Unmet Mental Health Needs Usually At Issue
By Annette M. Boyle
COLUMBIA, MO – For some veterans with unmet mental health needs, readjusting to civilian life can rapidly put them on the wrong side of the criminal justice system. In the past few years, partnerships between the courts and the VA have kept many veterans from continuing a downward spiral into prison by identifying and addressing these issues.
The need is huge. The Department of Justice estimated that more than 700,000 veterans in 2004 were under criminal justice supervision. In 2008, a veteran treatment court was established in Buffalo, NY, and quickly became a model for other jurisdictions. Today, 172 such courts or special dockets aim to provide services and oversight to veterans to help them reintegrate into society and stay out of the criminal justice system. By addressing the underlying causes of criminal involvement, the courts aim to reduce recidivism through treatment, intensive supervision and behavioral reinforcement.
A veterans treatment court. Photo from the VAntage Point Blog.
It’s hard to tell in advance who will need the highly structured support offered by the specialty courts, said Kelli Canada, an assistant professor at the University of Missouri School of Social Work. “It’s not like they’re discharged and in the criminal justice system the next day. There’s a lag time and an accumulation of violations.”
Veterans at risk of arrest and incarceration share characteristics with those in the general population. They tend to be male, minorities, single, young, anti-social and have unmet mental health needs, according to Canada’s research. That last factor drives much of the work of the specialty courts and the social workers who lead the interventions.
In the past decade, the number of veterans treated for mental illness and substance-use disorders has risen 38%. Nearly 20% or 460,000 veterans of the wars in Iraq and Afghanistan suffer from post-traumatic stress disorder (PTSD) or major depression. Approximately 345,000 veterans of Operations Enduring Freedom, Iraqi Freedom and New Dawn have a substance abuse problem.
“Many mental disorders, including PTSD can co-occur with substance use problems and uncontrolled anger or aggression, which can contribute to criminal conduct,” noted Canada and coauthor David Albright, also of the University of Missouri, in a study recently published in the Journal of Forensic Social Work
The researchers point out that, while “there is no empirical support suggesting that mental illness causes criminal justice involvement, recent research does conclude that incarcerated veterans report more psychiatric and substance use problems prior to arrest and high rates of lifetime trauma.” In addition, imprisoned veterans have higher rates of psychiatric disorders than veterans in the general community.
Despite widespread publicity about violence and criminal behavior in returning veterans, other recent research indicates that, overall, the most recent generation of veterans has about half the risk of incarceration compared with older cohorts and constitutes less than 4% of the total number of veterans in prison today. Those who are incarcerated, however, were three times more likely to have PTSD.2
PTSD also has been associated with higher rates of post-deployment arrest, and 1 in 4 incarcerated veterans were using drugs or alcohol when arrested, suggesting that addressing these two issues, in particular, might be especially helpful for veterans. Social workers might be singularly well suited to offer this assistance, Canada suggested.
“Social workers are equipped to provide support to veterans through research, education, outreach and advocacy, which allows social workers to connect veterans with helpful resources rather than criminalizing them,” she said, adding, “There are multiple points of intervention available before and along the continuum of the criminal justice system. We can provide preventative services to veterans when they are leaving the service. But for many there is too much going on at discharge. We need checkpoints along the first year to make sure veterans are readjusting well.”
Even when they’re suffering, many veterans still feel a stigma is associated with seeking mental health treatment. Consequently, “social workers in community settings should ask clients about military service status, combat exposure, trauma and barriers to adjustment as part of initial evaluations to provide the most appropriate services,” the Missouri researchers wrote. Assessing veterans for PTSD, traumatic brain injury (TBI) and substance abuse is particularly important, they note.
If upfront contact doesn’t occur or fails to connect an at-risk veteran to needed services, there’s another opportunity following arrest. “Veteran Justice Outreach Specialists (VJOs) work with jail administrators and police to help the veteran and family navigate the system, figure out what happens to benefits and determine what help is available,” Canada told U.S. Medicine
While factors such as PTSD and TBI that arose during military service might put some individuals at greater risk of criminal justice involvement, aspects of that same service can be very helpful in helping them get their lives back on track. The courts are a direct treatment model with a twist, Canada noted.
“The theory behind the veteran treatment courts is that using the group mentality and the military culture can help veterans,” she pointed out. “In many of the specialty courts, everyone has had military involvement — the judge, the social workers, even the parole officers.” As a result, the entire team understands the military life and structure the veteran has experienced and speaks the same language.
The veteran treatment courts offer an alternative to serving jail time for non-violent crimes. Veterans are matched with teams including social workers who assess their needs and develop individualized treatment plans. By helping veterans overcome barriers to access and the perceived stigma of mental health services, Canada said, “social workers have the ability to re-create the narrative surrounding mental health and veterans in the criminal justice system and help to ensure that veterans get the assistance they need.”
Canada KE, Albright DL. Veterans in the Criminal Justice System and the Role of Social Work, Journal of Forensic Social Work
Tsai J, Rosenheck RA, J Kasprow W, McGuire JF. Risk of incarceration and other characteristics of Iraq and Afghanistan era veterans in state and federal prisons. Psychiatr Serv
. 2013 Jan;64(1):36-43.
The most common age for diagnosis of schizophrenia is late teens to early 30s.
While veterans serving in the military during the Gulf War era (GWE) appear to have higher risk for multiple sclerosis and a range of neurological illnesses, little has been documented previously on prevalent types of MS or other clinical features.