Veterans and Mental Illness: The Unfortunate Tragedy
One of the highest threats in returning from military service is the detriment to a veteranís mental health. Mental health problems such as Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) are among the leading mental health issues among veterans. Research shows there is a correlation between PTSD and TBI and criminal behavior. Veteranís courts are an emerging specialty court, similar to drug and mental health courts, which seek to address the underlying causes of a veterans criminal behavior. This paper first describes the implementation, operation and effectiveness of existing veteranís courts. This paper seeks to review the literature on the correlation between a veterans mental health issues resulting from combat and criminality, and what the criminal justice system is implementing to support these veterans. Through this paper, I hope to shed greater light on the tragic mental health issues veteranís face upon returning from military service. More importantly, this paper seeks to address the need for widespread implementation of veteranís courts; so we may serve those who have served.
There is an unfortunate tragedy brewing as American soldiers who have been sent thousands of miles away to engage in deadly combat return home only to find themselves involved with the criminal justice system because of mental health issues.
It has become well known that one of the highest threats from combat service is the detriment to a veteranís mental health. The National Council on Disability (2009) estimates between 25-40% of veterans returning from military service have psychological and neurological injuries as a result of PTSD or TBI. There are two main disorders that veterans experience, Post-traumatic Stress Disorder (hereinafter referred to as PTSD) and Traumatic Brain Injury (hereinafter referred to as TBI). PTSD is defined as a mental and emotional disorder caused by exposure to a psychologically distressing event exceeding the scope of an ordinary human experience (Cavanaugh, 2001). TBI occurs when the brain is traumatically injured (Pratt, 2010). There is a strong association between TBI and PTSD (Pratt, 2010). An individual who suffers from PTSD or TBI generally has an average of 2.7 other mental health issues (Walls, 2011).
As one can imagine, soldiers returning home may have difficulty readjusting to life, and find themselves dealing with a slew of emotions after combat. There is a correlation between PTSD, TBI and criminal behavior. Research has shown that combat exposure, PTSD symptoms, substance abuse, and other post deployment adjustment problems are correlated with a veteranís involvement in the criminal justice system (White, M. D., Mulvey, P., Fox, A. M., & Choate, D., 2012; Saxon, A. J., Davis, T.M., Sloan, K. L., McKnight, K. M., McFall, M. E, & Kivlahan, D. R., 2001). Furthermore, criminalization of those with mental health issues results in incarceration becoming primary housing for the mentally ill, including veterans suffering from such problems.
As veterans are an important and prevalent part of society, it is important that veteran criminality stemming from combat related mental health issues be addressed. Fortunately, by implementing veteranís courts, state legislatures along with various counties and municipalities are beginning to address this issue.
The broad objective of this research paper is to review the existing literature regarding the prevalence of incarcerated veterans and how a veteranís mental health issues are correlated with criminality. This paper will first review the veteran population in the United States and the extent of veterans in the criminal justice system. Then it will explore the prevalence of mental health issues among veterans and how these mental health issues may cause criminality. I will conclude with an introduction to veteranís courts, and how their implementation is essential to dealing with the problem of a veteranís mental health issues. The goal of this paper is to shed greater light on the tragic mental health issues veteranís face upon returning from military service. This research paper seeks to address the need for widespread implementation of veteranís courts.
As of September 30, 2012, the estimated number of living veterans residing in the United States was 21,600,000 (Department of Veteran Affairs, 2012; Russell, 2009). The data determining veteran population in the United States was collected from the Department of Veteran Affairs, the Department of Defense and the United States Census Bureau (Department of Veteran Affairs, 2012). The States with the highest veteran populations are California, Florida, Texas, Pennsylvania and New York (Department of Veteran Affairs, 2012; Russell 2009). Many of the veterans among our population have served in combat. Over 1.5 million service men and women have served in Afghanistan and Iraq since 2002 (Brown, 2008). Nearly one-third of the military personnel who have been to Afghanistan and/or Iraq have been deployed more than once (Brown, 2008).
Veteran Population in the Criminal Justice System
Veterans are a specific population among incarcerated individuals. Incarcerated veterans are more likely to be older, white, have higher education, and more likely to be serving time for a violent offense over nonveterans (Noonan & Mumola, 2007). The number of incarcerated veterans has steadily declined since the mid 1980's (Noonan & Mumola, 2007). In 1986, 20% of all prisoners were veterans, in 1997 12% were veterans, and in 2004, 10% were veterans (Noonan & Mumola, 2007; Russell, 2009). About 140,000 veterans were incarcerated in 2004 (Noonan & Mumola, 2007). However, it is important to note these percentages do not include veterans involved in the criminal justice system who were not incarcerated as a result of their criminality.
There are several characteristics specific to veterans. Veterans have shorter criminal histories than nonveterans. However, veterans receive longer sentences (Noonan & Mumola, 2007). More than half of the incarcerated veterans serve time for a violent offense while nearly one third of veterans, compared to a quarter of nonveterans, were first-time offenders (Noonan & Mumola, 2007).
Veterans and Mental Health Issues
Due to high psychological stressors and experiences with physical combat, it is no surprise that mental health issues amongst veteran populations has gained so much interest. A significant percentage of returning veterans have been diagnosed with a mental health problem. Approximately 17% of Iraq veterans were diagnosed with a severe mental disorder: twice the level prior of deployments (White et al., 2012; Hoge, Castro, Messer, McGurk, Cotting & Koffman, 2004). Another study determined that between 17-28% of brigade combat teams are at risk for serious symptoms of PTSD (Russell, 2009). A Bureau of Justice Statistics report indicated that prior to incarceration, 25% of veterans were suffering from mental illness (Noonan & Mumola, 2007). Additionally, the U.S. Department of Veterans Affairs Fifth Annual Report (2007) suggests at least 30-40 percent of Iraq veterans will face serious psychological problems associated with PTSD.
As many veterans suffer from mental health issues, it is not uncommon to see self- medication with drugs or alcohol. The Bureau of Justice Statistics determined that 81% of veterans reported drug use problems prior to incarceration (Noonan & Mumola, 2007). Over half (55.6%) of the incarcerated veterans indicated they had a problematic experience with alcohol where approximately 7.5% indicated they suffered from extreme alcohol abuse (Russell, 2009). Self-reported data analyzed by White and colleagues (2012), found that crack cocaine and opiate use is twice as common in veterans as non-veterans (veterans 16.7% and 12.1%; non-veterans 8.3% and 6.4% respectively). Research has acknowledged and generally supports the view that the PTSD symptoms most likely precede the onset of alcohol and drug problems (Brown, 2008; Stewart, 1996). Although some may argue veterans entered military service with drug and alcohol problems, it is common knowledge that individuals entering military service endure extensive psychological, physical and medical testing (to include screening for drugs and alcohol) prior to enlistment[P1] .
A recent study conducted by Brown (2011) found a similar characteristic in males who after returning from combat had developed an alcohol problem. About 71 % of the males in his study appeared to have PTSD symptoms that would likely support a PTSD diagnoses. Among those individuals, 47% indicated they had experienced suicidal tendencies as a result of their symptoms.
Moreover, unemployment, homelessness, alcohol, divorce, domestic violence, and child abuse are additional problems confronting veterans. Each of these problems increases the likelihood that the veteran may encounter problems within the criminal justice system. Each of these problems may be either the triggering mechanism or the result of mental health issues (Brown, 2008).
Veteranís Mental Health in Earlier Eras
Mental health issues are not simply a current problem facing veterans, but a problem which dates back throughout history. Although PTSD was not identified as a psychiatric disorder until 1980, writings from the ancient Greeks have given descriptions that appear to match this syndrome (Friedman, 2005). Evidence suggests mental health disorders similar to PTSD, have been common in soldiers since the civil war (White, 2012).
During the American Civil War, mental disorders (similar to PTSD today) were referred to as nostalgia. The Union Army during the Civil War recognized over 2,600 cases of insanity in soldiers and over 5,200 cases of nostalgia (Meagher, 2007). In World War I, emotional difficulties were called shell shock syndrome. In World War II, mental health issues were described as combat neurosis or traumatic neurosis (Wessely & Jones, 2004). It was during World War II that the relationship among combat exposure, combat efficiency, and psychiatric breakdown began to be quantified (Wessely & Jones, 2004).
Following the Vietnam War, thousands of veterans were diagnosed with PTSD, while many others battled with symptoms of PTSD but never received formal diagnoses (Brown, W. 2008). The Vietnam War led to the introduction of the concept of PTSD, and also to a new epidemic of disturbed and violent veterans (Wessely & Jones, 2004). The actual number of Vietnam veterans who developed PTSD is unknown. Other research placed prevalence rates of PTSD at about one-third (Kulka, R. A., Schlenger, W. E., Fairbanks, J. A., Hough, R. L., Jordan, K. B., Marmar, C. R., & Weiss, D. S. , 1990). Also pertaining to the aftermath of the Vietnam War, studies have shown veterans suffering from PTSD also struggle with drugs and alcohol (White et. al, 2012; Bremner, J. D., Southwick, S. M., Darnell, A., & Charney, D. S., 1996). As many as 75% of male Vietnam combat veterans with lifetime PTSD had high levels of alcohol abuse or dependence (Brown, 2008; Kulka, 1990).
Link Between a Veteranís Mental Health Issues and Criminality
Novaco and Chentob (1998) found anger and aggression to be common manifestations of military and/or combat related trauma. In their study which compared veterans with and without PTSD, the research showed about 75% of the veterans with PTSD had engaged in physical aggressive behavior over the past year. Physical aggression was demonstrated in only 17% of the time in those veterans without PTSD.
One of the most recent studies conducted on the mental health of veterans was published in April of 2012. The study examined over 2,000 arrestees booked into the Maricopa County (AZ) jail in 2009. The interviews were conducted randomly from the inmate population and arrestees indicating military service were interviewed further. The research showed veterans to be 6.3% of the arrestee population (White et al., 2012). More than half of all veterans reported dealing with combat related issues, including PTSD, TBI, physical injury, substance abuse and other mental health issues (White et al., 2012). The study also found veterans more likely to report a mental health issue compared to non-veterans (40.9% versus 30.7%). The self-reported data analyzed by White and colleagues (2012) found that crack cocaine and opiate use is twice as common in veterans as non-veterans (veterans 16.7% and 12.1%; non-veterans 8.3% and 6.4% respectively). When looking at the charges of the various inmates, being a veteran was the most significant variable in predicting a violent criminal charge.
Soldiers returning home may have difficulty readjusting to life and could find themselves dealing with a slew of emotions after combat. Veterans are trained in violence and that violence may be necessary for survival. However, when they return home, the veterans have not learned to disavow the learned skill of violence (White et al., 2012). Similarly, William Brown has used the term ďmilitary total institutionĒ to describe the formal institution that develops and conducts the transitioning process of individuals form the civilian culture to the military culture beginning at the point of induction and extending to discharge (2011). As Brown argues, consistent with the sociological argument that people are products of their environment, the influences of the military total institution remains with many service members as they attempt to transition from being a service member to a veteran within the civilian culture (2011).
As such, some veterans may turn to alcohol and drugs as a way to self-medicate, which (if caught and convicted) can result in criminal charges. The symptoms of PTSD and other military service injuries can lead to behavior which may also draw the attention of the authorities (White et al., 2012). Veterans may be arrested for using marijuana as a coping mechanism, selling drugs for profit and affiliating with the violence associated with criminal activity (White et al., 2012). Moreover, Wilson and Zigelbaum (1986) argue ďcombat veterans are especially vulnerable to violent behavior if there exists an actual or perceived threatÖthere is an increased probability of violent behavior since they may revert to survival skills learned in the war to cope with the threatĒ (pp. 319).
Research has shown that combat exposure, PTSD symptoms, substance abuse, and other post deployment adjustment problems are correlated to veteran incarceration (White et al., 2012 as cited in McGuire et al., 2003; Saxon, Davis, Sloan, McKnight, McFall & Kivlahan, 2001; Yager, Lauger, & Gallops, 1984). Research from the National Vietnam Veterans Readjustment study shows an estimated 15.2% of men and 8.5% of women have symptoms of PTSD many years after the Vietnam War (Kulka et al., 1992). Combat exposure, trauma, substance abuse, PTSD symptoms and post deployment adjustment are predictors of veteran arrest (Saxon et al., 2001). Furthermore, criminalization of the mentally ill results in incarceration becoming their primary housing, including veterans suffering from such problems.
Although there is research showing a correlation between military service and criminal behavior, it is important to mention that the link between combat related problems, military service and criminality is of debate. One study found that mental illness was not a predictor of veteran incarceration (Erickson et al., 2008). However, the study did note veterans with mental illness had higher incarceration rates, but determined it not to be significant enough to deem mental illness a predictor (finding alcohol and drug use as a better predictor). The study also found that veterans exhibiting antisocial behavior after military service tend to have a history of conduct problems prior to military service. The study determined this by suggesting that depression may play an important part in antisocial behavior and it was not uncommon for individuals to have depression prior to enlistment (Erickson et al., 2008). Although there may be a debate throughout the literature, a recent case before the United States Supreme Court, Porter v. McCollum, (550 U.S. 30, 130 Sup. Ct. 447, 175 L. Ed. 2d 398, 2009), conducted a review of the existing literature and recognized the research as showing a substantial link between PTSD and criminality.
The Emergence of Veteranís Courts
Jurisdictions have responded to the increased amount of veterans in the criminal justice system by initiating veteranís courts. Veteranís courts work with authorities to determine the underlying causes of a veteranís criminal behavior so they may receive proper treatment. Veteranís courts are treatment courts which aim to provide rehabilitation to those individuals with mental health and substance abuse problems. This type of approach has been referred to as therapeutic jurisprudence. Therapeutic jurisprudence can be defined as an ďemerging field of law and a social science inquiry that explores the role of the law in fostering therapeutic or antitherapeutic outcomesĒ (Casey & Rottman, 2000, p. 445).
Veteranís courts are the newest addition to the larger theory of ďtherapeutic justice and problem-solving courtsĒ (Pratt, 2010, p. 51). Veteranís courts are designed especially for veterans who, after returning from military service, are charged with criminal offenses. The development of veteranís courts is because veterans within the criminal justice system have unique needs that slightly differ from what the mental health and drug courts offer (Russell, 2009).
There are differences between veteranís courts and drug or mental health courts. However, the differences are slight (Russell, 2009). A key difference between veteranís courts and drug and mental health courts is the emphasis of family involvement. While a primary concern is criminal activity, substance abuse and mental illness, veterans court also aim to address medical problems, homelessness, educational deficits, and family troubles with counseling (Russell, 2009). Another key difference between veteranís courts and other specialty courts is that, while in the program, the veteran is assigned a mentor who is also a veteran (Russell, 2009). The courts found mentors successful in relating to veterans through shared military experiences, and thus the veterans responded positively to their mentors and their treatment (Russell, 2009; Cavanaugh, 2011).
Research has shown drug and mental health courts to be successful. A recent article provides a review of the current empirical evidence relevant to community based alternatives to the prosecution of individuals with severe mental illness (Heilbrun et. al., 2012). The study found that overall reduction of the incidence of subsequent arrest and incarceration seems largely favorable for drug courts, community courts, mental health courts, and other similar courts. A study by Kalich and Evans (2006) found that in drug court programs, the more educated a person is the lower the chance of re-arrest within six months of admission to the program. Veteran arrestees are more likely than non-veteran arrestees to have completed at least some college (White et al., 2012). By analogy, as veterans are more likely to be educated versus nonveterans, it seems probable that they will also have a lower chance of re-arrest. There are two primary components of drug court programs: Intensive supervision and drug treatment (Kalich & Evans, 2006).Overall findings demonstrate that exposure to these two drug court components is linked to lower recidivism rates (Kalich & Evans, 2006). Moreover, the study also found that rates of recidivism after release from a drug court program were much lower than those in the comparison group. As veteranís courts are similar to drug and mental health courts, we can expect similar results.
Operation and Success of Veteranís Courts
The first veteranís court began in January 2008, in Buffalo, New York (Berenson, 2010). However, some accounts detail that Anchorage, Alaska established the first veteranís court in 2004 (Hawkins, 2010). The Buffalo veteranís court was implemented due to the belief that veterans have very unique needs that need to be addressed by the criminal justice system. The courtís mission is to ďsuccessfully rehabilitate veterans by diverting them from the traditional criminal justice systems and providing them with the tools they need in order to lead a productive and law-abiding lifestyleĒ (Russell, 2009, p. 364).
The Buffalo veteranís court was modeled after drug and mental health courts. The Buffalo court used the United States Department of Justiceís publication entitled Defining Drug Courts: The Key Components, in modeling this program (Russell, 2009). The Buffalo veteranís court aims to provide veterans dealing with substance abuse problems, mental health issues and emotional disabilities with life skills, job skills, academic training and placement services (Russell, 2009).
The Buffalo court allowed the defendants into the program before formal charging by the district attorney. The court program is at least one year in length and provides treatment and counseling for all mental health and substance abuse problems. The court found that veterans receiving treatment through the court responded much better to other veterans than the civilian community (Russell, 2009; Cavanaugh, 2011). Based upon this, the Buffalo court assigned a veteran mentor to each veteran defendant in the program (Russell, 2009).
Although there are no long term studies regarding the success of veteranís courts, the preliminary research has shown that veteranís courts have been successful in lowering recidivism rates (Hawkins, 2010). This is also true for the Buffalo veteranís court. As of December 2008, the Buffalo veteranís treatment court had seventy-five participants and three graduates (Russell, 2009). At the time of graduation, the veterans were substance free, receiving treatment for mental health concerns, had full-time employment or were full-time students and had suitable living arrangements (Russell, 2009).
The most common reason for supporting veterans courts is the notion that society must care for returning veterans who fought to maintain our freedom, and as a result have experienced things in war that no other ordinary citizen ever will (Hawkins, 2010). It is important to note that the implementation of veteranís court is not without opposition. The American Civil Liberties Union (ACLU) argues that veteranís courts create a class based criminal justice system and violates equal protection clauses (Hawkins, 2010).
As there is a link between mental health diagnoses and criminality in veterans, the establishment of veteranís courts is important to our judicial system. With the veteran population rising, the need for establishment of veteranís courts is also likely to rise. As society becomes more concerned with the veterans in the criminal justice system, veteranís courts are likely to continue emerging throughout the nation.
As noted above, many jurisdictions have responded to the issue of veterans in the criminal justice system by initiating a separate veteranís court. Veteranís courts work with authorities to treat veterans for the underlying causes of their criminality. Many veterans who have served their country undoubtedly experience mental health issues as a result of their service. The idea of veteranís courts is going to be an important area of research in the future. It is likely due to the success of the currently implemented veteranís courts that we will continue to see these types of specialty courts being established throughout the nation. Although the ACLU has argued against these types of courts, their opposition does not appear to have an effect on the operation and establishment of these courts.
As there is a link between mental health diagnoses and criminality in veterans, the establishment of veteranís courts is important to our judicial system. With the veteran population rising, the need for establishment of veteranís courts is also likely to rise. As society becomes more concerned with the veterans in the criminal justice system, veteranís courts are likely to continue emerging throughout the nation. . The continuing implementation of veteranís courts is important; so we may serve those who have served.
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ADVANCE \d4White, M. D., Mulvey, P., Fox, A. M., & Choate, D. (2012). A Hero=s welcome? Exploring the prevalence and problems of military veterans in the arrestee population. Justice Quarterly, 29(2), 1-29.
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* Jessie Vargas is a graduate student in the Criminal Justice Department at UNLV. This paper was an assignment for a graduate course called Seminar on the Administration of Justice.
 The term ďveteranĒ as used in this paper refers to any individual with military service, regardless of status (prior service, retired, reserve, or active duty).
The minimum length of the program is one year and as of the date of Russellís 2009 publication, most of the initial participants when the program began in 2008 had not yet had an opportunity to complete the full program.