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Like many Americans, Santia Nance plans to celebrate Christmas with her loved ones.

Doing so will be more challenging for Nance: Her fiancé is incarcerated in a Virginia prison and she said it's been more difficult to visit since the start of the COVID-19 pandemic. Nance, a co-founder of Sistas in Prison Reform, which advocates for free prison communication and criminal justice reform, said she and her son weren't able to see her fiancé on Thanksgiving this year. She's worried she could be turned away on Christmas, too.

"For the past four Christmases while he's been incarcerated, it's definitely [been] a difficult time and can get expensive, and to try to travel there to see him can be expensive and time consuming," said Nance. "But obviously during the holiday season, you want to be there as much as possible and try to get in as many phone calls or video visits as possible, but obviously that can definitely add up."

Nance is one of the many family members and friends of the more than 1.2 million people who are incarcerated in the United States who spend hundreds of dollars each month and navigate a confusing system of increasing restrictions to visit, communicate with and support their loved ones.

Though many organizations work to help people in prisons connect with the outside world during the holiday season, people who were incarcerated – or have loved ones who are – told USA TODAY this time of year can be particularly difficult for their mental health.

"The holidays are a horrible time for all of us, for those who are incarcerated and also for the family members, because it's like you grieve," said Sharon McKinney, executive director of the Texas Inmate Families Association.

Visiting can be even more difficult during the holidays

Research has shown regular contact with family members improves the mental health of incarcerated people and their family members, makes facilities safer and reduces the likelihood people will reoffend when they leave prison, according to Kirstin Cornnell, family and community support director at the Pennsylvania Prison Society. A 2011 study from the Minnesota Department of Corrections, for example, found a reduction in inmates reoffending when staff allowed increased visits and contact with family members.

Despite the reported benefits, Cornnell said when visiting resumed in Pennsylvania prisons after a pause during the onset of the pandemic, new barriers were in place, including fewer and shorter in-person visiting slots, registration required in advance and reduced transportation services to prisons, which can be several hours away from major cities. Cornnell said her organization still fields dozens of calls each week from families struggling to navigate the system, calling it a "lottery that's really hard to win, essentially."

"People are really struggling to be able to see their loved ones, but it's even harder on the holidays because that's when everybody is trying to see their loved one and time is limited," she said.

In-person visits fell from more than 200,000 in 2018 and 2019 to around 86,000 in 2021 and about 90,000 in 2022, according to Maria A. Bivens, press secretary for the Pennsylvania Department of Corrections. Bivens disputed Cornnell's characterization of the changes to visitation, saying the pre-scheduling system allows for better planning and ensures loved ones get their visit. She added that free "video visits" have become "unquestionably popular" and allowed the department to "facilitate significantly more visits than prior to the pandemic."

In Texas, the state's Department of Criminal Justice had to suspend visitation on Mondays, Wednesdays and Fridays due to persistent staffing issues, according to Amanda Hernandez, the department's director of communications.

McKinney, of the Texas Inmate Families Association, said visitation spots fill up quickly and may be even more challenging to schedule during the holiday season.

"I have seen people on our Facebook page go for months without being able to get a visitation spot," she said.

She added video visits are not comparable to seeing loved ones in person.

"You don't have that human interaction," she said. "You don't have that touch."

Despite progress, cost of phone calls is still 'egregious'

About a decade ago, phone calls to prisons and jails frequently cost more than $1 a minute, according to Wanda Bertram, communications strategist for nonprofit criminal justice research organization Prison Policy Initiative. The costs rose because private telecommunications companies monopolized the industry, and prison officials would often contract with them based on the commission payments companies offered them, Bertram said.

After years of advocacy work, Bertram said the Federal Communications Commission, state legislatures and utilities boards have stepped in to better regulate costs.

In 2020, the Federal Bureau of Prisons began offering inmates about 500 minutes of phone calls for free. States including Connecticut, California, Colorado, Minnesota and Massachusetts have also since made phone calls free, according to Bianca Tylek, executive director of the criminal justice advocacy group Worth Rises.

Tylek said about a dozen more states are considering legislation that would make phone calls free, and legislation signed by President Joe Biden in January gave the FCC more authority to limit fees on audio and video calls inside corrections facilities.

Still, Tylek said families are "spending egregious amounts of money to simply communicate with their loved ones." A 2015 survey by the Ella Baker Center found 34% of family members of incarcerated people reported going into debt to pay for phone calls and visitations.

Just how much a phone call costs can vary widely depending on the location. A 15-minute phone call from an Oklahoma state prison would cost about $2.10, while the same call would cost 15 cents in Illinois, according to a 2022 report from the Prison Policy Initiative.

The cost of other forms of communication can quickly add up. Denise Rock, executive director of prisoner advocacy group Florida Cares said sending an electronic message or photo costs 39 cents. Videos cost $1.60 in Florida. A 15-minute video visits costs $2.95, according to the Florida Department of Corrections.

"It really does take advantage of people who have a loved one incarcerated and we don't say too often, but really the people that have a loved one incarcerated, they're silent victims," Rock said.

'Rampant problems' with restrictions on mail

Meanwhile, Bertram said prisons are also increasing a number of restrictions on physical mail in what officials say is an attempt to reduce contraband. Last December, the Prison Policy Initiative found at least 14 state prison systems have begun scanning mail in recent years, a number the group says is likely an undercount.

Bertram estimated thousands of incarcerated people will not be able to get original copies of their holiday cards this year. Instead, she said they will receive a photocopy or have to view a scan on a tablet.

There have been "rampant problems" with the quality of scanned mail around the country, including letters being cut off and messages becoming illegible, according to Jesse Lerner-Kinglake, communications director for Just Detention International.

"During the holidays, it really comes to the fore just the pointlessness and the cruelty of these sorts of policies," he said.

How you can help inmates and their families this holiday season

Despite the increasing challenges, advocacy groups like Just Detention International have been working to help people in prison stay connected to the outside world during the holiday season. Each year, Lerner-Kinglake's organization sends holiday messages to incarcerated people who have experienced sexual abuse. Lerner-Kinglake said those wishing to participate this year can send a message online or have blank cards sent to them. Last year, the group sent more 28,000 cards to facilities nationwide, he said.

Johanna Mills, who became a program associate at Just Detention International after being released from prison in 2019, said the cards were a crucial lifeline for her when she was incarcerated.

"Receiving cards from people who support us and from JDI was such a gift. It's like receiving things from family," said Mills. "It got me through the holidays and definitely gave me the strength for yet another day of fighting for my freedom and for safety."

Incarcerated parents around the country can also select gifts for their children through Prison Fellowship's Angel Tree Christmas program. The group partners with local churches, which purchase and deliver the gifts, according to Michelle Payette, the program's leader. Payette said more than 250,000 children will receive a gift through the program this year.

Payette said when she was incarcerated more than a decade ago in a New York prison, participating in the Angel Tree Christmas program "completely transformed" her life. She said her son still has a Yankees fleece blanket she picked out for him one year.

"He actually received a better gift than my present that year because he was able to see that people can make mistakes and they can recover from them and that good can come out of every bad situation if we allow it," she said. "We broke some cycles of family dysfunction in my life thanks to Prison Fellowship Program and other volunteers coming in other organizations."

Contributing: The Associated Press