DMHAS: Jail Diversion

DMHAS Veteran's Services
 
Veteran's Jail Diversion and Trauma Recovery Services
 
Project Director: Jim Tackett, Director, Veterans Services
DMHAS/Office of the Commissioner

OVERVIEW

Connecticut was one of six states initially awarded a $2 million, 5 year grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to establish a statewide jail diversion program for veterans struggling with war trauma-related problems. Connecticut’s Veterans Diversion and Trauma Recovery (VDTR) Program began providing services in the Norwich and New London Courts in October 2009. In 2010 services were expanded to the Danielson Court and in May 2012 to the Middletown Court. A dedicated VDTR clinician is assigned to each of these courts. VDTR clinicians in the New London and Middletown Courts provide consultation support to courts that currently do not have a dedicated VDTR clinician.

 

The program strives to identify, engage and divert justice-involved veterans from arrest and incarceration into a seamless, community-based system of treatment and recovery support services. Although services are targeted to veterans newly returned from the wars in Afghanistan and Iraq, all Veterans are eligible.

 

To improve treatment outcomes, and to strengthen the likelihood that veterans may successfully fulfill the expectations of the Court, the program embraces the principles and values of DMHAS’ recovery-oriented healthcare system. These principles are based on the findings and recommendations of the Final Report of the President’s 2003 New Freedom Commission on Mental Health entitled Achieving the Promise: Transforming Mental Health Care in America. They stress the importance of person-centered treatment planning, expanded treatment choices, strength-based treatment planning, and the availability of integrated treatment services in the community.

 

To accomplish this service objective, DMHAS conducted a year-long comprehensive planning process that involved multiple stakeholders from several distinct systems. Agencies that helped shape DMHAS’ strategic plan include the judicial system, law enforcement, VA Healthcare and Benefits Administrations, federal Vet Center system, U.S. Naval Groton Sub Base, Connecticut Military Department, numerous state agencies (DOC, DOL, DSS, DVA) as well as an array of community providers and veterans service organizations. To view a list of stakeholders click on highlight.

 

A total of 29 agencies signed a memorandum of agreement pledging to support a new services delivery model that combines the strengths of each participating federal, state and community stakeholder.

 

KEY ELEMENTS OF THE CONNECTICUT VETERANS DIVERSION AND TRAUMA RECOVERY PROGRAM

1. Identify, engage, refer and divert veterans: Connecticut has established a formal jail diversion structure that, at the earliest opportunity along the criminal justice continuum, diverts veterans with trauma-related symptoms to a seamless system of treatment and recovery support services. 

This structure was formed, and is held together, by the commitment of each participating agency, consistent with their respective mission, to identify, engage and refer justice-involved veterans to diversion and trauma recovery support services. Law enforcement, bail commissioners, public defenders, prosecutors, court-based clinicians, marshals and judges have all signed on to support this effort. 

The seamless system of treatment and recovery support services is a new services delivery model that brings together the service offerings of each participating federal, state and community-based provider. To view the Connecticut Veterans Diversion and Trauma Recovery Model click on highlight. 

2. Systems Integration: The new services delivery model combines the strengths of each federal, state and community stakeholder, thereby offering diverted veterans an array and wealth of treatment and recovery support options as they develop their individual service plans.

 

Consistent with their respective mission (which includes eligibility considerations), each participating agency (VA, Vet Centers, DMHAS, other state agencies, community providers et al) has committed to provide services to justice-involved veterans who choose to access their services.

 

3. Service Planning/Services Coordination: A treatment planning process is now in place that values personal choice, and contemplates and addresses the treatment and recovery support needs of each individual veteran, including psychosocial needs.

 

In forming their treatment/service plans, veterans may choose from the wealth of treatment and recovery support options now available through multiple state, federal and community providers. Treatment planning is person-centered and strength-based: Their Plan acknowledges and supports successes in the life domains of work, housing, education, social supports and faith/spirituality. Because veterans have opportunity to access integrated treatment and recovery support services in the communities in which they live and work,  they do not have to risk losing their job, housing, local support system and/or their status in school as a condition of diversion (which often occurs among veterans who are directed to report to the VA).

 

Under the DMHAS Veterans’ Diversion/Trauma Recovery Program, veterans’ treatment plans often reflect the concurrent involvement of several provider systems (community, DMHAS, local Vet Center, VA Community-based outpatient clinic). The attached Referrals Graph (click on highlight) depicts the involvement of federal, state and community providers in veterans’ treatment plans. Such plans are supported by services coordination and community case management provided by program staff.

 

The end result is that -- through person-centered, strength-based planning that provides veterans’ the choice to access integrated services in their community – treatment outcomes are enhanced and the likelihood that veterans’ will successfully fulfill the expectations of the Court is strengthened.

SERVICES PROVIDED TO THE COURT

 

The Veterans Diversion/Trauma Recovery (VDTR) Program is another tool available to Judges. VDTR staff is court-based, available to:

  • Provide training to court personnel in trauma informed care, and the prevalent physical, psychological and emotional challenges facing veterans returning from war
  • Provide training to area law enforcement agencies and other first responders to assure that veterans’ are identified, engaged and referred to the program at the earliest opportunity along the criminal justice continuum
  • Conduct rapid determinations of veterans’ eligibility for services
  • Engage, screen and assess referred justice-involved veterans in a timely manner
  • Assist veterans in forming treatment/services plans that may be presented to the Court
  • Support veterans’ plans through intensive community case management
  • Transport veterans to services in the community
  • Provide written progress reports to the Court 

SERVICES PROVIDED TO VETERANS

  • Comprehensive assistance to veterans as they form their individual treatment and recovery support services plan
  • Referral to services provided by multiple state, local and federal providers
  • Access to trauma-integrated services provided by VDTR clinicians or other community, state or federal provider
  • An in-court ally at all court appearances
  • Ongoing support through the adjudication of their case and beyond
  • Intensive Community/Forensic Case Management
  • Transportation to appointments in the community
  • Basic needs supports such as clothing, bus pass and gas cards 

WHY DIVERSION AND TRAUMA RECOVERY SERVICES FOR VETERANS IS NEEDED

 

Studies have shown that large numbers of military personnel returning from the wars in Iraq and Afghanistan have struggled with psychological problems such as depression, anxiety and post traumatic stress disorder (1-4). A recent analysis of the literature showed that up to 20% of veterans who served in Afghanistan or Iraq meet criteria for PTSD after returning home (5).  Health surveys completed after a Unit’s return from deployment suggest that large percentages of service members report experiencing prevalent symptoms consistent with PTSD but below the level required for a full diagnosis. One longitudinal study showed that over 40% of returning veterans were reporting psychological problems in these post deployment health assessments (2).  Far too many soldiers experience first-time problems with alcohol and other drugs, and among younger service members over 50% are getting caught up in binge drinking (6). Also well-documented are the hardships faced by the families of those we send into service in our name (7-8).

 

We now know that the road home following service in a war zone has predictable emotional and behavioral challenges that every returning soldier, to varying degrees, must face (9). Research has shown that prolonged exposure to traumatic events, endemic to military service in both Iraq and Afghanistan, can result in physiological changes in the brain.  

 

The Paradox of PTSD

 

The following is a discussion of a recent article entitled, The Paradox of PTSD, written by Charles W. Hoge, MD, Colonel, U.S. Army (retired). Hoge directed the U.S. military's premiere research program on the mental health and neurological effects of the wars in Afghanistan and Iraq from 2002 to 2009 at Walter Reed Army Institute of Research. In his article he describes that medical professionals define PTSD based on a specific set of symptoms, which include feeling constantly on edge or hyper alert, having difficulty sleeping, experiencing nightmares, being distracted by intrusive deployment-related memories, feeling a lot of anger, having concentration or memory problems, feeling emotionally numb or detached, or avoiding doing things that were previously enjoyable (such as going out to a crowded mall or movie theater). There may also be feelings of guilt or a strong urge to self-medicate with alcohol or drugs to try to get some sleep or to temporarily forget things that happened downrange.

 

Hoge finds it paradoxical that many of these reactions, which medical professions label ‘symptoms,’ are also necessary adaptive physiological responses in combat, and skills that professional warriors hone in their training. There is a naïve expectation in society that veterans should be able to transition home smoothly and lead a “normal” life after serving in a war zone, with little understanding of what it means to be a warrior or what the normal human response is to extreme war-zone experiences. Combat-related responses don’t just shut off upon returning home.  The body doesn’t have an ‘on-off’ switch, for good reasons, since these responses have to do with survival.

 

Hoge provides the following examples of behaviors that combat veterans may exhibit once they are back home:

  • Situational awareness where a warrior is alert to environmental cues that might signal an enemy threat is life-saving in combat, but might be labeled “hypervigilance”
  • Rigorous mission rehearsal and attention to detail (involving checking and rechecking everything mission related) contributes to “re-experiencing” symptoms, intolerance of mistakes, or should’ve-would’ve-could’ve-type thinking
  • Continuous night-time operations and the ability to function on limited sleep causes biological changes in the normal sleep-wake (circadian) cycles that can interfere with sleep  
  • The ability to direct anger, which helps control fear and shut down pain awareness, makes it more likely for anger and rage to be expressed
  • The ability to shut down other emotions to focus on the mission, even after serious casualties, is an absolutely essential skill in the combat environment, but can turn into numbing and avoidance after deployment.

The bottom line is that “symptoms” are also skills (5).

 

Prolonged exposure to trauma ---------> physiological changes

 

In-Theatre
 Now Home
  • Situational Awareness
  • Hypervigilance
  • Attention to detail/rigorous
  • mission research
  • Intolerance of mistakes
  • Continuous night-time missions
  • Difficulty sleeping
  • Ability to direct anger
  • (which reduces fear)
  • Spring-loaded/difficulty
  • regulating emotions
  • Shut down emotions to
  • focus on mission
  • Emotional numbing/avoidance

 

 

Figure 1 provides a list of prevalent “symptoms” reported by returning combat personnel and suggests common behaviors that may often lead to arrest.

 

  Prevalent Trauma-Related 
 Symptoms
 Behaviors
  • Anxiety
  • Depression
  • Irritability
  • Anger
  • Increased Substance Use
  • Difficulty Sleeping
  • Hypervigilence
  • Excessive speeding
  • Erratic driving
  • Bar fights, Disorderlies, BOP
  • Firearms violations
  • DUI
  • Possession of illegal substances
  • Domestic Violence

 

                                                          FIGURE 1

Hoge summarizes that going to war changes how the body functions, and the expectation that this will reset quickly upon return home is unrealistic.  There is no switch to restore biological-physiological functions back to the way they were before deployment.  A dial is a better metaphor.  It’s best to understand these body responses from the perspective of how they serve important functions in a combat environment, and then look for ways to dial these responses down after returning home (5).

Most newly returned veterans lack insight regarding their symptoms

We now know that military service in a combat theater affects every deployed service member. No one comes away from war unchanged. All, to varying degrees, will experience some, or all, of the prevalent ‘”symptoms’ described above. All must transition through a “dialing down” process.  Most do well and seem to exhibit a strong, healthy resiliency, relying on the loving support of family and friends as they find their “new normal” in a purposeful life. But some get stuck. As many as 20% of returning veterans will be diagnosed with PTSD, and a majority will experience partial PTSD, a range of symptoms that does not rise to the level of a full-blown PTSD diagnosis (5).

In the sixties and seventies Vietnam Veterans returned from war facing the same challenges as today’s generation of returning veterans. PTSD hadn’t entered the psychiatric nomenclature as yet, not until fully five years after the war’s formal ending in May 1975. Subsequently, veterans with PTSD had no understanding of the source and dynamics of their symptoms, nor did clinicians at VA or anywhere else.

The majority of today’s returning veterans also lack insight into the difficulties they may experience during their transition to civilian life (10). Many newly returned veterans report being mystified by the behaviors that have led to their arrest. Many talk about feeling “spring-loaded”. Family members are also mystified, wondering why their loved one can’t sleep, drinks too much, and displays unpredictable moods swings.

We have learned a lot since 1975. After 30 years of evidenced based treatments for PTSD, principally within the VA, new therapies are available to help veterans successfully find their “new normal”. It is our challenge to help newly returned veterans to connect to treatment and support if they need it. We have a responsibility to assist veterans to excellence in their lives following their experiences in war. It begins by assuring their well-being upon their return from deployment. Law enforcement and other first responders, as well as judicial personnel, are in a unique position to provide leadership to newly returned veterans who have become justice-involved by referring them to jail diversion services.

References

1.  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.

2.  Milliken 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.

3.  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. (March 1); Vol 295, No 9.

4.  Hoge CW et al, “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care”. NEJM.2004. (July 1); Vol 351:13-22, No 1.

5.  Hoge CW, The Paradox of PTSD, VVA Veteran, Vietnam Veterans of America, Sep/Oct 2011

6.  Jacobson IG, Ryan MAK et al, “Alcohol Use and Alcohol-Related Problems Before and After Military Combat deployment”. JAMA. 2008. (August 13); Vol 300, No 6.

7.  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 (February).

8.  Fikretoglu D, “The Impact of Operational Stress Injuries on Veterans’ Families: A Review of the Existing Research,” Veterans Affairs Canada. Research Directorate. 2008 (May 2).

9.  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

10.  Harris Interactive, “The Military Mental Health Survey”. American Psychiatric Association. 2008. (June 30).

CONTACT US

NEW LONDON, NORWICH AND DANIELSON COURTS

Contact:  Chris Burke, LCSW, LADC, Team Leader
Veterans Diversion and Trauma Recovery Program
Southeastern Mental Health Authority
401 West Thames Street, Bldg. 301
Norwich, CT 06360
Office:  860-859-4602
Cell:     860-861-5542

MIDDLETOWN COURT

Marla Ackerley, LCSW, Team Leader
River Valley Services
Dutton Hall
P.O. Box 351
Middletown, CT  06457
860-262-5200

ALL OTHER COURTS

Contact:  Jim Tackett, Director, Veterans Services
DMHAS/Office of the Commissioner
410 Capitol Avenue
Hartford, CT 06134
Office: 860-418-6979
Cell: 860-655-6177
FAX: 860-418-6190

 




Content Last Modified on 4/24/2012 1:40:12 PM