A National Study of Veterans Treatment Court Participants: Who Benefits and Who Recidivates.

OBJECTIVE: We sought to examine the independent and interactive effects of common mental health disorders and chronic pain conditions on employment and work outcomes among individuals younger than 65 years of age. METHODS: We analyzed cross-sectional data from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000 to 2001 (N=5328). Common mental disorders were assessed using the short-form versions of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF). Chronic pain conditions and labor market outcomes were identified by self report. Logistic and linear regression analysis was used to provide estimates for work impairment based on the presence of a mental health disorder and/or a chronic pain condition. RESULTS: The interaction between presence of a mental health disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (OR 2.3 [1.2–4.2]) and number of days of work missed in the past month due to health (regression coefficient 1.5 [0.6]). In stratified analyses, this effect persisted in women but not men. The presence of a mental health disorder or chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days due to health, although the interaction was not significant. CONCLUSION: Mental health disorders and chronic pain are each associated with work disability. Mental health disorders are more highly associated with some work disability outcomes when accompanied by chronic pain, especially in women.

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Veterans treatment courts (VTCs) have expanded dramatically despite their limited empirical base. This pilot study examined MISSION-Criminal Justice (CJ), a co-occurring disorders wraparound intervention, delivered alongside two VTCs. Baseline data from 26 male veterans enrolled in two VTCs and MISSION-CJ, and 6-month follow-up data for 18 of the 26 veterans, are presented. Veterans on average were 37.5years old, 85% Caucasian, had significant histories of criminal justice involvement (14.3 lifetime arrests), had an average of 14.7years of alcohol use and 9.3years of illicit drug use, and roughly three-quarters reported mental health symptomatology. At 6-month follow-up, veterans demonstrated improvements in behavioral health, substance use, and criminal justice outcomes. This study demonstrated promising preliminary outcomes of MISSION-CJ in VTCs. A randomized controlled trial is a critical next step to examine whether these outcomes remain consistent with a more rigorous design.

Substance Abuse-Related Mortality Among Middle-Aged Male VA Psychiatric Patients

Understanding Associations Between Serious Mental Illness and HIV Among Patients in the VA Health System

Psychiatric medications can serve as important tools for addressing behavioral health issues among criminal justice-involved (CJI) veterans. This study used national data on 12,790 CJI veterans in the U.S. Department of Veterans Affairs (VA) Veterans Justice Outreach program from 2019 to 2020 to compare patterns of psychiatric medication prescriptions among veterans who entered a veterans treatment court (n = 6975), another specialty court (SC; n = 414), or no-SC (n = 5401). Different classes of medications were examined, including antidepressants, stimulants, antipsychotics, benzodiazepines, and medications for substance use disorders. The results showed that 60.2% of the total sample was prescribed a psychiatric medication within 1 year of entering the Veterans Justice Outreach program. There was no significant difference in overall psychiatric prescribing among veterans treatment court, other SC, and no-SC groups, but there were a few differences in certain classes of psychiatric medications. Moreover, about 7.8% of veterans who were in the no-SC group and were prescribed psychiatric medications did not have a psychiatric diagnosis. Veterans who were younger, non-Hispanic white, married, with a VA service-connected disability rating, had a diagnosis of mental and/or substance use disorder, and used more VA health care services were more likely to have been prescribed psychiatric medication. Together, these findings illustrate the essential role of psychiatric medications in courts and programs that serve CJI veterans, as well as the important link between VA service engagement and psychiatric prescriptions.

Justice-involved veterans return to civilian life with a variety of mental and physical health challenges that often go untreated and increase their risk for self-harm and involvement in the criminal-legal system. Veterans Treatment Courts (VTC) were created to respond to the unique problems of justice-involved veterans by attempting to coordinate services and support with the U.S. Department of Veterans Affairs (VA), local treatment providers, and the VTC. Our research has two distinct phases. In Phase 1, we conducted qualitative interviews with VTC team members in twenty (20) VTCs from each USA region; in each VTC, we gained the perspectives of team members – judges, prosecutors, defense attorneys, VJOs, VTC program coordinators, mentors, probation officers, and treatment providers – on the operation of VTCs, with a focus on how to improve service provision for justice-involved veterans. A total of 145 interviews were conducted. We begin by describing the unique problems and treatment needs of justice-involved veterans, and briefly summarize the findings from previous research on the implementation and impact of VTCs. We then present our research study protocol and highlight findings from our phase 1 qualitative interviews with VTC team members. In addition, we describe phase 2 of our project, which will include focus groups with VTC graduates, and quantitative analyses of the service provision networks of three VTCs.

ABSTRACTObjective: Despite the growing research on the effectiveness of specialty courts, including drug treatment courts (DTCs) and veterans treatment courts (VTCs), little is known about the unique treatment needs of individuals with co-occurring mental health and substance use disorders (COD) who are commonly served by these courts. This pilot study examines individuals with COD across two DTCs and two VTCs in Massachusetts to understand the characteristics and treatment needs of these unique populations.Methods: Baseline data for 112 individuals enrolled in a community-based COD treatment program within two DTCs (N = 86) and two VTCs (N = 26) with a Monte Carlo simulation of 10,000 samples were analyzed to assess differences in treatment needs.Results: DTC participants experienced more lifetime convictions (p = .000), months incarcerated (p = .000), and had a longer lifetime history of illicit drug use (p = .004). Meanwhile, a higher proportion of VTC participants experienced trauma (p < .002) and chronic medical problems (p < .001), and VTC participants experienced more severe acute behavioral health symptoms as measured by the BASIS-32 (p = .021).Conclusions: Given the unique differences in treatment needs between DTC and VTC participants, these findings have implications for specialty court management such as treatment planning, referrals to meet participants’ service needs, and even docket sizes.

Engaging vulnerable populations in drug treatment court: Six month outcomes from a co-occurring disorder wraparound intervention

New Models of Collaboration Between Criminal Justice and Mental Health Systems

Few studies have investigated the effect of mentorship on participants’ clinical or criminal justice outcomes in veterans treatment courts (VTCs). This study is an exploratory analysis of a VTC in Hillsborough County, Florida. Descriptive and inferential statistics were used to examine behavioral health changes between baseline and follow-up and compare participants with/without a mentor. Post hoc analyses explored the effect of mentorship on graduation and re-arrest rates. Participants with a mentor had significant improvements in mental health, trauma, substance use, and social support; and significantly higher levels of positive social interaction than those without a mentor. Mentor status was not meaningfully related to graduation and re-arrest rates in bivariate analyses, but post hoc analyses found that social support mediated the relationship between mentor satisfaction and re-arrest and graduation rates.

Continuing Care After Inpatient Psychiatric Treatment for Patients With Psychiatric and Substance Use Disorders

In the United States, there are increasing numbers of Veterans Treatment Courts (VTCs) that have been developed to improve Veteran reintegration. Our scoping study examined VTC scholarship published between 2008 and 2016 and summarized participant profiles, services provided, and effectiveness and implementation of VTCs. Of 1,207 sources pertaining to VTC, 206 sources were included for review, and 48 sources were selected for the analytic sample. The majority of VTC participants are White males, middle-aged (30–50 years of age), and had mental health and substance abuse disorders. Studies of VTC effectiveness reported mixed findings. Future rigorous research should expand on VTC outcomes, variability in VTC jurisdictions, and the role of peer mentors.

Medicalizing violence: The institutional politics of trauma in Veterans Treatment Courts.

This study compared characteristics and outcomes between veterans who participated in veterans treatment courts (VTCs) and veterans involved in criminal justice who participated in other treatment courts (TCs) or who participated in neither VTCs or TCs. Data from 22,708 veterans (N=8,083 VTC participants, 680 participants in other TCs [other-TC participants], and 13,945 participants in neither VTCs nor TCs [non-TC participants]) in the Veterans Justice Outreach (VJO) program were analyzed by using multilevel regression models. VTC participants were more likely than other VJO participants to have served in Iraq or Afghanistan, but there were no sociodemographic disparities in access to VTCs. VTC participants were more likely than non-TC participants to have drug or public-order offenses, and they were more likely than other-TC participants to have DUI offenses. VTC participants had better independent housing outcomes than other VJO participants, and they had better employment outcomes than non-TC participants. However, VTC and other-TC participants were also more likely to have jail sanctions and new incarcerations compared with non-TC participants. VTCs are a growing service model that serves a broad group of veterans with a range of criminal offenses. Although VTCs show moderate benefits in housing and employment, specialized services are needed to reduce recidivism and maximize these benefits.