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Co-Occurring Disorders and Military Justice

Creating Specialty Programs for Justice-Involved Individuals with Co-Occurring Disorders

Justice-involved individuals with co-occurring mental and substance use disorders can benefit from specialty programs. Three specialty programs are provided as examples:

Specialized law enforcement and behavioral health crisis response

Law enforcement based approaches can respond to veterans at their first contact with the justice system. Advanced trainings exist for crisis intervention team officers and behavioral health practitioners for responding to veterans in a behavioral health crisis.

Many adaptive behaviors for operating in combat do not translate to life as a civilian. Erratic driving is one example of a combat behavior that may result in a traffic accident or being pulled over by law enforcement. During deployment, service members are required to carry the firearm at all times and there are severe consequences if it is lost. After homecoming, many veterans continue to carry firearms. If a veteran in a behavioral health crisis comes into contact with law enforcement, the presence of firearms may exacerbate a tense situation.

Specialized responses. The crisis intervention team model is a strategy for improving the outcomes of law enforcement interactions with people experiencing a behavioral health crisis. The model was first developed by the Memphis Police Department. Essential elements of the model include:

  • Training for law enforcement officers
  • Community collaboration
  • Involvement of people with lived experience and family members
  • Law enforcement friendly crisis stabilization center

Officer training for the crisis intervention team model is based on the 40 hour curriculum. However, each curriculum is customized by the law enforcement agency that plans to implement the model. The training emphasizes role plays to teach officers practical skills, including recognizing signs and symptoms and how to verbally de-escalate crises.

Another specialized policing response relies on mental health specialists (who are often civilian employees or consultants of the law enforcement agency) to provide on-site or telephone assistance to officers. A third approach is a specialized community mental health response where a mobile crisis team is dispatched upon request from law enforcement. Mobile crisis teams may be deployed by callers requesting support or by specific requests from law enforcement. Mobile crisis teams provide initial support to people requesting their service, help to defuse crises, and provide service referrals.

Responding to Veterans. Additional training for officers in specialized law enforcement and practitioners in behavioral health crisis responses can be provided to meet the needs of veterans in a behavioral health crisis. These trainings provide the responders with an understanding of:

  • Military culture
  • Deployment and reintegration issues
  • Adaptive behaviors and triggers for veterans of Iraq and Afghanistan
  • Identifying veterans
  • Techniques for engaging veterans and descalating crises

The Chicago Police Department has develop a 40 hour advanced training for crisis intervention team officers that focuses on veterans, trauma, traumatic brain injury, and domestic violence. The advanced training curriculum addresses signs and symptoms of trauma, PTSD, common responses, and includes role play exercises.

Specialty courts

Court-based jail diversion programs place individuals into community-based services and supervision in lieu of incarceration. Court-based programs work with individuals who have been arrested for an offense. The majority of jail diversion programs intercept people after booking into the jail. Some court-based programs have specialized dockets, such as mental health courts or drug courts.

Court-based programs can be established to identify individuals at any point within the criminal case process, from initial appearance to pre-sentencing. Moreover, court-based programs may rely on traditional criminal courts to process diversion cases or employ a specialized docket, which can address all such cases. Depending on the court, an individual's case may be dismissed after completing the program, the case may not be prosecuted, sentencing may be deferred, or program participation may be part of the sentence.

Whether specialized or not, the major activities prior to enrollment in the program include:

  • Screening for mental and substance use disorders
  • Evaluating referrals against eligibility criteria
  • Accepting individuals into the program
  • Coordinating behavioral health and support services through an integrated supervision and service plan
  • Linking individuals participants to those services
  • Community-based supervision by pre-trial services, probation, or the court

Court-based jail diversion programs can provide specialized services for veterans through training and individualized service planning. Mental health court and drug courts may be providing individualized services to veterans without focusing specifically on veterans as a target population. Another option is a veteran treatment court.

Veterans Treatment Courts. Veterans treatment courts are a specialty court designed with veterans in mind. The first court was launched in 2008 in Buffalo, NY. Since that time more than 70 veterans treatment courts have been launched across the country. Veterans treatment courts employ a drug court model but focus on veterans with mental and substance use disorders. Two distinguishing features of veterans treatment courts are:

  • A partnership with the U.S. Department of Veterans Affairs such that a representative participates in the court
  • The use of volunteer veteran mentors who work directly with participants, including at court sessions. A mentor coordinator organizes the activities of the volunteer veteran mentors. Such mentors are veterans but are not necessarily in recovery.

Although the operations of veterans treatment courts vary, Judge Robert Russell, the founder of the first court, has identifies ten key components of the model:

  • Veterans treatment court integrate alcohol, drug treatment, and mental health services with justice system case processing.
  • Using a nonadversarial approach, prosecution and defense counsel promote public safety while protecting participants' due process rights.
  • Eligible participants are identified early and promptly placed in the veterans treatment court program.
  • Veterans treatment court provide access to a continuum of alcohol, drug, mental health and other related treatment and rehabilitation services.
  • Abstinence is monitored by frequent alcohol and other drug testing.
  • A coordinated strategy governs veterans treatment court responses to participants' compliance.
  • Ongoing judicial interaction with each veteran is essential.
  • Monitoring and evaluation measure the achievement of program goals and gauge effectiveness.
  • Continuing interdisciplinary education promotes effective veterans treatment court planning, implementation, and operations.
  • Forging partnerships among veterans treatment court, Veterans Administration, public agencies, and community-based organizations generates local support and enhances veteran treatment court effectiveness.

Reentry programs

Transition planning for veterans with co-occurring disorders who will be returning to the community from jail can link veterans to necessary services and supports. Jails hold people with many different legal statuses, including people who are:

  • Detained prior to an initial court appearance
  • Denied bail and held in pre-trial detention
  • Serving a short sentence (generally less than 12 months)
  • Awaiting transfer to another jurisdiction
  • Transferred from prison for court proceedings
  • Serving a sentence on contract from another jurisdiction (i.e., the state Department of Corrections)

Most jail inmates stay for no more than a month. Many are in jail for only a few days. Short stays make transition planning difficult, given the amount of work required to complete assessments and prepare linkages to community-based services. For individuals who are connected to services prior to jail, a short stay may have limited consequences. But for people who enter jail in a behavioral health crisis or who are not connected to services, the short stay can represent the difference between being released in a state of crisis or with connections to needed services and supports.

One approach for jail transition planning is the APIC model. APIC stands for:

  • Assess the clinical and social needs, and public safety risk of the inmate
  • Plan for the treatment and services required to address the inmate's needs
  • Identify required community and correctional programs responsible for post-release services
  • Coordinate the transition plan to ensure implementation and avoid gaps in care

During the assessment part of transition planning, standardized screening and assessment instruments are used to collect information about an inmate's behavioral health services and support needs. Public safety risks are also assessed. For veterans, the assessment piece may include gauging whether they have PTSD or military sexual trauma, or are connected to VA services as well as community-based services. Determine if the inmate is receiving veterans' benefits and potentially eligible for VA health care.

Planning for services involved identifying the inmate's immediate and long-term needs, with emphasis on the hours and days after release. The planning process should be in partnership with the inmate, who can provide information prior transitions. It is also important to take into account the inmate's preferences. An inmate may not want to receive VA health care regardless of his or her eligibility. Services to plan for include housing, medical services, integrated co-occurring disorders treatment, and child care.

After assessing and planning, the transition planner needs to identify the appropriate community-based service providers and establish linkages based on the inmates' needs and eligibility. This may represent a lot of providers or just a few. Supervision should be matched with the likelihood of reoffending, taking into account offense severity.

Coordinating the transition plan includes working with the inmates' case manager in the community and with the Veterans Justice Outreach specialist or other VA representative. Inreach services should be made available for the inmate to work with their case manager prior to release. Adequate medications should be provided to cover the gap between release and the first appointment at the behavioral health provider. A stakeholder committee may be formed to provide oversight for the reentry of veterans with co-occurring disorders.

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