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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Effective Strategies for Working with
Justice-Involved Veterans with Behavioral Health
NeedsLarke 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
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• 200 Welcome
• 205 Larke N. Huang, SAMHSA
• 210 David Morrissette, SAMHSA
• 215 Henry J. Steadman, Policy Research
  Associates
• 220 Jim Tackett, Connecticut Department of
  Mental Health Addiction Services
• 240 Nicholas Meyer, Policy Research Associates
• 255 Question Answer Period
• 315 Conclusion of Webinar

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Larke N. Huang, Ph.D.
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David Morrissette, Ph.D.
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Henry J. Steadman, Ph.D.
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Why This Is Different

• Who
• Where
• What

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Who

• National Guard and Reserve 40
• Women
• Female engagement teams
• Cultural support teams
• Lioness

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Where

• No single frontline

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What

• Improved explosive devices (IEDs)
• Traumatic brain injury
• Subclinical stress reactions/adjustments
• Wounded survivors
• Post-traumatic stress disorder

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Los Angeles Jail Study (n1,676)

• 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)

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Jim Tackett, B.A.
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Connecticut Military Support Program

• Provides free, confidential,
• statewide counseling services to
• Reserve Component Service Members
• And
• To their families

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Military Support Program

• 425 licensed clinicians located throughout the
  State
• Accessed through a 24/7 call center

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MSP Number of Individuals Served

• Calls to 24/7 MSP Call Center
  2,785
• Received MSP Case Management Services 2,502
• Referred to Outpatient Counseling
  1,255
• Direct Clinical Referrals to VA or Vet Center
  315
• Information, Referral and Advocacy Services
  1,627
• Transportation Service (episodes)
  1,234
• Reporting period April 2007 to May 31, 2011

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MSP Embedded Clinicians

• 28 MSP clinicians embedded within National Guard
  Units affected by deployment(s)
• Familiar, on-site presence, each units key POC
  for behavioral health matters
• Provide psycho-education services during drills,
  YRRP and FRG events
• Provide immediate access to behavioral health
  services

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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

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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, states attorneys,
  public defenders
• Partner with Statewide CIT program
• Inform/Enlist assistance of police officers

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Planning Key Stakeholders

• Federal VA Regional Office (VBA)
• VA Connecticut Healthcare System (VHA CT VISN)
• Vet Centers (VRC)
• DoD Naval Health Clinic New England, Groton
  Sub-Base
• Connecticut Military Department/National Guard
• Chief States 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

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CTs Approach Systems Integration

• Emphasizes Pre-Booking
• Focus on identifying, engaging and referring
  veterans at the earliest opportunity along the
  criminal justice continuum

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Sequential Intercepts for Change
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CTs Approach Systems Integration

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

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CTs Approach Systems Integration

• Total Veteran Treatment Referrals (N348)
• 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

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Referrals (N348)
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Veterans Focus of Treatment (N128)
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
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Focus of Treatment/Services (N128)
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Connecticuts 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

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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
  35113-22, No 1
• Hoge 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 9
• Miliken 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 18
• Presidential 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. 2008
• Pietrzak 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

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DMHAS Veterans Services

• Serving Connecticuts
• Veterans, Citizen Soldiers and Their Families
• Jim Tackett, Director
• DMHAS/Office of the Commissioner
• 410 Capitol Avenue
• Hartford, CT 06134
• 860-418-6979

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Nicholas Meyer, B.A.
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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

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

• 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

• 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
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Firearms are for Defense and Security
The United States Marine Corps The Riflemans
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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Ask Our Speakers
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