Transcript Slide 1

Co-Occurring Disorders,
Veterans & the Justice System
Sponsored by
The Substance Abuse and Mental Health
Services Administration’s (SAMHSA)
Center for Substance Abuse Treatment (CSAT)
and
Center for Mental Health Services (CMHS)
through the
Co-Occurring Disorders Integration and Innovation
Task Order
Stay Connected
 Visit the Co-Occurring Disorders Integration and
Innovation (CODI) Web site at http://coce.samhsa.gov
for key CODI resources, events, trainings and learning
tools
 Visit the Substance Abuse and Mental Health
Services Administration (SAMHSA) Web site at
http://www.samhsa.gov/ for other valuable resources.
 Join the CODI List Serve to receive event
announcements, product debuts, and much more.
– Send an email to [email protected] with “Subscribe”.
Presentation Overview
1. National and Community Priority
2. Veterans in the Justice System
3. Addressing Co-Occurring Disorders in Justice Settings
4. Risk Factors
5. Screening
6. Systems and Services Integration
7. Management and Supervision
(1) National Priority
(1) Strengthening Our Military Families
“Enhance the well-being and psychological health of the
military family
–
“By increasing behavioral health services through
prevention-based alternatives and increasing communitybased services
–
“By ensuring availability of critical substance abuse
prevention, treatment, and recovery services for Veterans
and their families
–
“By making our court systems more responsive to the
unique needs of Veterans and families”
(1) Leading Change
Military Families Strategic Initiative
–
“Supporting America’s service men and women—Active
Duty, National Guard, Reserve, and Veteran—together
with their families and communities by leading efforts to
ensure that needed behavioral health services are
accessible and that outcomes are positive.”
(1) A Court-Based Response
 Veterans Treatment Courts
– Growth
 50 courts established since the first docket was established
in January 2008
– Legislation
 Illinois, Nevada, and Texas
 Similar legislation passed in California and Minnesota
granting judges the discretion to order a veteran with combatrelated behavioral health service needs into treatment in lieu
of prison
(2) What are the reasons for focusing on
veterans in the justice system?
Persons Reporting Military Service
Philadelphia, PA
Travis County, TX
Time Period
1/2007–5/2010
(41 Months)
9/2008–11/2008
(3 Months)
% of Total Bookings
4.5%
3.4%
Average Monthly Bookings
193
153
% with Honorable Discharge
87%
86%
Branch of Service
48% Army
19% Navy
7% National Guard
50% Army
21% Navy
6% National Guard
Most Serious Charge
56% Misdemeanor
44% Felony
73% Misdemeanor
27% Felony
This table reviews the characteristics of inmates reporting service in the military at the jails in
Philadelphia, PA, and in Travis County, TX. Inmates with military service represented
approximately 4% of intakes. The majority had an honorable discharge, half served in the Army,
and most serious charge was a misdemeanor.
(3) Criminal Justice & Co-Occurring
Disorders
 A non-addictive mental disorder occurring
simultaneously and independently with an addictive
disorder
 Community corrections agencies are a major source of
referrals for community-based substance abuse
treatment
 Three quarters of jail inmates with a mental disorder
have a co-occurring substance use disorder
(3) Failure to Address COD
 Non-integrated approaches result in poor outcomes
– Lack of treatment engagement and adherence
– Continued use of ER, inpatient hospitalization
– Continued contact with criminal justice system
– Symptom recurrence
– Inappropriate treatment recommendations
– Overuse of medications
– Problems in working, family, and social roles
– Medical problems
(3) Prevalence of COD in Justice Settings
 Serious mental illness among jail inmates
– Axis I—schizophrenia spectrum, bipolar disorder, major
depression
 15% for men
 31% for women
 Co-occurring substance use disorder
– 72% to 75%
 13 million jail admissions between midyears 2008 and
2009
– 1 million are of people with co-occurring disorders
(4) 2 Million Deployed Since 2001
 Stressors facing veterans of OEF/OIF
– Long deployments
– Multiple deployments
– Reduced dwell time
– Behaviors adapted for the combat zone don’t transition
well to civilian life
 National Guard and Reservists have less support than
Active Duty
– Rapid demobilization
– Loss of support from unit peers
(4) Readjustment to Civilian Life
 Family strife
 Unemployment
 Access to alcohol and drugs
 Hyper vigilance
 Difficulty talking to anyone but unit peers
 Maintaining operational secrecy
 Access/willingness to use VA services
 TRICARE not offered by many healthcare providers
 Concerns with receiving behavioral healthcare
(4) PTSD & TBI among OEF/OIF
 RAND Survey of 1,965 returning veterans
– 18.5% had a mental illness
– 19.5% had a traumatic brain injury
 Post Deployment Health Assessments
– PTSD increases by 40% for Active Duty and 90% for
National Guard/Reserve in six months after returning
home
(5) Screening for Military Service
 Are you a veteran?
 Have you ever served in the U.S. Armed Forces?
(5) Types of Screens
 Co-occurring disorders
 Trauma and PTSD
 Criminal risk and need
(6) Eligibility for VA Health Services
 Factors that affect eligibility
– Active military service
– Reservists and National Guard members called to active
duty
– Discharge status
– Resources vary by priority groups
– Returning OEF/OIF have 5 years after discharge date
 Only 40% of eligible veterans use VA services
(6) Veterans Health Administration
 Veterans Integrated Service Networks
– VA Medical Centers
– Community Based Outpatient Clinics
 Vet Centers
(6) Developing Linkages with VA
 Network Level
– Network Homeless Coordinators
 Facility Level
– OEF/OIF Coordinators/Point of Contact
– Veterans Justice Outreach Specialist
 Vet Centers
(6) Community Partners
 Criminal Justice
– Judges, Prosecutor’s Office, Public Defender’s Office,
Court Administration, Law Enforcement, Jail, Probation
 Behavioral Health
– County/City Behavioral Health Agency(ies) and
Providers, Homeless Service Providers
 Veteran Organizations
– Veterans Service Organizations, Vet Center,
VAMC/CBOC, VISN, National Guard, Military Family
Organizations, Veteran Peer to Peer Providers
(7) Principles of Addressing COD in
Justice Settings
 Both disorders are primary
 Expect co-occurring disorders
 No wrong door
 Integration of treatment services
 Individualized programming
 Treatment comprehensiveness and flexibility
 Focus on motivation and engagement
 Graduating the intensity of treatment
 Service continuity
 Recovery support
23
(7) Integrated Approach for JusticeInvolved Veterans with COD
 Integrated approach needs to address
– Co-occurring disorders
– Criminal risks and needs
– Needs specific to veterans status (i.e., service-related
injury and disability)
 Need to address all three domains
 Lack of focus on co-occurring disorders will result in poor
program outcomes, including non-adherence to
treatment and supervision plans
(7) Case Management
 Effective case management strategies for justiceinvolved people with co-occurring disorders
– Focus on multiple needs—behavioral, medical, criminogenic, disability
– Motivational over confrontational approaches
– Graduated sanctions
– Provide support around daily activities
– Monitor attendance and compliance with treatment
– Work with supportive family members
– Respect the role of probation/parole supervision, court monitoring and
reporting
(7) Team Approach
 Establish a common language between behavioral
health providers, criminal justice agencies, and VA
 Develop treatment, supervision, and reporting plans that
are agreed upon by all parties
 Establish a graduated sanctions plan that may or may
not include jail days
 Use treatment practices that address co-occurring
disorders and criminogenic risks and needs
 Case managers and community corrections officers may
need smaller staff to client ratios
Guiding Questions
 Is linkage to the VA a viable option?
 Does the veteran have private insurance, Medicaid, or
TRICARE?
 How will you address trauma?
 Does this justify a new program or a recalibration of a
current program?
 How can this be conducted using an integrated
approach?