By J. Justin Collins, CLASV AmeriCorps Summer 13 Fellow & Student Advisor

Since 2001, approximately 2.2 Million servicemen and women have deployed overseas in support of Operation Enduring Freedom (“OEF”) and Operation Iraqi Freedom (“OIF”). [i]  Of these deployed servicemembers, 36.7% took small arms fire, 48% killed an enemy combatant, 51% handled human remains, 28% were responsible for the death of a non-combatant, and 86% knew someone who was killed or seriously injured.[ii]  As these men and women return from overseas, they bring with them a different kind of battlefield trauma: the invisible wounds of war.  Now more than ever before, mental health injuries and other cognitive disorders are the most substantial threat to the health and wellbeing of our returning veterans.

While Post-Traumatic Stress Disorder (“PTSD”), Traumatic Brain Injury (“TBI”), and other combat related mental health conditions are relative newcomers to the realm of clinical pathology, their effects are nothing new.  We have observed the psychological effects of battlefield trauma for generations.  However, lacking a true understanding of these conditions, they were mistakenly described as insanity, melancholia, shell-shock, combat fatigue, and nervous exhaustion.[iii]  It was not until after the War in Vietnam that researchers began to explore the effects of combat on veterans’ mental health.[iv]  The American Psychiatric Association only formally recognized PTSD as a mental health pathology in 1980 when it was included in the Diagnostic and Statistical Manual of Mental Disorders.[v]

Armed with a greater understanding of theses invisible wounds, we are now aware that our combat veterans face substantial psychological challenges as they return home and attempt to transition back into their families and communities.  According to the National Center for PTSD, approximately 770,000 OEF/OIF Veterans are currently suffering from PTSD.[vi]   These veterans often experience flashbacks, hyper-vigilance, exaggerated startle response, difficulty concentrating, loss of sleep, irritability, depression, and bouts of uncontrollable rage.[vii]  Without treatment, those suffering from these conditions treat their symptoms by avoiding stimuli associated with the trauma, withdrawing from social settings, practicing emotional avoidance and isolation, and self-medicating with drugs and alcohol.[viii]

Perpetuated by misunderstanding and an ingrained military culture of denial, many veterans don’t recognize their illness or don’t seek treatment for fear of being seen as fragile or weak.[ix]  As these invisible injuries continue to go untreated, they lead to more serious problems.  Emotional withdrawal and anti-social behavior lead to interpersonal problems, friction with family and friends, depression, self-blame, and guilt.[x]  But the challenges for those suffering from mental health injuries do not stop there.

Eventually, veterans begin to face problems of unemployment, homelessness, and criminality.[xi]  The number of OEF/OIF Veterans living on the streets, at risk of losing their homes, living in temporary housing, or receiving federal vouchers for rent has more than doubled since 2010.[xii]  Studies are also showing a link between combat related mental illness and substance abuse.[xiii]  As these invisible wounds continue to go untreated, suffers fall into a cycle of addiction, associated criminality, arrest, prosecution, conviction, incarceration, release, relapse, criminality and re-arrest.[xiv]  Unsurprisingly, approximately 346,500 veterans are currently incarcerated in our jails and prisons.[xv]

Fortunately, a new judicial model, the Veterans’ Court, promises to put an end to this vicious cycle.  An innovative spin on a familiar concept, veterans’ courts are modeled after the popular drug treatment court approach.  The basic structure is simple.  Justice involved veterans, who have a treatable mental health or substance abuse condition related to or resulting from their combat service, are diverted out of the traditional criminal justice system into a special veterans’ court docket.[xvi]  Instead of going to jail, a veteran agrees to plead guilty to a suspended sentence and begins a program of judicially supervised treatment.

This non-adversarial approach relies upon two fundamental principles: treatment and accountability.[xvii]  Veterans in the program participate in regular court appearances, random drug testing, a sanction and incentive structure, intensive and coordinated rehabilitation and education, and supervision by law enforcement.[xviii]  If the veteran recidivates, their sentence is imposed and they are incarcerated.  However, if they successfully complete their treatment program, they are released from their sentence and can rejoin society.[xix]

A unique aspect of the veterans’ court model is that it can function on little additional funding.  Because justice involved veterans are already eligible for services through the VA Veterans Health Administration, no additional funding is required for mental health and substance abuse treatment services.[xx]  Additionally, partnerships with community service organizations and veterans outreach groups provide further resources.  In addition to VA treatment services, veterans’ courts have been successful in bringing together resources for academic and vocational skills improvement, residential/housing assistance, outpatient and transition support, and job placement and job retention services.[xxi]  Volunteer commitments from court staff and case managers can bring the remaining cost to almost negligible amounts.[xxii]

The veterans’ treatment court model is also designed specifically to serve military clientele.  Many veterans’ courts have implemented mentorship programs to pair current program enrollees with veterans who have survived their own struggles with mental health injuries.[xxiii]  Finding that veterans were more likely to respond favorably to another veteran than to others who did not have similar experiences, the mentorship component is proving to dramatically increase the effectiveness of the veterans’ court model.[xxiv]  The hierarchical structure of the veterans’ court approach is also producing favorable results.  As veterans enter the program, many treat the court as a chain of command with the judge as a quasi-commanding officer.[xxv]  Familiar and comfortable with this paradigm, veterans are often seen standing before the judge at ‘parade rest’, entirely of their own accord.[xxvi]

Perhaps most importantly, the veterans’ court model works.  A survey of veterans’ courts from across the country shows a successful program completion rate of 69%.[xxvii]  While the veterans’ court approach has not been around long enough to generate statistically significant samples, similar diversion and treatment models have been effective at reducing recidivism rates from 70% without any program to between 16% and 27% for successful graduates.[xxviii]  In addition to producing results for veterans, this model is also reaping benefits throughout the community as well.  The clustering of veterans within the program allows for more efficient disbursement of VA treatment resources.[xxix]  While incarceration costs an average of $30,000-$32,000 per inmate/per year, a successful veterans’ court completion costs only $2700, simultaneously alleviating overcrowded prisons and the burden on the taxpayer.[xxx]

As this model continues to provide incredible results for veterans and their communities, we move closer to achieving a realistic and sustainable judicial approaching to treating the invisible wounds of war.  Veterans’ Treatment Courts are now operating in 168 jurisdictions across the country with resounding success.[xxxi]  By focusing on treatment of the underlying condition, this model is breaking the cycle of recidivism, reducing a substantial burden on our criminal justice system, making our communities safer, and giving our veterans the opportunity to become productive members of society once again.