Spotlight on Veterans in the Justice System
On any given day, veterans account for 9 of every 100 individuals in U.S. jails and prisons (1). The unmet mental health needs of justice-involved veterans are of growing concern as more veterans return home with service-related trauma and mental health needs. It is estimated that approximately 14% of veterans returning from Iraq or Afghanistan have post-traumatic stress disorder (PTSD). The rate is the same for depression (2). Between 12% and 15% screen positive for alcohol misuse (3). I crossed paths with 3 justice-involved veterans while working as a Community Treatment Specialist at PSA’s Social Services and Assessment Center (SSAC) in 2005. Veterans don’t give up their stories readily. They come from an ordered and disciplined social environment where personal courage, honor, and selfless service are the cultural norm. Stigma is the number one reason veterans do not seek or delay receiving treatment for mental health services.
Dave was a veteran of the Vietnam War. He was referred to the SSAC because he had been testing positive for opiates. Dave had been using heroin well over 30 years and in and out of treatment. Although he’d seen combat, Dave reported no mental health history, current or past. He reported never having experienced depression, sadness, or hopelessness. He reported never having experienced anxiety or tension. He denied seeing or hearing things that were not there. He reported no history of having suicidal or homicidal thoughts. By the time I got to the 8th and last question under Psychiatric Status of the Addiction Severity Index (ASI), I felt I was wasting time and feared that Dave, who had been very obliging, was going to be irritated by my line of questioning. Still I asked, “Have you ever been prescribed medication for any psychological or emotional problems?” To my surprise, he said he’d been prescribed Thorazine, a powerful neuroleptic used to treat Schizophrenia. This happened a long time ago while he was in residential treatment. Without heroin, Dave was wracked by nightmares that repeatedly took him back to a war that had ended in 1975.
Ellen was slim with cropped blond hair. She had a swagger despite a gun injury that had left her with a permanent limp. I remember talking to her about adaptive equipment that would allow her to drive a car. Surprisingly, she thought her driving days were behind her. Ellen spoke frankly about smoking crack. She liked her alcohol, too. She was drinking before she joined the military and continued drinking throughout her military career. I learned she joined the military, in part, to get away from her father who had been sexually abusing her since childhood. The only time Ellen didn’t drink was during the six-month period she was assigned to clean-up duty at the site of the World Trade Center after 9-11. She had command over a group of men and said she needed every ounce of concentration to get the job done. I admit I was puzzled why so much concentration was required to clean up rubble. I learned later that clean-up involved picking up bits and pieces of decomposing body parts. Ellen casually dropped this piece of information while answering questions about how much, how often, and the last time she had smoked crack or drank alcohol and why was she using so much? Ellen wasn’t in denial. She never said she didn’t have a crack or alcohol problem. She simply declared she had no intentions of quitting. “I am not going to stop using, Ms. Park!” she said airily as she walked away. I responded with “OK!” Was there anything I could have said that would have brought her back to the table?
I interviewed Jeff in the cellblock. Jeff had the wide-eyed look of someone unaccustomed to the cellblock. He came forward eagerly to be interviewed. Jeff had a full-time job and was living on his own. I learned that Jeff was a veteran of Operation Iraqi Freedom (OIF) and did not consider himself to have seen combat because he was “in the rear with the gear”. He reported no ill effects from his time in service and had moved on putting OIF well behind him. Jeff was dubious to find himself in the cellblock. I asked him about his marijuana use. He said he smoked marijuana but not often until recently. When asked why he found himself smoking more now than usual, Jeff got teary. Jeff said that his military buddies have been coming home in body bags. He couldn’t sleep thinking about his friends. He found himself angry and agitated and scared. Marijuana “took off the edge”. I remember asking Jeff if he had heard of post-traumatic stress disorder. To my surprise, Jeff laughed and said, “Yes. It’s that thing they talked to us about during debriefing. I swore to myself I would never get it.”
One doesn’t get to choose when it comes to PTSD or other service related mental health needs. Long deployments, multiple deployments, and little time between deployments have been the hallmark of Operation Iraqi Freedom and Operation Enduring Freedom. They are also major contributing factors for combat-related mental health conditions (4). The National Vietnam Veterans Readjustment Study (NVVRS) conducted between 1986 and 1988 offers us the best predictor for justice system involvement of veterans with combat-related mental health conditions. Of the estimated 15% of Vietnam veterans suffering from PTSD, the NVVRS found that nearly half of them had been arrested one or more times (5).
Former Mayor Vincent C. Gray marked this past Veterans Day by releasing the Service Members, Veterans and Their Families Action Plan. This Plan lays out goals, objectives and strategies to guide District government agencies in developing a coordinated system of care that addresses the important needs of service members, veterans and their families (SMVF) along five priority areas: criminal justice, economic security and employment, housing and homelessness, education, and health care. The goal for the criminal justice segment is to decrease the number of incarcerated service members and veterans; for which the following objectives were identified:
- Improve identification of veterans and service members involved in the DC criminal justice system.
- Educate law enforcement, judges, corrections officers and mental health services providers on the unique issues faced by SMVF population.
- Ensure that veterans and services members are represented on advisory bodies.
- Improve awareness of and access to resources that serve criminal justice-involved SMVF.
- Improve discharge planning for veterans exiting DC Jail.
While not a DC Government agency, PSA has an important role in meeting the goals of this plan for the city since we interview every person arrested in the District on federal and local criminal charges. In preparing reports for the both D.C. Superior Court and U.S. District Court, PSA gathers information that helps judicial officers in setting release conditions and includes verification of data on a defendant's community ties, criminal and juvenile delinquency history, physical health, mental health, substance use disorders; probation, parole, or supervised release status, and veteran status. Whereas a few years ago, PSA had only one “yes/no” question asking if the defendant is a veteran, we now ask if the defendant is in current or had previous military status, which military branch, type of discharge, and discharge date. Considering the various ways in which veteran status can be defined, this expanded list still might not be sufficient in identifying all defendants that have served in some capacity in the armed forces. The diagnostic intake questionnaire includes 200+ items and is administered when defendants are first interviewed before arraignment. Veteran status also could be identified if the defendant is referred to the SSAC and administered the ASI.
PSA began collecting data on veteran status in 2011. In FY 2014, there were 327 defendants who identified themselves as veterans. Each year, about 330 new defendants identify themselves as veterans.
The criminal justice system is by no means the best place to address the unique issues faced by service members and veterans. However, it is one of the key places where these individuals are identified as needing services. For this reason, in the interest of public health and public safety, the criminal justice system must be proactive in expanding ways to not only identify service members and veterans, but also connect them to comprehensive and appropriate services.
1) Greenberg, G. & Rosenheck, R. (2008). Jail incarceration, homelessness, and mental health: A national study. Psychiatric Services, 59, 170-177 and Noonan, M. & Mumola, C. (2007). Veterans in state and federal prison, 2004. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.
2) Tanelian, T. & Jaycox, L.A., Eds. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Center for Military Health Policy Research.
3) Milliken, C.S., Auchterlonie, J.L., & Hoge, C.W. (2007). Longitudinal assessment of mental health problems among Active and Reserve Component soldiers returning from the Iraq war. Journal of the American Medical Association, 298, 2141-2148.
4) Mental Health Advisory Team Five. (2008). Operation Iraqi Freedom 06-08: Iraq and Operation Enduring Freedom 08: Afghanistan. Washington, DC: U.S. Army Medical Command, Office of the Surgeon General. Available from: http://www.armymedicine.army.mil/news/mhat/mhat_v/mhat-v.efm.
5) National Center for PTSD. (n.d.) Epidemiogical facts about PTSD. White River Junction, VT: Author. Available from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_epidemiological.html.