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VETERAN’S TREATMENT COURT PROJECT

Introduction

Introduction

Purpose

Provide a general overview Why What How

Background of the project

My Background The National Center for Veteran Studies

at the University of Utah (NCVS) Directed Research

Intended audience

Assumptions Legal Community

Judges, prosecution and defense attorneys Service Providers

Overview

How to use this course

Chapters Format

Video and PDF slideshow Design Purpose

Crash course

Continue to next section…

JUST WHAT IS A DEPLOYMENT?

One soldier’s perspective

Personal Deployment Experience Pre-mobilization (3 months) Short leave Camp Bucca (9 months) Mission Demobilization Reunion Reintegration

Saying Goodbye

Pre-mobilization training

Gas Chamber

Pepper Spray

Short leave home

Camp Bucca (9 months)

Living Quarters

Responding to IDF

Friends

Missing Family

Christmas

Travel

Mid-tour leave

Opportunities to do good

Preparing to come home


CHAPTER I

Who are Veteran’s

Topics Covered

General overview of military structure Who makes up the military community The military justice system When does one become a “Veteran”

A general overview

Military Structure

Military Structure

Department of Defense United States Army (USA) United States Navy (USN) United States Marine Corp (USMC) United States Air Force (USAF)

Department of Homeland Security United States Coast Guard (USCG)

Military Structure

Army 1775 Active Duty: 522,388 Reserve: 202,000 National Guard: 352,000 Mission:

“The Army’s mission is to fight and win our Nation’s wars by providing prompt, sustained land dominance across the full range of military operations and spectrum of conflict in support of combatant commanders.”

Sources: www.todaysmilitary.com & www.army.mil & http://open.dodlive.mil/data-gov/demographics/

Military Structure

Navy Established: 1775 Active: 337,690 Reserve: 61,891 Mission: “The mission of the

Navy is to maintain, train and equip combat-ready Naval forces capable of winning wars, deterring aggression and maintaining freedom of the seas.”

Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/ & www.navy.mil

Military Structure

Marine Corps Established: 1775 Active: 184,000 Reserve: 42,602 Mission

“The Marine Corps shall be organized, trained, and equipped to provide fleet marine forces of combined arms, together with supporting air components, for service with the fleet in the seizure or defense of advanced naval bases and for the conduct of such land operations as may be essential to the prosecution of a naval campaign.” - 10 U.S.C. § 5063

Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/

Military Structure

Air Force Established Active: 352,000 Reserve: 109,622 Guard: 160,700 Mission: “The mission of the

United States Air Force is to fly, fight and win...in air, space and cyberspace.”

Sources www.todaysmilitary.com & http://open.dodlive.mil/data-gov/demographics/ & www.af.mil

Military Structure

Officer Rank Commissioned officer Warrant officer

Enlisted Rank Lower enlisted Non-commissioned officer

Types of punishment – commander’s discretion Restriction of duties Detention/confinement Forfeiture of pay Reduction in rank Extra duties

Court Martial Offenses

Sex Offenses Perjury and False

Statements Assault and

related offenses Escape and

related offenses Homicide Desertion

Disobedience Theft Offenses Robbery Fraud Offenses Conduct

unbecoming an officer

Alcohol and drug offenses

Military Discharge

Administrative Honorable

Meets or exceeds the requirements

Full benefits General

Some form of non-judicial content

Under Other Than Honorable Conditions Significant

departure from military conduct

Lose most benefits

Judicial Process Bad Conduct

Punitive discharge Nearly all benefits

lost Dishonorable

Can only be given through a General Court Martial for serious offenses (i.e. murder, rape and desertion)

Source: http://www.eielson.af.mil/news/story.asp?id=123117744


Overview

Part I Recent Combat Deployments

Part II Reactions to op-tempo Troop issues stemming from OEF/OIF

OEF/OIF Operational Tempo (op-tempo)

Part 1: Recent Combat Deployments

Stressors from OEF/OIF

Risk of death or injury Witness death of

buddies Kill others in combat Constant fear of threat Prolonged separation Sexual Trauma More severe physical

trauma TBI Prior traumatic event

PTSD Substance Abuse Suicide Reunion/

Reintegration issues

Cause Possible Effect

Sources: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp & Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

Common reactions

Trouble sleeping, overly tired

Stomach upset, trouble eating

Headaches and sweating when thinking of the war

Rapid heartbeat or breathing

Existing health problems become worse

Experiencing shock, being numb, unable to feel happy

Bad dreams, nightmares Flashbacks or frequent

unwanted memories Anger Feeling nervous, helpless or

fearful Feeling guilty, self-blame,

shame Feeling sad, rejected, or

abandoned Agitated, easily upset,

irritated, or annoyed Feeling hopeless about the

future

Common Physical ReactionsCommon Mental and Emotional Reactions

Source: Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

Common reactions, cont.

Trouble concentrating

Edgy, jumpy and easily startled

Being on guard, always alert, concerned too much about safety and security

Aggressive driving habits

Avoiding people or places related to the trauma

Too much drinking, smoking, or drug use

Lack of exercise, poor diet, or health care

Problems doing regular tasks at work or school

Behavioral Reactions Behavioral Reactions

Source: Returning From the War Zone: A guide for Military Personnel, PDF guide available at http://www.ptsd.va.gov/public/reintegration/guide-pdf/SMGuide.pdf

My Story

I gave the briefings about reunion/reintegration

Effects from above Slamming door at law

school Felt strong and like I

didn’t need help Hand to hand with

brothers Honeymoon and then

trouble Connecting with

other vets

What about those that leave the military? 2002 – 2009

1 million troops left OEF/OIF 46% went to the VA for services 48% percent that went in for care have

mental health problems (220,800 troops)

Source: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp

Why don’t vets reach out for help? Concern over being seen as weak Concern about being treated differently Concern that others would lose confidence

in them Concerns about privacy They prefer to rely on family and friends They don't believe treatment is effective Concerns about side effects of treatments Problems with access, such as cost or

location of treatmentSource: Mental Health Effects of Serving in Afghanistan and Iraq, available at http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp


ALL ABOUT PTSD

What is PTSD

“Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event.”

Sources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Likelihood of getting PTSD

How intense the trauma was or how long it lasted

If you lost someone you were close to or were hurt

How close you were to the event How strong your reaction was How much you felt in control of events How much help and support you got

after the eventSources: What is PTSD?, National Center for PTSD, USDVA, available at http://www.ptsd.va.gov/public/pages/handouts-pdf/handout_What_is_PTSD.pdf & What is PTSD? from http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp

Onset of PTSD

Can be immediate Months Years 30% of individuals develop chronic

symptoms


Symptoms of PTSD

Reliving the event Avoiding situations that remind you of

the event Feeling numb Feeling keyed up (also called

hyperarousal)


Problems associated with PTSD Drinking or drug problems. Feelings of hopelessness, shame, or

despair. Employment problems. Relationships problems including divorce

and violence. Physical symptoms.



TRAUMATIC BRAIN INJURY

All About TBI from Combat

What is TBI?

“Traumatic brain injury (TBI) occurs from a sudden blow or jolt to the head.”

TBI is the injury, not the symptoms Similar to a concussion Mild, moderate or severe 80% of all TBIs are moderate and can

have full recovery

Source: Traumatic Brain Injury and PTSD available at http://www.ptsd.va.gov/public/pages/traumatic_brain_injury_and_ptsd.asp.

Symptoms that follow a TBI

Symptoms that follow TBI are known as post-concussion syndrome (PCS)

Not all of the symptoms are present all the time


Symptoms

Headache Feeling dizzy Being tired Trouble sleeping Vision problems Feeling bothered

by noise and light

Memory problems Trouble staying

focused Poor judgment and

acting without thinking

Being slowed down Trouble putting

thoughts into words

Physical Cognitive (mental)


Symptoms, continued

Depression Anger outbursts

and quick to anger Anxiety (fear,

worry, or feeling nervous)

Personality changes

Represent getting better

Not to cause worry or concern

Symptoms of TBI overlap symptoms of PTSD

Both stem from trauma

Emotional (feelings) Symptoms are normal


Coping with TBI

Ease back into life Avoid alcohol and drugs Listen to the symptoms Symptoms are a normal part of

getting better Involve family


TBIs from OIF/OEF

Main causes of TBI in OIF/OEF vets: Blats, vehicle accidents, and gunshot wounds

22% of all OEF/OIF wounds are brain injuries 12% of all Vietnam wounds were brain injuries Veteran’s symptoms last longer than regular

civilian injuries Often coupled with more than one problem:

PTSD, chronic pain, substance abuse


What’s being done to mitigate?

Source: Softening TBI Implications from IED Impacts available at http://www.youtube.com/watch?v=_AkoYAp9bts


WHAT DO THESE ISSUES CREATE IN CRIMINAL BEHAVIOR?

Chapter III

The underlying reason behind the current project

Source: KSL.com available at http://www.ksl.com/?nid=148&sid=12175791

PTSD v. other mental health

Research looks at the increased rate of violence for those who have PTSD

Limited research on those who are combat vets and not diagnosed with PTSD

Difference between having a mental health issue and the expression of that issue

Should this discussion be limited to just those who have PTSD? Those who are not seeking care Group with PTSD-like symptoms Battlemind – those skills that keep troops alive in combat

need to be turned off when at home Information from PTSD should be applied to

understanding combat veteran’s needs

How to turn off combat mindset…

Veteran’s, Invisible Wounds of War, and Co-occurring Disorders “In a 2008 Rand Corporation report that has received much public attention, it was noted

that since October 2001, almost 1.64 million U.S. troops have been deployed for Operation Iraqi Freedom (OIF; Iraq) and Operation Enduring Freedom (OEF; Afghanistan).2 The report highlights the invisible wounds of war, relating to the psychological aftermath of these military initiatives. The two main invisible psychiatric and neurological areas of concern are posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI).”

“Data are also emerging about the importance of recognizing that the co-occurring conditions of substance abuse and mental health problems are often a major obstacle to full functioning of returning veterans. Male veterans aged 18 to 25 are more likely than older male veterans to have had co-occurring serious mental illness and a substance use disorder.3 A study of approximately 300,000 soldiers who returned after deployment for OIF/OEF demonstrated elevated rates of mental health problems compared with soldiers

returning from other conflicts.4 In a study of soldiers who were surveyed after deployment and screened again, approximately 6 months later, 27 to 35 percent reported symptoms placing them at mental health risk, including symptoms of PTSD, depression, alcohol misuse, and suicidal ideation, as well as self-reported aggression.5 Seal and colleagues6 reported that among a group of OIF/OEF veterans seen at VA facilities, 27 percent had three or more mental health diagnoses, including depressive disorders, PTSD, and substance use disorders. Traumatic brain injury and posttraumatic stress disorder in veterans also commonly occur together and can be difficult to distinguish,7 and both can be associated with co-occurring substance use disorders.”

“Thus, there is a growing recognition of the clinical and research attention needed to gain a better understanding of the prevalence and phenomenology of mental health, neuropsychiatric, and substance use conditions among veterans.”

Source: Veterans and the Justice System: The Next Forensic Frontier, Debra A. Pinals, MD available at http://www.jaapl.org/cgi/content/full/38/2/163

PTSD and criminal behavior

“At times the symptoms of PTSD may contribute to the likelihood that persons with the disorder will get in trouble with others or with the law. PTSD affects the way in which individuals perceive, process, and respond to people and situations (1). Trauma survivors with PTSD may be more prone to feeling threatened in many situations, even when the feeling of threat is not warranted. Some may act impulsively or go to extremes to protect themselves”

Source: Criminal Behavior and PTSD: An Analysis available at http://www.ptsd.va.gov/professional/pages/criminal-behavior-ptsd.asp

Relationship between PTSD and Crime “It is important to note that any

relationship between PTSD and crime could be correlational rather than causative.”


How PTSD affects functioning Cognition

Flashbacks Perceived threats Beliefs about justice

Heightened psychological arousal Anger and irritability Hypervigilance Exaggerated startle response

Emotional reactions Psychological distress Heightened emotions Emotional numbing


The way forward

“Symptoms of PTSD can sometimes lead to a lifestyle that is more likely to result in aggressive or criminal behavior. Individuals with PTSD are often plagued by memories of the trauma and are chronically anxious. Feeling the need to be always "on guard" can cause survivors to misinterpret benign situations as threatening and cause them to respond with self-protective behavior. Increased physiological arousal may result in impulsive behavior that is out of proportion to the perceived threat.”

“Further epidemiological research is needed to determine the complex relationship between PTSD and crime. Even with this much-needed research, the role that PTSD may play in criminal behavior should be carefully appraised on a case-by-case basis.”



HOW MIGHT REHABILITATION BE THE BEST MODEL?

Chapter IV

Social cost of an all volunteer military Burden shifting 1% percent of the population serves Cost of not handling the issue

Fears about ticking time bomb Getting system in place Use federal funds where available VA resources

Theories of the justice system Forms of punishment

Utilitarian (criminals calculate between punishment and pleasure) General deterrence – instills fear Specific deterrence – prevent future

misconduct by the individual Rehabilitation

Retributivism Because of the harm done to society, society

may harm the individual

Source: Joshua Dresler, Understanding Criminal Law, 3rd Ed. LexisNexis, Chapter 2

Why rehabilitation?

Society has a burden to do its part PTSD, TBI, substance abuse, domestic

violence are treatable! Veterans who are caught up into the criminal

justice system are often first time offenders First time offense may represent a veteran

who should get help but is not reaching out. Solve the problem quickly and effectively

using top-notch support programs Treat the issue before it becomes “malignant”

Realization from drug court model “Drug courts work by recognizing that

unless substance abuse ends, fines and jail time are unlikely to prevent future criminal activity. Consequently, drug courts, through frequent testing and court supervision, focus upon eliminating drug addiction as a long-term solution to crime.”

Source: Utah Drug Courts available at http://www.utcourts.gov/drugcourts/

Non-judicial punishment in the military Used to bring about specific

performance Timely correction Application by analogy rather than

duplication


WHAT IS BEING DONE AT THE NATIONAL AND LOCAL LEVEL

Chapter V

National Associations

National Association of Drug Court Professionals (NADCP)

Justice Center: The Council of State Governments

Federal involvement

Veteran’s Administration (VA) Bureau of Justice Assistance (BJA)

Local involvement

Federal Magistrate Judge Warner Judge John Baxter (Salt Lake City Justice

Court) Salt Lake County District Attorney Sim

Gill

Drug Courts

Adult Drug Court Model

“A specially designed court calendar or docket, the purposes of which are to achieve a reduction in recidivism and substance abuse among nonviolent substance abusing offenders and to increase the offender’s likelihood of successful habilitation through early, continuous, and intense judicially supervised treatment, mandatory periodic drug testing, community supervision, and use of appropriate sanctions and other rehabilitation services (Bureau of Justice Assistance, 2005).”

Source: http://www.nadcp.org/learn/what-are-drug-courts/models

Drug Courts vs. Traditional Courts Level of supervision

Traditional: Court involvement generally does not take place unless a probation violation has been reported. Therefore, follow-ups for urinalyses may not be as frequent.

Drug Courts: Throughout the duration of drug court, defendants attend required and regular treatment sessions and court appearances as well as undergo random urinalyses.


Drug Courts vs. Traditional Courts Reductions in Recidivism

Traditional: According to the United States Department of Justice, 45 percent of defendants convicted of drug possession will commit a similar crime within the next several years. In fact, the more often a defendant is arrested for a drug offense, the more likely they are to commit an additional offense.

Drug Courts: Drug court participants exhibit a lower recidivism rate ranging from five percent to 28 percent. The recidivism rate for drug court graduates is approximately four percent. Additionally, urinalysis reports for drug court participants are generally 90 percent negative.


Drug Courts vs. Traditional Courts Emphasis on Long Term Recovery

Traditional: In many cases, drug addiction may not be the only problem faced by offenders. Poor reading skills, low levels of self-respect, and troubled family relationships are just a few of the issues offenders face outside of the courts. Traditional processes may refer offenders to treatment programs but follow up is not generally conducted.

Drug Court: Drug courts often recommend that participants develop skills and connections that will allow them to survive following treatment. For example, some programs suggest that participants attain their GED or develop ties with community mentors. Many Utah drug courts also encourage alumni groups so that the recovery process will continue after treatment ends.


The 10 Key Components of Drug Courts1. Drug courts integrate alcohol and other drug treatment services with

justice system case processing2. Using a nonadversarial approach, prosecution and defense counsel

promote public safety while protecting participants’ due process rights3. Eligible participants are identified early and promptly placed in the drug

court program4. Drug courts provide access to a continuum of alcohol, drug, and other

related treatment and rehabilitation services5. Abstinence is monitored by frequent alcohol and other drug testing6. A coordinated strategy governs drug court responses to participants'’

compliance7. Ongoing judicial interaction with each drug court participant is essential8. Monitoring and evaluation measure the achievement of program goals

and gauge effectiveness9. Continuing interdisciplinary education promotes effective drug court

planning, implementation, and operations10. Forging partnerships among drug courts, public agencies, and

community-based organizations generates local support and enhances drug court effectiveness

Source: National Drug Court Institute available at http://www.ndci.org/publications/ten-key-componets

Facts about Drug Court Success Drug Courts Reduce Crime FACT: Nationwide, 75% of Drug

Court graduates remain arrest-free at least two years after leaving the program.

FACT: Rigorous studies examining long-term outcomes of individual Drug Courts have found that reductions in crime last at least 3 years and can endure for over 14 years.

FACT: The most rigorous and conservative scientific “meta-analyses” have all concluded that Drug Courts significantly reduce crime as much as 35 percent more than other sentencing options.

Drug Courts Save Money FACT: Nationwide, for every $1.00

invested in Drug Court, taxpayers save as much as $3.36 in avoided criminal justice costs alone.

FACT: When considering other cost offsets such as savings from reduced victimization and healthcare service utilization, studies have shown benefits range up to $12 for every $1 invested.

FACT: Drug Courts produce cost savings ranging from $4,000 to $12,000 per client. These cost savings reflect reduced prison costs, reduced revolving-door arrests and trials, and reduced victimization.

FACT: In 2007, for every Federal dollar invested in Drug Court, $9.00 was leveraged in state funding.

Source: NADCP, Drug Courts Work, available at http://nadcp.org/learn/drug-courts-work

Facts about Drug Court Success + Drug Courts Ensure Compliance FACT: Unless substance

abusing/addicted offenders are regularly supervised by a judge and held accountable, 70% drop out of treatment prematurely.

FACT: Drug Courts provide more comprehensive and closer supervision than other community-based supervision programs.

FACT: Drug Courts are six times more likely to keep offenders in treatment long enough for them to get better.

+ Drug Courts Combat meth addiction

FACT: For methamphetamine-addicted people, Drug Courts increase treatment program graduation rates by nearly 80%.

FACT: When compared to eight other programs, Drug Courts quadrupled the length of abstinence from methamphetamine.

FACT: Drug Courts reduce methamphetamine use by more than 50% compared to outpatient treatment alone.

+ Drug Courts Restore Families FACT: Parents in Family Drug Court

are more likely to go to treatment and complete it.

FACT: Children of Family Drug Court participants spend significantly less time in out-of-home placements such as foster care.

FACT: Family re-unification rates are 50% higher for Family Drug Court participants.

Source: NADCP, Drug Courts Work, available at http://nadcp.org/learn/drug-courts-work

Numbers

There are more than 2,300 drug courts nationwide

More than 120,000 people will receive services in one year.

Source: NADCP, Types of Drug Courts, available athttp://www.nadcp.org/learn/what-are-drug-courts/models

Mental Health Courts

Definition of a Mental Health Court “The Current Working Definition of a Mental Health Court

is a court with a specialized docket for certain defendants with mental illnesses.9 These courts vary as to the types of charges and mental illness diagnoses accepted as well as the participants’ demographics and plea requirements, but they are united by the common themes of substituting a problem-solving model for traditional criminal court processing and an emphasis on linking defendants to effective treatment and supports. In general, mental health court participants are identified through mental health screening and assessments and voluntarily participate in a judicially supervised treatment plan developed jointly by a team of court staff and mental health professionals. Incentives reward adherence to the treatment plan or other court conditions; non-adherence may be sanctioned, and success or graduation is defined according to predetermined criteria.”Source: Mental Health Court Research Guide, available at:

http://consensusproject.org/jc_publications/mental-health-courts-a-guide-to-research-informed-policy-and-practice

Essential Elements of a Mental Health Court1. Planning and administration2. Target population3. Timely participation identification and linkage

to services4. Terms of Participation5. Informed Choice6. Treatment supports and services7. Confidentiality 8. Court team9. Monitoring adherence to court requirements10. Sustainability Source: Mental Health Court Research Guide, Appendix A, available at:

http://consensusproject.org/jc_publications/mental-health-courts-a-guide-to-research-informed-policy-and-practice

Success from mental health courts Recidivism

Lower recidivism rates for those who participate in court supervised program over those who do not

Higher chance of success for those who complete the program compared to those who do not

Mental Health Outcomes Research indicates that these are more effective

with getting people help rather than traditional criminal justice system

Cost savings Lower recidivism means lower costs long term

Source: Mental Health Court Research Guide, available at: http://consensusproject.org/jc_publications/mental-health-courts-a-guide-to-research-informed-policy-and-practice

Training

NADCP Online

New York State Unified Court System http://e-learning.nycourts.gov/


SUPPORT SYSTEMS AT THE LOCAL LEVEL

Chapter VI

Department of Veterans Affairs Streamlined clinics PTSD Screening www.va.gov

Local Law Enforcement

Crisis Intervention Training http://www.nami.org

Anonymous help

MilitaryOneSource.com

Education Institutions

National Center for Veteran’s Studies University of Utah

Veteran’s Organizations

VFW American Legion

Identification

Self-Identification National Guard / Reserve Commands Community based


VETERAN’S COURT IN ACTION

Chapter VIII

Which Model?

Drug Court Model Mental Health Court Model Mixed model

Veteran’s with substance abuse issues Veteran’s with PTSD or TBI needs

Key Actors

Identification & Interaction

Most important step Problem with self-identification as a

veteran “Have you ever served in the military?” First interaction (LEO) Second interaction (detention) Third interaction (public defender) Fourth interaction (court)

Process

Criteria

Who is a veteran? Who qualifies for service “If you are a veteran, you get in” Combat veteran Diagnosable issue All offenders or non-violent offenses only

Intake

Judicial discretion Prosecutorial discretion Defense attorney’s recommendation

Supervision

Court monitoring Frequent contact Reports from VA Taking care to not abuse VA’s primary

responsibility (i.e. VA is not the enforcer)

Post-completion

Documentation Inter-agency communication

Repeat offenses?

What to do? May indicate a need to revise criteria for

treatment May indicate failure to receive

suppervision

Recap

Conclusion

Thank you!