in prior research ( Folk et al., 2016 ; Moore et al., 2016 ). Items include: 1) residential stability, 2) homeownership, 3) current marital status, 4) largest source of support, 5) valid driver’s license, 6) financial support of children, 7) educational and vocational upgrades, and 8) volunteerism in the community. Scores were averaged across the eight dichotomous indicators to create a total functioning index. Cronbach’s alpha was not calculated because this is a formative construct.

Descriptive statistics and bivariate correlations are presented in Table 1 . In line with our hypotheses and previous literature, family contact predicted fewer self-reported offenses and official records of arrest, symptoms of alcohol dependence, depression, stress, and borderline personality disorder, and more hours employed and adaptive community functioning. As hypothesized, family contact was positively related to each of the mediators – family connectedness prior to release and post-release planning. T2 family connectedness was positively related to self-reported arrests and official records of arrest, and negatively related to all mental health indicators. Post-release plans in contrast, were related to official records of arrest, hours employed, and community functioning. Few gender and race differences were found in the primary study variables. After a B-H correction, men disclosed significantly more self-reported arrests ( t (277.14) = −3.41, p < .001), and symptoms of alcohol (( t (277.14) = −4.22 p < .001) and marijuana ( t (322.75) = −3.84, p < .001) dependence than women; Blacks were significantly more connected to their families at baseline ( t (335.06)= −4.80, p < .001) and had more frequent phone contact with families during incarceration ( t (177)= −3.84, p < .001) than Whites.

Bivariate Relations and Descriptive Statistics

Measurement Model for Post-Release Adjustment

Mplus statistical software was used to create four latent dependent variables (indicated with capital letters throughout the manuscript): Recidivism, Substance Dependence, Mental Health Symptoms, and Community Adjustment. Recidivism was composed of self-reported and official records of arrests and self-reported offenses; Substance Dependence of hard drug dependence, alcohol dependence, and marijuana dependence symptoms; Mental Health Symptoms of depression, anxiety, stress, and borderline personality disorder features; and Community Adjustment of total hours employed and community functioning. Missing data were handled using Full Information Maximum Likelihood (FIML; Graham, 2009 ; Muthén & Muthén, 1998-2012 ; Schafer & Graham, 2002 ). 1

A confirmatory factor analysis using maximum likelihood estimation was conducted for the four latent variables, including intercorrelations among all latent variables and a correlated residual for self-reported arrests and official records of arrest ( Folk et al., 2016 ; Moore et al., 2016 ). This model fit the data acceptably ( χ 2 (47) = 102.44, p < .001; RMSEA = .05 with 95% CI .04 to .06, CFI = 0.96, SRMR = .05). Factor loadings were all significant and standardized estimates ranged from .48 to .88. On Recidivism, Substance Dependence, and Mental Health Symptoms, higher scores indicated worse functioning; higher scores indicated more adaptive functioning on the Community Adjustment latent variable (see Figure 1 ).

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Measurement Model. All parameter estimates are standardized. ** p <.001; χ 2 (47) = 102.44, *** p <.001; RMSEA =.05 with 95% CI .04 to .06, CFI =.96, SRMR =.05

Structural Model: Family Contact, Connectedness, Planning, and Post-Release Outcomes

The structural model depicted in Figure 2 fit the data acceptably ( χ 2 (89) = 178.67, p < .001; RMSEA = .05 with 95% CI .04 to .05, CFI = 0.93, SRMR = .06) using maximum likelihood estimation. Results indicate family connectedness at the onset of incarceration is positively related to having contact with one’s family and pre-release family connectedness. Further, pre-release family connectedness mediates the relationship between having contact with one’s family during incarceration and Mental Health Symptoms during the first year post-release. The indirect effect from T1 family connectedness to Mental Health Symptoms through T2 family connectedness was significant, ß = −.16, p < .001, as was the indirect effect from contact to Mental Health symptoms through T 2 family connectedness, ß = −.06, p < .05. The indirect effect from T1 family connectedness to Mental Health Symptoms through contact with family and T2 family connectedness was also significant, ß = −.02, p < .05. Those who are more connected to their family at the onset of incarceration tend to have more contact with their family during incarceration. This in turn predicts increased family connectedness prior to release, which predicts having fewer symptoms of mental illness during the first year post-release. Family contact did not influence post-release planning, but having more post-release plans was significantly related to Community Adjustment. Those who made post-release plans tended to function more adaptively in the community during the first year post-release. No other structural pathways were significant.

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Structural Model with Results. All parameter estimates are standardized. Although not depicted in the figure for ease of representation, disturbance terms for all latent variables are correlated. p <.05*; p <.01**; χ 2 (89)=178.67, p <.001; RMSEA =.05 with 95% CI .04 to .05, CFI =0.93, SRMR =.06. The indirect effect from Phase 1 family connectedness to mental health symptoms through contact with family and Phase 3 family connectedness was significant, ß=−.02, p <.05.

Type of family contact.

To evaluate whether type of contact influences the structural relationships, the mean family contact variable was substituted by each mode of contact ( Table 2 ). We employed this method rather than entering all forms of contact at once to avoid partialling of variance, which makes interpretation and real world applicability challenging.

Differences Based on Contact Type

The model for visits fit the data acceptably ( χ 2 = 168.70, p < .001; RMSEA = .04 with 95% CI .03 to .05; CFI = .94; SRMR = .06). Apart from visits not significantly predicting T2 family connectedness, the pattern of direct effects paralleled the initial model. There was a significant indirect effect from T1 family connectedness to Mental Health Symptoms through T2 family connectedness ( β = −.16, p < .001).

The model for phone contact fit the data acceptably ( χ 2 = 180.93, p < .001; RMSEA = .05 with 95% CI .04 to .06; CFI = .93; SRMR = .06). The pattern of direct effects paralleled the initial model. There was a significant indirect effect from T1 family connectedness to Mental Health Symptoms through T2 family connectedness ( β = −.09, p < .001) and from phone contact to mental illness through T2 family connectedness ( β = −.04, p = .02); the indirect effect from T1 family connectedness to mental illness through phone contact and T2 family connectedness was marginally significant ( β = −.01, p = .068).

The model for letters fit the data acceptably ( χ 2 = 174.81, p < .001; RMSEA = .04 with 95% CI .03 to .05; CFI = .94; SRMR = .07). The pattern of direct effects paralleled the initial model. There was a significant indirect effect from T1 family connectedness to Mental Health Symptoms through T2 family connectedness ( β = −. 16, p < .001) and from letters to Mental Health Symptoms through T2 family connectedness ( β = −.05, p = .031); the indirect effect from T1 family connectedness to Mental Health Symptoms through letters and T2 family connectedness was marginally significant ( β = −.01, p = .072).

Contrary to hypotheses, family contact was unrelated to post-release planning, regardless of the type of contact being considered. Further, as in the full model, neither family connectedness nor post-release plans were related to Recidivism and Substance Dependence.

Multiple-group Analyses

Multiple-group analysis was used to examine differences between individuals released from jail and those transferred to and released from prison. These analyses were conducted with frequency of contact aggregated across type since there were few differences when considering type of contact.

Measurement invariance.

A series of nested multiple-group models were tested to determine whether factorial invariance existed in the measurement of the outcome variables between individuals who were and were not transferred prior to release. Chi-square difference tests were computed to compare the models. In the fully unconstrained model, a Heywood case emerged in the transfer group due to negative residual variance in the community functioning indicator. Since the confidence interval for this residual contained 0, it is likely due to sampling error ( Dillon, Kumar, & Mulani, 1987 ) and was therefore fixed to 0. As shown in Table 3 , scalar invariance was achieved (i.e., loadings and intercepts are constrained to be equal across groups). This implies the meaning of the construct (i.e., factor loadings) and the levels of the underlying items (i.e., intercepts) are equal across groups. In other words, the two groups are comparable on their scores on the latent variables.

Measurement Invariance Models

Note. The final model is denoted in bold.

Full uniqueness measurement invariance was not achieved; as the model fit significantly worse when the residuals were constrained to be equal. Without full uniqueness measurement invariance, groups can still be compared on the latent variable, but they are measured with different amounts of error between groups ( Van de Schoot, Lugtig, & Hox, 2012 ). As such, we use the model where factor loadings and intercepts, and the correlation between the latent variables, are constrained to be equal across groups.

Structural invariance.

Two models were tested and compared to determine whether structural invariance was present. In the unconstrained model ( χ 2 (200) = 319.46, p < .001; RMSEA = .05 with 90% CI .04 to .06, CFI = 0.91, SRMR = .09), all structural paths were allowed to be freely estimated for each group; in the constrained model ( χ 2 (213) = 332.21, p < .001; RMSEA = .05 with 90% CI .04 to .06, CFI = 0.92, SRMR = .10), all structural paths were set to be equal across the two groups. The two models were not significantly different from one another (Δ χ 2 (13) = 12.75, p > .05) 2 , so we accept the constrained model as the more parsimonious one. This suggests individuals who were released directly from the jail and those who were transferred prior to release do not differ in the model overall (except for the differences in residuals at the CFA level).

Secondary Analyses of Gender and Race Differences

Multiple-group analysis was used to examine differences in the structural model based on gender and race. Regarding gender, the unconstrained model where structural paths were allowed to be freely estimated for each group the model fit the data well ( χ 2 (200) = 328.23, p < .001; RMSEA = .05 with 90% CI .04 to .06, CFI = 0.91, SRMR = .10). The fully constrained model, however, ( χ 2 (213) = 357.48, p < .001; RMSEA = .05 with 90% CI .04 to .06, CFI = 0.90, SRMR = . 12) was significantly different from the unconstrained model (Δ χ 2 (13) = 29.25, p < .05). An examination of the residuals and modifications indices suggested the pathway between contact with family and post-release plans was significant for females ( β = .60, p < .001) but not for males ( β = −.15, p = .13) ( χ 2 (212) = 336.32, p < .001; RMSEA = .05 with 90% CI .04 to .06, CFI = 0.91, SRMR = .11).

Regarding race (comparing Blacks vs. White), the unconstrained model where structural paths were allowed to be freely estimated for each group the model fit the data satisfactorily ( χ 2 (200) = 346.02, p < .001; RMSEA = .06 with 90% CI .05 to .07, CFI = 0.89, SRMR = .11). The fully constrained model, however, ( χ 2 (213) = 371.10, p < .001; RMSEA = .06 with 90% CI .05 to .07, CFI = 0.88, SRMR = .13) was significantly different from the unconstrained model (Δ χ 2 (13) = 25.08, p < .05). An examination of the residuals and modifications indices suggested the pathway between contact with family and post-release plans was significant for Whites ( β = .34, p < .01) but not for Blacks ( β = −.04, p = .77) ( χ 2 (212) = 365.93, p < .001; RMSEA = .06 with 90% CI .05 to .07, CFI = 0.88, SRMR = .13).

Results of this longitudinal study of incarcerated individuals confirm having contact with family during incarceration is beneficial to post-release functioning; specifically, increased contact with family during incarceration facilitates family connectedness, which in turn promotes better post-release mental health. On the bivariate level, we also replicated and extended prior research by documenting a link between family contact and lower rates of recidivism, alcohol dependence, and mental health symptoms, as well as more adaptive aspects of community functioning.

The link between pre-release family connectedness and better post-release mental health is consistent with prior literature documenting the strong association between perceived social support and mental health (e.g., Kawachi & Berkman, 2001 ; Thoits, 1995 ). In accordance with the stress buffering hypothesis, perceived social support buffers against stress when support meets the demands of the stressor (e.g., Cohen & Wills, 1985 ). One way to meet needs associated with the stress of incarceration is through maintaining contact with loved ones. The current study suggests having contact with family promotes increased feelings of family connectedness, which in turn predicts better post-release mental health.

Contrary to our hypotheses, family connectedness was unrelated to recidivism, substance misuse, or community adjustment - the more behavioral outcomes. It may be perceived support from family is not sufficient to promote behavioral change. Other factors such as one’s ability to obtain tangible support may be stronger predictors, as ex-prisoners frequently rely on family for support with housing and employment ( Naser & La Vigne, 2006 ); unfortunately, tangible support was not assessed.

Post-release plans, on the other hand, were related to adaptive community functioning during the first year post-release. Those who made plans for where they would live and work, and whether they would pursue further education, seemed more likely to execute these plans and function adaptively in the community. Surprisingly, frequency of contact with family was unrelated to the number of plans incarcerated individuals made. When examining gender and racial differences, however, this pathway was significant for females and Whites, but not males and Blacks. It is unclear why this relation would differ based on one’s gender or race. One possibility is that females and Whites have contact with different types of family members than males and Blacks. For example, age of family member may matter. Incarcerated people may be more inclined to discuss post-release employment with adult family members than with minor age children who would be unable to facilitate employment opportunities. Exploration of differences based on who contact is with is an important avenue for future research.

There were no differences in the structural model based on whether individuals were incarcerated in jail or prison. The similarity in structural models was surprising given the differences in average length of incarceration, barriers to contact, and rules surrounding visitation in jail compared to prison environments. This study is the first, to our knowledge, to compare the implications of family contact for individuals incarcerated in jail and prison.

Results further suggest in-person visits, phone calls, and letters have roughly equivalent effects on family connectedness and mental health during the first year post-release. The direction and magnitude of effects were similar across the three models. Although visitation was not significantly related to changes in family connectedness, the effect was positive. Visits may have a weaker relation to changes in family connectedness because visits are restricted to occur less frequently and entail multiple logistical barriers (e.g., distance, expenses). It is also possible effects of visitation on family connectedness differ as a function of who is visiting. Some evidence suggests receiving visits from one’s children during incarceration is related to higher risk of recidivism ( Bales & Mears, 2008 ) and rule-breaking behavior in prison ( Jiang, Fisher-Giorlando, & Mo, 2005 ). Future investigations are needed to determine whether receiving visits from different family members has different implications for these processes.

Limitations and Future Directions

Although the results of this study hold implications for understanding how contact with family during incarceration impacts post-release functioning, there are several limitations. First, family connectedness was assessed using a one-item measure. We were unable to examine the impact of different forms of social support, which may differentially impact post-release functioning. Future studies should consider assessing the ways incarcerated individuals feel supported by their families (e.g., emotional support, tangible support). Second, contact with family included visits, phone calls, and letters received, but not letters sent or video contact. Frequency of writing letters likely contributes to the amount of contact received; future studies should assess both letters sent and received. Relatedly, with technological advances, video visitation and email are becoming increasingly common in correctional facilities; differences in outcomes based on technology-based forms of contact should also be explored.

Also, quality of the contact and who contact is with likely predicts whether it benefits functioning. For example, family contact involving conflict may be less likely to increase family connectedness and post-release planning. Relatedly, the effects of contact may differ based on whether contact is with adult family or their minor age children. Children are unlikely to be able to facilitate planning for employment, housing, etc. There is some research suggesting having contact with one’s children during incarceration may have iatrogenic effects. For example, incarcerated individuals who receive visits from children during incarceration are more likely to engage in drug and property rule-breaking behavior ( N =14,000; Jiang, et al., 2005 ), and incarcerated mothers who receive visits from or write to and receive letters from children are more likely to be written up for rule-breaking behavior than mothers who do not receive visits or write to or receive letters from the children ( N =751; Benning & Lahm, 2016). Future research should explore differences in outcomes based on both who contact is with and the quality of the contact.

Furthermore, much of the existing research on how contact impacts post-release functioning has been conducted with single sex samples. It is possible these effects differ based on the incarcerated individual’s gender, particularly when considering contact between incarcerated parents and their children where gender roles may be more salient and pronounced. Future research should consider gender differences in these relations.

Finally, as with any non-experimental design, there are limitations to our ability to make causal claims. To strengthen our understanding about directionality of effects, we evaluated family connectedness at the start and end of incarceration, which allowed us to look at predictors of change in this construct. Although there are no doubt unmeasured variables, the mediating role of family connectedness between contact and post-release mental health makes it unlikely the relationship between contact and mental health is a spurious one.

Applied Implications

Allowing families to connect during incarceration can positively impact post-release functioning, particularly in regard to mental health. Results of the current study suggest form of contact does not matter, but the frequency with which families communicate is influential. There are numerous barriers to maintaining contact. Regarding in-person visitation, distance, lack of transportation, and the cost of traveling to correctional facilities are often prohibitive. Literacy, both of the incarcerated individual and of the family member, can impede communication through letters. The cost of phone calls, which cannot be returned if the family member misses it due to being unavailable, is often extremely limiting. And, due to the screening of communication by correctional officers, concerns regarding privacy and general discomfort with the spaces and procedures may inhibit families’ ability to connect during contact. Given these barriers, it is encouraging that family contact regardless of form is predictive of post-release outcomes, as different forms of contact will be more feasible for some families than others.

Additional resources and macro-level changes are needed to make contact more feasible. Actions such as the Federal Communications Commission’s 2013 caps on the cost of making phone calls from correctional facilities (and proposed 2015 caps, which were stayed by court order) are an important step to ensuring families can afford to maintain contact, but for many this is not enough. It still costs 21 cents per minute to make a debit interstate call and 25 cents per minute for a collect interstate call from a correctional facility, compared to typical commercial rates of 4 cents per minute; this does not include the exorbitant fees charged to add money to an account to make calls.

Facilities should also take steps to allow for higher quality contact. Visits can be stressful due to long wait times, invasive searches, and the lack of child-friendly spaces. These conditions can undermine the benefits of family contact and as such need to be addressed ( Poehlmann et al., 2010 ). Interventions which combine family-focused contact (e.g., not through Plexiglas, ability to play with and hold children) and programming like parenting interventions (e.g., Grayson, 2007 ) may be most useful in promoting high quality contact, although systematic evaluations of such programs are still needed. It is possible to be both behind bars and connected to family; modifications to practices and policies can make this so.

Supplementary Material

Supplemental material, acknowledgments.

This research was supported by the National Institute on Drug Abuse grants RO1DA14694 and F31DA039620.

Many thanks to the members of the Human Emotions Research Lab for their assistance with this research.

These results have not been previously disseminated in any form.

1 FIML uses all data available about a participant, including other measures at that time point and outcome measures, to determine the model parameters. Data values are not imputed; model parameters are estimated using all available information. This technique is widely accepted ( Little, Jorgensen, Lang, & Moore, 2014 ; Schafer & Graham, 2002 ), especially in longitudinal research where people sometimes miss an entire wave of data collection, and provides more reliable results than Listwise deletion ( Schafer & Graham, 2002 ).

2 Although there were 12 structural paths, we also constrained the mean of the exogenous variable, T1 family connectedness, in the fully constrained model; this results in the 13 degree of freedom difference. The mean of T1 family connectedness was specified in the model to include all participants with available data (“Why is,” n.d.).

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Conjugal Visit Laws by State 2024

California refers to these visits as contact visits. Conjugal visits have had a notorious past recently in the United States , as they were often not allowed to see their family unless it was for brief contact or to speak with them on the phone. Conjugal visits began as a way for an incarcerated partner to spend private time with their domestic partner, spouse, or life partner. Historically, these were granted as a result of mental health as well as some rights that have since been argued in court. For example, cases have gone to the Supreme Court which have been filed as visits being considered privileges instead of rights.

The right to procreate, religious freedom, marital privacy and to abstain from cruel and unusual punishment has been brought up and observed by the court. Of course, married spouses can't procreate if one is incarcerated, and this has been a topic of hot debate in the legal community for years. Although the rules have since been relaxed to allow more private time with one's family, especially to incentivize good behavior and rehabilitation, it is still a controversy within social parameters.

In 1993, only 17 states had conjugal visit programs, which went down to 6 in 2000. By 2015, almost all states had eliminated the need for these programs in favor of more progressive values. California was one of the first to create a program based around contact visits, which allows the inmate time with their family instead of "private time" with their spouses as a means of forced love or procreation.

Washington and Connecticut

Connecticut and Washington have similar programs within their prison systems, referring to conjugal visits as extended family visits. Of course, the focus has been to take the stigma away from conjugal visits as a means of procreation, a short time, and a privilege as a result of good behavior. Extended family visits are much more wholesome and inclusive, giving relatively ample time to connect with one's family, regardless if they have a partner or not. Inmates can see their children, parents, cousins, or anyone who is deemed to have been, and still is, close to the prisoner.

Of course, there are proponents of this system that say this aids rehabilitation in favor of being good role models for their children or younger siblings. Others feel if someone has committed a heinous crime, their rights should be fully stripped away to severely punish their behavior.

On a cheerier note, New York has named its program the "family reunion program", which is an apt name for the state that holds the largest city in America by volume, New York City. NYC's finest have always had their handful of many different issues, including organized crime. The authorities are seeking a larger change in the incarceration system and want to adopt a stance that focuses more on the rehabilitation of the inmate that shows signs of regret, instead of severe punishment for punishment's sake.

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Benefits and risks of conjugal visits in prison: A systematic literature review.

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  • Kalebic N | 0000-0001-5228-0823
  • Taylor PJ | 0000-0002-3998-6095

Criminal Behaviour and Mental Health : CBMH , 01 Oct 2021 , 31(5): 343-361 https://doi.org/10.1002/cbm.2215   PMID: 34597428 

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Election update: Prop. 1 — Gavin Newsom’s mental health plan — holds narrow lead

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Recent polls show many Californians were undecided heading into Election Day on Gov. Newsom’s Proposition 1, which would fund new mental health treatment facilities.

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California voters by a thin margin are favoring Gov. Gavin Newsom’s $6.4 billion plan to build mental health treatment beds and housing through a ballot measure that he characterizes as critical to addressing the state’s homelessness crisis.

Proposition 1 is a two-part ballot initiative . It includes a bond to build treatment facilities and permanent supportive housing for people with mental health and addiction challenges. It also proposes changes to a longstanding tax on personal incomes over $1 million, known as the Mental Health Services Act, by requiring counties to spend 30% of that revenue on housing instead of other services.

As of 8:30 a.m. Thursday with about 4 million votes counted, the measure is leading by a margin of 50.3% to 49.7%.

Newsom has previously said Prop. 1 will help California fulfill a decadeslong promise to get “people off the streets, out of tents and into treatment.” 

The Yes on Prop. 1 campaign amassed a nearly $21 million war chest for the ballot measure, drawing support from law enforcement groups, major health care organizations and the mental health advocacy group NAMI California. 

“This is exactly where we thought we’d be,” Anthony York, a spokesman for the Yes on Prop. 1 campaign, said on Wednesday. “There are 2 to 3 million ballots outstanding. I’d say we’re cautiously optimistic.”

In contrast, the opposition campaign raised very little money. Opponents are led by clients of mental health services and some small mental health agencies who worry their programs could lose funding if the measure passes. Others, including the Howard Jarvis Taxpayers Association, opposed the measure because of its cost. 

Paul Simmons, executive director of the opposition campaign, struck hopeful tone as early votes started rolling in Tuesday night.

“We expected to be further behind in the early voting,” Simmons said. “This being at 51% or 50% is very encouraging to me.” 

Recent polling casts uncertainty over what many initially considered an easy win for the governor. Fifty percent of likely voters supported the measure a week ago, according to the latest poll by UC Berkeley’s Institute of Governmental Studies . The poll tallied opposition at 34% and undecided at 16%. 

Prop. 1 needs a simple majority of the vote to pass.

Jon Coupal, executive director of the Howard Jarvis Taxpayer Association, said the results so far show that Californians are concerned about government spending.

“This has two strikes. No. 1, it was a bond measure. People are sensitive right now to government debt. A lot of people had the reaction of, I’m all for helping the homeless but do we really need a bond to do this?

“Then secondly, I think people are well aware of the billions of dollars we have thrown at homelessness and mental health and the problem just seems to get worse, so I think people may look at that and say, you’re asking for more money and you’re not demonstrating any results,” he said.

Here’s a look at what the measure would do.

What does Prop. 1 promise?

The dual bond measure and change to California’s so-called “millionaire’s tax” are Newsom’s attempt to increase the state’s mental health and addiction treatment capacity and get people living in encampments into stable housing.

The number of unhoused Californians had ballooned to 181,000 people in 2022 during the most recent point-in-time count, a 60% increase over the past decade. New research from UCSF estimated that more than 21,000 homeless people currently experience hallucinations. Meanwhile, the number of acute care mental health hospital beds decreased by at least 30% between 1995 and 2016, according to the California Hospital Association.

The bond measure is supposed to build a combined 11,150 treatment beds and housing units with some set aside for veterans.

Where will the money go?

Money raised by the bond would be funneled into two existing state programs: the Behavioral Health Continuum Infrastructure Program and Project Homekey.

The behavioral health program would get a $4.4 billion infusion to build 6,800 in-patient mental health and substance use disorder treatment beds. The Department of Health Care Services will award grants to counties and local organizations to construct, acquire and expand treatment capacity. To date the department has awarded more than $1.6 billion to a variety of programs including crisis care and children’s facilities as part of a pre-existing budget investment.

Project Homekey would get $2 billion to build 4,350 units of supportive housing for people with mental health and addiction challenges. A little more than half of the units will be reserved for homeless veterans. Project Homekey is an extension of Newsom’s pandemic-era efforts to house people living in encampments during the height of the COVID-19 pandemic. The state budget previously gave the Department of Housing and Community Services $736 million to convert hotels, motels and other buildings into housing. 

How much will it cost?

Bonds allow government agencies to borrow money and repay debt over time. Prop. 1 is estimated to cost $310 million annually over 30 years, totaling $9.3 billion, according to the nonpartisan Legislative Analyst’s Office . Payments would be made from the state general fund.

California is facing state budget cuts for the second consecutive year with some estimates projecting a $73 billion dollar shortfall.

What other changes have happened recently?

Newsom has made mental health a signature issue. If Prop. 1 passes, it would represent another milestone in his overhaul of California’s behavioral health system . 

Last year, Newsom signed a law easing restrictions on California’s decades-old’ conservatorship law, which limits who can be placed in involuntary treatment programs .

In 2022, his signature mental health push established a special court system to compel people with untreated mental health and addiction challenges into treatment programs. 

And in 2021, Newsom poured more than $4 billion in one-time funds into children’s programs to address rising suicide rates and overdoses among youth .

Who opposed it and why?

A coalition of small mental health organizations, disability advocates and current clients of county mental health programs opposed Prop. 1. They argued that the measure would increase the amount of involuntary treatment and divert money from local organizations that serve hard-to-reach populations, such as LGBTQ people and communities of color.

more on proposition 1

Gavin Newsom hits the road for Prop. 1 as support falls for his mental health measure

Gavin Newsom hits the road for Prop. 1 as support falls for his mental health measure

Homelessness is on the California ballot this March. Will conditions change on the street?

Homelessness is on the California ballot this March. Will conditions change on the street?

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Kristen Hwang Health Reporter

Kristen Hwang reports on health care and policy for CalMatters. She is passionate about humanizing data-driven stories and examining the intersection of public health and social justice. Prior to joining... More by Kristen Hwang

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Jeanne covers California’s state government, labor, and politics for CalMatters. She has previously written about homelessness and the state’s economic divide. Prior to joining CalMatters she covered... More by Jeanne Kuang

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This International Women’s Day, 8 March 2024, join the United Nations in celebrating under the theme Invest in women: Accelerate progress .

The world is facing many crises, ranging from geopolitical conflicts to soaring poverty levels and the escalating impacts of climate change. These challenges can only be addressed by solutions that empower women. By investing in women, we can spark change and speed the transition towards a healthier, safer, and more equal world for all.

Needed per year to achieve gender equality

An additional $360 billion is needed per year to achieve gender equality.

20% to boost GDP per capita could be achieved by closing the gender gap

Closing gender gaps in employment could boost GDP per capita by 20 per cent. 

300 million jobs created by 2030 by investing in care services

Closing gaps in care and expanding services with decent jobs could spark almost 300 million jobs by 2035.

If current trends continue, more than  342 million women and girls could be living extreme poverty  by 2030. To ensure women’s needs and priorities are considered, governments must prioritize gender-responsive financing and increase public spending on essential services and social protection.

Policymakers must also value, recognize, and account for the vital contribution women make to economies worldwide through paid and unpaid care work.  Women spend around three times more time on unpaid care work than men and if these activities were assigned a monetary value they would account for more than 40 per cent of GDP .

Investing in women and championing gender equality turbocharges a future where everyone in society can thrive, creating a world of boundless opportunity and empowerment for all.

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When Teens Visit Doctors, Increasingly the Subject is Mental Health

Matt Richtel

By Matt Richtel

Increasingly, doctor visits by adolescents and young adults involve mental health diagnoses, along with the prescription of psychiatric medications.

That was the conclusion of a new study that found that in 2019, 17 percent of outpatient doctor visits for patients ages 13 to 24 in the United States involved a behavioral or mental health condition, including anxiety, depression, suicidal ideation, self-harm or other issues. That figure rose sharply from 2006, when just 9 percent of doctor’s visits involved psychiatric illnesses.

The study , published Thursday in JAMA Network Open, also found a sharp increase in the proportion of visits involving psychiatric medications. In 2019, 22.4 percent of outpatient visits by the 13-24 age group involved the prescription of at least one psychiatric drug, up from 13 percent in 2006.

The Big Picture

The study is the latest evidence in a shift in the kinds of ailments affecting children, adolescents and young adults. For many decades, their health care visits involved more bodily ailments, such as broken bones, viruses and drunken-driving injuries. Increasingly, however, doctors are seeing a wide variety of behavioral and mental health issues.

An instructor stands next to a whiteboard in front of a classroom of students wearing orange uniforms.

The reasons are not entirely clear. Some experts have said that modern life presents a new kind of mental pressure, even as society has limited the risks of physical ailments.

The latest study does not posit a reason for the shift. But the pandemic alone was not to blame, it noted. “These findings suggest the increase in mental health conditions seen among youth during the pandemic occurred in the setting of already increasing rates of psychiatric illness,” wrote the authors, a pediatrician and psychiatrist at Harvard Medical School. “Treatment and prevention strategies will need to account for factors beyond the direct and indirect effects of the pandemic.”

The Numbers

The analysis was drawn from the National Ambulatory Care Survey, which asks a sample of clinicians from across the country about the reasons for patient visits. Between 2006 and 2019, patients aged 13 to 24 made 1.1 billion health care visits, of which 145 million involved mental health issues. But the share of mental-health-related visits rose each year, the study found, as did the prescription of psychiatric medications, including stimulants, antipsychotics, mood stabilizers and anti-anxiety drugs.

The study found that antidepressants had the greatest increase, but it did not specify the exact level, said Dr. Florence T. Bourgeois, a pediatrician at Boston Children’s Hospital, an associate professor of pediatrics at Harvard Medical School and a co-author of the paper.

The prescription patterns leave an open question, she said.

“We can’t differentiate whether this speaks to the severity of conditions or changes in prescribing attitudes and trends,” she said. Either way, she added, “We are treating these conditions aggressively.”

Matt Richtel is a health and science reporter for The Times, based in Boulder, Colo. More about Matt Richtel

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Can You Have Conjugal Visits During Inpatient Drug Rehab?

When you enter an inpatient drug rehab, you cannot have conjugal visits with your spouse or significant other. However, your loved ones and family may visit you during rehab at designated times to participate in your treatment process.

Why Conjugal Visits Are Not Allowed

Family visits, inpatient treatment options.

Married Couple-Can You Have Conjugal Visits During Inpatient Drug Rehab?

For those of you struggling with alcohol or drug abuse and entering an inpatient treatment center , no conjugal visits will be allowed. While each rehab facility has their own set of rules, conjugal visits are not likely allowed at any treatment center .

Despite this, inpatient treatment facilities still want you to have a strong support system. In fact, there are several instances in which your family members and loved ones can visit you as part of your specialized residential treatment program.

Family visits may involve participating in types of treatment, including family therapy sessions.

Conjugal visits are not allowed at addiction treatment centers for several reasons. Dopamine receptors in the brain are activated during sex, creating feelings of pleasure.

In a similar manner, drug or alcohol abuse can also affect dopamine receptors. Because of this, a healthcare professional will monitor your levels to insure your safety during the treatment process.

Additionally, sex can be a distraction for those seeking sobriety. While receiving inpatient drug treatment, your primary focus should be on the alcohol or drug addiction recovery process.

Get Started On The Road To Recovery.

Get Confidential Help 24/7. Call Today!

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), family support plays a significant role in the recovery process. Those in inpatient drug addiction recovery may receive family visits when approved by your treatment team.

Some substance abuse treatment programs do not allow visits from loved ones, only phone calls. Depending on the type of treatment required, an important part of your treatment may be receiving emotional support from loved ones.

Family Therapy

Although you can participate in support groups with peers at the treatment center, specific family-oriented therapy sessions can be warranted. 

Family therapy and other group therapy options with your loved ones can help promote emotional support. These therapy sessions will be monitored by staff.

Are Visits Beneficial?

Those in rehab can benefit from family visits as it promotes a connection to the outside world and the support needed to help you throughout the recovery process.

As an inpatient, you will participate in rehab programs for drug or alcohol addiction. You will live on-site for an extended period of time designated by your healthcare representative.

While on-site, you will have 24/7 access to staff members who can assist you. With inpatient care, you will have a scheduled routine, participating in various treatment programs.

Medical Detox

During the early stages of treatment, medical detoxification may occur to support you as you experience uncomfortable withdrawal symptoms. 

Detox allows your body to heal by removing the unnecessary and harmful toxins brought on by drug use. It is possible withdrawal symptoms can take place, but medical professionals will monitor you throughout the process.

Medication-Assisted Treatment (MAT)

Those with opioid use disorder or alcohol use disorder may take part in a medication-assisted treatment (MAT) program . MAT is only available for those suffering from an opioid use disorder or an alcohol use disorder, and this option combines therapy with medications.

Aftercare Resources

Aftercare resources may be provided by an inpatient drug rehab center before you leave. Aftercare may come in the form of sober living homes, 12-step programs, or outpatient therapy options.

Ohio Recovery Center

At Ohio Recovery Center , we provide a comfortable and structured environment for those seeking addiction or mental health treatment. 

We offer a wide range of substance abuse treatment options for you to consider including inpatient care, therapy options, and evidence-based treatment plans .

Contact us today to learn more about the rehab programs we have to offer.

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Senior Housing News

MSNBC: Should Nursing Homes Allow for Conjugal Visits?

A report published in the Journal of Medical Ethics regarding the ability of adults living in senior care communities to engage in intimate relationships has forced nursing home providers to talk about a subject many rather would not: senior sex. 

But the industry shouldn’t be so prudish, writes the head of NYU’s Langone Medical Center’s Division of Medical Ethics in an MSNBC piece , going on to suggest that nursing homes should be “at least as tolerant as a prison” in regards to allowing some sort of conjugal visits. 

When it comes to the elderly, almost no one wants to talk about sex. This is especially true when nursing home and residential care are involved. Advertisement Nursing homes are simply not set up to permit romance. Privacy is at a premium and few room doors lock. Most rooms are double-occupancy with single beds. And nursing home staff don’t typically encourage romance and sex. It’s one less thing for nursing home owners and administrators to worry about. We’re so prudish about the elderly and intimate relationships that we don’t even broach the topic when a loved one is heading to a home. We consider freedom and autonomy when debating who will have the right to pull the feeding tube or turn off the dialysis machine if Mom or Dad can’t communicate, but we do nothing to ensure their right to enjoy themselves in an area of life that matters a great deal to them. Sex may not be for every nursing home resident, but it is surely for some. That’s autonomy worth talking about. Advertisement A nursing home ought be at least as tolerant as a prison. Some prisons permit conjugal visits. Shouldn’t we expect the same of nursing homes? If you care about your parents’ and grandparents’ dignity, sex ought to be a topic of conversation regarding the nursing home if that’s where they’re headed or where they now live.

Read the original article at MSNBC .

Written by  Alyssa Gerace

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Peru allows Natalee Holloway’s killer multiple conjugal visits for his mental health, rehabilitation

Peru allows Natalee Holloway's killer multiple conjugal visits for his mental health, rehabilitation

Fears Pablo Escobar’s escaped herd of randy cocaine hippos will explode SIXFOLD into 1,000-strong army after cull stalls

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Joran van der Sloot, who murdered Alabama teen Natalee Holloway when she refused his sexual advances and then killed Peru business heiress Stefany Flores exactly five years later, is currently seeing up to three women in conjugal visits in his Peruvian prison.

A Peruvian official with knowledge of the situation told Fox News Digital that every inmate’s right to conjugal visits is protected by the country’s constitution.

“That Joran van ser Sloot is having free rein to have sexual encounters [is] nothing strange,” he said. “Within the intraprison environment, the inmate’s sexual relationship is important for his rehabilitation and resocialization.”

Despite a documented history of murdering women, van der Sloot got married in prison to Leidy Figueroa in 2014 while serving a 28-year sentence for Flores’ death. 

Figueroa was seven months pregnant when they tied the knot. His Lima-based lawyer, Maximo Altez, told Fox News Digital in May 2023 that she was divorcing him after he had years tacked on to his sentence for smuggling drugs into the prison with the help of another girlfriend, Eva Pacohuanaco.

Joran van der Sloot bends over to sign paperwork

Joran van der Sloot signing papers at Peru’s mountaintop Challapalca Prison, where he was being held previously. (APTN)

“He’s a player, and has always been a player,” his childhood friend, Cas Arends, told the New York Post . “Women have always been attracted to him for some reason.”

Armando Regil Velasco contributed to this report.

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CHOP Researchers Find Pre-Existing Mental Health Diagnoses May Prolong Time to Recovery from Concussion

Published on Mar 07, 2024

Minds Matter Concussion Program

Researchers from the Minds Matter Concussion Program at Children’s Hospital of Philadelphia (CHOP) found that youth with pre-existing mental health diagnoses experienced a greater burden from emotional symptoms after concussion, as well as a prolonged time to recovery. Importantly, the study was the first of its kind to find a “dose-response” effect--that a greater number of mental health diagnoses was associated with increased emotional symptoms after concussion and a longer recovery. This finding suggests that addressing pre-existing mental health diagnoses is critical to the management of concussion and supporting children through recovery. The study was recently published by the journal Sports Health .

Concussions are a common childhood injury, with approximately 2 million sports- and recreation-related concussions occurring annually in the United States. As a form of mild traumatic brain injury, concussions can impact a youth’s ability to participate in school and sports in a way that negatively affects their quality of life. Concussions can also cause a variety of cognitive, emotional, sleep and visual issues.

A child’s health prior to injury can exacerbate these symptoms and impact recovery, and researchers suspect this may be the case with mental health conditions. However, prior studies examining mental health diagnoses on concussion prognosis and recovery have yielded conflicting data, and their impact on the emotional burden of a concussion is poorly understood.

conjugal visit mental hospital

The researchers utilized a prospective registry of youth concussion to study differences in emotional symptom burden – irritability, sadness, nervousness and feeling more emotional – and developed a predictive risk model for how this might affect prolonged recovery. The total number of pre-existing mental health diagnoses, ranging from 0, 1, 2, and 3 or more, was taken into consideration. A cohort of 3105 youth with concussions were assessed in this study.

The study found that those with a history of mental health diagnoses had a greater emotional symptom burden after their injury, with an average of 7 emotional symptoms compared with 4 among patients who did not have prior mental health diagnoses. Additionally, the greater the number of mental health diagnoses a patient had prior to the injury, the more emotional symptoms they experienced during the period following their injury. This “dose-response” effect is a novel finding not previously described. Patients with mental health diagnoses were also more likely to have issues with vision and balance and took longer to return to exercise and recover fully from their concussions.

Interestingly, the study also found that boys with prolonged recovery after a concussion experienced greater emotional burden than girls, a finding that has important implications for clinical practice. In general, girls have a higher prevalence of mental health conditions, such as depression and anxiety, and experience a greater overall concussion symptom burden compared to boys.  As a result, there may be implicit bias where boys may not be expected by clinicians to have as high emotional burden after concussion compared to girls, and thus, may not be as actively screened and treated for mental health concerns to the same degree as girls are. The study’s findings indicate that in the setting of prolonged recovery, boys have a greater emotional burden than girls, highlighting the importance of universal screening for emotional symptoms and mental health conditions after concussion.

christina master headshot

This study was supported by the National Institute of Neurological Disorders and Stroke grants 1K23NS128275-01 and R01 NS097549 and the Children’s Hospital of Philadelphia Frontier Program.

Master et al, “Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents.” Sports Health . Online February 13, 2024. DOI: 10.1177/19417381241228870.

Contact: Ben Leach, The Children’s Hospital of Philadelphia, 267-426-2857 or [email protected]

Patients struggle to get lifesaving medication after cyberattack on a major health care company

Desperate patients around the country have been forced to choose between paying out of pocket for essential medications or forgoing them entirely as the aftermath of a cyberattack on a major health care company stretches into its third week. 

Change Healthcare, a little-known but critical subsidiary of UnitedHealth Group, detected the attack on Feb. 21. Since then, pharmacies, doctors offices and patients say their lives and work have been upended by widespread outages in systems commonly used for medical billing and insurance claims. 

Disruptions to copay assistance and coupon card processing at pharmacies, in particular, have highlighted key vulnerabilities in a system on which people’s lives depend.

Ronda Miller, 54, said she and her husband rely on a discount card to afford his insulin — he has Type 2 diabetes and congestive heart failure. But when she tried to pick up his medication at her pharmacy in Deadwood, South Dakota, on Feb. 22, the card could not be processed. Without it, the medications would cost hundreds of dollars.

“When you are diabetic, whether it’s Type 1 or Type 2, without insulin they’re going to die,” Miller said.

Ronda Miller and her husband John Paul Miller.

Change Healthcare’s technology is involved in transactions throughout the industry — beyond those involving United Healthcare insurance. The company says it completes 15 billion transactions a year, amounting to $1.5 trillion in health claims. On its website, Change said the hack affected 21 parts of its business, including many that providers use to receive payments, get reimbursed by insurers and process patients’ insurance eligibility.

“Anything that requires interaction between health plans, a pharmacy, a facility, an office has been disrupted,” said Dr. Jesse Ehrenfeld, the president of the American Medical Association. “That has far-reaching implications, whether you’re on routine, standard medications, whether you rely on a rebate program from a pharmaceutical company, whether you’re just trying to get clearance to have routine elective surgery.” 

UnitedHealth Group said in a statement that it took “immediate action to disconnect Change Healthcare’s systems to prevent further impact” and that the services would “remain offline until we are certain we can turn them back on safely.”

The company said Tuesday that a new network connecting pharmacies to benefit managers could come online as soon as Thursday.

Laura Lester, who owns Marion Family Pharmacy in Marion, Virginia, said the biggest effect in her community has been on patients who can’t afford their medications without copay assistance cards.

“We’ve got people walking away from diabetes medicines, antipsychotics, ADHD medications,” she said. 

“We had one woman yesterday who had to pay $1,100 out of pocket because the copay card wasn’t working,” she added. The patient needed the medication for her irritable bowel syndrome, she said.

Even patients who don’t use copay assistance have faced immense challenges. Donna Hamlet, 73, a breast cancer patient at Florida Cancer Specialists & Research Institute, takes a medication called IBRANCE that would cost her around $16,000 a month without insurance. But on Feb. 23, she said, a pharmacy told her it couldn’t process her refill through insurance because of the cyberattack.

Donna Hamlet, a 16-year breast cancer survivor.

Without the drug, Hamlet said, “the cancer would fill up my body, and I guess I would die.”

After four or five days of phone calls, she got her prescription filled via OptumRx, a UnitedHealth Group pharmacy benefit manager. 

Nathan Walcker, the CEO of the Florida institute treating Hamlet, estimates that $350 million worth of the practice’s charges have been affected by billing delays due to the cyberattack.

But Walcker said he worries most about patients who can’t get prior authorizations processed — many insurance companies require them for cancer treatments, which can cost up to $100,000 per course. 

“We have no ability today to even know if we have a prior authorization in hand for a new patient,” he said. 

The Centers for Medicare and Medicaid Services on Tuesday encouraged Medicare and Medicaid programs to remove or relax prior authorizations during the outage and to consider giving health care providers advance funding. Hospitals can submit accelerated payment requests, CMS said, and Medicare providers struggling to submit claims can send paper versions and may be eligible for exceptions or extensions.

UnitedHealth Group said that as of Tuesday, around 90% of claims were “flowing uninterrupted,” with pharmacy claims “flowing at near-normal levels,” thanks to temporary fixes or systems’ coming back online.

The company has encouraged health care providers to switch to an Optum system to expedite submitting claims and receiving payments. Meanwhile, the new network connection that the company expects Thursday should address “the majority of the coupon volume” managed by Change Healthcare, it said.

Optum is also offering temporary loans to medical practices, but providers say they’re insufficient.

Dr. Christine Meyer, who owns an internal medicine practice in Exton, Pennsylvania, said her office submits up to $600,000 a month in claims but was offered only a monthly loan of $4,000.

Amid the sudden halt in revenue, Meyer said, the small offer was “an emotional slap in the face.”

Her practice is manually submitting some claims to insurance websites, she said, and her staff printed around 1,000 paper claims and FedExed them to Medicare. 

“The next thing I have to do is start to cut expenses, stop buying supplies and vaccines, then reduce our staff, then reduce our hours and then, God forbid, the unthinkable: just shut our doors,” Meyer said.

Doctors, pharmacists and industry experts say the hack has exposed major vulnerabilities in the health sector, particularly given Change Healthcare’s dominance. 

“How do you have a system where it has this big of a leak and almost two weeks later, you’re leaving the small pharmacy owners to try to figure out a solution?” asked Dr. Mayank Amin, the owner of Skippack Pharmacy in Skippack, Pennsylvania.

Amin said he and his staff have spent hours calling insurance companies to find out patients’ eligibility manually, one at a time. The work has kept him up until 2 a.m every night, he said. He even plans to pick up free samples of a blood-thinner medication from a local doctor’s office to distribute to a patient.

“What do I get out of this? Zero profit but the feeling that you’re able to help somebody who relies on you,” he said.

Ronda Miller said that her pharmacy in South Dakota gave her husband a free box of his diabetes medication for now and that his doctor also provided a sample. But for families like hers, she said, the disruption has meant “playing with people’s lives.”

Change Healthcare said the perpetrator of the cyberattack “represented itself to us as ALPHV/Blackcat.” Alphv was involved in the attack on MGM Resorts last year, costing the company $100 million. It is developed and maintained by a group of Russian-speaking cybercriminals.

In total last year, victims of cybercrime sent a record $1 billion in extortion payments to ransomware criminals, according to Chainalysis , a company that tracks cryptocurrency payments.

UnitedHealthcare didn’t answer questions about whether it paid a ransom. But experts at the cybersecurity company Recorded Future and the cryptocurrency analytics company Tenable pointed to a bitcoin wallet that received a payment of more than $22 million Friday. The companies say the wallet, which was viewed by NBC News, belonged to Alphv. Wired first reported the news.

The sum has since been doled out, mostly in $3.2 million portions that the two companies haven’t been able to trace fully. Alphv’s site on the dark web claims it is no longer operational.

Cybersecurity expert Eric Noonan, the CEO of CyberSheath, said that if UnitedHealth did pay a ransom, “it’s a terrible precedent, because what it now does is say this is a viable market.”

Change Healthcare was “a very attractive target,” Noonan said, because it runs critical infrastructure and the attack has had visible consequences.

Noonan said UnitedHealth needs to address whether patients’ personal information has been compromised. Thus far, the company has said only that its teams are “actively engaged and working to understand the impact.” 

Noonan also called for the federal government to require mandatory minimum cybersecurity for all critical infrastructure sectors, including health care.

“Americans, I think, are somewhat defenseless in this regard, because they’re relying on the companies to implement the right levels of cybersecurity, and that’s largely not happening,” he said.

conjugal visit mental hospital

Daniella Silva is a reporter for NBC News, focusing on education and how laws, policies and practices affect students and teachers. She also writes about immigration.

conjugal visit mental hospital

Aria Bendix is the breaking health reporter for NBC News Digital.

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‘Kashchenko’: Moscow’s most famous psychiatric hospital

conjugal visit mental hospital

As Moscow grew, the Preobrazhenskaya Hospital (the first psychiatric clinic) couldn’t treat all the arriving patients anymore. This fact made local psychiatrists quite concerned. They asked Nikolai Alexeyev, the city mayor, for help. In 1889, he organized fundraising to solve this problem. At first, the mayor only wanted to expand the Preobrazhenskaya Hospital, but then, he decided that Moscow needed a second clinic with 300 new beds.

The Alexeyev Psychiatric Clinical Hospital.

The Alexeyev Psychiatric Clinical Hospital.

A commission of psychiatrists and city officials, headed by Alexeyev, decided to build the new clinic on the territory of the former Beketov manor. In the middle of the 19th century, merchant Kanatchikov bought these lands and named them ‘Kanatchikova dacha’, which then stuck to the hospital itself.

N. A. Alekseyev, 1880s.

N. A. Alekseyev, 1880s.

Famous psychiatrist Viktor Butske designed the plan of the future clinic: it had to be a complex of distant two-floor pavilions joined with warm passages for doctors. This complex had a ‘U’-shape and was divided into two halves - for men and women. The departments were located at the sides of the central administrative building. This plan left a lot of free space on the territory, as Butske understood that the complex would, most likely, be expanded later.

Viktor Butske, the plan developer and first head of the Alexeyev hospital.

Viktor Butske, the plan developer and first head of the Alexeyev hospital.

The construction began in 1890. The first half of the red and white brick complex started operating in 1894 and, in two years, the second was opened. In the following several years, the clinic was expanded with extra departments (for example, for chronically ailing people). It’s remarkable that practically all the money for the building was donated by rich Muscovites encouraged by Nikolai Alexeyev. The mayor, meanwhile, was shot and killed in 1893. Experts then found out that his killer had a mental disorder… And the new hospital was named in honor of Alexeyev.

The administrative building of the hospital, 1913.

The administrative building of the hospital, 1913.

When the first half was opened, Viktor Butske became the head of the hospital. He was a supporter of the ‘no-restraint’ system. That’s why straitjackets were never used in Alexeyev Hospital - the doctors wrapped aggressive patients into wet bed sheets to calm them down. Butske understood that the atmosphere mattered. Each department had its own garden. All the wards were well-furnished, except the ones for the violent. He made sure all the staff respected the ill and were kind to them. At first, the hospital used some isolation rooms and kept window screens in the wards for violent patients, but these measures had disappeared completely by 1903.

 A living room in the women’s ward, 1904-1906.

A living room in the women’s ward, 1904-1906.

As the number of patients grew, Butske had decided to let some of them live and work out of the clinic and organized the system of patronage. In 1900, he started to relocate some patients into families living in the villages near Moscow (for example, Troparyovo and Belyayevo, which are now parts of the city). Of course, the hospital staff kept supervising such patients. Butske knew that the patronage would do well: while he worked at the Preobrazhenskaya hospital, a friend of his was declared to have an incurable mental disorder. The doctor put his friend with a peasant family and it helped a lot to fight the illness.

The pool room in the department for the chronically ailing, 1904-1906.

The pool room in the department for the chronically ailing, 1904-1906.

Butske was replaced by another remarkable psychiatrist named Pyotr Kashchenko in 1904. The new hospital head kept developing the ideas of the ‘no-restraint’ system. The patients were also allowed to receive visitors. One of the doctors remembered that Leo Tolstoy once came to see someone there. Kashchenko did his best to destigmatize the patients with mental disorders and to socialize them. He already had some experience of applying work therapy and, in 1905, a new building for workshops and entertainment was built for the hospital.

The sewing workshop room in the women’s ward, 1904-1906

The sewing workshop room in the women’s ward, 1904-1906

When the Russian Revolution of 1905 started, Kashchenko organised medical brigades to help injured revolutionaries. At the time, he was too respected to be punished for his political views. The Soviet administration then honored the doctor for his deeds: In 1922, they renamed the Alexeyev Hospital after Kashchenko, though he had left for St. Petersburg in 1907. Unfortunately, during the Soviet period, people were still afraid of psychiatric hospitals (because of repressions) and of people with mental disorders, so the name of the great doctor received negative associations.

 Pyotr Kashchenko.

Pyotr Kashchenko.

During World War II, Kashchenko Hospital also received soldiers with craniocerebral injuries. Due to medication shortage, they were often treated with electroshock therapy - a notorious method that causes scientific disputes, though its efficacy is proven.

In the Soviet era, the hospital admitted some famous people. Joseph Brodsky spent some time there between 1963-1964 to undergo a psychiatric examination. The poet didn’t have an official job and was accused of “social parasitism”. Brodsky insisted that writing poetry was real work, but the court didn’t agree. The friends of the poet hoped the examination would save him from punishment, but it didn’t: In March 1964, Brodsky was condemned to compulsory labor In the Arkhangelsk area (990 km north-east of Moscow) and, later, had to emigrate. In the Kaschenko Hospital, Brodsky wrote a dark and hopeless poem titled ‘Novy God na Kanatchikovoy Dache’ (“New Year at Kanatchikova Dacha”).

Joseph Brodsky, 1972.

Joseph Brodsky, 1972.

Famous Soviet bard and singer Vladimir Vysotsky also spent some time at the Kashchenko Hospital to treat his alcoholism. He described the life of the patients in a humorous song called ‘A letter to the editors office of ‘Obvious-Incredible’ TV program from an insane asylum - Kanatchikova Dacha’. There is an interesting detail: Vysotsky sings that the chief doctor named Margulis finally banned watching TV at the hospital. This is a fictional character. The real chief doctor at the time was Valentin Morkovkin, who later complained that he had done a lot for Soviet psychiatry (he had published many scientific works), but had finally become known as a doctor who tried to help Vysotsky.

Vladimir Vysotsky, 1978.

Vladimir Vysotsky, 1978.

In 1994, the hospital was renamed back to the ‘Alexeyev Psychiatric Clinical Hospital’. Nowadays, it has numerous departments, branch clinics and even a radio station called ‘Zazerkalye’ (“Through the Looking Glass”) and runs psychiatric education courses. The primary principles of freedom and respect are still kept there. And even though the hospital’s name has changed, the people still commonly call it ‘Kashchenko’.

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Trial seeks people with long COVID cognitive symptoms

Media Contact: Susan Gregg - 206-390-3226, [email protected]  

illustration of a brain affected by a long-COVID virus

UW Medicine clinical scientists will help evaluate therapies for long COVID as part of the RECOVER Initiative clinical trials series directed by the National Institutes of Health. 

RECOVER, which stands for Researching COVID to Enhance Recovery, encompasses several studies nationwide to assess several potential therapies. These include drugs, biologics, medical devices and other approaches.

The Seattle site is enrolling potential participants for one such trial, RECOVER-NEURO. It will examine interventions for brain fog, memory lapses, difficulty with attention and other cognitive problems that persistently trouble some people who have had COVID. 

People with long COVID can experience symptoms continuously or intermittently for months after their initial infection. Symptoms vary among individuals. Commonly reported problems are fatigue, brain fog, decreased physical endurance, memory lapses or difficulty learning and solving problems. 

U.S. trial sites will evaluate different treatments. This simultaneous gathering of data will determine more quickly which therapies are effective. Interventions that do not show promise can be ended, and those trials would then switch to test other approaches. 

Previously, during the first part of the RECOVER Initiative, observational studies were established to examine and track COVID-19 patients. This effort aims to learn why some people develop long-term symptoms while others recover completely. These ongoing studies have so far recruited more than 24,000 participants. Researchers also are analyzing more than 60 million electronic health records and more than 40 pathobiology studies to see how COVID-19 affects different body tissues and organs. 

 Initial data helped in developing the phase 2 clinical trials, which typically test the safety and effectiveness of treatments in groups of 100 to 300 participants. 

UW Medicine in Seattle is one of the sites for the first two clinical trials in this series. The research team is headed by Dr. Helen Chu, professor of medicine at the University of Washington School of Medicine. Chu is an expert in communicable respiratory diseases. 

When the novel coronavirus made its way to the United States, Chu’s team was prepared to detect it through community surveillance methods already in place in their Seattle Flu Study. The team has continued to conduct major research projects on the consequences of the COVID infection as well as its prevention and treatment. 

The team is actively enrolling participants for the RECOVER-NEURO trial, which will assess whether long COVID-based declines in cognitive function and attention might be improved by interventions that selectively focus on enhancing those areas. UW Medicine researchers will evaluate the effectiveness of online cognitive-training programs and transcranial direct-current stimulation to reduce these neurological symptoms. 

If you are interested to enroll in RECOVER-NEURO, please email [email protected].

Find more information on these NIH RECOVER Initiative clinical trials. 

Written by Leila Gray.

For details about UW Medicine, please visit  http://uwmedicine.org/about .

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COMMENTS

  1. Pros and Cons of Conjugal Visits

    These visits allow inmates to maintain relationships with their partners or spouses, which can help reduce feelings of isolation and loneliness. The emotional connection formed during conjugal visits can provide inmates with a support system and a sense of belonging, leading to improved mental health.

  2. 9 Arresting Facts About Conjugal Visits

    In April 2010, a 50-year-old inmate killed his 46-year-old girlfriend during a conjugal visit in a German prison. After sending him letters in prison, she became his girlfriend and participated ...

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    Natalee Holloway Peru allows Natalee Holloway's killer multiple conjugal visits for his mental health, rehabilitation Peru's prison population has a constitutional right to conjugal visits ...

  4. Psychosocial Consequences of Conjugal Visits in Prison

    A total of 20 inmates (the experimental group) received conjugal visits lasting 44 hours every 4-6 weeks, while the other 20 inmates saw wives weekly or biweekly for regular visits lasting 3-4 hours in a common visiting room. The men were interviewed individually and completed a questionnaire. The interview examined attitudes, beliefs, and ...

  5. Conjugal visit

    A conjugal visit is a scheduled period in which an inmate of a prison or jail is permitted to spend several hours or days in private with a visitor. The visitor is usually their legal spouse. The generally recognized basis for permitting such visits in modern times is to preserve family bonds and increase the chances of success for a prisoner's eventual return to ordinary life after release ...

  6. Pros and Cons of Conjugal Visits

    Spending time alone with your spouse, even briefly, might help improve inmates' emotional and mental health. Conjugal Visits Reduce Sexual Violence. Sexual violence includes various forms of abuse, such as rape, ... Conjugal Visit: An Emerging Human Right. As indicated above, many people today view spousal visitation as an extension of the ...

  7. conjugal visits and recidivism

    Furthermore, conjugal visits have been shown to have positive effects on the mental health and well-being of inmates. Being able to maintain a healthy and intimate relationship with a partner can provide emotional support and a sense of connection, which can be particularly important for those who are incarcerated for long periods of time.

  8. Behind Bars but Connected to Family: Evidence for the Benefits of

    There was a significant indirect effect from T1 family connectedness to Mental Health Symptoms through T2 family ... Although visitation was not significantly related to changes in family connectedness, the effect was positive. Visits may have a weaker relation to changes in family connectedness because visits are restricted to occur less ...

  9. Benefits and risks of conjugal visits in prison: A systematic

    Criminal Behaviour and Mental Health is an interdisciplinary journal connecting criminology and psychiatry to explore all aspects of the ... Only some countries permit private conjugal visits in prison between a prisoner and community living partner. Aims. Our aim was to find evidence from published international literature on the safety ...

  10. Benefits and risks of conjugal visits in prison: A systematic

    The balance of evidence about conjugal visiting is positive, but there is little of it, and stable family relationships have, elsewhere, been associated with desistance from crime, the contribution of conjugal visit to these should be better researched. BACKGROUND Imprisonment impacts on lives beyond the prisoner's. In particular, family and intimate relationships are affected.

  11. Benefits and risks of conjugal visits in prison: A systematic

    Conjugal visits are believed to have positive effects during and after confinement. ... co‐response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional ...

  12. Conjugal Visit Laws by State 2024

    Conjugal visits began as a way for an incarcerated partner to spend private time with their domestic partner, spouse, or life partner. Historically, these were granted as a result of mental health as well as some rights that have since been argued in court. For example, cases have gone to the Supreme Court which have been filed as visits being ...

  13. Benefits and risks of conjugal visits in prison: A systematic

    Seventeen papers were identified from 12 independent studies, all but three of them from North America. The only study of health benefits found a positive association with maintaining sexual relationships. The three before-and-after study of partnership qualities suggested benefit, but conjugal visiting was within a wider family-support programme.

  14. California election result: Proposition 1 mental health bond

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  16. Conjugal Association in Prison

    Federal standards for prisons adopted in 1980 encourage family visits for inmates, leaving the way open for a conjugal visiting program in the Federal system. A Federal task force which reviewed the literature and visited programs in California, Minnesota, and New York concluded that most were poorly run because of political and administrative ...

  17. When Teens Visit Doctors, Increasingly the Subject is Mental Health

    That was the conclusion of a new study that found that in 2019, 17 percent of outpatient doctor visits for patients ages 13 to 24 in the United States involved a behavioral or mental health ...

  18. Can You Have Conjugal Visits During Inpatient Drug Rehab?

    Family Visits. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), family support plays a significant role in the recovery process. Those in inpatient drug addiction recovery may receive family visits when approved by your treatment team. Some substance abuse treatment programs do not allow visits from loved ones, only phone calls.

  19. MSNBC: Should Nursing Homes Allow for Conjugal Visits?

    But the industry shouldn't be so prudish, writes the head of NYU's Langone Medical Center's Division of Medical Ethics in an MSNBC piece, going on to suggest that nursing homes should be ...

  20. Do people in mental health institutions get conjugal visits?

    1 comment. Best. stevebuscemiofficial • 6 yr. ago. I was in a psych ward and no you dont get conjugal visits. You only get visits from family members. One of the reasons they state is that sometimes partners can be a direct trigger to the person. 5.

  21. Peru allows Natalee Holloway's killer multiple conjugal visits for his

    Peru allows Natalee Holloway's killer multiple conjugal visits for his mental health, rehabilitation. Up next . Fears Pablo Escobar's escaped herd of randy cocaine hippos will explode SIXFOLD into 1,000-strong army after cull stalls. Published on 28 February 2024. Author . NewsFinale .

  22. CHOP Researchers Find Pre-Existing Mental Health Diagnoses May Prolong

    Researchers from the Minds Matter Concussion Program at Children's Hospital of Philadelphia (CHOP) found that youth with pre-existing mental health diagnoses experienced a greater burden from emotional symptoms after concussion, as well as a prolonged time to recovery. Importantly, the study was the first of its kind to find a "dose-response" effect--that a greater number of mental ...

  23. A Journey of Resilience and Unity: My Visit to the Hopi Reservation

    Roselyn Tso, a citizen of the Navajo Nation, is the director of the Indian Health Service. As director, Ms. Tso administers a nationwide health care delivery program that is responsible for providing preventive, curative, and community health care to approximately 2.7 million American Indians and Alaska Natives in hospitals, clinics, and other settings throughout the United States.

  24. Patients struggle to get medication after cyberattack on Change Healthcare

    After a cyberattack on Change Healthcare, patients are struggling to access and afford essential medication. Outages persist in systems used for medical billing and insurance claims.

  25. 'Kashchenko': Moscow's most famous psychiatric hospital

    Kashchenko did his best to destigmatize the patients with mental disorders and to socialize them. He already had some experience of applying work therapy and, in 1905, a new building for workshops ...

  26. Trial seeks people with long COVID cognitive symptoms

    These ongoing studies have so far recruited more than 24,000 participants. Researchers also are analyzing more than 60 million electronic health records and more than 40 pathobiology studies to see how COVID-19 affects different body tissues and organs.

  27. A Bitter Pill: Moscow Closes Its Psychiatric Hospitals

    Hospital No. 12 is a unique facility in Moscow in offering outpatient services to patients in borderline psychiatric state. "They were real professionals, saving lives there," says Yelena ...

  28. Visiting a Russian hospital: what to expect

    How to access hospital treatment in Russia. To access hospital treatment in Russia as a foreign resident, you will need either public health insurance through your employment in Russia or private insurance, giving you access to private facilities.Some nationals, such as citizens from some EU/EFTA countries, can access medical treatment in Russia thanks to their home country's reciprocal ...

  29. Morozovskaya Children's Hospital in Moscow (Russia)

    Morozovskaya Children's Hospital is the largest multidisciplinary children's medical institution in Europe, founded in 1903. It is located on a huge territory and represents a whole city within a city. The leading specialists of Moscow work here. According to the statistics, the effectiveness of treatment in the clinic is not inferior to the ...