Agenda

Effective Strategies for Working with Justice-Involved Veterans with Behavioral Health Needs

Larke N. Huang, Ph.D.David Morrissette, Ph.D.Henry J. Steadman, Ph.D.

Jim Tackett, B.A.Nicholas Meyer, B.A.

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Agenda

2:00 Welcome2:05 Larke N. Huang, SAMHSA2:10 David Morrissette, SAMHSA2:15 Henry J. Steadman, Policy Research Associates2:20 Jim Tackett, Connecticut Department of Mental

Health & Addiction Services2:40 Nicholas Meyer, Policy Research Associates2:55 Question & Answer Period3:15 Conclusion of Webinar

Larke N. Huang, Ph.D.

David Morrissette, Ph.D.

Henry J. Steadman, Ph.D.

Why This Is Different

• Who

• Where

• What

Who

• National Guard and Reserve – 40%

• Women– Female engagement teams – Cultural support teams – Lioness

Where

• No single frontline

What

• Improved explosive devices (IEDs)– Traumatic brain injury

• Subclinical stress reactions/adjustments

• Wounded survivors– Post-traumatic stress disorder

Los Angeles Jail Study (n=1,676)

– Mental disorder – 35%– Alcohol abuse or dependence – 48%– Drug abuse or dependence – 62%– Serious medical condition – 33%– Long-term homelessness – 21%– Unemployed prior to incarceration – 73%– Less likely to use VA services in the year following

than a homeless comparison sample (38% v. 84%)

Jim Tackett, B.A.

Connecticut Military Support Program

Provides free, confidential, statewide counseling services to

Reserve Component Service MembersAnd

To their families

Military Support Program

• 425 licensed clinicians located throughout the State

• Accessed through a 24/7 call center

MSP: Number of Individuals Served

Calls to 24/7 MSP Call Center 2,785Received MSP Case Management Services 2,502Referred to Outpatient Counseling 1,255Direct Clinical Referrals to VA or Vet Center 315Information, Referral and Advocacy Services 1,627Transportation Service (episodes) 1,234

Reporting period: April 2007 to May 31, 2011

MSP Embedded Clinicians

• 28 MSP clinicians embedded within National Guard Units affected by deployment(s)

• Familiar, on-site presence, each unit’s key POC for behavioral health matters

• Provide psycho-education services during drills, YRRP and FRG events

• Provide immediate access to behavioral health services

Jail Diversion & Trauma Recovery

• SAMHSA, Center for Mental Health Services• $2 million, 5 year grant – 1st cohort• Target population:

– Our newest generation of Veterans returning from the Afghanistan and Iraq Wars

– All Veterans experiencing trauma-related problems

Building Upon Existing Strengths

• OEF/OIF Statewide Task Force• Existing statewide mental health jail diversion

program– Rely upon existing relationships with judicial

staff, bail commissioners, state’s attorneys, public defenders

• Partner with Statewide CIT program– Inform/Enlist assistance of police officers

Planning: Key Stakeholders

• Federal VA Regional Office (VBA)

• VA Connecticut Healthcare System (VHA: CT & VISN)

• Vet Centers (VR&C)• DoD Naval Health Clinic New

England, Groton Sub-Base• Connecticut Military

Department/National Guard• Chief State’s Attorneys Office• Public Defenders Office

• Judicial Division, Court Support Services Division

• CIT Teams and Local Law Enforcement

• Federal and State Departments of Labor

• Deptartments of Social Services, Correction, Veterans’ Affairs

• Others• 22 Veterans (8 OEF/OIF); 2

family members

CT’s Approach: Systems Integration

• Emphasizes Pre-Booking – Focus on identifying, engaging and referring

veterans at the earliest opportunity along the criminal justice continuum

Sequential Intercepts for Change


• Integrates Services of Multiple Systems to strengthen access to appropriate and timely treatment/recovery support services

• Strong Services Coordination


Total Veteran Treatment Referrals (N=348)10/1/2009 to 6/30/2011

• VA Healthcare System 116• Vet Center System 25• Community Provider 110• DMHAS/SMHA 68• Other State Agency 29

Referrals (N=348)

7% 20%

33%

8%

32%

VA CT Healthcare System

Vet Center System

DMHAS/SMHA

Community-BasedTreatment/Service Providers

Other State Agency

Veterans’ Focus of Treatment (N=128)

Substance Abuse 81

Mental Health 68

PTSD 38

Suicide Prevention 7

Traumatic Brain Injury 7

Gambling 4

Family/Intimate Partner Violence 5

Veterans Benefits 35

Housing Services 24

Vocational/Educational Services 18

Medical 29

Basic Needs 15

Focus of Treatment/Services (N=128)

53%

19%

63%

23%27%

Substance Abuse

Mental Health

Housing

Voc/Ed

Medical

Connecticut’s Plan Going Forward

• Step into footprint of existing statewide Mental Health Jail Diversion program

• Establish statewide Mentor Program– Cadre of trained mentors and peer mentors– Engage veterans at every point along the criminal

justice continuum– Implementation end of Yr 4 Yr 5

References

Department of Defense Task Force on Mental Health: “An Achievable Vision: Final Report of the DoD Task Force on Mental Health”. DoD. June 2007

Hoge CW et al, “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care”. NEJM. (July 1); Vol 351;13-22, No 1Hoge CW et al, “Mental Health Problems, Use of Mental Health Services, and Attrition from Military Service After Returning from

Deployment to Iraq or Afghanistan”. JAMA. 2006. (Mar 1); Vol 295, No 9Miliken CS, Auchterlonie JL, Hoge CW, “Longitudinal Assessment of Mental Health Problems Among Active and Reserve

Component Soldiers Returning from the Iraq War”. JAMA. 2007 (Nov 14); Vol 298, No 18Presidential Task Force on Military Deployment Services for Youth, Families and Service Members, “The Psychological Needs of

U.S. Military Service Members and Their Families: A Preliminary Report”. Amer Psych Assoc. 2007. (Feb)Tanielian T, Jaycox LH et al, “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to

Assist Recovery”. RAND Center for Military Health Policy Research, RAND Corporation. April. 2008Pietrzak RH, Goldstein MB, Malley JC et al, “Partial and Full PTSD are Associated with Psychosocial and Health Difficulties in

Soldiers Returning from Operations Enduring Freedom and Iraqi Freedom” (Manuscript: Oct 2008). Corresponding author: Robert H Pietrzak, VA Connecticut Healthcare System, 950 Campbell Ave/151E, West Haven, CT 06516. Phone: 860-638-7467

Connecticut Department of Mental Health and Addiction Services, “Findings on the Aftereffects of Service in Operations Enduring Freedom and Iraqi Freedom and The First 18 Months Performance of the Military Support Program”. October 2008

DMHAS Veterans’ Services

Serving Connecticut’s Veterans, Citizen Soldiers and Their Families

Jim Tackett, DirectorDMHAS/Office of the Commissioner

410 Capitol AvenueHartford, CT 06134

860-418-6979

Nicholas Meyer, B.A.

Criminal Justice Involvement Can Be Easy & Unintentional

• Driving in a combat zone is much different then driving in the U.S.

Driving toward the center of the road to avoid IEDs on the shoulder

No use of directionals or obedience to traffic devises

A HMMWV (Humvee) or an M1A1 Abrams Tank handle and drive differently then a Honda Civic

Right of way is generally given to U.S. troops

• After a deployment, it may be difficult for a service member or veteran to adapt back to operating a vehicle properly in the U.S. This can result in:

Traffic violations and citations for the service member or veteran

Accidents that result in severe injury or death of the service member or veteran, or other involved parties

• For many Americans the paradigm is still…

• Instilled in the minds of Americans are images from movies like Rambo: a PTSD-plagued combat veteran that reigns death and destruction down upon U.S. civilians.

On occasion, law enforcement may see an OEF or OIF veteran as threat if he or she owns a firearm

Some civilians may be fearful of a combat veteran that owns a firearm

Law Enforcement and the General Population Must Adapt Their Preconceived Notions of a Combat Veteran

• In reality…

• The U.S. Military has developed intense training for service members in order for them to distinguish friend from foe.

Weapons safety is rigorously trained and advocated

Intentional non-combatant deaths are prosecuted to the full extent of U.S. military and/or civilian law

Paradigm Shift Needed

Firearms are for Defense and Security

The United States Marine Corps“The Rifleman’s Creed”

This is my rifle. There are many like it but this one is mine. My rifle is my best friend. It is my

life. I must master it as I master my life. My rifle, without me is useless. Without my rifle, I

am useless. I must fire my rifle true. I must shoot straighter than any enemy who is trying to kill me. I must shoot him before he shoots

me. I will....

My rifle and myself know that what counts in this war is not the rounds we fire, the noise of our burst, nor the smoke we make. We know

that it is the hits that count. We will hit...

My rifle is human, even as I, because it is my life. Thus, I will learn it as a brother. I will

learn its weakness, its strength, its parts, its accessories, its sights and its barrel. I will

keep my rifle clean and ready, even as I am clean and ready. We will become part of each

other. We will...

Before God I swear this creed. My rifle and myself are the defenders of my country. We are the masters of our enemy. We are the saviors of my life. So be it, until victory is

America's and there is no enemy, but Peace

• When in a combat zone, firearms are for the defense of you and your unit

Your firearm is never more than an arms-reach away

Your firearm is taken everywhere, even in combat zone locations where hostilities are unlikely

There are severe UCMJ penalties for losing or intentionally damaging a firearm

• After a deployment and back in the United States a service member or veteran generally no longer has the 24/7 companionship of a firearm.

This may cause a service member or veteran to feel defenseless

A service member or veteran may fear loosing their constitutional right to bear arms if they seek treatment for PTSD or other behavioral health issues

A service member or veteran could react aggressively at an attempt to seize their firearm

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