How Does a History of Trauma Affect the Experience of Imprisonment for Individuals in Women’s Prisons: A Qualitative Exploration

Abstract The majority of women in prison have experienced prior traumatic events. Imprisonment can also be considered a traumatic experience. Research exploring how imprisonment affects women with trauma histories is scarce. To examine this, qualitative interviews were conducted with 50 participants imprisoned in three women’s prisons in England. Four overarching themes were identified using thematic analysis: the traumatizing prison system; triggering power dynamics; trust in relationships; and surviving and thriving. Aspects of the prison environment and staff behavior were experienced as triggering and traumatizing, while peer relationships provided some mitigation of these difficulties. These findings have implications for the design of women’s prisons, improvements in staff recruitment and training, and the implementation of trauma-informed care for individuals in women’s prisons.


INTRODUCTION
High rates of traumatic experiences have been found in prison populations (Baranyi et al., 2018).Both childhood and adulthood trauma are highly prevalent in women's prison populations (Friestad et al., 2014;Karatzias et al., 2018;Stensrud, et al., 2019; and appear to be higher than in community samples (Grella et al., 2013;Messina & Grella, 2006;Radatz and Wright, 2017).The level and degree of psychological damage caused by seemingly similar traumatic experiences may differ depending on a range of factors, such as the individual's previous experiences of trauma (Kessler et al, 2017); their gender (Blanco et al, 2018), or their resilience and personal coping strategies (Iacoviello & Charney, 2014;Nugent et al, 2014), in addition to events that occur during imprisonment, such as being assaulted or witnessing violence (Anderson, Pitner and Wooten, 2020).

The Trauma Histories of Imprisoned Women
A review of the needs of women in custody (Corston, 2007) undertaken in England and Wales in 2007 reported that the majority of women indicated they experienced sexual, physical or emotional abuse prior to imprisonment.Since then, research undertaken in the UK and internationally (Messina & Grella, 2006;Stensrud et al., 2019, andVillagra et al., 2019;Williams et al., 2012) consistently found high rates of reported abuse amongst incarcerated women.In addition to interpersonal violence, women in prison reported more childhood household dysfunction (including witnessing violence between other family members; parental conflict or separation, or the imprisonment of a family member) compared with community samples (Messina & Grella, 2006) and women in custody were significantly more likely than imprisoned men to have reported five or more different adverse experiences occurring before the age of 16.
Childhood trauma appears to increase the likelihood of women experiencing traumatic events later in life (Spatz Widom et al., 2008), including intimate partner violence and abuse (Jones et al., 2018).The Ministry of Justice (2018) reported that almost 60% of women in contact with the Criminal Justice System (CJS) in England experienced intimate partner violence and abuse as adults and were often in abusive and violent relationships which they may return to upon their release from prison (The Prison Reform Trust, 2017).

The Impact of Imprisonment
Imprisonment can be a traumatic experience (Haney, 2012), with male participants reporting exposure to violence, feeling unsafe and negative impacts upon health (De Viggiani, 2006;DeVeaux, 2013).Whilst studies about female experiences of imprisonment are rare and usually small-scale, evidence suggests that women also report negative impacts upon their physical and mental health (Douglas, Plugge and Fitzpatrick, 2009) and report more negative effects of long-term imprisonment than men (Crewe et al., 2017).Douglas et al. (2009) described participants as being adversely affected by the shock of their arrival into custody, being separated from their loved ones, living for prolonged periods in poor conditions, witnessing others in distress and experiencing regimes where they felt disempowered.These experiences, in addition to sexual and physical assaults that can occur in prison, constitute incarceration-based trauma, a term used by Anderson, Pitner and Wooten (2020).They described incarceration as an "ongoing threat to one's life, bodily integrity and sanity " (p. 192), and proposed a conceptual framework of the impacts of previous trauma, and incarceration-based trauma on the adjustment of women after release from prison.
Whilst being a potential site for (re)traumatisation, prison may paradoxically provide a haven from the abuse and hardship individuals experiences outside of prison, as demonstrated by a qualitative study conducted in Australia (Segrave and Carlton, 2010).Within prisons, safety can be galvanized through positive peer relationships (Patel et al., 2021), helping individuals achieve social capital (Wright et al., 2013) and recruit social support.Taylor and colleagues (2000) theorized that women favor a "tend-and-befriend" approach to stress, rather than "fight or flight" and this may, in turn, protect individuals from some of the negative impacts of trauma (Maschi et al, 2013).

Trauma-Informed Women's Prisons
The impact of imprisonment for those who have already suffered traumatic life events and/or symptoms of mental health disorders can be damaging, and the high rate of self-harm within women's prisons in Her Majesty's Prison and Probation Service (HMPPS) for England and Wales (Ministry of Justice, 2021) underscore these difficulties.In order to address this, in 2015, trauma awareness training was introduced for women's prison staff within HMPPS.The aim was for staff to understand the prevalence and impact of trauma amongst women in prison, and to recognize the ways in which prison environments and systems could retraumatise the residents.Lastly, to learn how to effectively provide support to those who have experienced traumatic life events.The Ministry of Justice ( 2018) included an ambition within the Female Offender Strategy (that a trauma-informed approach would be implemented across all women's prisons in England.Whilst the definition of this was not specified within the strategy, the proposal emphasized a continuation of trauma awareness training for prison staff, and the expansion of the availability of a prisoner-led trauma support group.Although the features of trauma-informed and responsive environments vary across organizations, these largely pivot upon the principles of safety, trustworthiness, choice, collaboration and empowerment (Harris & Fallot, 2001;Menschner & Maul, 2016), as well as peer support (SAMHSA, 2014).The overall goal of a trauma-informed approach is to minimize the extent to which service users are re-traumatized or triggered by aspects of the way they experience the service.In principle then, if individuals are imprisoned, and incarceration is part of their sentence, trauma-informed and responsive prison environments and services may lessen the negative and compounding effects of imprisonment upon individuals' preexisting vulnerabilities.
Due to a dearth of research into the effects of imprisonment on women, the roll-out of trauma-informed care and related training in the UK women's prison estate has not been underpinned by such research.Whilst some narrative accounts do exist (Kupers, 1996), they are mainly focused upon male experiences and are outdated.Given the prevalence and particular nature of trauma in the lives of women who come into custody, it is imperative to understand how women's trauma histories affect their experience of imprisonment.Such evidence could focus efforts on the provision of suitable alternatives to custody (as outlined as a priority within the Female Offender Strategy, (2018)), with the aim of reducing the use of imprisonment for women, as well as on the improvement of care and outcomes for those women who are imprisoned.The following study formed part of a wider project examining the extent to which women's prisons can become trauma-informed and responsive environments.This current qualitative study seeks to examine: In what ways do the trauma histories of women affect how they perceive the prison environment and the experience of imprisonment?How do prior experiences of trauma affect the way women perceive their treatment by, and interactions with, prison staff?How are women's perceptions of their interactions and relationships with peers in custody affected by their previous experiences of trauma?

Design and Data Collection
The research involved face-to-face interviews with 50 participants 1 from three women's prisons.The first author collected all data at each of the sites and led data analysis.A semi-structured 1 Not all participants identified as female (i.e.non-binary; male), although this was rare.Numbers are not given, to protect the anonymity of participants.Care has been taken to reflect this in the language used to describe participants in a way which interview schedule with open questions was developed to provide some structure to the meetings, whilst retaining flexibility for the researcher to focus on the different information provided by the participants (Coolican, 2019).Questions sought to explore the impact of participants' prior trauma upon their perceptions of imprisonment, and their experiences of living in prison.

Recruitment
Three different types of prisons, in different parts of the country, were chosen to represent the heterogeneity of individuals in women's prisons, as well as to provide a diversity of participant experiences in the findings.These included a large privately managed prison (P1), with a high turnover of individuals entering and leaving and a large population of women on remandthis refers to those awaiting trial, and not yet convicted or sentenced for their offence(s); a smaller public sector prison that served the local courts and held individuals on remand as well as those serving custodial sentences (P2); another public sector prison which only housed sentenced women (P3).All prisons were designated "closed" security prisons, which meant that their environments were broadly homogenous (for example, consistent daily regimes and similar restrictions on the freedom of movement within the sites).
Participants were eligible to take part in the research if they were living on normal location (for example, not in care and separation units; healthcare, or a residential location such as a Therapeutic Community) and excluded if they were deemed by healthcare staff to be at high risk of suicide, were actively seriously self-harming, or had been assessed by medical staff as unfit to work due to being either physically or mentally unwell on the date of the research interviews.
Participants were advertised for and recruited differently at each prison.At P1, a combination of self-selection and convenience sampling was used.This method was determined after a focus group with incarcerated women who held jobs as Peer Support Workers, which was held to gain their insights into the most meaningful way of encouraging individuals to engage with the research.Systematic random sampling was carried out at P2.At P3, a self-selecting sampling method was used on the two wings within the prison where research permission had been granted.The number of participants required at each site was not prescribed in advance of the research, or at the outset of the data collection.New participants continued to be recruited until data saturation was reached.Interviews were undertaken with 18 people at P1,20 at P2, and 13 at P3.One of the participants at P2 reported no history of trauma in their life prior to imprisonment, and the data from their interview was therefore discounted from the analysis.

Procedure
Interviews were conducted in private spaces, lasting between 20 minutes and two hours, and were audio-recorded and later transcribed.Additionally, handwritten notes were made by the researcher, capturing contextual information which would complement the transcription data (for example, the demeanor and body language of the interviewee, as well as their emotional expression and engagement).Each interviewee was assigned a unique reference number to ensure anonymity, allowing participants to speak freely about their experiences without identification.
Basic demographic information (age, ethnicity and prior prison experience) was gathered about each participant.Participants were also asked to describe experiences in their lives which they found traumatic.All participants reported having had prior trauma in their lives before coming into custody, including kidnapping; being in abusive/sexually violent relationships; sexual violence does not make specific reference to gender.Generally the phrase 'individuals in prison' is used interchangeably with 'participants' throughout.Sometimes the phrase 'women in prison' has been used for convenience when referring to a large group of individuals within the women's estate rather than to the participant group itself.
or sexual exploitation, and experiences of childhood abuse (neglect, or sexual, physical or emotional abuse).Other experiences described by the participants included bereavements and experiencing parental separation or divorce during their childhoods.Information about the participants is shown in Table 1.

Ethical Considerations
Ethical approval was obtained from the University (HR-18/19-8105) and the Ministry of Justice National Research Committee (2018-189).
Ethical issues were considered and attended to in a range of ways during the data collection phase of the research.As all participants reported prior traumatic experiences, trauma-informed and responsive practice principles of safety, choice, collaboration, trust and empowerment (Menschner & Maul, 2016) were adhered to across all aspects of the study, as described in Table 2.This minimized the possibility that any individuals would be triggered or distressed by their involvement in the research.
Time was spent discussing the research with participants prior to the interviews starting in order to allay any anxieties and develop trust between the researcher and participant and to ensure that the process was understood, and informed consent could be given.At the end of each interview, the researcher ensured that participants were not distressed or otherwise negatively affected by their involvement.Participants were thanked and reminded about the value and importance of their contributions.

Reflexivity
The first author had access to each site as part of their employment, although they did not specifically work at the locations of the research.Their familiarity with the prison system allowed them to navigate the practical difficulties inherent in undertaking prison research and data collection, in particular understanding the terminology and cultures of prison systems and being able to develop rapports with individuals during interviews.Additionally, having not directly worked at the prisons where the research occurred, the role of researcher gave the first author a distinctly different role to their ordinary employment, enabling them to give the women in prison a voice through the research.The first author reflexively took note of how their professional role, background, characteristics and presence as a researcher impacted different aspects of the process, which was regularly checked with the research team to ensure that themes were not derived from assumptions.Other authors of this paper have expertise in forensic psychiatry and conducting research into traumatized populations; to limit the influence of prior assumptions, themes and suggestions were checked through an iterative return to the lived experiences communicated within the data.

Analysis
The six-phase process of inductive Thematic Analysis (Braun & Clarke, 2021) was used by the first author to analyze the interview transcripts and identify themes from the data.The first author familiarized themselves with the data during the transcription process, as well as by reading and re-reading the completed transcripts and the handwritten notes that were made about

Trauma responsive service principle Actions taken Safety
Research locations within each prison were chosen to maximize the extent to which participants felt safe during the interviews: Acknowledging that different areas felt safe to different people.
The interviews took place in familiar locations where possible.The rooms were private spaces where the interviews would not be disturbed, interrupted or overheard.The rooms were clean and uncluttered and fit for purpose, with the aim of creating a calm atmosphere.The interview rooms were set up to be comfortable for the participants.

Choice
The participants were given choices about how several aspects of the research interviews happened: They could choose whether they wanted to take part or not.
As far as possible the individuals could decide which day and at what time the interviews would take place.
At the outset of the interviews, participants were given the choice as to whereabout in the room they sat (whilst adhering to the safety and security principles which requires staff to be located closest to the door).

Collaboration
As far as possible, in order to share power in the process with the participants, they were encouraged to collaborate in how the interview was undertaken: After the interview structure had been explained to then, participants were offered the opportunity to control the order in which they answered each question.
It was also explained that they could decide whether they answered each question or not.
Participants were told that they could stop at any time, for a break, or because they wanted the process to end.They were also told how they could withdraw their consent later if they changed their mind about engaging.

Trust
From the moment of the first meeting, opportunities were created for trust to be developed between the participants and researcher: Time was spent engaging in introductory discussions with the potential participants.
The researcher explained about the research and the process, and answered any questions asked, clearly and openly.
The researcher attended all interview appointments at the pre-arranged times and provided a consistent and clear message about the research and about the boundaries of confidentiality and the participant's anonymity in the process.

Empowerment
The researcher spent time during each interview identifying, highlighting, and reinforcing the strengths and skills that the participants demonstrated and described during their interviews.All participants were thanked for their contribution and praised for their honesty and for the openness with which they gave the accounts of their lives and their prison experiences.
each interview.This led to the initial generation of codes, which was managed using the software package NVivo version 12 (QSR International, 2018).The next step was to collate codes into coherent and meaningful themes; these were reviewed for several months as the first author iteratively returned to raw data, codes and initial themes and consulted with other study authors.
Where possible, in vivo descriptors drawing upon participants' own words were used to define and name the themes.

FINDINGS
The four major themes identified using inductive Thematic Analysis were the traumatizing prison system; triggering power dynamics; trust in relationships; and surviving and thriving (Table 3).The first two themes primarily reflected perceived difficulties or negative aspects of the participants' experiences of being in prison.The final two themes included more positive aspects of the participants' engagements with others, as well as helpful and constructive strategies or responses that enabled them to cope or thrive during their time in custody.

1) The Traumatizing Prison System
Irrespective of their prior experiences of trauma, most participants emphasized prison as stressful, intense and challenging, and described their imprisonment and experiences in custody as traumatizing.These beliefs and experiences were expressed within four sub-themes: "the stressful prison environment" (sub-theme 1a); the "persistent sense of threat" (sub-theme 1 b) which imprisonment created; "punitive and unfair practices and procedures" (sub-theme 1c), and "uncertainty" (subtheme 1d) about how they were managed within the system.

1a) The Stressful Prison Environment
This theme represented participants' introspection about how they emotionally reacted to the prison environment, with many describing their overall perception of their situation when they arrived in prison as traumatizing.One participant (R6) still vividly recalled her arrival into custody, even though it had been several years ago: "[coming into prison] was a massive trauma in itself … … I was just … .absolutely heart-broken … it just seemed alien.I've had … traumas outside, but in here, in prison it was different … ".First-time entrants to custody explained how they had come into custody with preconceived ideas about prison derived largely from the media portrayal of prison life, which was often negative and fear-inducing.One participant with no previous prison experience (R1), described their apprehension as the court date approached, "I only knew prison on TV and in documentaries, and of course they only show you the worst prisons in the World … so coming here you think, 'Oh my God! That's it, I will not survive!"Such preconceptions contributed to participants' anticipation that they would be unsafe.
Even though participants came into prison expecting it to be a challenging experience, most participants explicitly stated that they found prison to be more stressful than they anticipated.Life in prison was viewed as a constant and overwhelming challenge, especially for those who had no prior experience of custody.One individual, who was newly sentenced (R32), stated: "It's just horrible.It's horrible.You know like, you think of it when you're outside [in the community], and you obviously always know it's not going to be nice, it's prison, it's not meant to be nice, but this place is … horrible".
The noisy prison environment was problematic for most participants, creating an atmosphere of chaos and disorder, which was reminiscent of traumatic family circumstances for some participants.One individual reportedly struggled to tolerate the chaos of the environment, even with prior prison experience (R43): " … .even the noise, the busyness, and that's when like-… .all… .everythingcomes back to you, all your childhood memories … everything".
The environment felt especially intense for those individuals who were already experiencing high levels of anxiety and emotional arousal.One participant (R6) explained, "When my anxiety is bad, sometimes … I get stressed when there are a lot of people."This heightened anxiety and emotional distress was also apparent for a participant who viewed herself as normally confident and assertive (R34).She stated, "I'm a little bit of an emotional roller coastera lot of ups and downs, something I've not particularly felt on the outside … … ".Several others also indicated that they had stronger emotional responses to situations in prison than they might have had in the community.Their lives were so restricted in prison that small things which would have been inconsequential in the community took on greater significance.One participant (R5) commented, "Everything is magnified, like the smallest … … I've seen people cry over not being able to get jam!".1b) Persistent Sense of Threat Perceptions of a 'stressful prison environment' were powered by a persistent and generalized sense that prison was unsafe, and that potential threat was all around them.A young person familiar with custody (R21) described feeling fearful "because anything could happenan officer could start on you; a prisoner could startanything could happen … .and if you're not fully aware of what's going on, or fully in control, then you could end up in all sorts of trouble".
Living in a state of near constant fear in prison mirrored the way several participants described abusive relationships or neglectful and abusive childhoods.Some participants, who may never have previously had a place of safety to retreat to, felt able to let down their guard in their rooms: " … the only time I feel safe is when my door's locked … I know nothing's going to go wrong" (R28).The sanctity of this space provided participants with a semblance of control; a participant with substantial prior prison experience (R22) stated, " … I love that time behind my door … You don't have to talk to anyone you don't want to.I cherish that time".1c) Punitive and Unfair Practices and Procedures Most of the participants described the prison system, and rules governing their lives in custody, as adversarial, unduly harsh, punishing, or unfair.A particular area of contention for many participants was the complaints system, which was perceived as being subjective and inherently unfair.Most interviewees lacked faith in the complaints system as a means of resolving their complaints.One participant felt they had been unfairly treated (R19), but was reluctant to complain, stating: " … I felt like I couldn't really complain because I didn't feel confident that it would be dealt with properly and it would probably just be dismissed because I'm a prisoner and she's a staff member, and they won't take my word for it."Having mustered the courage to submit a complaint, they discovered that the person they were complaining about was the staff member tasked with investigating and responding to the complaint.
There was a widely held perception amongst interviewees that the system was biased against them and worked in favor of staff.One individual who had been in prison for several years (R3), stated, ".the bottom line is that the officer will always come out on topthe house always wins.A lot of the time I just let them … .maybe I would engage with it more if we weren't in this environment, you know?".Another participant who had been in and out of the same prison on multiple prior sentences (R38), described the disadvantageous position of those living in prison, and the hopelessness of trying to combat it, "You'll never ever beat the system, no matter what you do".

1d) Uncertainty
An example of this subtheme related to unclear rules, which often induced panic or fear, especially for new entrants to custody who lacked prior knowledge of how prisons are run or what behavior is expected.Lack of clarity and transparency about prison rules created anxiety for individuals who were well versed in behaving in the 'right' way to avoid threat or punishment in childhood or in their abusive relationships.One participant described similarities between living with her controlling husband staff (R4): "staff, sometimes … they might shout at you and all you're doing is walking around … and then you panicthinking, 'oh God, I'm going to get into trouble'".
Change, and how this was both managed and communicated, often compounded participants' distress.The unpredictability of such change reinforced that the participants' lack of control whilst in custody.Staff shortages meant that planned work; education sessions or therapeutic activities would sometimes be canceled without warning.A young interviewee (R18) indicated how this was unsettling: " … .havingcertain things at certain times is what a lot of people need in here, and people like to know things are going to happen at certain times … .sometimesthen, when something is out of sync, it can really feel like everything is up in the air".Unexplained transfers, either to a different residential area within the prison or to a new prison, were described as unsettling.One participant was angry during the interview about their experience that morning (R16), " … .todaythey've woken me up -'you're moving!'It doesn't make sense.They're just trying to make my life a living hell".

2) Triggering Power Dynamics
The second overarching theme described the triggering power dynamic of living within a system perceived as traumatizing, which mirrored the dynamics within the abusive relationships many participants had experienced prior to imprisonment.There were two sub-themes: the participants' "lack of agency and autonomy" (sub-theme 2a) relative to staff whilst in custody, and their "loss of identity, individuality and humanity" (sub-theme 2b).

2a) Lack of Agency and Autonomy
Many interviewees described being at the mercy of staff and the prison system more broadly.One participant (R29) described how they had resigned themselves to having little or no control over their life: "I feel like [the staff] … … since I've been in custody-they've taken over my life … … I think they have more power.I don't think [residents] have power … .".The majority of the participants communicated having limited opportunities, as adults, to make decisions about basic aspects of their day-to-day lives; this lack of responsibility over daily life was a constant reminder for one long-term prison resident (R38) that she was being controlled: "They control your money, they control your canteen, they control your food, they control what day you can do your washing".Another participant (R36) described how this was silencing and quashed their ability to make choices: "Most things are done for you in this prison … … I don't think that's a good thing, because I think you should have your own mind to say, 'I don't want this, and I do want this'".
The reality of being trapped within a distressing environment where they had limited control, had clear parallels with prior circumstances of trauma.One participant who described previous abusive partners (R8), stated, "it's like being in a relationshipdomestic abuse, and you can't do nothing about it, you can't go for a walk … you can't get out".Another individual (R5) indicated that this was exacerbated by control being exerted by multiple people, " … … here I am in exactly the same situation [referencing lack of control], but it's magnified because it's not just one person, it's everyone telling you what to do, when to do it, where to go, so I find that quite difficult".
Despite most participants understanding the need for prison officers' positions of authority, many believed some staff abused this, choosing to punish them on a whim and wielding and exercising their power as if on a "power trip" (R2).Ultimately this was perceived as "an abuse of power" (R34) in some cases.This power was reinforced by rhetoric used by staff reminding those in prison of the power dynamic at play: "'I'm the gaffer, you'll listen to me!'; 'you have to listen to me because I'm in charge!'those are quotes from certain officers" (R44).In addition to language, symbols of power were prolific in the prison environment, including staff uniform, which provided a very visual separation between staff and those in custody and reinforced the status and power differential of officers.Others identified the "power of the keys" (R9) as a specific symbol of the officers' power over them-" … .oncethey get a set of keys I think it just goes to their head-… ."(R7).
Participants also felt that prison officers shouting was a means of staff exerting control over individuals in prison.Most interviewees found it triggering: " … every time they shout, I jump" (R9).Many participants also described physical touch by staff-especially male staff-as triggering.Two individuals voiced their distress at being physically restrained by staff (a procedure used to control distressed or aggressive individuals): " … .prison is like legal domestic abuse, because … .there have been times when they [physically] restrain you for reasons that aren't founded … it could have just been dealt with by talking to me, rather than having me in their grip" (R20); "I was [seriously sexually assaulted] … .Things in prison make it worse … .officerstouching me, [restraining me] … .Takes me straight back [to the abuse]" (R11).Such experiences were the ultimate means of reinforcing the participants' absence of control.

2b) Loss of Identity, Individuality and Humanity
The indignity of having no control over their daily lives led participants to feel dehumanized and that they were being treated "like caged animals" (R2).A young individual with no prior criminal history (R9) stated: "We're not scumbags, we're not savages, we're not animals.We're just girls that have maybe just come off the path in our life, you know, and we just need help to get back on track … .".Two participants felt that staff looked down on people in prison as though they were insignificant, because of the crimes they had committed: "Talk to us more.Try to have an open mind.Don't talk down to us.Try and not be patronising or condescending.Just talk to us like a normal human being, you know, not like we're another species, or something from the bottom of your shoe" (R20)." … they think they can speak to you and look at you how they want, and I'm sorry I'm human and I know I've made mistakes, and I've held my hands up and I'm being punished for that, but I'm still human … you don't have to treat me like I'm a piece of dirt under your shoe, because that's not who I am." (R7).
This degrading treatment also extended to a sense of invisibility.As one individual (R9) stated, "You could cry buckets in front of them and they'll just look at you as if you're nothing and your emotions mean absolutely nothing in the world".Being treated impersonally and, at worst, dehumanized led to individuals feeling that they were just stuck within a system and were not considered individuals with unique needs and experiences.One person nearing the end of their sentence (R34), described: "It just beggars belief how you're spoken to sometimes … … like you're just a piece of machine that they just need to put from A to B to C … .Pass you around and fit their criteria … .theymiss out the human aspect".
These sensitivities were again amplified for those who had previously lived in relationships characterized by physical or emotional abuse.This level of disrespect was perceived at odds with expectations of professionalism, echoing the themes relating to abuse of power.One individual (R3) described the following incident: "I've seen a lady clean the floor as her job as a wing cleaner.An officer was eating cake … .andshe was dropping crumbs on the floor that the lady had just cleaned, and she said, 'well, me and my officers can do that'-As a human to human, I just think that's unacceptable".

3) Trust in Relationships
'Trust in relationships' was the third overarching theme in this analysis.Whilst most participants described initial difficulties trusting others when they came into custody, supportive "connections with peers" (sub-theme 3a) were identified as a significant means of mitigating difficult aspects of prison life.Whilst the negative behaviors of staff, and the power imbalance described (theme 2), affected the participants' capacity to trust staff, this theme also emphasized meaningful and positive "interactions with staff" (sub-theme 3 b), which developed over time.

3a) Connections with Peers
Most interviewees described general difficulties trusting others due to their prior abuse or exploitation by others, which initially impacted their development of relationships and connections with other prison residents.One participant (R46) consciously chose not to make friends with other people in prison as a means of self-protection: "These are associates, they're not friends.But then I don't come here to make friends.I've come here to serve my time for what crime I've done and then to go home … .I wouldn't tell them my darkest secrets … .".However, for the majority of participants, relationships with peers facilitated a sense of increased psychological and physical safety in an environment which felt inherently unsafe (as described in previous themes).For many participants, other individuals in custody became a crucial source of supportthe people whom they could rely on to help them through.One participant, who had served a lengthy period in custody (R31), indicated that they got support from a core group of other long-term residents: " … we … .get support from each other.So, I know within my little group it's safe … .noone's going to cause no dramas, no one's going to breach something that I confided in them or anything like thatwe're safe".
Other participants noted that serving long sentences provided them with the opportunity to develop strong and supportive relationships with peers: " … .becausethey know me, they know when I'm low or when I've got an issue, or something happened, and they try to protect me." (R6) These friendships acted like a buffer against the harsher aspects of prison life, enabling people to cope, as participant R3 described, " … .youbuild up that relationship with people, so it becomes an easier place to live in.I'm quite comfortable here now because of that -I've been here 15 months".
Whilst some disliked room sharing, at least initially, others stated that they had formed strong friendships and allegiances when they shared a room.The benefits of having someone they could trust were clear for one participant (R9): "[My room-mate] is my officer; she is my therapist.She is my everything in one … .withouther I honestly don't know what I would have done, because I know the things that she helped me with when I first got here".

3b) Interactions with Staff
Whilst most participants preferred seeking support from peers, there was an acknowledgement that interactions with staff were also important.In order to function during potentially long periods of imprisonment and obtain what they needed, it was sometimes necessary to engage well and foster good relationships with staff.
In addition to the power dynamic described (theme 2), the behavior of some staff impacted the extent to which participants felt they could trust them.One participant (R45) explained the impact of previous betrayals, " … .there'ssome staff I don't trust because … .ifyou speak to them … .itsort of gets repeated to other prisoners, so it's not … .I don't like that … ".These understandable defenses were overcome by examples of consideration and care.Several interviewees spoke of the importance of first impressions when arriving in custody and could identify officers who stood out in their kindness: " … I had a very, very kind officer-a very caring officer, I have to say.She could see how distressed I was, so she tried to calm me down … and that made me a little at ease" (R1).
Another participant spoke of their distress when entering custody at Christmas, leaving their young child: " … .everythingwas really bad timing, but the staff in health care were fantastic … … there was [name] … .I can remember her sitting on my bed for two hours while I was sobbing, I poured my whole heart out to her … ".
Feeling listened to, understood, validated and shown empathy counteracted the 'loss of identity, individuality and humanity' (sub-theme 2 b).Such engagements presented the opportunity to give those in custody attention they may not have received previously: " … .at the end of the day, some people, they've never been listened to … .evenif you just give that person five minutes of you listening to them, they could have been their whole life and they feel like nobody's listened, and that one thing could save somebody's life at the end of the daylike that's how serious it isespecially in this environment … " (R51).
Feelings of 'containment' were also identified as important (the absence of which were identified in sub-theme 1d).In this regard, boundaries made individuals feel safer and reassured them that appropriate action would be taken if needed.One young participant (R9) identified two examples of boundaried care: " … these are the kind of officers that we need around.They make me feel secure.They make me feel like if I have an issue and I panic about it I know that them two will get the job done … .".
One individual (R3) made the link between the benefits of boundaries and clarity for those who experienced abuse and inconsistency in their previous relationships: "The rules here are set.You understand them, whereas in an abusive relationship the rules are constantly changing so you never understand where you're at … .".However, the behavior of some staff led to several participants reportedly feeling cautious, as participant R43 described, " … some of them stick to their word … .andsome of them, they say they're going to do it … … and they're lying … Some of them lie".Despite this, social connections with others in custody were highlighted by most participants as being significant in bolstering their capacity to cope with the stressors of imprisonment.However, in both emotional and practical terms, this was embedded in a system where relationships with others in prison, including staff, were heavily loaded with potential danger.Most individuals recognized that they had to negotiate trust with othersand to do so relatively quicklyin order to cope with their custodial sentences, and to build the relationships they needed to feel safer in prison.

4) Surviving and Thriving
The final theme of 'surviving and thriving' in prison related to safety-seeking behaviors used to deal with prison life.As well as personal strategies, described in 'survival mode' (sub-theme 5a) and 'finding ways to cope and thrive' (sub-theme 5c), participants commonly described the importance of support services (sub-theme 5 b) yet some reported difficulties in accessing necessary care to manage their mental and physical health needs effectively.A combination of these services meant some individuals, who had been in prison either often or long enough to become familiar with the environment, no longer routinely experienced prolonged periods of heightened anxiety and stress and were even able to thrive (sub-theme 5c) during their time in custody.

4a) Survival Mode
Many participants described developing safety-seeking behaviors to cope with the traumatic experience of coming into custody.Such behaviors enabled them to cope with the anxiety, fear and distress from perceived threats in the environment.Some participants described a 'freeze' response to the situationbeing as quiet as possible or wanting to blend in as much as possible to avoid drawing attention to themselves.As participant R9 described, "I want to try and be as invisible as possible … That makes me feel safer".Others physically separated themselves from the chaos and unpredictability of prison life when lots of individuals were out of their rooms together, using a 'flight' response by withdrawing to the relative safety of their rooms, where they could be on their own: "I keep myself to myself, because … .I have to, for my own sanity" (R19).One participant (R33) functioned by retreating to happier experiences in their mind, facilitating their denial of the reality of imprisonment: "That is my real life, and this is my pretend life".
Some participants indicated that they adopted something more akin to a 'fight' response in order to protect themselves from situations within which they felt unsafe.One young interviewee (R21) commented, "If like … .I was to think [staff] was to attack me, I would do something crazy, before I've even thought about, before I'd even know the level of danger that I'm in … .".One experienced interviewee (R7), advocated giving the impression of being able to handle yourself, in order to stay safe: " … you cannot show vulnerability in prison … .youshow that little bit of vulnerability and everybody's on you, you know?If you don't show that, and you take no shit from anybody then they'll leave you alone and they're fine, you know?And that's how you have to be in prisonit's very bad to be like that, but you do".

4b) Support and Services
As well as finding the prison system inherently traumatizing, many participants reported that they were not able to access support whilst in custody.They described the inadequacy of mental health care support, as well as insufficient staff training or awareness around mental health or developmental conditions: " … .stafftreat you the same as everyone, and compare me to someone that hasn't got autism or ADHDthey're going to respond totally different."(R49).
Some participants spoke of their frustration that requests for mental health support were not met: "I asked to speak to someone, even when I got sentenced, because … .I do suffer from depression and anxiety, and no-one's there basically.I just have to sit in my room … ."(R29) or, alternatively, that support offered was inappropriate.One participant (R15) described how a male recovery worker had been sent to interview them, even though their file indicated they were victimized by a male partner over many years: " … .[hecame] … .to ask me some real personal questions and I had to actually say to him, "I'm not comfortable talking to you about this because you're a male."… … .I actually felt really vulnerable … .".
Some individuals indicated that they had resorted to behaving in extreme ways to get help.One participant (R13) felt the need to self-harm when unable to obtain the assistance required: "When I self-harm they can't handle it … … I'm not doing it to manipulate them.I'm not doing it for any physical gain or materialistic gain … I'm doing it because I feel like I have literally no control over anything and I'm at a loss … .".A young person who had been in custody for a while (R21) described reluctantly using similar strategies to regain control: " … I've just done crazy stuff before just to get [moved] out of the prison … .Yeah, done really mad stuff so they made sure they removed me immediately.And not even because I've wanted to, just because I've been so desperate to make stuff happen for myself".
The impact of the perceived lack of support or actual difficulties accessing available or appropriate services made participants feel uncared for and abandoned by staff and the system writ large: " … the system is letting people down" (R7).The magnitude of need in prison settings was emphasized by one participant (R51) in particular: … .[the]ladies here, we need help. in many ways we're broken and it's like this is the time for us to heal, not only our behavior but our minds and bodies as well", yet there was consensus that the support was not available in a punitive system.When considered in the context of their prior trauma, perceived neglect from gate-keepers to care contributed to intense feelings of isolation and was acted out in desperate behaviors to receive appropriate care and attention.
A few participants reported positive experiences and subsequent impacts to their quality of lives after accessing mental health services and other forms of support.One participant who was misusing drugs when they came to prison (R27) outlined their successes in custody: " … I've been off the methadone [since June 2019] … .I've been clean since June 2018 … .andI've done [substance abuse treatment programmes] … .I've worked down the gardens … … I've done five months of one to one mental health work … … .I've really done a lot!".Another interviewee (R5) spoke of the positive impacts of accessing therapy: "I'm getting better.I think the therapy helps me because I have someone who I can talk to, and I can understand it … .I'm actually quite lucky because I get that second chance.I get this time to go over my past traumas and understand them, and then go out and do something about it … .itcan sort of open your eyes and see maybe I'm not so worthless?".

4c) Finding Ways to Cope and Thrive
Meaningful connections with others (as described in the 'trust in relationships' theme) was key for reducing individuals' anxieties and created a sense of psychological stability, given the limited availability or quality of support from other sources.Some individuals enhanced their sense of control or agency by consciously adopting a positive mindset, or actively choosing positive behaviors.Mentally 'escaping' prison life was a strategy used by several interviewees: "I go to the gym.I'm big on the gym, and even the gym staffthe guy that works therehe's great.He's always getting me and my friend on a circuit and makes us feel really, really good, and … .justmakes me feel like a normal person."(R9).
Many participants spoke about the positive impact of taking roles and responsibilities which helped others during their time in prison.One older individual with a lengthy criminal record (R12) described their actions, " … I donate between 50 pence and a pound a week to every charity [available on the computer system] -10p, 10p, 15p, 20p, yeahand it makes me feel better for all the wrongs I've done.Every week I do that".Another well-educated participant, who recognized the opportunity to use their knowledge and skills to help others (R9), stated, " … being able now to advise these girls, it's keeping me going and that's how I'm dealing with my anxiety, and that's how it's making me a stronger person".
Several participants described the importance of ongoing contact with friends and family during their time in custody.Participant R6 described their support network, "I've got my family, I've got my parents, my sister.I've got a lot of supporters out there who are fighting for [my appeal] … … I've got my partner and my daughter.I've got my Nan as well, and my mother-in-law, so yeah, I've got a wide group of people".Having the support of people with whom they already had a strong emotional bond made it easier for them to cope with their distress, as well as enabling them to maintain positive connections with the outside world: "[Having a telephone in your room] makes a huge difference.You can calm down easier.You can speak to your friends and family.You are not isolated.I mean you are isolated, but you still haveif you feel low, you can call them … .That was lovely."(R1) Overall, participants reported finding a range of ways they survived, coped or thrived during their time in custody, irrespective of their trauma histories and the impact of these on their perceptions and experiences of prison life.

DISCUSSION
The current study presents a substantial qualitative inquiry into the lived experiences of individuals in women's prisons.By examining perceptions and experiences of the prison environment, and interactions with previous histories of trauma, this study was able to identify many ways in which routine aspects of daily prison life, including their lack of control and power dynamics with staff, are triggering for individuals in custody with histories of trauma.The study also found that the prison environment and procedures were experienced as traumatic, irrespective of participants' trauma histories.Additionally, the study highlighted the crucial role played by supportive relationships and positive connections with peers, as a means of mitigating the hardships of prison life, despite mistrust arising from prior trauma.Finally, the adaptive strategies employed by the individuals to survive, cope and thrive in custody were identified.This study addresses a lack of research in the UK women's prison estate about the complex needs of this population, and the interaction between their prior experiences and their experiences in custody.The findings will contribute to the improvement of practices, policies and the treatment of individuals in women's prisons.
The research question examined the impact of participants' trauma histories upon their perceptions and experiences of the prison environment.Overall, participants experienced the prison system as traumatizing and hostile, and were shocked by the intensity and chaos of the prison environment and persistently fearful within it.Prison was perceived as a punitive environment, with unfair and inconsistently applied rules.These findings support the views of scholars (Anderson et al., 2020;Haney, 2012) who posited that imprisonment itself was a traumatic experience and concur with DeVeaux's (2013) personal account of the negative impacts of prison custody.The finding that participants experienced the environment as intense was similar to those of De Viggiani (2006), where male participants reported prison as a stressful place to live.
The study also identified that many participants found the lack power and control over their lives whilst in prison to be particularly triggering, given their histories of intimate partner violence and abuse.Whilst it is an established part of the prison experience, that those who are incarcerated lack some agency and autonomy over their lives (Irwin & Owen, 2005), the findings from the current study contextualize why this lack of agency and power is so problematic for individuals with histories of trauma.The findings lend weight to the need for prisons to become trauma-informed and responsive, as well as to find ways to enable incarcerated individuals to have autonomy over their lives in custody, to support the goal of post-release rehabilitation.
Methods used by participants to cope, survive and, in some cases, thrive within the harsh custodial environment were also identified.Participants reported using various safety-seeking behaviors, enabling them to escape or avoid potential threats.The perception that participants' rooms were their safe sanctuaries, is consistent with the evidence that some individuals find safe spaces to retreat to in order to cope with prolonged trauma (Harris & Fallot, 2001).In addition, resilience was shown by those participants who had spent longer in prison and had found ways to take some power back and therefore felt more able to cope with the challenges of imprisonment.For these individuals, resilience provided a means of protecting against the negative impacts of trauma and stress (Iacoviello & Charney, 2014).Additionally, consistent with the 'empowerment' principle of trauma-informed care (Menschner & Maul, 2016;SAMHSA, 2014), improvising or being employed in helping roles gave individuals a sense of purpose and shifted their perceptions toward being agents of change for themselves and others.
The perceived insufficiency or inadequacy of support and services for individuals in prison appeared to have made some participants feel uncared for, unsupported or abandoned by the system within which they were contained.This was triggering for those with histories of neglect or abandonment by care givers.However, imprisonment was deemed inherently traumatizing irrespective of the trauma histories reported by participants, as found by Douglas, Plugge and Fitzpatrick (2009); although for many, negative impacts were exacerbated by those aspects of their prison experience which were similar to their prior trauma, such as being physically restrained.It should also be noted that according to the lived experiences of the sample, those with prior prison experience appeared to be less negatively impacted by their current imprisonment.This may have been driven by their familiarity with the environment and the development of effective coping strategies, which involved engaging with a wide range of activities, work opportunities and services whilst in custody that allowed participants to distract themselves from the difficulties of imprisonment.This is consistent with the findings of Elzy, Clark, Dollard and Hummer (2013) showing that girls with avoidance coping strategies exhibited lower trauma symptoms The improvisatory coping mechanisms of women in prison should be explored further in future research.
The second research question examined how prior experiences of trauma affected the way participants perceive their treatment by, and interactions with, prison staff.Findings indicated that most participants were triggered by the power dynamics, their lack of control and possible abuses of power, and these were reminiscent of prior experiences of interpersonal and relational harm.The ways in which power is balanced between incarcerated women and staff has been explored ethnographically by Rowe (2016); this research described the balance of power between the staff and women in two women's prisons, and the different strategies and tactics used by both staff and residents to achieve their differing goals.The significance of power in Rowe's research echoes with the findings of the current study, although this current study examined power in relationships within the context of the trauma histories of the participants.The current finding, that the way some staff treated or interacted with participants was triggering, is important and can be used to shape the attitude and skill requirements of staff recruited to support the aim of trauma-informed women's prisons.Some participants' trauma histories made it difficult for them to trust members of staff, as also indicated elsewhere (Bell et al., 2019;Gobin & Freyd, 2014).Yet, concerningly, this study found mistrust arose from staff's damaging behavior, ranging from insensitivity to abuses of power.
However, being more familiar and ingrained in prison, as well as the consistent, dependable and supportive behavior of certain staff, mitigated some of the difficulties with trust for some participants, enabling them to develop trusting relationships with small numbers of staff.
The third research question examined how participants' perceptions of their relationships with peers in custody were affected by previous experiences of trauma.It appeared that trust took less time to develop with peers than with staff, possibly due to the intensity of the living situation, whereby individuals were forced to live in very close proximity with others (De Viggiani, 2006).Additionally, the imbalance of power inherent to encounters with staff was not present with peers who instead shared a mutual understanding of prison life.This was consistent with the findings of Patel and colleagues (Patel et al., 2021), showing that belonging and acceptance by peers was a key aspect of life in prison for women in their sample, and that shared life experiences eased friendship-making amongst the incarcerated women.This finding highlights the potential value of peer support services within women's prisons.
Contrary to the high rates of abuse and assaults reported in women's prison facilities in America (Anderson, Pitner and Wooten, 2020), participants did not describe feeling unsafe or fearful that they might be assaulted by their peers whilst living in close proximity.Interviewees' prior trauma histories did not appear to have substantially impact their relationships with peers.Rather, friendships with peers were seen by most participants as crucial to their survival in custody.This is consistent with other findings reporting the positive benefits of friendships in prison (Patel et al., 2021;Wright et al., 2012).Given parallels between staff power and prior abusive relationships, it was understandable that bonding with other people with shared experiences and equal power became an important means of enabling them to cope (Taylor et al., 2000).Such connections established a sense of belonging, and this feelingas opposed to feeling alonecontributed to individuals feeling safer in prison, as well as feeling cared for.This is contrary to the superficial or competitive nature of the relationships between men in prison reported by De Viggiani (2006).It appeared relationships acted as a protective barrier against the harsh and difficult environment and system within which women lived (Maschi et al., 2013) and supports the 'tend and befriend' response to stress favored by women, also posited by Taylor and colleagues (2000).
Overall, the perceptions and reported experiences of the study participants indicated that the ambition of the Female Offender Strategy for England and Wales (MoJ, 2018)-to develop a trauma-informed approach within women's prisons-has not yet been realized in the prisons studied, despite trauma awareness staff training being embedded in all three sites.Overwhelmingly, the findings indicated that individuals with trauma histories are further traumatized and regularly triggered by the prison environment and staff behavior, and by many aspects of their experiences in custody.Participants reported a range of negative effects of imprisonment, which were often made more damaging because of similarities with their prior trauma histories.Given these findings, and the prevalence of trauma in the lives of women in prison, before HMPPS can describe women's prisons as trauma-informed or responsive, the organization must first address the multiple ways in which the prison system and environment; incarceration itself, and the individuals' experiences and opportunities throughout their time in custody, can exacerbate the difficulties already faced by those with prior trauma.

STRENGTHS AND LIMITATIONS
This study has provided ground-up insights from individuals in women's prisons about their experiences whilst incarcerated, and how this interacts with prior trauma.The inductive nature of the analysis allowed for in-depth exploration of the realities of prison life from the perspective of those with current lived experience, without any preexisting coding framework.Given the scarcity of research in this area, the present study provides valuable practical evidence for policy makers, prison managers and staff to consider how to create prison environments, regimes and policies that do not further traumatize these individuals.The personal narratives of the 50 participants interviewed from three different types of prisons within the women's estate in different areas of the country ensured that a wide range of experiences were captured within the data, and the adoption of trauma-informed and responsive practices throughout, ensured that participants were not negatively impacted by their involvement.
Limitations of the present study included a potential response bias; in this regard, individuals whose imprisonment more seriously negatively impacted them might have been those assessed by healthcare staff as unfit to work due to their ill health and would therefore have been excluded from the sample.Also, people who were actively engaged in therapy, education, work, or other constructive coping activities may have been unavailable at the time of the research interviews, as they mainly took place during the same times of day as work, education and other activities.To counter this, the researcher offered some evening appointments, in order that those employed or undertaking activities during the day could book an interview at an alternative time.

IMPLICATIONS
This study's findings have identified the range of ways in which the prison experience can be distressing, traumatizing and triggering for individuals with traumatic histories.The findings add to a growing evidence base promoting the movement toward more trauma-informed and responsive prisons.Until women can feel psychologically and physically safe in prison; can develop trusting relationships with staff; are able to make choices and collaborate about their treatment and daily lives and can be empowered to develop skills to enable them to move forward with their live, efforts to rehabilitate women in prison are likely to be unsuccessful.The findings of this study support the delivery of this element of the Female Offender Strategy (MoJ, 2018) by clarifying the ways in which prison is experienced by those with histories of trauma, thus indicating the true extent, breadth and depth of change required within women's prisons.However, more fundamentally, the findings demonstrate that whilst prisons which are trauma informed might be better than prisons which are not, ultimately imprisonment is harmful to individuals with trauma histories.This underlines the importance of the vision within the Female Offender Strategy (2018), that vulnerable women should receive community support to prevent them coming into contact with the criminal justice system, and that appropriate alternatives to custody should be developed in order that fewer women convicted of crime should be sent to prison.
Whilst incarceration is still employed as a sanction, prison environments should be adapted to reduce or remove those aspects and features which contribute to the spaces being traumatizing, oppressive and hostile by design (Jewkes et al., 2019).Policies and procedures that are traumatizing or triggering should be revised (such as the way physical restraints are used), or adapted to reduce negative impact (for example, moving toward reducing prison transfers, and clearly communicating and planning such transfers when they are essential).Staff recruitment and training should also be developed, to ensure that staff have the attitudes, skills and knowledge required to work effectively with individuals with trauma histories.Additionally, consideration should be given to the provision of ongoing staff supervision and support, to minimize and address inappropriate uses of power or control by prison staff in their daily working practices.
Empowering individuals to become more routinely involved in decision-making about their daily lives and facilitating their influence on how prisons operate would develop their sense of their power and control over their experience of imprisonment.This would align with the traumainformed care principles of empowerment and choice (SAMHSA, 2014).Additionally, our findings about the significance of peer relationships supports the need for those in prison to design and deliver a broader range of peer support services using their own experiences.This would further enhance the sense of responsibility and purpose, which was found to be protective in the present study and would be consistent with another principle of trauma-informed care (SAMHSA, 2014).
Further research could examine the different effects of imprisonment for those with different types of trauma histories.This builds on the current study's findings that those who had been in abusive intimate relationships experienced the power dynamics with prison staff as well as their lack of control over their day-to-day lives as particularly triggering.It is possible that such learning could provide additional recommendations about ways in which individuals might be better supported in custody.Additionally, further research should explore how other characteristics (for example, gender; age, or ethnicity) differentially impact experiences of imprisonment and how this is informed by potential differences in their trauma histories.

Table 1 .
Demographic information about participants.

Table 2 .
The application of trauma responsive principles to the research.