Monetary Sanctions as Chronic and Acute Health Stressors: The Emotional Strain of People Who Owe Court Fines and Fees
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Monetary Sanctions as Chronic and Acute Health Stressors: The Emotional Strain of People Who Owe Court Fines and Fees A le x es H a r r is a n d T y ler Smi th In this article, we explore the experiences of people who carry monetary sanction (or penal) debt across eight U.S. states. Using 519 interviews with people sentenced to fines and fees, we analyze the mental and emo- tional aspects of their experiences. Situating our analysis within research on the social determinants of health and the stress universe, we suggest that monetary sanctions create an overwhelmingly palpable sense of fear, frustration, anxiety, and despair. We theorize the ways in which monetary sanctions function as both acute and chronic health stressors for people who are unable to pay off their debts, highlight the mechanisms linking penal debt with mental and emotional burdens, and generalize our findings using national data from the U.S. Federal Reserve. We find that the system of monetary sanctions generates a great deal of stress and strain that becomes an internalized punishment affecting many realms of people’s lives. Keywords: health, stress, criminal legal system, monetary sanctions, fines and fees Monetary sanctions lead to long-term criminal ris 2016; Harris, Smith, and Obara 2019; O’Neil legal entanglement, supervision, and punish- and Strellman 2020). Monetary sanctions can ment for people who are unable to afford them. affect people’s behavioral transitions to adult- These fiscal penalties, also called legal financial hood, influence their self-identities, and limit obligations (LFOs), include court sanctioned their abilities to move into successful life paths fines, fees, restitution, and surcharges as well (Harris 2016). Current research outlines the as various cost points and hidden costs related “piling on” (Uggen and Stewart 2015) of mon- to the completion of mandated sentences (Har- etary sanctions as it puts strain on family net- Alexes Harris is UW Presidential Term Professor and sociology professor at the University of Washington, United States. Tyler Smith is a doctoral student in the Department of Sociology at the University of Washington, United States. © 2022 Russell Sage Foundation. Harris, Alexes, and Tyler Smith. 2022. “Monetary Sanctions as Chronic and Acute Health Stressors: The Emotional Strain of People Who Owe Court Fines and Fees.” RSF: The Russell Sage Foundation Journal of the Social Sciences 8(2): 36–56. DOI: 10.7758/RSF.2022.8.2.02. We are thankful to the reviewers for their substantive and theoretical suggestions for strengthening our analysis. This research was funded by a grant to the University of Washington from Arnold Ventures (Alexes Harris, PI). We thank the faculty and graduate student collaborators of the Multi-State Study of Monetary Sanctions for their intellectual contri- butions to the project. Partial support for this research came from a Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure grant, P2C HD042828, to the Center for Stud- ies in Demography and Ecology at the University of Washington. Direct correspondence to: Alexes Harris, at yharris@uw.edu, Department of Sociology, Box 353340, University of Washington, Seattle, WA 98195, United States; and Tyler Smith, at tjsmith1@uw.edu, University of Washington, United States. Open Access Policy: RSF: The Russell Sage Foundation Journal of the Social Sciences is an open access journal. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported Li- cense.
chron ic a n d acu te he a lth str essors 37
works and takes away resources for housing points that leave many on “thin ice.” This study
and employment stability (Pattillo et al. 2022, further demonstrates how court debt remains
this volume). The inability to pay monetary persistent for long periods and includes ongo-
sanctions creates a palpable sense of fear, frus- ing negative experiences related to people’s re-
tration, anger, and resignation (Harris 2016; Ca- duced economic means and fiscal liability.1
digan and Kirk 2020; Pattillo and Kirk 2020). In We also show how the stress and strain of
other words, monetary sanctions lead to a great monetary sanctions could lead to negative
deal of stress and strain for those who are un- health outcomes. Many respondents suggested
able to pay. that their stress led to mental health concerns,
This article examines the role that monetary particularly severe anxiety and depressive
sanctions have in creating stress, mental strain, symptoms. In addition, several of our respon-
and emotional exhaustion for people who have dents indicated how monetary sanctions might
experienced criminal legal contact. We frame decrease physical health by influencing their
our analysis using the stress process paradigm daily choices of travel, food consumption, and
(Pearlin 1989; Wheaton 1994), which empha- health decisions. We bolster these findings us-
sizes how “social factors bear on the kinds of ing a nationally representative sample, show-
stressors to which people are exposed, the per- ing that individuals who have household legal
sonal and social resources to which people have debt are more likely to have lower overall health
access, and the emotional, behavioral, and than individuals who do not. Although the
physical disorders through which stress is man- scope of our original study does not allow us to
ifested” (Pearlin 1989, 254). We specifically ask draw a definitive conclusion about health im-
how monetary sanctions create both acute and pacts, these preliminary results suggest such a
chronic stressors in people’s lives. We frame relationship. Further, although we do not at-
the sentencing of monetary sanctions as the tempt to argue causality, we do draw out the
primary stressor, and related criminal legal possible associations between penal debt, ex-
contact—due to nonpayment and remaining treme stress, and health outcomes.
penal debt—as secondary stressors. Acute Our findings reveal that court-imposed
stress refers to the specific, stress-inducing mo- monetary sanctions—to those who have no
ments that generally result from this criminal ability to pay and even those struggling to make
legal contact. For our participants, these mo- monthly payments—function as an underex-
ments included the sentencing of monetary amined mechanism that further associates
sanctions themselves, summons to court to ex- criminal legal engagement with negative out-
plain their financial circumstances, warrants comes such as stress and anxiety. We argue that
issued for their arrest, the loss of driver’s li- the stress and cumulative disadvantages gener-
censes, and even incarceration. In addition to ated by the system of monetary sanctions could
these specific moments of stress, participants exacerbate existing anxieties or create new dis-
also described an ongoing experience of anxi- orders that further exacerbate economic and
ety due to their inability to fully pay court- racial health inequities. We follow the argu-
ordered fiscal penalties. Individuals felt this ments of scholars who suggest that the crimi-
chronic stress daily as they balanced paying nal legal system serves as a key social determi-
their LFOs with the costs of their basic needs nant of health, especially for people of color
and the basic needs of their families. They also and those from poor communities. By under-
worried about the constant possibility of crim- standing monetary sanctions as a form of le-
inal legal intervention and how that interven- gally and socially produced stress, we outline
tion could further disrupt their lives. As Mi- the context for future research to explore the
chele Cadigan and Gabriela Kirk (2020) association between criminal legal debt and
illustrate, individuals with court debt face and poorer health outcomes for individuals, fami-
endure a recurring cycle of procedural pressure lies, and their communities.
1. The inability of individuals to pay their LFOs, as well as laws that do not allow for unpayable LFOs to be waived,
means that legal debt could represent a permanent punishment for many people (Harris 2016).
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences38 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
The Stress Process Model cannot manage or control, either acute or
Research, public discourse, and policy discus- chronic, leads to poor health outcomes.
sions increasingly cite a set of social determi- This interaction between social circum-
nants that affect individual, family, community, stances, stress, and health disparities has led
and population health (Warren and Hernandez scholars to suggest a more robust “sociological
2007; Williams et al. 1997; CSDH 2008). Scholars study of stress” (Pearlin 1989). Leonard Pearl-
of health outcomes encourage examinations of in’s stress process model emphasizes the im-
how economic and social resources are orga- portance of social structures in determining
nized and distributed within social contexts how stress may be produced and how it will
versus only behavioral and medical factors affect an individual’s well-being. He describes
(Amick et al. 1995; Tarlov 1996; Raphael 2006). two distinct types of stress that may result from
This framework recognizes that people are sit- social circumstances. First are primary stress-
uated within not only individual biology and ors, which are specific life events, circum-
lifestyle choices but also social contexts that stances, or trauma that are generally unwanted
shape health outcomes. and disruptive. These moments may be thought
An important question is then raised about of as “the first to occur in people’s experiences”
why certain institutional and societal pressures and the origin of many types of socially pro-
produce such dramatic negative health out- duced stress (1989, 248). A host of secondary
comes. A central association arises in the expe- stressors may flow from these primary stress-
rience of stress. Stress can be produced by life ors. Secondary stressors are events or circum-
pressures, including those relating to workplace stances that occur as a direct result of the pri-
burdens, poor health, financial vulnerability, mary stressor but are also independently stress
and relationship tensions (Hammen et al. 2009). producing. The key point Pearlin emphasizes
In response to these perceived stressors, our is that a single primary stress event often does
bodies attempt to adapt with various chemical not occur in isolation, but instead “one event
and psychological reactions (McEwen 2012). leads to another event or triggers chronic
“The way a person can anticipate a certain strains; strains, for their part, beget other
stressor and then control it, largely defines the strains or events” (247). From this perspective,
resulting stress response” (Mariotti 2015, 1). we can see how primary and secondary stress-
Long-term emotional pressure can thus lead to ors can produce both acute and chronic stress.
ongoing or chronic “cognitive, emotional, and Both primary and secondary stressors may re-
behavioral dysfunctions” (Mariotti 2015, 2). sult in specific, highly stressful events (acute
Studies find that chronic stress can lead to im- stress) and may result in more prolonged feel-
mune dysfunction, depression, serious disease, ings of anxiety that occur in relation to those
and hypertension, and can even promote cancer events (chronic stress).
development (Lucassen et al. 2014; Glaser and Scholars refer to this complex interaction
Kiecolt-Glaser 2005; Dantzer et al. 2008; Rosen- between stress, health, and context as the
thal and Alter 2012; Lundgren et al. 2011; Heidt “stress process paradigm” to emphasize that
et al. 2014). In contrast to chronic stress, acute stress is not simply an internally produced
stress is pressure experienced by a terrifying or state, but that it is caused and reproduced by
traumatic event such as the death of a family an interaction with the institutional environ-
member, car accident, or assault. Such events ment (Pearlin et al. 2005).2 Studies that examine
can lead to similar biological and behavioral re- the stress process should focus on the social
sponses as those of chronic stress (Shors, Gal- and economic circumstances in which people
legos, and Breindl 1997; Barton, Blanchard, and are embedded and how these dimensions of
Hickling 1996). In short, the stress that people social organization lead to varying exposure to
2. Others have expanded the model to develop a family stress model to better understand inequality between
families (Turney and Sugie 2021). We do not explore this expanded model here, but the connection between
monetary sanctions and familial health dynamics is an important avenue for future research (see Boches et al.
2022, this volume).
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 39
stress, the ways in which it manifests, and the and their communities (for a review, see Mas-
resources people have to manage it. Thus, to soglia and Pridemore 2015). To varying degrees,
understand the social determinants of health criminal legal events such as police surveil-
we must understanding the social determi- lance, arrest, conviction, and incarceration af-
nants of stress itself. fect people’s psychological well-being, rates of
hypertension, and exposure to infectious dis-
Cr i m i n a l Leg a l C o n tac t eases (Schnittker et al. 2015; Hirschfield et al.
a n d H e a lt h O u tc o m e s 2006; Massoglia 2008a). This research clearly
How might the criminal legal system influence demonstrates that entanglement with the crim-
the stress process paradigm for people under inal legal system at all levels has a negative ef-
its control? Sadly, one of the most salient insti- fect on health.
tutions in the lives of disadvantaged individu- An important mechanism likely linking
als is that of the criminal legal system. Over the criminal legal contact and health outcomes is
last forty-five years, the United States incarcer- the production of stress. In an examination of
ation rate has increased by 500 percent to over neighborhood-level frisk and use of force pro-
6.6 million people in 2016, leaving the United portions, Alyasah Sewell, Kevin Jefferson, and
States with the highest incarceration rate in the Hedwig Lee find higher levels of psychological
world (Kaeble and Cowhig 2018; The Sentenc- distress among men living in neighborhoods
ing Project 2019). Comparatively, the United with intense police surveillance (2016, 9). Other
States has created a truly exceptional criminal studies find associations between current and
legal system in terms of raw numbers and in recent incarceration and depression for those
the disparate rates by which people of color are confined; although the role of stress was not
surveilled, arrested, convicted, and incarcer- often clear (Sykes 2007; Goffman 1961; Masso-
ated. In 2017 for example, Black people made glia 2008a; Schnittker et al. 2015; Steadman et
up 13.4 percent of the U.S. population but 33.1 al. 2009). In an analysis of recently incarcerated
percent of the people housed in state and fed- fathers, Kristin Turney, Christopher Wildeman,
eral prisons. Latinx people made up 18.5 per- and Jason Schnittker (2012) attempt to disen-
cent of the U.S. population but 23.4 percent of tangle the effects of current and recent incar-
the incarcerated population. Black women have ceration on mental well-being and find that
an imprisonment rate of ninety-t wo, Latina both currently and recently incarcerated fa-
women of sixty-seven, and White women of thers have higher rates of depression than their
forty-nine per hundred thousand people. The counterparts. Using Pearlin’s stress process
rate of imprisonment for Black men is 2,330, framework, they suggest that incarceration cre-
Latino men 1,054, and White men 397 per hun- ates a “fundamental shift in the life course”
dred thousand (Bronson and Carson 2019). Not generating economic insecurity and disrupted
only are large numbers of people in the United romantic, family, and friendship networks
States ensnared in the criminal legal system, (477). These strained life dimensions collec-
but this entanglement and control is also per- tively function as secondary stressors resulting
formed disproportionately on racially and eth- from incarceration, which their analysis sug-
nically marginalized people. gests could be a cause of the higher rates of
These overwhelming statistics sketch the depression.
broad collection of people, their families, and Although these studies have begun to sketch
communities who have had criminal legal en- the connection between the stress of criminal
tanglement. A developing subfield within the legal contact and health outcomes, significant
study of the criminal legal system is the dispa- gaps remain. Specifically, little research has ex-
rate health outcomes observed for people ar- plored the production and impact of stress
rested, convicted, and incarcerated (Binswanger through sanctions outside of arrests and incar-
et al. 2011). Consistent with the findings that ceration. In this article, we turn attention to the
social status affects health outcomes, contact latent anxiety created by the ongoing punish-
with the criminal legal system often decreases ment of monetary sanctions. This stress is in-
the well-being of individuals, their families, dependent of the usual focus of contacts with
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences40 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
the criminal legal system. Although we can en- a felony conviction (3 percent), we can safely
vision how visible points of contact (such as assume that a large segment of the U.S. popula-
arrest and incarceration) can lead to stress, it tion has been charged with monetary sanctions
is more difficult to see the anxiety and emo- at some point in their lifetime (Kaeble and Cow-
tional trauma generated from the enduring and hig 2018; Shannon et al. 2017). Further, this debt
invisible force of the system of monetary sanc- burden is borne disproportionately by African
tions. Just as they experience a chronic illness, American men, 33 percent of whom are esti-
people who owe monetary sanctions experi- mated to have a felony conviction (Shannon et
ence chronic stress and acute moments of anx- al. 2017). Monetary sanction debt is a signifi-
iety as they move through their lives and are cant component to criminal legal entangle-
constantly confronted by the criminal legal sys- ment, disparately so, and an obvious dimen-
tem and its representatives. Our research sug- sion that could influence the well-being of
gests that it is important to understand how individuals and their families.
individuals manage the anxiety of meeting The burgeoning subfield studying monetary
their legal obligations while also trying to nav- sanctions highlights the negative effects of
igate both the legal system and their daily lives. these sanctions and links them to economic
instability, neighborhood debt burden, diffi-
M o n e ta ry S a n c t i o n s a s culty with community reentry, and social dis-
Stress Producer integration (Cadigan and Kirk 2020; Harris
We suggest that the system of monetary sanc- 2016; Pattillo and Kirk 2020; Friedman and Pat-
tions is an important mechanism connecting tillo 2019; O’Neill et al. forthcoming; Shannon
criminal legal contact with stress, strain, and et al. 2020; Cadigan and Smith 2021; Sebastian,
anxiety for individuals and their families. Court- Lang, and Short 2020; Link et al. 2021). Al-
imposed monetary sanctions, also called legal though this research has yet to examine the re-
financial obligations, are fines, fees, surcharges, lationship between long-term court-imposed
costs, and restitution that people entangled monetary sanctions and health outcomes, re-
with legal systems must pay to become com- search suggests that extreme pressure is put on
pletely free (Pattillo and Kirk 2021). Every state debtors by courts and other legal agents to
in the United States sentences some form of make regular payments even in instances of
these monetary sanctions on traffic citation, poverty (Harris 2016). Using interview and court
misdemeanor, juvenile, and felony convictions observational data, Cadigan and Kirk (2020) il-
(Harris 2016; Kohler-Hausmann 2018; Natapoff lustrate the powerful pressure and anxiety peo-
2018; Paik 2020). People remain under court su- ple feel because of their inability to make full
pervision until their debt is paid. They are also or regular payments toward their monetary
subject to court summons to explain their fiscal sanctions. Similarly, Mary Pattillo and Kirk
circumstances, warrants if they do not show up (2020) describe how interview respondents pro-
to court, loss of driver’s licenses for nonpay- cess the court-imposed debt as an injustice that
ment, and even incarceration. Furthermore, in serves as a “double punishment” that feels like
many states, as highlighted recently with Flori- “extortion” (64, 66). The cumulative body of re-
da’s Amendment 4, until one pays their fines search on monetary sanctions clearly illustrates
and fees in full, they are unable to vote, serve on a punishment schema that puts undo pressure
juries, or run for elected office (see Morse 2021). and strain on individuals who are “too poor to
No national statistics cite the total number pay” (62) and leads to feelings of perpetual
of people who have unpaid monetary sanc- stress and frustration.
tions. One recent report, however, did find that
of twenty-five states, at least $27.6 billion in T h i s S t u dy
fines and fees is owed to state and local juris- This analysis examines how monetary sanc-
dictions (Hammons 2021). Taking this known tions extend the experience of conviction and
amount, along with the numbers of people cur- incarceration into the community and exacer-
rently under some form of criminal legal con- bate economic and psychological stressors for
trol (6.6 million), and those estimated to have people unable to pay their court debts. Adapt-
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 41
ing Pearlin’s stress universe framework to as- eight states. To begin, we pulled all the excerpts
sess interview data with people who owe mon- regarding health from the Washington State in-
etary sanctions, we examine how the sentencing terviews and coded inductively using NVivo
of monetary sanctions served as a primary software. For our larger project, we did not ask
stressor associated with acute moments of fear, a direct question in our open-ended interview
anxiety, and stress, as well as long-term chronic protocol about health; however, respondents
emotional distress. Further, we illustrate how regularly discussed issues related to their men-
nonpayment or irregular payments lead to sec- tal and emotional well-being during the inter-
ondary stressors as further legal entanglements views. As outlined in the introduction to this
and punishments ensue. As a result, additional volume (Harris, Pattillo, and Sykes 2022), the
stress fomented and accumulated. The related full research team developed a codebook for
chronic and acute stress, as interviewees ex- reviewing all interview transcripts. Regarding
plained, become a form of internalized social health, these codes included a section on emo-
control that dictated their behaviors and con- tions, health, and substance use. For this anal-
stricted their abilities to engage in their lives. ysis, we used these codes to pull excerpts from
The interview data illustrate how people em- the interview transcripts and then recoded the
body this stress, creating an indeterminate data for further detail. We identified the follow-
punishment served outside of the courtrooms ing sets of codes as important: financial drain,
and jail cells of the criminal legal system. In multiple ways they create stress, hard to pay all
sum, our analysis indicates ways in which these monthly bills and pay LFOs, related disability
monetary sanctions are associated with condi- and illnesses, impact on personal relation-
tions of severe stress and emotional strain. We ships, criminal conviction and monetary sanc-
also situate our findings using a national sur- tion, consequences for employment. We then
vey of household economics to show that this began writing memos using these codes to ex-
association between legal debt and negative plore how respondents described their stress
household outcomes is likely generalizable. and where, why, and when monetary sanctions
increased (or decreased) their anxiety. We then
Data a n d M e t h o d s read the interview transcripts for the same
Our analysis is set within the context of a questions across the other seven states while
broader national study of monetary sanctions. looking for both similar and outlying senti-
The aim of the Multi-State Study of Monetary ments to build on the outline we had devel-
Sanctions was to examine the systems, prac- oped.
tices, and related consequences of court sen- The resulting analysis walks through these
tenced fines, fees, and related court costs in dimensions, first examining the sentencing of
eight states.3 For this analysis, we wanted to monetary sanctions as a primary stressor and
explore the topic of stress and strain as it re- then outlining the resulting secondary stress-
lates to the punishment of monetary sanc- ors related to nonpayment or ongoing penal
tions. We were interested in how interviewees debt. We use the concepts of chronic and acute
talked about their anxiety and how monetary stress to illustrate the relationship between
sanctions might generate stress or other re- wellness and monetary sanctions and show
lated health problems. At the outset of our how the feelings of anxiety ebb and flow de-
analysis, we expected to find discussions about pending on moments of contact with the crim-
physical health problems, but were surprised inal legal system.
and overwhelmed that the interviewees spent To preface these findings from our interview
a great amount of time describing their stress data, we use national survey data provided by
and anxiety. the Federal Reserve Bank for 2019 (Federal Re-
Our analysis here relies on interviews with serve 2020). These nationally representative
people sentenced to monetary sanctions in all data provide a broader view for illustrating the
3. Washington, California, Texas, New York, Minnesota, Illinois, Georgia and Missouri (for a description of study
sites, see Harris, Pattillo, Sykes 2022, this volume).
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences42 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
Table 1. Descriptive Statistics for Selected Questions
Question n Mean SD
Do you or someone in your immediate family currently have 12,135 0.06 0.23
any unpaid legal expenses, fines, fees, or court costs? (Y/N)
In general, would you say your physical health is. . . ? 10,794 3.43 0.94
(1 = Excellent; 5 = Poor)
Did health limitations or disability contribute to you not 7,118 0.25 0.43
working/not working as much as you wanted? (Y/N)
Was illness or health a reason you did not attend college? 503 0.12 0.33
(Y/N)
In the past twelve months, was there a time you needed 12,085 0.07 0.25
mental health services but went without because you
couldn’t afford it? (Y/N)
In the past twelve months, was there a time you needed dental 12,110 0.18 0.38
health services but went without because you couldn’t afford
it? (Y/N)
In the past twelve months, was there a time you needed follow- 12,101 0.08 0.27
up care but went without because you couldn’t afford it?
(Y/N)
In the past twelve months, have you had any unexpected major 12,114 0.24 0.43
medical expenses that you had to pay for out of pocket?
Source: Authors’ tabulation based on SHED data (Federal Reserve 2020).
relationship between legal debt and health out- We do not intend to directly compare our inter-
comes. The Survey of Household Economic and view data analysis with the SHED data. Instead,
Decisionmaking (SHED) is an annual national we offer a broad and simple statistical analysis
survey that measures the economic well-being that shows a significant relationship between
and risk factors of households in the United health and legal debt. These findings provide
States. It is one of the only national surveys to increased justification for the in-depth explora-
include a question asking about court debt: “do tion of this relationship in our interview data
you, or someone in your immediate family, cur- and suggests that these findings may be gener-
rently have unpaid legal expenses, fines, fees, alizable to a sample beyond the states in our
or court costs?” We use this question to com- study. It is also likely that the national data are
pare differences in general health and health- understated, in that most likely our population
related issues between people with legal debt of interest (people with legal debt and criminal
and those without such debt. This question is legal entanglements) are underreported in the
not ideal in that it potentially represents house- SHED data (see Pettit 2012).4 Our aim is to high-
hold legal debt instead of personal debt, but we light the overall association between monetary
believe that it is a useful tool for exploring the sanctions and anxiety and stress outcomes,
relationship between personal or household without ascribing any directionality.
debt and health-related outcomes. Table 1 lists
the questions we selected from the SHED data Findings
that related to health outcomes and the de- The system of monetary sanctions generates a
scriptive composition of the sample. great deal of stress and strain that becomes an
The purpose of supplementing our qualita- internalized punishment affecting many
tive work with a national sample is important. realms of people’s lives.
4. Many people who are marginalized through poverty and criminal legal contact are underrepresented in na-
tional survey data.
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 43
Figure 1. Ratings of General Health for Individuals in Households
No Legal Debt
0.4
0.3
Proportion
0.2
0.1
0.0
1 2 3 4 5
Health
Has Legal Debt
0.4
0.3
Proportion
0.2
0.1
0.0
1 2 3 4 5
Health
Source: Authors’ tabulation.
C o n n ec t i n g Leg a l D e b t with debt were more likely to indicate that they
w i t h H e a lt h O u tc o m e s did not receive mental health care (χ2 = 149.3,
In the Federal Reserve’s national dataset, indi- p < .001), dental health care (χ 2 = 349.22,
viduals were asked to rate their general health p < .001), or follow-up care (χ2 = 243.93, p < .001)
(a score of 1 being poor and 5 being excellent). because of cost. Finally, individuals who had
Figure 1 shows the distribution of answers of legal debt more often indicated that they had
individuals who had legal debt against those also accrued some form of medical debt within
who did not. Individuals who have legal debt the past twelve months (χ2 = 18.16, p < .001). The
are more likely to indicate that their health falls proportions associated with these findings are
into the lower range. A one-sided t-test con- presented in table 2.
firms a significant difference between the aver- In sum, the survey data illustrate significant
age rating of individuals with legal debt and differences between people who live with
those without (x = 3.12 and 3.44, respectively; household court related debt and those who do
t = 7.19, p < .001). not. Individuals in households with legal debt
We also explored associations between legal were less healthy, worked less because of health
debt, structural impacts, and health-care con- concerns, and were less likely to receive health-
sequences of having legal debt using Pearson’s care services because of cost. We present this
chi-square tests. These tests revealed a signifi- nationally sampled data in our findings as a
cant association between carrying legal debt preliminary indication that LFOs may have se-
and working less due to health concerns rious impacts on long-term health. This sug-
(χ2 = 56.28, p < .001), although we did not find gests that court debt can lead to differential
an association between legal debt and not at- health outcomes and serves as a springboard
tending college due to health concerns (χ2 = for exploring stress as a possible linking mech-
.06, p = .80). Further, we found that individuals anism.
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences44 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
Table 2. Average Percentage of Individuals Indicating Health-Related Outcomes
No Legal Has Legal
Question Debt Debt
Did health limitations or disability contribute to you not working 23.7 38.9
or not working as much as you wanted?
Was illness or health a reason you did not attend college? 11.9 14.0
In the past twelve months, was there a time you needed mental 6.0 18.1
health services but went without because you couldn’t afford it?
In the past twelve months, was there a time you needed dental 16.3 44.5
health services but went without because you couldn’t afford it?
In the past twelve months, was there a time you needed follow-up 6.1 23.5
care but went without because you couldn’t afford it?
In the past twelve months, have you had any unexpected major 23.3 30.4
medical expenses that you had to pay for out of pocket?
Source: Authors’ tabulation based on SHED data (Federal Reserve 2020).
Table 3. Sources of Stress from Monetary Sanctions
Acute Stress Chronic Stress
Primary stressor sentencing of LFOS anxiety over ability to pay
balancing payments and basic needs
Secondary stressors court summons fear of criminal legal intervention
loss of driver’s license lack of transportation
arrest on warrants
incarceration
Source: Authors’ tabulation.
H ow P eo p le D e s c r i b e d would arise from intense interactions either in
Their Stress courtrooms or during potential encounters
We use the stress universe framework to ana- with police during traffic stops. A summary of
lyze our participants’ experiences with LFOs in these stress processes as they relate to LFOs is
the greater context of economic precarity, lim- outlined in table 3.
ited financial resources, and constant pressure
from the criminal legal system. We suggest that P r i m a ry S t r e s s o r : P u n i s h m e n t
the sentencing of monetary sanctions is a pri- o f M o n e ta ry S a n c t i o n s
mary stressor for people sentenced within the For many people, the sentence of fines and fees
criminal legal system. We find a secondary set functions as a primary stressor that triggers
of stressors that revolved around being sum- chronic stress related to attempting to balance
moned to court, having their driver’s license budgets and manage day-to-day living. Many of
suspended, and experiencing police encoun- our respondents described constantly thinking
ters that could end in incarceration. Within this about their monetary sanctions as they went
framework, we outline the ways in which inter- about their daily lives. A key concern was
viewees described the constant feelings of whether they would be able to balance the cost
stress and anxiety associated with their monthly of basic needs with their monthly payments.
budgets and living expenses, in addition to Several respondents talked about making daily
their court-ordered payments. Much of this calculations about their spending to make sure
stress is chronic and ongoing, but acute stress that they would have enough money left over
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 45
to pay their LFOs. Jacob, a Native American spondents frequently related how stressful this
man from a rural county in Washington State, fiscal balancing act made them feel. As Mark,
described his thinking process when calculat- an African American man from Washington
ing his daily expenses. State, remarked, “[LFO payments] take money
out of my pocket to pay, that I could be paying
There’s times that I went without eating and for rent, that I could be paying for food, and
without buying. . . . Up to this day I’ve never supplies, and health . . . then it’s still costing
bought anything for myself. . . . I always sold me. It’s still affecting my debt. It’s still a debt.
my socks. My underwear I sold. I would buy It’s still a burden.”
those, but I’d wear them till they were falling Here Mark made an important point, that
apart, and I’d still sell them. . . . Even getting even when making regular payments, people
in my car and how much gas am I gonna sentenced to court costs are burdened and con-
waste to go to this place, and should I walk strained in their living circumstances. It is not
to here and park here. I’d have to analyze ev- just that being unable to pay that is a hardship,
ery move, everything I did to cent amounts. but also that paying down these debts is diffi-
From waking up till going to bed. Should I cult even for those with a bit of extra money to
eat this? No, ’cause then I’m gonna have to make regular monthly payments. Like Mark,
buy this tomorrow. Or should I just eat half? respondents were concerned that the court-
When I was paying fines like that it was mandated monetary sanctions could cause
worse. It was like that’s the first thing that them to lose their housing or be unable to af-
you paid off, and then the next thing was like ford food and basic supplies.5 Even people who
how am I gonna do it for next month? And it said they had stable employment related how
was constantly like that for a lot of years, required payments influenced their ability to
man. Like I tell you, up to this day I still bud- provide for both themselves and their family
get myself. I still stress . . . that extra bill members. Individuals talked about how it was
killed us man. Killed me. already difficult to get steady employment be-
cause they had a criminal record and that LFOs
Jacob described how the chronic strain of further burdened their earning capabilities. As
debt to the courts shaped every economic deci- indicated by the project’s survey statistics (Har-
sion he made—he regularly policed his spend- ris, Pattillo, and Sykes 2022, this volume), many
ing to stay compliant with his court-ordered people were also unemployed or had serious
debt, but also to stretch what money he had to illnesses that prevented them from working.
live. He explained that he was already living in However, these individuals were still sentenced
precarious economic situations and that the to monetary sanctions. Within these precarious
added court bill owed to the state strained his contexts, many people expressed a sense of
finances even further. His description of how hopelessness about being able to pay. Rachel,
he adapted his life to living in debt is interest- a white woman from California, explained her
ing. “Up to this day,” he said, illustrating how anxiety: “Stress is the biggest factor. It’s always
the punishment of monetary sanctions con- constantly on the back of your mind that you’re
strained even his current behaviors and orien- not free. You have to keep paying. Every cent
tation toward money in that he had internal- you earn, it’s owed to the state, to a judge, to
ized this economic pressure and continued to the county, to somewhere that you’re never go-
live with the sense of punishment even after he ing to get.”
completed his payments. Several respondents said that they made
One of the main concerns that respondents daily calculations about their spending to
expressed in interviews was just this—how make sure that they had enough left over to be
their required monthly payments interrupted able to pay their LFOs. They needed to be able
their ability to meet other financial needs. Re- to both afford their basic needs and pay their
5. For a detailed examination of the connection between monetary sanctions and housing difficulties, see Pattillo,
Harris, and Sykes 2022, this volume.
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences46 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
debts to retain their freedom from the courts their significant others and children, or to meet
and incarceration. This constant calculation the responsibilities that they had to other fam-
could be incredibly stressful. Kyle from Seattle ily members while also paying their LFOs. Many
described the types of calculations he would interviewees who were parents expressed their
make every week: “So this week I didn’t get as guilt in telling their children that they could not
many hours of overtime as I wanted, so that take them out to eat or to activities that might
means there’s going to be this much out of my cost money. Annalise from Texas talked about
check, that means, so the motorcycle pay- how difficult it was to explain to her children
ments, I still have to do that, and I still have why she could not buy them the items they
to put this much in savings. Well, that leaves needed:
me with a smaller amount to work with. Well,
I still have to give these people money for my It’s just like I said, [LFOs] made it hard or
LFO’s otherwise they’re going to put a warrant impossible to be able to do certain things
out.” that my kids really needed if it was clothes or
Frequently the interviewees described every something they really, really needed. Like,
economic transaction as tinged with anxiety “Okay well, they gonna have to wait because
and concern over balancing necessities with fi- I have to pay this so I don’t get in trouble so
nancial legal obligations. “It was daily stress,” I can get this cleared and then maybe we can
Richard from Georgia said, “making sure I had try to get it later on.” Even though they really,
the money at the end of every month to pay.” really, really needed it. And, of course they
Sarah from Missouri expressed the same senti- don’t understand because it’s like, “Hey, I
ment when asked if she worried about money, need this,” and I’m like, “Hey, mom doesn’t
stating that she worried “all day, every day want to get in trouble. We have to take care
where the next dollar was going to come from.” of this first, it’s priority.”
In response to these pressures, people de-
scribed important life necessities as being Annalise described her penal debt as a con-
traded off to pay the court the minimum stant reminder of the court’s control and power
amount due. Brady, a biracial man from New over her life: if she did not make her monthly
York, compared this daily balance to playing a payments she would “get in trouble.” She tried
game of Jenga: “Start piling on, on the top of to avoid this consequence at all cost, even if it
each other. Whatever one you decide to handle meant her children had to go without.
first, it might seem to the most to be important Interviewees gave example after example of
to you, but the other thing turns out to be the the tension and disappointment they and their
most important. Then the whole tower come family members felt because of their legal debt.
falling down. And then you have to catch every- Jacob from Washington spoke of taking care of
thing else at once.” his nieces and nephews: “[The LFO] took
Having to pay LFOs took money directly out money away from them that I could [have used]
of their hands that would otherwise go to meet- taking care of them. Diapers, food, clothes.” An-
ing their basic needs. This constant money other man from Washington State, Jerry, de-
management down to the last cent generated scribed the stress from “so many responsibili-
a palpable sense of urgency, strain, and anxi- ties” on his shoulders for not just himself, but
ety. The sentence of monetary sanctions then also for his family members. These constant
can be seen as a primary stressor that induced considerations over spending money were a
a great deal of chronic stress and anxiety for clear source of anxiety and emotional stress
people. that was ever-present in the lives of these indi-
viduals.
S u pp o r t i n g Fa m i ly a n d C h i ld r e n Owing monetary sanctions can lead to fam-
Meeting family responsibilities became an ad- ily members’ stress as well. Many interviewees
ditional source of chronic stress for many who described how penal debt brought a shadow
owed monetary sanctions. Some respondents to people’s immediate and extended family
expressed anxiety over being able to provide for networks. During the court observations con-
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 47
ducted for the larger project, court officials go on the back burner. Housing, food, and
would tell people to ask their partners, par- then electricity. And then anything else after
ents, and even friends for money to pay toward that.” The people we spoke with made difficult
their legal debt. As Daniel Boches and his col- choices—some prioritized making regular pay-
leagues (2022, this volume) illustrate in detail, ments, others prioritized paying to secure their
penal debt became a burden and stressor for basic needs. Either way, people sentenced to
all household members and beyond. At times, monetary sanctions faced extremely difficult
people described having to ask family for choices that generated a great deal of stress.
money to directly pay their LFO bills; at other Other interviewees spoke about how LFO
times, they described instances of being un- debt affected their credit, making it hard for
able to pay their share of other household bills. them to get loans or approval for apartment
These findings are echoed by other studies in rental contracts. Delinquent debt that the
this volume. Beth Huebner and Sarah Shannon courts trade to collections agencies will appear
(2022, this volume) illustrate how some proba- on credit scores as negative marks. Having this
tion officers required the inclusion of all legal debt on one’s credit score was, as Geoff
household members’ income in paperwork described it, like putting “a bad mark on your
calculating minimum payments and ability to whole application process.” In a similar way,
pay. Mary Pattillo and her colleagues (2022, Lindsey from Minnesota summed up her anxi-
this volume) also illustrate the recursive rela- ety about being able to get ahead of her pay-
tionship between housing insecurity and pe- ments: “Well first of all it gives me anxiety. Be-
nal debt and show how the debt undermines cause I know that it’s there. And I have an
the stability of the entire family. Monetary anxiety disorder, just in general. It just stresses
sanctions thus cause stress and anxiety not me out thinking about all this money. I don’t
only for people charged, but also for the people think I’ll ever be able to get a loan to buy a
they love. house or even a car. That alone debilitates me
sometimes. I don’t think I’ll ever be able to get
S ec u r i n g S t r u c t u r a l S ta b i li t y ahead because I can’t get credit.”
Respondents were also concerned about how Again we see how the siphoning of financial
paying their LFOs influenced their opportuni- resources leads to stress—and even debilitating
ties for structural stability. One concern was anxiety—over whether individuals can make
that paying their LFOs would not leave them enough income to cover their daily expenses.
enough for rent and they could lose their hous- We see the ways in which the burden of
ing because of it. Jerry told us that he usually LFO debt can exacerbate the restricted employ-
had enough to pay his rent, but that at times ment opportunities of those already discrim-
recently he had come up “short and behind” inated against because of their criminal rec
with his income and that often did not have ord. However, LFOs are even more frequently
money left over to pay his court costs. Mitchell assessed to individuals found guilty of
from Washington State, who had been living misdemeanor-level crimes (Kohler-Hausmann
with his parents to save money, talked about 2018). Thus the financial burden is spread over
how paying LFOs drained his ability to buy a an even greater number of individuals who
home or a car. “I’m still struggling,” he said, contact the criminal legal system than those
“because that money that I’m putting towards “marked” by a felony conviction (Pager 2003).
my fines could go to a house, you know, an The interviewees illustrate how this unpayable
apartment, a car. It’s not easy, it’s not easy. I’ll debt leads to a constant pressure and balanc-
tell you that right now.” Others told us that they ing act of household budgets, takes resources
prioritized paying for their housing as a basic away from children and destabilizes access to
need, even if it meant that they had to delay housing, credit, and food. This chronic stress
their LFO payments. As Geoff, a Native Ameri- functions as an additional punishment that
can welder from Washington State, described strains relationships, affects the ability to be
it, “it’s another bill I have to pay. Something I safe and healthy, and invades people’s con-
can’t afford to pay, so it’s just going to have to stant thoughts.
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciences48 state mon eta ry sa nctions a n d the costs of the cr imina l lega l system
S ec o n da ry S t r e s s o r s : was just like, “No she missed it.” I had a war-
C o n s eq u e n c e s o f P e n a l D e b t rant for the failure to appear at the time be-
Several secondary stressors arouse for people cause I missed my court date. I went imme-
who did not or could not pay their monetary diately—the very next day—to my attorney
sanctions regularly. These stressors included and they rescheduled the court date by the
acute moments of stress, such as mandatory end of the week. Say I missed my court date
court summons to explain why they were not on Monday, I went the next day, which was
making payments, suspension of a driver’s li- Tuesday. She was able to get me back into the
cense for nonpayment, and being arrested on courtroom on Friday, to be able to try to have
warrants. Individuals also expressed chronic that court date rescheduled. The district at-
anxiety in relation to these stressors. For ex- torney was there, had already issued a war-
ample, not being able to drive caused many in- rant for me for my failure to appear, and ar-
terviewees chronic stress when they attempted rested me on it.
to search for transportation for themselves or
their children. Individuals also lived with a pal- Moments like these, when the criminal legal
pable fear of criminal legal surveillance and system intervenes in the lives of people who
concerns over how criminal legal intervention owe debt can lead to acute moments of stress
might affect their lives. We outline these sec- and anxiety: Will I get arrested? Will I go to jail?
ondary stressors and their consequences in the Beth Huebner and Sarah Shannon (2022, this
following sections. volume) highlight a court observation when a
person was threatened by a judge, who told
M a n dat e d C o u r t App e a r a n c e s them that if they did not complete their pay-
Variability is considerable across and within ment, they would not need to worry about their
the states in terms of how courts monitor peo- fine but would instead need to bring their
ple, collect LFO debt, and sanction people for “toothbrush” to court—meaning that they
nonpayment. In most jurisdictions, people who would be sent to jail. People described such
owed debt were still required to appear in court instances with powerful emotions, which in-
hearings for review to explain why they had not cluded fear and anxiety.
been making payments and not showing up to Many interviewees described an ongoing
these hearings could lead to serious conse- anxiety from being under such intensive crim-
quences.6 Patricia, an African American woman inal legal system surveillance. Court supervi-
from Illinois, described this cycle of review sion remains in effect until people pay their pe-
hearings as a matter-of-fact process for indi- nal debts in full. Respondents said that judges
viduals who had trouble paying their court would frequently summon them into court to
debt, pointing out that “if you don’t have stuff review payments even when they had no viable
paid, then you have to keep coming to court. way of getting to court without relying on oth-
Don’t miss court or you’ll have a warrant.” ers or public transit. In many cases, partici-
Kate, a respondent from Washington State, pants had to take time off work to attend review
said that she missed her court date because she hearings to discuss their LFO payments. Even
worked multiple jobs. She went to court to re- when people did not have resources to make
schedule the date after missing her first appear- payments, they were mandated by the courts to
ance and was promptly arrested for failure to attend hearings to explain their reasons for
appear. nonpayment—essentially, they were forced to
display or perform their accountability to the
Honestly just missed the court date and court via their explanations (Martin et al. 2022,
when I went to go have it rescheduled, which this volume; Harris 2016). Individuals faced not
was within reason, the DA [district attorney] only specific moments of stress during these
6. For example, during the Washington State court observations, nearly every individual reviewed was found
nonwillful because of indigency or some other barrier to payment. Individuals are rarely found to have willfully
chosen not to pay court debt, but are still frequently called in to court to have their ability to pay reviewed.
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l scienceschron ic a n d acu te he a lth str essors 49
summoned court reviews, but also a perpetual Jerry continued to describe his circum-
sense of stress over when these reviews might stances as a sort of “frogger” game trying to get
happen, how responding to summons might on and off the freeway to work without getting
affect their day-to-day lives, and the potential stopped by the police:
consequences if they cannot meet these obliga-
tions. “It’s basically me trying to get from my apart-
ment across the I-205 into Oregon. It’s a
Lo s i n g a Dr i v e r ’ s Li c e n s e short-ass drive. It’s only like a five-minute
Another common concern was automatic driv- drive, whatever. But it’s like that long-ass
er’s license suspension.7 Suspension for non- drive is any moment I can get pulled up on
payment on court fines and fees is a regular by the police. They run my name or whatever,
practice across the states studied (Stewart et of course they’re going to see I’m on proba-
al. 2022, this volume; Martin et al. 2022, this tion for driving without a license. And then
volume). These policies had severe impacts on that’s automatic pull over and automatic go
the ability of individuals to go to work, bring to jail. So, that’s the only thing really hinder-
their children to school and childcare, make ing me from doing anything—leaving the
appointments, and go about their daily lives. house and trying to get to Portland.”
Many people said they abided by their suspen-
sions, doing their best to manage their inabil- He concluded by describing his aim of pay-
ity to travel. Such decisions left many with on- ing off all his monetary sanctions so the anxiety
going stress about transportation needs. could be alleviated:
Others believed that their needs for transpor-
tation were too great, leading to anxious mo- “I can’t do anything without a license. So I’m
ments when they chose to drive with a sus- trying to get all these court fees and court
pended license. fines situated and out the way so I can get my
For Jerry in Washington State, the suspen- license back and actually not have to worry
sion of his license meant that he had to rely on about am I going to get pulled over today and
his fiancé to get him to and from work. Often go to jail and lose my job.”
when he was scheduled for double shifts at his
job, he would need to call in to cancel his shift Jerry’s story is similar to the distressing and
because he had no way of getting there. Some- demoralizing cycles other people described
times he would drive himself regardless, even once they fell behind in making payments on
though his license was suspended. Jerry ex- their monetary sanctions. Interviewees fre-
pressed his frustration at appearing before the quently spoke of losing their driver’s licenses,
court hours away from his home: which prevented them from getting to work or
made it more difficult to maintain employ-
“Yeah, [the court is] like five hours away. I ment. Robert Stewart and his colleagues (2022,
don’t have a license, like you said on top of this volume) examine how LFOs exacerbate spa-
it I work a full-time job. I’m not going to be tial and political inequalities and find that peo-
able to come out here. They’re just like really ple described a great deal of limited resources
fixated on me coming out here. It’s really in- and access to transportation. As a result, many
convenient because I feel like, like today I people, particularly in rural locations, felt
had to drive five hours just to sit in a court forced to drive their cars even when their li-
room . . . Just for them to tell me that I have censes were suspended, constantly worrying
to come back for another hearing. This is a about the repercussions if police caught them.
hearing I had to call off work.” Overall, the anxiety of being sentenced LFOs
7. Many traffic and driving under the influence convictions in Washington result in the automatic suspension of
an individual’s driver’s license. Individuals may not have their license reinstated until all LFOs are paid off. See
Washington State Department of Licensing, “Types of Suspensions,” https://www.dol.wa.gov/driverslicense
/suspensions.html (accessed August 12, 2021).
r sf: t he russell sage f ou n dat ion jou r na l of t he so ci a l sciencesYou can also read
