Eight years ago, a Buffalo, New York, judge launched veterans treatment courts with a simple but powerful premise: If you treat veteran offenders for underlying mental health and substance use issues, as well as address their crimes, they'll have a better shot at life success.
Preliminary research partially supports the point, with a study led by Department of Veterans Affairs and Yale University psychologist Jack Tsai, PhD, showing that veterans who go through these courts are more likely to find jobs and housing than those served by other types of court systems.
In fact, veterans treatment courts have become so popular that what started in 2008 as a single pilot program in Buffalo has swelled to 435 programs around the country—348 more than existed in 2012.
"Communities are adopting these programs out of a real desire to honor and serve those who have served our country but who have ended up in contact with the criminal justice system," says Sean Clark, JD, national coordinator for the Veterans Justice Outreach (VJO) Program, which links veterans involved with the criminal justice system to VA services.
Thanks to their promise and growing success, APA has been supporting veterans treatment courts on Capitol Hill, both by urging congressional delegations to push for dockets in their home states and by inserting language in federal legislation to fund expansion of the model, says Heather O'Beirne Kelly, PhD, APA's lead for military and veterans policy.
"The data on the courts are compelling," says Kelly, who notes that APA has partnered on this effort with Melissa Fitzgerald, senior director of Justice for Vets, the organization leading the charge for the courts.
A focus on treatment
Veterans treatment courts are an offshoot of the mental health and drug treatment courts started in the 1990s by the Hon. Robert Russell, an associate judge in Buffalo's City Court. He saw the sentencing of nonviolent offenders with mental health or drug problems as a revolving door with few positive outcomes. In response, he advocated treatment as an integral part of sentencing.
The veterans courts, also spearheaded by Russell, are similar in philosophy but go a few steps further, thanks to their exclusive focus on veterans and resulting connection to VA services, says Tsai. For instance, veterans are paired with veterans outreach specialists—often mental health professionals—from the VJO who serve as liaisons between the court and the VA and with veteran mentors who provide practical and emotional assistance in a language veterans can relate to.
"In other kinds of treatment courts, there isn't this common bond," Tsai explains. "In veterans treatment courts, [both defendants and helpers] are veterans, so there is this common culture."
The courts serve veterans from many conflicts who are eligible for VA treatment, with about a third coming from the recent wars in Iraq and Afghanistan.
The courts also vary by jurisdiction because they're developed by local communities rather than by the VA or federal or state government. Some are designated veterans treatment courts, while others are dockets or tracks within existing mental health, drug or criminal courts. Some courts accept veterans who have committed violent crimes, while others do not. (The most common offenses are driving under the influence, drug-related crimes and disorderly conduct.)
Use and outcomes
Researchers are starting to get a picture of who is using these courts and how the model is helping shape the trajectory of defendants' lives and health. In a study of the electronic health records of 7,500 veterans who used the system from 2011 to 2014, Andrea K. Finley, PhD, at the VA Palo Alto Health Care System, found that 80 percent of veterans who used the courts had at least one mental health diagnosis, and 80 percent had at least one substance use disorder. Most had multiple conditions, either mental health and substance abuse problems combined, or multiple disorders within one or both categories. More specifically, 59 percent of veterans had depression, 40 percent had post-traumatic stress disorder, and 33 percent had anxiety disorders. In addition, 65 percent had alcohol-related disorders and 16 percent had opioid-related disorders.
Finley also found that the vast majority of veterans in the courts ended up using VA care. Of those diagnosed with a mental health disorder, 95 percent received mental health treatment, and of those diagnosed with a substance use disorder, 80 percent received substance use disorder treatment.
"If you're familiar with how hard it is to motivate people to use substance use disorder treatment, to have almost everyone using treatment is great," she says.
What's more, veterans stayed with treatment. Two-thirds of the sample made three or more outpatient visits or took part in seven or more days of residential treatment in the year after diagnosis, she found. Veterans treatment court users also made gains in practical life arenas, according to the study by Tsai and colleagues, which is under review. Using VJO data, the team examined five-year outcomes of 8,803 veterans who received VA treatment and went through the veterans treatment courts from 2010 to 2015, compared with 680 veterans attending other kinds of treatment courts and 13,935 veterans who attended traditional criminal courts.
Those who went to veterans treatment courts were slightly more likely to have housing and jobs at the end of a year than veterans in the other court systems, the team found. However, they were also slightly more likely to end up back in jail or prison over the year than those in other court systems.
While the data can't definitively explain the higher recidivism rates, both Tsai and Clark point out that treatment court veterans are more closely monitored than veterans in other systems, and that incarceration can actually be a positive part of their treatment plan.
Court sanctions are "not a sign of failure on the part of an individual defendant," says Clark. "In fact, relapse is very consistent with the path to recovery, which tends to have some turns to it."
Overall, says Finley, the courts are a model for how health care, criminal justice and local communities can work together to provide veterans with optimal care—a big need given the large number of vulnerable veterans and the changing health-care landscape.
"Veterans treatment courts are real trailblazers in building these relationships and in showing how to apply these lessons to other groups of veterans who may be struggling and need treatment."
For more on veterans courts, see the March 2012 issue of the APA Monitor on Psychology.
