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Fall 2013, Volume 21, Number 4

Photo of a lawyer talking to his client with a judge in the background

Veterans Court Provides Treatment and Support

When Tim* returned from his third deployment to Afghanistan, he struggled with what he describes as combat stress. During his last deployment, Tim encountered a road-side bomb and was injured, but was able to heal from his injuries. Two other soldiers in his unit were not as fortunate.

Back home, to quiet the flashbacks, Tim began drinking heavily. In just two weeks, Tim was arrested in a serious automobile accident. He had been driving under the influence. Fortunately, he resides in a community that identified him as a veteran and worked to divert him from jail and into services to address his substance use and trauma.

Tim's story is just one example of why veteran treatment courts are needed and why the national expansion is happening so rapidly.

SAMHSA has long recognized the need for behavioral health interventions for those in the criminal justice system—first in drug and mental health courts, and more recently with the emergence of the veterans' specialty court. SAMHSA launched the Jail Diversion and Trauma Recovery – Priority to Veterans (PDF, 580 KB) grant program in 2008. The grants support jail diversion programs and offer veterans an opportunity to prevent further trauma stemming from incarceration, while engaging them in recovery services and supports.

Specialty Courts in the U.S.

Jail diversion efforts and specialty courts have been in existence since 1989. With more than 3,000 in the United States, these courts aim to address the problems that lead to involvement in the criminal justice system and to minimize jail-time exposure that can further traumatize. Drug and mental health courts have been most common; however, the recognition that veterans have unique needs led to the emergence and expansion of veterans courts.

In 2008, Judge Robert Russell of Buffalo, NY, pioneered what he calls a "hybrid" specialty court for veterans. He recognized that many were facing not only substance abuse and mental illness, but also unemployment, homelessness, and strained relationships. He understood that in order to help those who have served the nation, a trauma-informed and peer-inclusive approach would be needed in the courtroom along with a facilitated diversion process. Judge Russell's model has been replicated and he has worked closely with SAMHSA's Jail Diversion and Trauma Recovery – Priority to Veterans grant program to expand these efforts nationally.

SAMHSA's National Survey on Drug Use and Health 2008 report indicates an average of 9.3 percent of male veterans aged 21 to 39 experienced at least one major depressive episode in the past year. Female veterans were twice as likely to struggle with depression.

Yet many veterans are uncomfortable seeking mental health or other services—especially if doing so might affect their careers. Like Tim, many veterans use substances to calm, numb, or reduce high levels of adrenalin. According to statistics from SAMHSA's Treatment Episode Data Set, based on Veterans Seeking Treatment in Non-VA Facilities, alcohol was the most frequently reported primary substance of abuse for veterans aged 21 to 39, and veterans admitted for treatment were more likely than nonveterans to report alcohol as their primary substance of abuse.

Traffic altercations, weapons charges, public nuisance and drunkenness, domestic violence, and other offenses have been on the rise among American veterans.

But justice intervention has enabled many veterans to get support and work through healing and recovery.

Building on drug or mental health courts, veterans courts integrate veteran peers as part of the service model. They can serve as mentors, volunteers, or paid forensic peer specialists as an essential part of the treatment team. Another distinct difference is that the U.S. Department of Veterans Affairs is also involved, primarily through the Veterans Justice Outreach Specialists.

SAMHSA grants launched in 2008, with additional pilot efforts started in 2009 and 2010, support jail diversion efforts for veterans and others who live with PTSD and other trauma-related disorders, and who become justice-involved. A total of 13 states have received a five-year SAMHSA grant. The grants comprise:

Pre-implementation: The state forms an advisory committee and identifies a pilot community. Once identified, community stakeholders develop a strategic plan to divert veterans and others with trauma-related disorders involved in the justice system.

Early implementation: Beginning in year two, the pilot site implements the strategic plan that is trauma-informed.

Full implementation: Evaluative information is used to refine the pilot program as well as inform state efforts to expand diversion activity and recovery support for veterans and persons with trauma-related disorders.

States are encouraged to expand to additional sites, transfer knowledge, and inform policies across the state. In addition to successfully diverting thousands of veterans, states have trained more than 1,600 court systems, police departments, health departments, and service agencies on how to work with justice-involved veterans, informed state policies and legislation involving veterans in the justice system, expanded the use of peers in recovery support, and brought together key stakeholders to ensure that such programs are sustained over time. Many states have engaged in collaborative efforts with the state's Department of Veterans Affairs, veteran service organizations, community behavioral health agencies, and veterans who have themselves experienced behavioral health problems.

Mission Direct Vet

As one of the first SAMHSA-funded pilot sites, the Massachusetts Department of Mental Health had been exploring how best to support veterans in the state with programs and services. The SAMHSA grant afforded not only a means to put services in place, but also a way to engage in new partnerships.

"This grant enabled the Department of Veteran Services and the Department of Mental Health to collaborate," said Debra Pinals, M.D., Principal Investigator, Assistant Commissioner, Forensic Mental Health Services at the Massachusetts Department of Mental Health. "We weren't actively doing that before. We also put a statewide stakeholders group together to help organize and expand our efforts under this grant."

Ms. Pinals explained that their grant program, Mission Direct Vet, uses an evidence-based approach to provide critical intervention, maintenance, and sobriety services by integrating state service systems, and providing outreach, dual-recovery therapy for both mental and substance use disorders, case management and peer team delivery, and free support services for veterans and other trauma survivors. Although the program started in Western Massachusetts and Worcester, the statewide effort has expanded beyond the grant.

Diversion can take place in a variety of settings, depending on the community and the governing laws. It can occur at pre-booking, with law enforcement or emergency services, during arrest and detention, or through the specialty court. In recent years, a trend has emerged in which many programs divert veterans post-plea. Some communities support the traditional pretrial diversion and specialty treatment court programs that don't require a guilty plea in order to engage in a diversion program, which enables veterans to pursue recovery without a criminal record.

How you ask the question is important. "Did you ever serve in the U.S. armed forces?" will give you many more positive responses than "Are you a veteran?"
- SAMHSA National GAINS CENTER 2011

Once a veteran is accepted to the program and the court has established the terms of diversion, trauma-specific services are established as a term of parole. Most programs use either the Seeking Safety or Trauma Empowerment models of service delivery.

There is discrepancy in how communities define "veteran." Some believe that eligibility for the program should depend on discharge status, deployment, or combat service. Communities also differ in whether they include all veterans or primarily those from Operation Enduring Freedom/Operation Iraqi Freedom.

According to David Morrissette, Ph.D., L.C.S.W., CAPT, U.S. Public Health Service and Acting Branch Chief of SAMHSA's Community Support Program, "When SAMHSA first awarded jail diversion grants that prioritized veterans in 2008, there was one veteran court in the U.S. Now there are well over 100. SAMHSA stepped up with the support that communities and states needed to divert veterans from incarceration and help them to heal from trauma."

*A pseudonym

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