Out of Jail, Out of Work, Out of Luck

“I apply for jobs everywhere and it starts off good but then they see my CORI [Criminal Offender Record Information] and come up with a reason not to keep me.”

“I tried to get jobs left and right but no one will hire you [with a CORI]. I ended up going on Social Security [disability] for my addiction.”

“Nobody’s gonna hire a large black woman in a doo-rag.”

“I’ve been in so many job training programs I think they should hire me to teach the program.”

“I worked for a couple of weeks doing office work for a tow truck company but that ended when the boss asked me to give him a blow job for $200.”

“I pretty much always worked but after 17 years working as a CNA [certified nursing assistant] I have neck and back pain caused by a lifetime of lifting. Maybe I could do something else but I’m not qualified.”

“My husband threw me out of a truck.  I had neck surgery to repair the damage but the surgery made my speech sound slurred. I can’t get a job with slurred speech.”

“After I got out of jail I found a job pretty quickly. The boss knew about it and treated me badly because he knew I wouldn’t quit because I couldn’t get another job with my CORI. I was there about six months. Then, some money went missing from the registrar and the boss accused me. So I quit.”

“I want to work but right now I have to take care of my family. They all have problems. My mother, my brother, my daughter – they all depend on me.”

“The only jobs I can get are crappy jobs – the kinds of jobs where the boss gives you a few hours here and there and only tells you at the last minute when to come in.”

“The job was okay but then the manager started messing with me, not giving me enough hours, giving the good shifts to his friends. Then I found out that I need to work thirty hours a week to get benefits [EITC – Earned Income Tax Credit]. If I complain he’ll probably come up with a reason to fire me.”

“I finally got a job thanks to Annie Dookhan [the Massachsuetts crime lab chemist who admitted to falsifying evidence].  My record cleared through Annie Dookhan but 10 years of my life were ruined.”

Over the past decade I have followed the lives of 47 Massachusetts’ women with histories of incarceration. Their lives have taken a multitude of twists and turns, good times and bad times. Some have managed to secure housing, stay away from drugs, and avoid jail. Some have not.

In contrast to their varied housing, health, criminal justice, and family paths, not a single woman has been steadily employed throughout the past ten years.  At a time in which the federal and many state governments are advocating and implementing work requirements for recipients of food stamps and Medicaid, the women’s utter lack of success in the realm of employment is particularly worrisome.

Gendered Obstacles to Employment

Struggles with employment for formerly incarcerated Americans are well documented. An Urban Institute study found that employers were least likely to hire former prisoners compared with other disadvantaged groups, such as welfare recipients).  In another study, Robert Apel and Gary Sweeten found that young adults who were incarcerated following their first conviction were significantly less likely to secure employment than similar young people who were convicted for the first time but were not incarcerated.

Studies also show that previously incarcerated women face particularly stiff obstacles in finding and retaining employment, though little research has looked at why.  Interestingly, the same patterns seems to holds true following substance abuse treatment: Research suggests that men make greater gains in work income and are more likely to be employed post-treatment compared to women post-treatment.

In addition to the disadvantages of having a criminal record — disadvantages shared by formerly incarcerated men — the women deal with sexual abuse and exploitation, the need to balance work with family responsibilities, and the low-wages and erratic hours typical in “pink ghetto” jobs such as waitressing.

Why This Matters

First, recent research finds that, as of 2010, people with felony convictions account for 8 percent of the overall population and 33 percent of the African-American male population. Many of these nineteen million people encounter the same barriers identified by the women quoted at the top of this article. Second, many millions of Americans work in the same sorts of at-will, temporary, part-time jobs that present insurmountable obstacles to steady employment for the women I know.

Criminologist Shadd Maruna explains that meaningful work provides formerly incarcerated people with a ‘‘sense of empowerment and potency.’’ Indeed, jobs that individuals experience as rewarding may serve to decrease the motivation to commit crime.

In American culture the importance of work goes beyond material rewards.  As Eve Bertram demonstrates in The Workfare State: Public Assistance Politics from the New Deal to the New Democrats  “Work has always held a vaunted role in American political culture … as a moral imperative, a social obligation, and a source of economic security.”

Political theorist Judith Shklar further makes the point that “The dignity of work and of personal achievement, and the contempt for aristocratic idleness, have since Colonial times been an important part of American civic self-identification. The opportunity to work and to be paid an earned reward for one’s labor was a social right, because it was a primary source of public respect. It was seen as such, however, not only because it was a defiant cultural and moral departure from the corrupt European past, but also because paid labor separated the free man from the slave.”

For the women I have come to know jobs become a sort of holy grail – proof not only that you are able to do what good citizens are expected to do in America but also that others see you as good enough to hire and pay.

Unfortunately, most of the jobs held by the Massachusetts women turn out to be cheap Grail imitations. Even when they landed jobs and were not quickly fired, they typically experienced their jobs as exploitive or even abusive, and eventually  quit.

Are There Solutions?

Complicated problems need complicated solutions.

State and federal governments need to remove legal barriers such as lifetime bans on receiving certain occupational licenses that are faced by people with felony convictions or criminal records.

Raising the minimum wage has been shown to reduce recidivism. Incentivizing employers to hire permanent, full-time workers rather than just-in-time scheduling would likely lead to stronger social contracts between employers and employees, and give workers both hard proof and symbolic assurance that they are valued at their jobs.

Making it easier for workers to report racist comments and behaviors as well as sexual harassment and exploitation at work — and coming down harder on abusive bosses, managers and co-workers, would remove some of the most serious obstacles the Massachusetts women report.

Even if we as a society were to do all of these things, many of the women I have come to know have suffered too much pain, too much abuse, and too many hits to their self-confidence, sense of autonomy and ultimately their ability to work steadily even in an ideal place of employment. And these women are not a few outliers.  Criminal justice and economic policies of the past decades wreaked havoc with the occupational potentials of millions of Americans.

To begin to repair that damage we need a new New Deal. I’d like to think that at municipal, county, state and federal levels we can come together to create programs along the lines of AmeriCorps — groups of people working for pay at public projects that build communities and preserve the environment while providing workers with the feeling that they are making meaningful contributions to society. This idea is not a panacea, but it makes a whole lot more sense than sending the millions of formerly incarcerated Americans into the frayed margins of the lowest-wage market.



A Plan to Tackle the Opioid Crisis: The Good, the Bad, and the Missing

The “CARE Act,” a bill addressing the opioid crisis, is moving its way through the Massachusetts legislature’s Joint Committee on Mental Health, Substance Use and Recovery. Proposed by Republican Governor Charlie Baker, “An Act Relative to Combating Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” is offered as a “comprehensive approach to addressing the problem of opioid addiction.”

The CARE Act includes some excellent provisions (a call for evidence-based treatment), a few provisions that should be fleshed out (harm reduction), and one glaringly bad provision (expansion of involuntary civil commitment). It also fails to include a prevention plan that researches and addresses the root causes of the opioid crisis.

My comments on the CARE Act are based upon my research as a medical sociologist as well as my understanding of the research literature in fields relevant to the Act. For the past decade I have followed and documented the experiences of a cohort of women released from MCI-Framingham. All of these women have substance abuse challenges and the majority have cycled through a variety of in-patient and out-patient treatment programs within prison, public health services, and privately run facilities.

The Good: Calling for Evidence-based Treatment

The bill draws attention to knowledge gaps regarding drug treatment. At the current time treatment programs are not required to use evidence-based methods, clearly state what constitutes effective treatment, or prove that treatment is effective.

The Act calls for the establishment of a commission comprising representatives from the Department of Health and Human Services, the insurance industry, clinicians, and family members of individuals with substance abuse disorder or mental illness to review evidence-based treatment approaches to substance use disorders and mental health conditions. While the bill does not limit the commission to these individuals, the inclusion of researchers and scholars with up-to-date expertise regarding treatment effectiveness should be made explicit in the bill.

Assessment of Treatment Effectiveness: Throughout much of the drug treatment industry, outcomes are measured in terms of the percent of patients who complete the treatment program. Because treatment programs do not definitively cure substance abuse, and many of the same people cycle through multiple programs, the bill should specify a requirement of long-term outcome tracking consistent with evidence-based research standards.

The Good: Oversight of Treatment Facilities and Personnel

DMH and DPH Oversight Authority: Before licensing new treatment programs or approving the transfer of license for an existing program, DMH and DPH/BSAS will require that a facility demonstrate that it “provides the range and quality of services necessary to meet the current critical treatment needs of the Commonwealth’s patients.”

This provision should be expanded to itemize the minimum range and quality of services that are acceptable.

“Cherry picking”: Under the proposed law, treatment facilities will be required to “make treatment available to patients with public health insurance on the same basis as patients with private insurance.” This important provision aims to eliminate ‘cherry picking’; that is, practices designed to encourage patients who are seen as desirable and discourage patients deemed undesirable.

It would be useful to spell out how compliance will be assessed and non-compliance addressed.

Recovery Coaches: The bill calls for the establishment of professional credentials for recovery coaches; that is, lay mentors who may be helpful to individuals struggling with addiction. Currently, anyone can call him or herself a recovery coach without any kind of training, credentialing or supervision process. Some coaches volunteer their time; others are paid. Typically, the sole qualification for coaching is having been an addict in the past. Much of the attractiveness of referring substance users to recovery coaches is that their services are less expensive than those of trained health care providers such as social workers, psychologists, nurse practitioners and physicians.

Recovery coaches frequently are oriented towards twelve-step ‘abstinence only’ ideas that are shown in the research literature not to be effective. Because ‘evidence’ for the effectiveness of recovery coaches is anecdotal, the bill should be scrupulous in calling for research to evaluate diverse approaches to coaching.

Establishing a commission, as laid out in the bill, is a good first step towards ensuring that coaching is appropriate, effective and not used as a substitute for other treatment modalities. However, the make-up of the commission, as spelled out in the proposed bill, runs the risk of promoting coaching without adequate research or mechanisms for tracking the work and the long-term effectiveness of coaches.

The Bad: Expansion of Involuntary (Civil) Commitment

Involuntary (Civil) Commitment: The CARE Act seeks to regulate and expand the use of Section 35, which permits the courts to involuntarily commit someone who has an alcohol or substance use disorder and there is a likelihood of serious harm as a result of his/her alcohol or substance use.

While regulation is a worthy aim, expansion is not. The Commonwealth should exercise the utmost caution in confining individuals who have not been accused or tried for a crime.  Because this action abrogates the most fundamental principle of American democracy and concern for civil rights, it should not be seen as a standard part of the toolkit for addressing substance abuse problems.

According to numbers provided by the Massachusetts Department of Public Health, civil commitments have increased by 36% between 2010 and 2017. In 2017 the total number of commitments was 6,531. This number represents the failure to develop and fully fund other systems in the Commonwealth to prevent substance abuse and treat people with substance use disorder.

Civil commitment runs counter to the CARE Act’s call for evidence-based treatment. There is no medical or scholarly evidence supporting the effectiveness of involuntary commitment for substance use issues. To the contrary, there are suggestions in the research literature that involuntary commitment may cause harm in that immediately following a period of detoxification, an individual’s tolerance for opioids may decrease, thus setting up the individual for heightened risk of overdose upon release from the treatment program.

The bill calls for allowing involuntary confinement for up to 72 hours without a judicial hearing (as currently required under Section 35) inappropriately expands the use of civil commitment. According to the language of the bill,

“[A] physician may admit the person to the facility for care and treatment for up to 72 hours, during which time, staff of the substance use treatment facility shall attempt to engage the individual in voluntary treatment. … A person shall be discharged at the end of the 72-hour period unless the person has consented to treatment under section 35B. If the superintendent determines that the failure to provide continued treatment to the person would create a likelihood of serious harm by reason of an alcohol or substance use disorder, the superintendent shall file a petition under section 35 prior to discharge.”

Because it is unlikely that effective treatment can be provided in 72 hours, the 3 day holding period essentially amounts to a forced detoxification. Some individuals will return to the streets– dope sick – after the 72 hours. Some individuals may be too sick to provide meaningful informed consent to further in-patient treatment. Other individuals may find that already being confined increases the chances of a judge approving further confinement. While this policy suggestion is new so has not been studied, research shows that for defendants in criminal cases “being detained [as opposed to being out on bail] before trial significantly increases the probability of a conviction, primarily through an increase in guilty pleas.”

The bill does not eliminate the practice of sending people who have been civilly committed to jail. Currently, if a woman who is civilly committed also has an outstanding criminal case, she can be sent to a twenty day program at the state prison MCI-Framingham. However, if she is able to make bail, she will sent to a Department of Mental Health or Department of Public Health facility. This practice runs counter to treatment principles and discriminates against residents without the financial resources to pay bail.

There is no similar legal restriction regarding men. At the present time civilly committed men are sent to treatment facilities but if the use of Section 35 is expanded it is likely that there will be a shortage of space in men’s treatment facilities which may lead to civil commitment in jails.

Inappropriate Role for Police Officers: The Act proposes that in the case that a clinical professional is not available to assess and commit an individual under Section 35, “a police officer who believes that failure to treat a person would create a likelihood of serious harm by reason of an alcohol or substance use disorder may restrain or authorize the restraint of such person for transportation to an appropriate treatment facility.” Our American legal system calls for the separation of policing from judicial authority and from medical authority in order to ensure the protection of individual rights. Allowing police officers to decide on involuntarily commitment runs counter to this legal principle.

Exacerbating Family Tension: Data supplied by DPH indicate that the majority of individuals sectioned are under 24 years of age. It seems likely that in many or most cases parents’ are involved in requesting commitment. This situation often exacerbates family tensions. It would be useful for the commission created by the CARE Act to assess and share the services available to help families avert the adversarial situation of parents sectioning their kids.

The Missing: Prevention

The Act addresses prevention solely in terms of regulating physicians’ and dentists’ prescribing of pain medication. Over-prescription of opioids has a role in creating the current crisis, but the demand for narcotics has not been driven solely by prescribing practices. Better regulation certainly is important, but it is insufficient to focus solely on the “supply” side without attention to the “demand” side.

Data show that certain towns and communities in the Commonwealth are hot spots for the current opioid crisis. However, there is no research — and no call for research — into the social conditions that result in high levels of substance use and abuse in those particular communities. In order to get ahead of the opioid crisis, the Commonwealth must launch research as well as policies that look at the opioid epidemic as a symptom of deeper problems and not simply as the problem itself.

Without investigating the “demand” side, that is, looking at environmental and social conditions that give rise to the desire to use opioids, public responses will remain at the level of trying to fix the damage that already has been done. If we are indeed experiencing an opioid “epidemic,” then we must carry out standard public health measures regarding identification of the sources and epicenters of the epidemic as well as public health measures for addressing the spread of the epidemic.

The bill should establish a committee and fund basic, interdisciplinary research aimed at understanding why so many residents of the Commonwealth, and particularly young residents, are drawn to substances that they very likely know lead to serious illness or death.

The Incomplete: Harm Reduction

Naloxone Access: The Care Act calls for increased access to naloxone (Narcan) by directing the Department of Public Health to authorize every pharmacy in the Commonwealth to dispense naloxone and by protecting practitioners who prescribe and pharmacists who dispense naloxone in good faith from criminal or civil liability. While naloxone cannot prevent or cure addiction, it is a solidly evidence-based means for saving lives, at least in the short-term.

It would be useful to expand and improve training in naloxone usage, especially to help first responders and police officers understand that the cycle of addiction often includes numerous overdose events before an individual is able to desist from substance abuse. Friends and families of individuals treated with naloxone report inappropriate comments such as, “Why bother, he’ll just O.D. again” and “I’ve been at this address a dozen times already. Some people just don’t want to learn.” This kind of comment may dissuade people from seeking further treatment.

Syringe Exchanges and Safe Injection Sites: Beyond expanding access to naloxone (Narcan), the bill offers little in terms of harm reduction. As part of a multi-faceted approach to addressing the opioid crisis, the bill should expand syringe exchanges and call for the establishment of safe injection sites.

What you can do about this:

Contact your representatives as well as members of the Joint Committee on Mental Health, Substance Use and Recovery. Share your concerns and comments. Click here to find your representatives.



Housing Tribulations: Still Can’t Catch a Break, January 2018

Over the past decade I have witnessed homeless and criminalized women enter and move through middle age. While they articulate ever greater understandings of their own life histories and circumstances, they remain trapped by policies and prejudices that prevent even the brightest and most highly motivated from catching a break.  Over time they increasingly express fatigue; they become less able to manage the physical tribulations of poverty and homelessness. And unlike those of us blessed by good fortune, they become pessimistic about their chances of ever being able to lead the secure, fulfilling lives that they (like all of us) desire.

Ginger’s Housing Saga

Ginger is a vivacious, fun-loving, socially astute and faithful friend who  invests in nurturing relationships with the people she knows (including me). She also is a trans woman who has struggled to survive since her early teens in one of the most conservative neighborhoods in Boston. She turned 46 this month.

Back in April 2017 Ginger received a voucher for housing (Section VIII). As I wrote in a previous update, she was ecstatic at the prospect of having her own home after decades of homelessness. But the two dedicated advocates at the excellent agencies helping her with housing were not able to locate an apartment that is within her allotted budget, passes necessary inspections, and has a landlord willing to rent to tenants whose (full market value) rent is paid via  Section VIII.

Throughout the Fall of 2017 she stayed with various friends who lived in rooming houses in which they are not allowed to have overnight guests. Typically she would sneak into her friend’s room for a couple of days, get caught, be back out on the streets, and then cycle to another friend. Each time I saw her she looked tired and told me that she felt that she had changed – that she had become “moody.” 

Ginger told me recently that she regretted that when there was a choice between getting on the list for an apartment or on the list for a room in a rooming house she chose the apartment. “If I had chosen the room I’d have one by now. But I don’t want a room – I want an apartment where I have my own bathroom and my own things.” (The issue of having to choose between the list for an apartment and the list for a room has long struck me as a particularly ridiculous requirement.  It sets folks up for blaming themselves for making the “wrong” choice when in fact they have no control over the situation.) Ginger told me, that “I have been patient and so has my housing advocate.” But I could see her patience beginning to wear thin.

Ginger at the Homeless Shelter

Her housing advocate advised her to go to one of the homeless shelters in Boston.

Homeless Shelter in Mansfield, MA.

Ginger did, “but the girls there were nasty to me. They tell me I don’t belong because I’m not a real woman.” She decided to leave the shelter both because she didn’t want to put up with the abusive behavior of the other women and “because I didn’t want to get into trouble for fighting.” For someone who has lived much of her life on the margins of “normative” society, Ginger is acutely conscious of following the rules, however arbitrary they may be. The shelter offered to pay her bus fare — one way — to go to Florida to stay with her brother but, “I don’t want to risk losing my chance of housing here [in Massachusetts].” Shipping “problematic” homeless or mentally ill off to other states, is, unfortunately, a national trend. The last time Ginger tried the “geographic cure” by going to Florida she was raped and ended up homeless, broke and finally eating out of garbage cans.

At the Psychiatric Hospital

In November she called me from the back of an ambulance taking her from a large Boston hospital to a psychiatric hospital outside the city. “It all became too much: being homeless, my mother being gone (dead), my housing situation, everything.” After getting into an argument with a relative with whom she had been staying for a few days, “I grabbed every pill I could find and ran out and started popping them. I got on the bus and by the time I got to [the hospital] I was woozy.” At the hospital she told the nurses that she had tried to kill herself. Ginger and I have discussed this numerous times and it’s still not clear to me whether she actually tried to kill herself or whether this was a last ditch attempt to get a safe place to stay. I’m not sure that Ginger herself knows either. In a sense, it doesn’t matter. The real point is her utter despair.

The psychiatric hospital is located on a lovely campus that cannot be reached by public transportation. As a consequence, none of her friends could come visit her or bring her a change of clothes.  With my daughter’s permission I brought some of her clothes to Ginger (my daughter, a young adult, was delighted.) Ginger promised me that, “I won’t do anything in the clothes that your daughter wouldn’t approve of!”

I was able to spend time with Ginger each week during visiting hours. She liked the hospital, especially the daily organized walks outside on the campus. But she felt “disappointed in myself that I’m here after twenty-five years of being okay.” In fact, the last time she had been in a psychiatric hospital she was a teen-ager grappling with her identity as a trans woman. When her family learned that their child whom they had raised as a son had come to identify as a girl, “The priest came and threw holy water on me – an exorcism – and I went crazy. That’s why I was sent here.”

McLean Hospital, Belmont Massachusetts

The staff told us that Ginger is “a model patient.” She was scrupulous about following all of the many rules of attending group therapy, participating in “constructive activities” such as decorating little cardboard boxes with red and green glitter for Christmas, being supportive of other patients, and learning to “use my DBT” (the Dialectical Behavior Therapy approach used at the hospital at this time.) It was easy to see that Ginger was a staff favorite – she joked around with the nurses, complimented staff members on their clothes and hair, and willingly ran errands for other patients.

After a month or so she earned the privilege of going off-campus with an approved visitor. Together, we went out for coffee, to a thrift store and to the local supermarket where she used a big chunk of her Social Security (SSI) check to purchase two mega bags of assorted smaller bags of chips, a large tray of mini cupcakes, two large trays of Christmas cookies, and a packet of coffee. With the exception of the coffee, all of the purchases were intended as gifts for staff or patients at the hospital.

On the way back to the hospital she told me that “this was the best day ever,” and I think she really meant it. Quite simply, she was delighted to be out and about, to be with someone who cares for her and could take her in the car to places she wanted to go. She particularly emphasized how happy she was that she could buy things for other people. The chips were for another patient in her unit who has three small kids and whose kids love Doritos. The cupcakes were for the staff. The cookies for the patients. “It feels so good to do things for other people. It makes me feel “good about me that I am buying these things for other people.”

Ginger at Respite Care

As the weeks went on the problem of what to do with her took center stage. The excellent psychiatric staff did not want to release her to homelessness, but they didn’t have a valid medical reason to keep her in the hospital. They were able to extend her stay through Christmas and New Year, and then arranged to send her by ambulance to a respite care facility for homeless people in Boston.

Boston Health Care for the Homeless is a superb organization that provides first rate services for many people in the Boston area. Without the Barbara McGinnis House

Barbara McInnis House

respite care facility, folks would be on the streets the day after surgery, managing complicated medical care, with broken legs and hips, and while declining during terminal illnesses. (I urge readers to consider donating to this wonderful organization.)


However, Ginger does not belong in a medical facility. Her challenge is housing, not disease. She does not need complicated medical treatments nor does she need to spend time resting in bed. She needs housing. And while she (and I) are relieved that she has a safe place to stay while waiting for some sort of housing solution to come through, her stay at the respite facility bears a bit too much of a resemblance to being in jail. Like other patients, she is not allowed out of the facility except for documented medical appointment to which she must be accompanied by an approved caregiver. She cannot have any outside food; upon arrival she had to discard the remaining cupcakes and Doritos that she hoped to be able to share with a new set of staff and patients. She is only allowed visitors for a couple of hours, several days a week. The floor she is on is kept locked. And while Ginger rarely complains about rules (even ones that seem egregious to me), she called me up today to ask if I could bring her soap. She has been using the soap dispensers in the facility and her skin has become so dry that it is pealing. She has money to buy better soap but she is not allowed out to do so. (Ironically, soap — at ridiculously marked-up prices — is available for purchase in prisons in Massachusetts.)

When I went to visit her today I found three armed guards at the entrance to the facility (that’s normal) and had to go through a security check in order for a guard to unlock the elevator for me to go up to see Ginger.

What’s Next?

I don’t know. Neither does Ginger. Her housing advocate took her to look at an apartment yesterday, but it has to pass inspection which will take at least two weeks. She has moved up to the top of a list for a studio apartment down the street from the facility where she currently is staying. Apparently, she told me today, she possibly could have been accepted into this building a few months ago but it turns out that her two housing advocates were not communicating with one another (despite Ginger’s repeated efforts to get them to talk.) One of these options may work out. Or not. Neither Ginger nor I feel as optimistic as we did when she received her housing voucher nearly a year ago.

What I’ve Learned from Ginger

I often feel furious when I hear that the homeless shelter offered to pay for a one way ticket to Florida. Or when I hear that the housing authorities took so long to inspect an apartment that the landlord changed his mind about renting it to someone with a housing voucher. Or that the emergency room doctors sent to a mental hospital a woman I know to be quite sane. Or that the psychiatrists sent her to a locked respite care facility because they didn’t know what else to do with her.

But Ginger rarely gets angry at the people she sees as doing their best to help her. I have never heard her blame a doctor, nurse, social worker, case worker, therapist, housing advocate or even judge or law enforcement officer for the miseries she has endured for thirty years. Ginger may not have taken any Sociology courses (she barely made it through a year or two of high school) but she understands that all of these folks have their hands tied by the same institutional structures, public policies, and correctional and welfare systems that have sent her from pillar to post since she was a teen-ager. She truly believes that the people she encounters in the system are well-intentioned, are doing the best they can given insufficient funding and irrational rules. And I have witnessed time and again that these people really like her and want to help her. What I’ve learned from Ginger is that it’s not just homeless women who can’t catch a break, neither can the overwhelmingly good-hearted people who work in the institutions that have failed her for a third of a century.


As I finished writing this article I saw that the U.S. Conference of Mayors has selected Boston Mayor Martin J. Walsh as chair of the council’s committee on housing.  This honor is in recognition of the priority he has placed on creating affordable housing: “Since Walsh took office in 2014, some 13,551 new units of housing have been completed, and an additional 8,412 units are under construction. The administration has committed more than $100 million in funding toward the creation and preservation of affordable housing,,” according to the Boston Business JournalMayor Walsh also has called for restrictions on short-term web-based rental (air bnb and the like) that squeeze low-income renters out of the market. All of this sounds promising but as Ginger has learned, when dealing with housing you must not count your chickens before they hatch (or before there is a home for them to settle in to roost.)

Ginger’s tribulations are not unique. Read about Carly’s experiences with housing here.

The Women of Can’t Catch a Break: Fall 2017

The summer can be a slow time for anyone looking for jobs, housing or just trying to get things done. That’s true for must of us, and doubly true for people who are dependent on multiple social service and governmental agencies with shifting personnel and rules. For many of the women, the dominant theme of the summer was waiting, waiting and waiting some more.

Ginger (see “The New Price of Freedomwas super excited last spring when her case manager at a housing agency told her she would get her into an apartment soon. In mid-summer the case-manager took Ginger she was taken to see an apartment in a community right outside Boston. She was thrilled – oohing and aahing as she described “my stove” and “my floors” in this recently renovated flat. She was waiting for it to be approved by the Housing Authority and she was sure there wouldn’t be any problems because the apartment seemed in great condition. We talked about where she would get a bed and what color sheets she wanted. She lined up my help to drive her possessions to the apartment (it turns out all that she owns — aside from a few outfits and toiletries — is a box of assorted glasses and cups she has received as Christmas presents or won at raffles at homeless programs over the years.)

And then she waited some more. Finally, the inspector came and found a leak in the basement of the building. The landlord was told he had to fix the problem before it could be approved. She waited for the repair and then she waited for the inspector to come back. Her housing advocate repeated to her that she just needs to be patient, that these things take a while.

They seem to have taken too long because in early October the landlord withdrew the offer of the apartment.

As of this writing, Ginger remains homeless, though her case-manager has promised to take her next week to see another apartment.

Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) is still in prison, waiting to find out when she will be let out. Her release date is up in the air while the system sorts out various old charges, warrants, and probation and parole violations.

Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“) is still trying to regain custody of her children. It’s been two years at this point and she is beyond frustrated. In the middle of the summer I accompanied her to a long-awaited Court date.

We met in front of the Court House. Kahtia was sitting outside by herself, an hour before the scheduled Court time – she wanted to be sure not to be held up by public transportation or arrive looking disheveled. In fact, she looked lovely. She had a nice, modern haircut, was wearing beautiful make-up, had her new teeth (they look beautiful and natural), and was wearing a long flowing dress. She was very optimistic because the judge had told her that this would be it – that she would get the kids at this hearing. We joked around and made small talk and reminisced and talked about movies and news stories until it was time to go upstairs.

Outside the courtroom we sat down to wait and wait and wait. And as the hours went on Kahtia wilted.

Finally, a social worker from Kahtia’s lawyer’s office came out to show her the report DCF had filed. The report included descriptions of her visits with the children (all positive reports) and reports from her therapist and psychiatrist. And here is where it got weird. The therapist wrote that Kahtia has done well and learned to manage her emotions,  but then commented that she has failed to go for some of her urines (drug tests). The strange part is that Kahtia is not mandated to go for urines. It was her own idea and she goes voluntarily because she believes this will help her show that she should get her kids back. She missed one or two urines when she was sick. But DCF seized on that one comment from the therapist and gave it more weight than all of the positive feedback.  When Kahtia saw this document she became upset and interpreted it as further evidence that DCF has it in for her.

After another lengthy wait, the social worker returned to tell her that it’s time to go in to Court, but that she can’t bring anyone with her (she had hoped to bring me or sister with her for support) and that a new judge would be hearing the case. This was particularly devastating because Kahtia felt the judge who had been on the case since the beginning was fair and understood the issues. He was set to retire but told her he’d stay on her case until the end. At the last hearing he had berated DCF for dragging things out when Kahtia clearly was complying with all of their requests.

Kahtia was shocked by the news and furious to learn that her lawyer likely knew about the new judge a couple of hours ago but only told her as she was walking into the courtroom. We begged for a few minutes to help Kahtia calm down.

She went into the court room and came out a few minutes later. It turned out that one of the translators hadn’t arrived.

Another wait and she went in again, just for a few minutes. The case was continued for two months, at which time the lawyers will offer motions. Her lawyer will ask to increase her hours with the girls (for no known reason the hours had been cut from 2 per week to 1 per week). DCF will ask to see Kahtia’s mental health and other records for the two years preceding the opening of this case as well as a report from her domestic violence counselor. We asked why this necessitates a two month wait. We were told that all of the lawyers couldn’t find a date that worked for them any earlier.

The delay means the girls won’t start the school year in their mother’s neighborhood and likely will have to transfer schools mid-year, again.

The day that started so hopefully ended with crushing pain, again.

Melanie, one of the few women who has been employed for most of the past ten years, was let go from her job last spring because of health problems.  Earlier in the summer her mother — a woman who had held her family together even when she herself was extremely ill — passed away. “I feel the hits just keep coming, with losing my job and then my mother,” Melanie told me.

Francesca (see “The Bitch at the Welfare Office“) has been busy. During the summer and into September her time and efforts revolved around caring for her granddaughter. She and her son mostly got along well and were doing a good job of raising the child (whose mother died about a year ago.) Francesca organized pool parties, took her granddaughter shopping for school clothes, and more or less lived her long-time dream of having a house with her kids and being a Mom and homemaker.

Unfortunately, about a month ago she and her son had an argument during which “he disrespected me. He said I’m dead to him he doesn’t want me in his or [his daughter’s] life; that I’m a loser and never will get anywhere in life. That’s something his [abusive] dad would say to me when we were married.” He kicked her out of their house and threatened to throw her possessions onto the street.

Francesca handled the situation with a great deal of grace and a maturity that, she told me, she knew she didn’t have even a few years ago. She moved in with her boyfriend, continues to spend time with her granddaughter, and has started an on-line business that she conducts from her phone. The downside, and this is not new for her, is that her boyfriend lives in a fairly remote community and Francesca does not have a car. He has a car and a steady job so she is dependent on him for transportation and for financial support. In the past, this sort of power imbalance has not ended well for her.

Tonya continues to amaze me with her resilience and resourcefulness. In July everything seemed to be going wrong. “The blows are coming left and right. They cut my income. I go into panic mode at  the threat of being homeless. My mother is 70 years old and out on the street [due to a fire in her apartment].”

Tonya’s check was cut because she did not consistently make it to her required community service (required in order to get cash benefits – transitional assistance). She was supposed to go to a certain office in downtown Boston everyday, but often did not have money for transportation to get there. “It costs almost $100 a month and the trip takes an hour and a half. They cut me from $490 to $478.” I asked how she’d been able to stay on transitional assistance for so long – the usual cut-off is two years. “Because I’ve been applying and reapplying for Disability. I have pain in my body. So many forms to fill out. Susan, I don’t want to do it anymore. I’m 42 and I’m exhausted. I gained 65, 70 pounds.” She described pain in her knees, back and hands.

“The one good thing is that “my record cleared through Annie Dookhan [the state employee who tainted evidence in the state’s drug labs] but ten years of my life were ruined [because of her record]. I feel I won’t last a lot longer. My father died at 52. I’m going down the same path. Drinking, stressed, tired. I just keeping do more programs and more job training.” One recent program “told me I need to wear business clothes, but I can’t afford to even do my hair, I wear a scarf all the time. Susan, nothing has progressed since you met me. I just want to be a normal person but you can’t on welfare. They want you to be then they make it impossible. … It’s an ongoing battle. Non-stop.”

A month or so later I ran into her as she was walking her son home from day camp. (Full disclosure: I’ve known her son since the day he was born and I can say — with full scientific integrity — that he is the cutest child in the world!) She had signed up for another job skills program but missed the first day of the  because she did not have money for transportation. So she enrolled in another program that teaches people how to be an employee (how to look for a job, how to set an alarm clock, how to talk to your boss). The program is far too basic for her; in fact, she could teach it she has taken it so many times. “But I have to be in a program in order to get help for sending my son to camp. He is at the [] Camp and loves it!”

Tonya always manages to surprise me. Yesterday she sent me a photo of the broccoli she managed to grow in the little patch of dust outside her apartment. I told her that I believe the success of her broccoli plant is an omen of good things to come.


For those of you who have come to know the women — and for those of you meeting them here for the first time — please feel free to ask questions. You can post your questions in the Comments or email them directly to me at ssered@suffolk.edu. I’ll pass along your questions to the women as best I can. They know that I write about their lives and are eager to share their thoughts and opinions with more people.

To read previous updates click on:  Early Summer 2017  January 2017   Summer 2016   New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 

Check back often for more updates on the women of Can’t Catch a Break!


Pinktober 2017

I’ve written about the commodification and cute-ification of pinkwashing in earlier posts, as well as issues around the cultic glorification of “survivors,” the profits to be made in pinkwashing, and perhaps most troubling — increasing inclinations to present breast cancer as if it is a normal life stage for women. Here are the links to those articles:  Pinktober: A Consumer Dystopia and Pink Ribbon Extravaganza and Pinkwashing: It Really Can Get Worse

This year I’m just going to share a round-up of the latest images that have crossed my screen.

The Sexification of Breast Cancer

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The Commodification of Breast Cancer

These seem to be advertising make-up and nail polish, much of which, according to the most rigorous research, actually is carcinogenic. Particularly important to point out the serious health risks endured by women working in nail salons.

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Lethal Breasts: A theme I haven’t seen much in the past – the idea that women’s breasts are lethal – to women!Image result for breast skeleton pink ribbon


Save the tata's!!!


If breast cancer doesn’t kill you, walking around in these might:

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This year you can join the “Vape for Breast Cancer” movement

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Or just go about killing yourself the quick way


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The guys want to get in on the pink weapon action too! 

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I definitely feel safer knowing that “Lumberton Police Chief Danny Sullins and his officers, including (from left) Sgt. Chad Wilson, Off. Dale Tinsley, Lt. Joey Breaux, and Sgt. Kenneth Powell, have taken the “pink challenge” made to Hardin County.”  In case you’re wondering, that’s the same Lumberton that made national headlines for a particularly gruesome case of beating a man to death.

Medicalizing Healthy Breasts, or Just Plain Weird?

I’m not sure how to categorize this one but it does give me a weird feeling in the pit of my stomach.

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Substance Abuse and Social Capital

While the Donald Trump / Jeff Sessions administration is working to re-invigorate the war on drug users, a number of new studies look at relationships between social / cultural / economic capital on the one hand, and drug use, on the other. In my own research with criminalized women in the Boston area I witness the drug-encouraging perfect storm of poverty, marginalization, and the absence of meaningful opportunities for understanding how social inequalities cause suffering.

Despite popular articles (including this one in the New York Times) extolling drug treatment in prisons, newly emerging research suggests that locking up drug users is just about the worst thing we can do if we want to reduce drug-related deaths. By removing people from sources of social and cultural capital, we are exacerbating the very conditions that lead far too many Americans to abuse substances to begin with.

Opiate deaths in a former manufacturing community

A recently published qualitative study looks at factors contributing to drug overdose in the Monongahela Valley of Pennsylvania. This is a region that used to be a center of steel production but is now economically very depressed as manufacturing has shifted out of the area. The author interviewed people at a drug treatment program and found that they mostly spoke about lack of jobs and overall hopelessness in the local communities. The author concludes, “While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.”

To me, it’s interesting that the author makes the connection between poverty and social isolation for the “post-industrial periphery” but I think the same argument can be made for urban and suburban areas.  When people feel isolated and hopeless — and, of course, when mood altering substances are easily available — drug use can be quite attractive.

I suppose that the appeal of 12 step groups such as Alcoholics Anonymous and Narcotics Anonymous lies both in the sense of community (though, of course, it’s a constructed community that one loses as soon as one “relapses”) and the hope relayed by the success stories recited at meetings. Unfortunately, however, the hope and success (which is not as common as 12 step proponents like to claim) are limited to the specific context of the meetings. Commitment to sobriety does not change the economic reality of dead-end jobs, companies that do not have loyalty to employees, wages that don’t allow people to save money towards things like home ownership that truly bring hope, and so on.

Social capital and drug overdoses: a quantitative analysis

Another new study makes a similar point. In “Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States” the authors used large-scale county-level data. The data show a pretty clear correlation between low social capital and high overdose death rates. The authors measured social capital in terms of the density of civic organizations, the percentage of adults who voted in elections, response rate to the census, and the number of non-profit organizations in the county.

While these measures are not perfect (in my opinion) they are suggestive. I’m particularly interested in the correlation between voting and drug overdose rates. In my own work I see a connection between substance abuse and the sense that one is stuck in world over which one has no power to make things better. Not just hopelessness but also powerlessness seem to drive at least some of the excessive drug use that we are witnessing around the country. In fact, according to the Sentencing Project, “one of every thirteen African Americans has lost their voting rights due to felony disenfranchisement.” Moreover, “A record 6.1 million Americans are forbidden to vote because of … laws restricting voting rights for those convicted of felony-level crimes. The number of disenfranchised individuals has increased dramatically along with the rise in criminal justice populations in recent decades, rising from an estimated 1.17 million in 1976 to 6.1 million today.”

What this study cannot get at is the variability of access to social capital within particular counties. I sometimes hear the women I have come to know speak with deep sadness about how other people seem to get the breaks while they just can’t catch a break. These women are likely to see their misfortunes as an individual failure or bad karma, but when I look at their life experiences I often see how identifiable policies forced them to be cut off from sources of social capital. Locked into jails, homeless shelters, rehab programs, low income housing and temporary jobs (at best), they are systematically excluded from the primary sources of social capital in our communities.

The women I know tell me that they want to help others, but even volunteer positions require criminal background checks. Many want to be part of church communities, but they find that churches drop them like hot potatoes when it becomes clear that they need more help than the congregations want to provide to any one individual.

Creating social and cultural capital: A revolutionary program in San Francisco

I’ll close here with a third article I read this week. This one highlights a program that addresses social and cultural capital in a very profound way. “Making the case for innovative reentry employment programs: previously incarcerated women as birth doulas – a case study,” documents a San Francisco program in which formerly incarcerated and low-income women were trained as birth doulas. 

According to the authors, “Realigning women within communities via birth support to other women also provides culturally relevant and appropriate members of the healthcare team for traditionally vulnerable populations. Doulas are important members of the healthcare workforce and can improve birth outcomes. Our work testing doula training, as a reentry vocational program has been successful in producing 16 culturally relevant and appropriate doulas of color that experienced no re-arrests and to date no program participant has experienced recidivism.”

Of course, not everyone is suited to be a doula! But the lesson from this project is far broader. Through participation in the program the women joined an on-going community, learned that they can be powerful agents in helping other women take control of their own births, and they not only acquire but also create meaningful social and cultural capital.


On-going Zika Crisis in Brazil: Lessons for the U.S.

A report released this week by the Human Rights Watch documents the ongoing tragedy of Zika in Brazil. The Brazilian government has declared an end to the national public health emergency. Yet pregnant women are still becoming infected with the Zika virus, babies are coming into the world carrying the effects of Zika, and families will continue to care for their Zika-affected children for years to come. More broadly, the social, economic and environmental conditions that gave rise to and then exacerbated the Zika outbreak in Brazil have not changed. Sadly, many of these conditions are present in the United States as well. And while Zika has not wrecked havoc in the continental US (Puerto Rico has experienced significant Zika outbreaks), these same conditions are fertile ground for a multitude of public health disasters.

Environment and Infrastructure

I spoke with Margaret Wurth, a children’s rights researcher who spent a year interviewing nearly fifty women and girls who were pregnant or gave birth in two of the states most affected by Zika. She learned that Brazilian authorities warned women to spray their homes with insect repellant and to cover open water jars, “but there is only so much as individual can do.” In communities with erratic water supplies, people have no choice other than to fill tanks with drinking water. But these same tanks can quickly become breeding grounds for mosquitoes. The Human Rights Watch report also describes, “Untreated sewage flowing into open, uncovered channels, storm drains, roads, or waterways.”

Wurth recalls meeting a pregnant sixteen year old who did everything she could to protect herself and her fetus. She wore long sleeves, doused herself and her home with insect repellent and covered water jars in and near her house. She did not know, however, that Zika can be transmitted sexually. And she could not, of course, single-handedly clean up the standing water and sewage in her favela.

In the United States most communities have covered sewage disposal systems and household running water. Yet the American Society of Civil Engineers graded the country with a D+ in wastewater management in 2017. Their assessment is that more than $105 billion is needed for wastewater funding. With Congress stalled and no real plan for investing in infrastructure, this kind of funding seems unlikely. And while some states have reasonably good water and sewage systems, in other states – most notably Alaska and Mississippi – significant numbers of households lack both.

Reproductive Health and Rights

One in five of Brazilian mothers raising children with Zika syndrome are under the age of twenty. These young women were unlikely to have access to birth control. Given Brazil’s prohibition on abortion, women may turn to dangerous “backstreet” abortions. A young woman who especially touched Wurth’s heart underwent a clandestine abortion at the age of thirteen; she had become pregnant as a consequence of rape. Wurth met women who had used caustic acid to induce abortion. Facing the terror and the stigma of bearing a child with Zika-syndrome, these women risked their lives. Not all survived.

In the United States access to contraception and abortion are increasingly under attack. The Republican health care bills would further reduce access to reproductive health care through defunding Planned Parenthood and removing birth control from the list of basic services insurance must cover.

In Brazil, government efforts to educate about Zika are disproportionately aimed at women, implicitly absolving men of the responsibility to prevent transmission or to help raise children living with Zika-syndrome. “Mothers are overwhelmingly the primary carers for kids with Zika syndrome. It’s very challenging. They can’t continue working or going to school. They often need to travel long distances and fight with agencies and officials to get the services they are entitled to,” according to Wurth.

In the United States family planning is similarly delegated to women, especially in communities that do not allow comprehensive sex education in schools. An abstinence-only curriculum does not prepare young men to be responsible sexual partners. And, like in Brazil, American mothers – especially low income mothers – face suspicion when they request government services. Republican demands that food stamp and Medicaid recipients work at paying jobs will hit hard at mothers of disabled children.

The Way Forward

There are measures that should be taken in the short and long terms to prevent future outbreaks of diseases like Zika, and to support those who are most affected. Developing and maintaining safe water distribution and sewage systems in all communities is crucial. Women and girls need access to the full range of medical services, including contraception and abortion. Men must be educated to shoulder their share of the responsibility for sexual safety, family planning and child rearing. And families and communities must be able to rely on ongoing support to care for ill and disabled individuals.

It’s unclear if the Brazilian government’s declaring the Zika crisis over was naively optimistic or blatantly political. In any case, it is eerily reminiscent of the declaration that “America has the best health care system in the world” when all data show health care in the US ranking last among developed nations. There are important lessons for the US both in the underlying causes of the Zika disaster in Brazil and in the Brazilian government’s response. We ignore them at our own peril.

The Women of Can’t Catch a Break: Early Summer 2017 Update

I’ve finally had time this summer to try to touch bases with all of the forty-eight women who started in this project eight years ago.

Seven women have disappeared from (my) sight. None of their old addresses or phone numbers are still good. None of the people we knew in common have heard from them. I couldn’t reach any of their family members. And I couldn’t find any trace using Google searches (I tried various nicknames and known aliases).

Five women are dead.

Only three women are currently housed, sober and employed (or stay-at-home moms whose husbands are employed), and have been so throughout most of the eight year period. 

The rest of the women continue to cycle in and out of housing, jobs, detox and rehab, hospitals, and jail. Some of these women have stable housing but are on Disability. In some cases, they are unable to do any kind of work. More commonly, they cannot find a job that for which they are qualified and that allows them sufficient flexibility to take care of children, health problems or mental health crises.

I’ve been reminded again and again that I cannot predict how any particular woman will be faring at any given time. Just this week I went to jail to visit a woman whom I never dreamed would end up incarcerated again. At just about the same time, I learned that a woman whom I assumed would continue to bounce between prison and the streets is now stably housed and raising her children. 

To read previous updates click on:  January 2017   Summer 2016   New Years 2016   Summer 2015   Christmas 2014 / 2015    Fall 2014 

Andrea passed away.  The fifth woman for whom we’ve written a Eulogy, Andrea was the only one whose death was described as “natural.” Two others were murdered (see Eulogy for Elizabeth and Orange-Frosted Hostess Cupcakes), one died with a needle in her arm (see Eulogy for Nicole), and one died of complications of HIV/AIDS (see Eulogy for Junie). Andrea had a congenital heart defect, but I can’t help but wonder whether the decade she lived in homeless shelters contributed to her death.

Andrea loved working out while watching exercise shows on television. For years, she urged me to do the same. I would smile and nod my head, and tell her that I’d try. Finally, this spring, not long after she died, I started going to a zumba class. I wish I could tell Andrea about it.

Carly (see “A New Home for Carly“) is still homeless. Though she has a voucher for Section VIII (subsidized housing), she cannot find an apartment in the permitted price range. DCF (child welfare department) has not returned her baby to her custody. She’s been told she needs to see a therapist (she is) and attend a parenting class (she is waiting for DCF to run one), but the reality is that without an apartment she is unlikely to get her child back. She has been focusing a great deal of her attention on reaching out to the baby’s father. He is incarcerated, so it’s not clear to me how she expects him to become involved with the child.

As of this writing, Erin is no longer using drugs and seems to have settled down. “One day I just decided to stop. I can’t live like this again. I knew if I kept using I’d die.” She continues, however, to experience memory lapses, “probably [caused by] the drugs. I used to be on anti-psychotics, mood stabilizers. I was diagnosed bi-polar but I think they freely throw that [diagnosis] around. My problems are more because of how I lived.”

Erin’s husband died last year. She now is living with a man whom she has known for many years. He is employed, and she makes a bit of money selling cosmetics. Her main concern at this time is her back. She suffers from degenerative disk disease that interferes with her sleep and with her ability to stand up straight.

Two months ago Francesca (see “The Bitch at the Welfare Office“) had major surgery on her neck. Both before and after the surgery her doctors prescribed large amounts of Percocet, an opioid that has always been her drug of choice. There were a few weeks during which I was worried that she was going to slide right off the slippery slope of monitored pain medication use back into drug abuse, but she seems to have weathered the worst of the post-surgical pain and is doing a good job of going about her life. She still lives with her son and granddaughter, works part-time, and is involved with a man who does not seem (to me) to be abusive.

Ginger (seeThe New Price of Freedom) called me every single day when my father was in the hospital back in January. She never intruded – she’d just call to say that she is thinking of me and is available if I need to talk. It amazes me that she has this much compassion — and consistency in showing compassion — when she herself is homeless.

The last time we spoke she was optimistic about getting housing. She’s been working with a case manager at a housing agency and had been told that she is high on the housing list. But as of this writing I haven’t heard from her for a month. Her phone number is no longer working and I don’t know where she is.

Isabella (see “Failure by Design: Isabella’s Experiences with Social Services“) is back in jail. Though still unemployed and grieving for her late husband, she seemed to be managing her life. She had a reasonable place to live, was consistent about going to the methadone clinic for her daily dose, and had re-established good relationships with her family.

Then, a few months ago she was in a car accident (it was not her fault). She was knocked unconscious at the time of the accident. She woke up in the hospital — handcuffed to the side of the bed.

It turns out that when the police checked her identification on their computer system they found that she had outstanding warrants on a number of old drug charges. Because she had moved frequently, she had not received the summonses to appear in court.

After a week in the hospital, she was transferred to jail, where she detoxed from methadone. The detox process led to major weight loss and seizures. She now is feeling better and is happy to be off the methadone. She would like to enter a drug treatment program to get support in staying clean.

In the meantime, she has lost her apartment as well as all of her belongings (from jail she couldn’t arrange to transfer her clothes and furniture to a storage locker.) No one in her family has written or come to see her.

Kahtia (See “Prostitution, Decriminalization and the Problem of Consent“) continues to work with DCF to regain custody of her children. Each time it seems that the matter is resolved, something else comes up.

She is still going to all of the required appointments and programs, still volunteering at  soup kitchen, and still seeing her children once each week.

Unfortunately, her health has deteriorated. She has trouble breathing, carries oxygen with her, and struggles to go up the four flights of stairs to her apartment. Most days she only goes out one time so that she won’t have to navigate the stairs more than once. It’s unclear to me how she’ll manage when her children come back home.

This week she was too sick to go to her volunteer job. At this writing, she is sitting in the emergency room waiting to see a doctor.

Melanie – a woman who had worked steadily for the first seven years I knew her, is now on Disability because of mental health challenges. She desperately wants to go back to work.

Patricia has overcome a great deal in her life. Her mother died of an overdose and her father is serving time in a European prison for drug trafficking. She began drinking in her early teens, and ended up in prison because of a string of DUIs.

After her stint in prison she trained as a medical assistant and worked fairly consistently for the past six years. At this point she feels that she is a functioning alcoholic, though there are times she drinks too much and has to phone in to miss work. Unfortunately, she recently lost her job at a clinic.  “A doctor behaved inappropriately to me. The clinic fired me, not him, because he brings in the clients and the money.”  As of this writing, she has been collecting unemployment for several months.

Even with all of that history, Patricia looks and sounds like a soccer mom! She relishes hosting pajama parties and going to her kids’ school events. Patricia is one of the few women who has never been homeless. An attractive woman with a friendly and pleasing manner, she has always had a boyfriend, a “sugar daddy” (her words) or extended family to stay with. She and I agree that the fact that she has never been forced onto the streets or into the shelters is a function of how she looks and sounds (middle-class) as well as the reason that she continues to look and sound so very well.

Paula, a white woman in her early fifties, had fallen off our radar for a number of years. A few years ago she was arrested on a drug charge. Last year we heard through the grapevine that she died of an overdose. It turns out that she, in her words, “almost died”.  Paula explains, “I caught pneumonia and I was using hard, so I got septic and my lungs acquired ARDS – a fatal lung disease. I was on life support for 6 weeks.”

Just last week she told me, “I’m OK, I guess. I’m clean but lost both parents and am dealing with an alcoholic husband. We’re living in a low rent room in [central Massachusetts]. I have been out of prison now for two years and have lived in five different spots. It sucks.”

On the positive side, “I passed my driving test and bought my first car. I never thought I’d actually have a car!”

Life is unpredictable for all of us – the reality of impermanence is one of the four noble truths of Buddhism. But the women of Can’t Catch a Break seem especially vulnerable to shifts in public policies and in social service programming as well as to the vicissitudes of luck and fate, and the challenges of their own mortal bodies.


Will Massachusetts Pass Meaningful Criminal Justice Reform Legislation?

I wish to thank Jean Trounstine for contribution to this post.

On June 19, 2017, I spent the afternoon and early evening at the Massachusetts State House listening to testimony regarding several bills aimed at reforming incarceration policies. The large Gardner Auditorium was packed with people wearing T shirts calling for the end to mass incarceration, solitary confinement, mandatory minimum sentencing, and parole reform, and for “jobs not jails.” The members of the Joint Committee on the Judiciary listened intently to testimony from criminal justice experts, legislators, sheriffs, attorneys, physicians, and people personally impacted by criminal justice policies. With the exception of a representative of the association of Massachusetts District Attorneys, speakers from all over the Commonwealth spoke to failures of current policies to keep people safe, to safeguard human rights of prisoners, and to provide appropriate health care services to justice-involved individuals.

It all seemed so promising. If only this whole crew hadn’t been there before.

Nearly all of the bills have been proposed in the past (albeit sometimes in slightly different forms). None of the bills seemed terribly controversial, at least to me. None proposed a complete overhaul of the criminal justice system. Rather, the bills, cumulatively, addressed several of the most obviously ineffective or inequitable current practices.

House Bill 74 – implementing programs to reduce recidivism

The first bill introduced, House Bill 74, calls for implementing the recommendations made as part of an extensive review conducted by the Council of State Governments Justice Center and chaired jointly by Governor Baker, the Lieutenant Governor, Senate President, Speaker of the House of Representatives, and Chief Justice of the Supreme Judicial Court.

As a sociologist, I often find political discourse and machinations to be a bit confusing. In this case, it was hard to get my head around reiterations that “all the players” were involved in crafting this legislation.  Other proponents expressed pride that “all justice partners”; that is, representatives from all three branches of state government, worked on the bill. I also heard the term “all the stakeholders”.  However, there did not seem to be any representation of incarcerated or formerly incarcerated men and women on the committee that crafted the bill. Surely “all the stakeholders” include the people most directly affected by these policies. Indeed, I’d argue that they – not politicians or bureaucrats — have the most at stake in decisions regarding prison policy.

Though many people involved with the court and prison systems had hoped for far-reaching recommendations from this review and committee, the bill focuses rather narrowly on reducing recidivism. While that certainly is an important goal, it does not speak to disrupting the school-to-prison pipeline or to other policies and social conditions that send people into the prison system to begin with.

The recommendations to reduce recidivism center on prisoner education, opportunities for early release for good behavior, and post-release supervision. A centerpiece of  the bill calls for rewards for good behavior (for example, completing vocational training programs). The rewards consist of shaving days off the sentence and adding them to the period of parole (community supervision). I strongly support efforts to reduce incarceration rates, but I am concerned that lengthy and intensive supervision on parole can lead to re-incarceration due to technical violations of the conditions of parole. In my own ongoing research with criminalized women in Massachusetts, I’ve seen intensive supervision with requirements for frequent meetings with parole officers, urine tests, proof of attending programs, etc. interfere with the ability to hold down a job and manage the myriad other responsibilities that are part of modern life.

H.74 emphasizes expanding programs of various sorts: pre-trial, during incarceration and post-incarceration. Programs can be good, bad or indifferent, but programs are not a substitute for the material resources most justice-involved people desperately need: Housing, decent jobs that pay living wages, family reunification. I am particularly troubled by a lack of clarity regarding mandatory program attendance for pre-trial individuals. Given that people who are awaiting trial have not been found guilty of a crime, it is be problematic to require them to attend any sort of program.

The consensus at the hearing is that the measures to reduce recidivism outlined in this bill should be the start, not the totality, of criminal justice reform in Massachusetts. No one testified against the bill but many said in their testimony that it did not go far enough.

S819 and H741 – bills eliminating mandatory minimum sentences for low level drug crimes

More substantively, Senator Creem spoke to S819 and H741 – bills eliminating mandatory minimum sentences for low level drug crimes. She, and other supporters of the bills, made the important points that mandatory minimums have not been effective in reducing drug use; they have led to mass incarceration; they have ruined lives of young people locked up for years on trafficking chargers for what essentially amounted to sharing illicit substances with friends; and they clearly have disproportionately impacted racial minorities. There were also panels of sheriffs, defense attorneys, impacted people, and Senators Evandro Carvalho and Sonia Chang-Diaz, both who represent districts where mandatory minimums are levied with unrelenting consistency.

Collectively, they made the point that mandatory minimums undermine the American system of justice by putting power in the hands of prosecutors rather than judges. Prosecutors decide whether the charge will be one that automatically triggers a mandatory minimum or not. And prosecutors can use the threat of mandatory minimums to encourage people to “choose” to plead guilty to a lesser charge. Opponents of this practice argued that prosecutors in essence function as judges, taking away from individuals the right to a trial in front of a judge who hears arguments both from the prosecution and the defense, and who can evaluate the particular circumstances of the individual and the case.

The only opposition to ending mandatory minimums came from DA Conley of the District Attorney’s Association. Conley argued that judges are “out of touch with what goes on in communities” and that prosecutors should properly have sentencing discretion. Many people testifying after the DA rebutted his claims, some of which were not based in fact.

House Bill 3121, Senate Bill 779, An Act Related to Parole

A panel of lawyers, activists, and two formerly incarcerated testified about the importance of reforming the broken parole process in Massachusetts without which packed prisons keep expanding. They spoke of how the Parole Board needs more expertise from sociologists, psychologists, addiction and mental health specialists, and juvenile justice experts. In other words, to judge the fate of our prisoners, our Board needs more than criminal justice backgrounds. Two formerly incarcerated men talked of how the process had been daunting and almost impossible to deal with without attorneys. Massachusetts currently has a dismal paroling rate which is also costing the state $53,000 for each prisoner who could be concluding their sentence in the community, going to school, working, and at least aiming to give back to their communities.

H.2248 and H.2249 – bills limiting the use of solitary confinement

Speakers testified regarding a bill to reform (oversee, control and minimize) the use of solitary confinement in Massachusetts jails and prisons. Attorneys, advocated and families of prisoners described its overuse in the Commonwealth; to the long-lasting damage it causes prisoners; and to its utter failure to make prisons or communities safer.

A representative of Maine’s ACLU testified that six years ago Maine passed solitary confinement reforms similar to those proposed in Massachusetts. In that time, Maine reduced the use of solitary confinement by 90%; prisons have become safer; and medical and emergency rooms visits have been reduced.

H719, H720, H721, H2248, H2249 – bills regarding treatment of mentally ill prisoners

Rep. Ruth Balser introduced five bills regarding the treatment of mentally ill and addicted prisoners. Among other measures, she called for Department of Mental Health oversight of mental health services in Department of Corrections facilities.  (These services currently are outsourced to private companies.) The bills generated little discussion. I’d like to believe that this reflects a clear consensus regarding the important issues addressed in the bills.

H 3494 — creating a medical parole board to consider medical release from prison

This bill would allow for early release of people with extremely serious or terminal conditions. Physicians testifying in favor of the bill spoke of paraplegic prisoners, prisoners undergoing intense chemotherapy, and prisoners with blood terminal disorders developing infected sores from the use of shackles. No opposition to the bill was voiced at the hearing.

Two bills regarding women were heard

H.3586 – An act relative to justice-involved women

Representative Kay Khan presented H.3586 which brings together a call for careful collection and analysis of data, policies and programs for justice-involved women.

The bill requires the commissioner to evaluate the program delivery system for existing programming for parenting skills and related training for incarcerated women and the effectiveness of these programs. In my own research I see women repeatedly cycle through programs of various sorts. I have found it near impossible to learn whether these programs are proven effective. Often, no data are available at all. At best, data regarding the completion rates of programs are available. Completion rates, however, do not get at whether programs actually contribute to individuals going on and implementing the skills taught in the program.

The bill also calls on the commissioner to develop programs with a focus on family preservation and reunification. In my research I have seen that a great deal of the programming for justice-involved women encourages women to “put yourself first” and “do you!” Given that the vast majority of justice-involved women are mothers – and that all justice-involved women are daughters, sisters, cousins, etc. – it is appropriate for program emphasis to be placed on family preservation and reunification. Let me be clear, these goals are not simply a matter of instilling the right attitude in women or even teaching them skills. These goals require that concrete, material resources such as appropriate housing are put into place for justice-involved women and their families. Many of these women need affordable housing, comprehensive day care and after school programs, and hiring practices that make it feasible for parents with criminal records to be become employed.

 Senate Bill 770, An Act providing community-based sentencing alternatives for primary caretakers of dependent children who have been convicted of non-violent crimes

Late in the day, way past school pick-up time, dinner time, kids’ bath time and homework time, we got to hear testimony from formerly incarcerated mothers and their children.

When mothers are sent to prison, their children become collateral captives, following their mothers into the institutional circuit and often ending up in foster care or living with an extended family member who may be less able to parent than the incarcerated mother.

In many cases, the children of incarcerated mothers are given into the custody of family members, a scenario that is not without problems. Often, the caregiver is a grandmother who, while well-intentioned, is not physically able to keep up with young children.  Children hear relatives speak ill of their incarcerated mothers, or feel forced into choosing loyalty to their mother or to another family member. In a few cases, custody actually has gone to a family member who sexually abused the mother when she was a child, or who implicitly or explicitly allowed that abuse to go on.

Foster care, of course, carries its own set of problems, ranging from frequent changes and churns to the well-documented overuse of prescribed psychotropic medications. For mothers, separation from children is experienced as a severe and ongoing trauma. These mothers frequently describe feelings of extreme helplessness, powerlessness, guilt, anxiety and panic, often leading to increased prescriptions of psychotropic medication.

The testimony of formerly incarcerated mothers and the testimony of children of incarcerated parents made it clear that it is in the interests of families to keep mothers at home, in the community, with adequate support (except, of course, in those few cases where mothers have engaged in acts of violence.) Creating community based sentencing alternatives for primary caretakers of dependent children will allow many more children to benefit from the on-going presence of their mothers at the same time as it will allow mothers to develop the resources, skills and support networks that they need in order to be effective parents.

This bill, too, has been heard before. Lining up to testify felt a bit like a reunion. Maybe this time we’ll see some real change.


The GOP’s Comprehensive Plan to Undermine Women’s Health Care

(Published June 20, 2017 in the Huffington Post)

As Senate Republicans continue to craft a healthcare bill behind closed doors, a Trump Administration’s reported plan  would exempt many employers from including contraceptive coverage in health insurance plans. While the Administration has framed their executive order as a protection of “religious freedom,” it is just one part of a frightening new wave of policies that will particularly harm women.

According to the Congressional Budget Office, millions of Americans will lose health insurance under the American Health Care Act (AHCA), already passed by the Republican House of Representatives. Low- and moderate-income Americans will lose the most because the plan decreases insurance subsidies and will eventually eliminate the Medicaid expansion.

This is especially troubling for women. Consistently, year after year, American women earn less than men. And according to the Department of Labor, women are more likely than men to be among the working poor. At the same time, women use more medical services and spend more on health care than men. They make more visits each year to primary care physicians and are more likely to take at least one prescription drug on a daily basis.

Under the House version of the AHCA and the Trump Administration’s order, women’s access to care through their insurance will decline. The bill eliminates the Affordable Care Act’s requirements for insurance plans to cover “essential benefits” like birth control and maternity care. Worse yet, this move will reduce the largest health safety net for women in the country. The Republican House plan singles out Planned Parenthood, prohibiting federal funding for one year after the law goes into effect.

Reduced access to birth control will lead to more unwanted pregnancies. Yet under the Republican House bill, qualified health plans cannot include abortion coverage except for pregnancies that present life-threatening physical risks and pregnancies that resulted from rape or incest. Not only does this reduce access to a needed medical procedure, but it also leaves questions about how to determine if a pregnancy is life-threatening or how to confirm if it’s a result of rape or incest. And it could potentially force women to prove—to the satisfaction of an insurance company—that she indeed was raped. This would certainly delay performing the abortion. Delays, in turn, present health risks to women.

The Republican House bill does allow insurance to pay to treat “any infection, injury, disease or disorder that has been caused or exacerbated by the performance of an abortion.” But legal abortions performed by a qualified medical provider in a suitable medical setting are extremely safe. While it is unlikely that the House’s intent is to encourage illicit abortions, this provision seems to acknowledge that an increase in unsafe abortions may be a consequence of the policy.

The Administration’s order and the Republican House bill will have devastating effects for women’s health in the United States. Our maternal mortality rate is already the highest among all developed countries.  And while this rate is decreasing in nearly every other nation, it continues to rise in the U.S. Our high maternal death rate is in part the result of unplanned pregnancies – more than half of all pregnancies in the U.S. – and a health system that makes accessing care difficult, especially for new mothers. The President’s order, together with Congress’s “repeal and replace” bill, will only lead to more tragedy. Now, the Senate has the chance to take out these harmful provisions and reaffirm the value of women’s health.