2. 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.

3. 3 Agenda 2:00Welcome 2:05Larke N. Huang, SAMHSA 2:10David Morrissette, SAMHSA 2:15Henry J. Steadman, Policy Research Associates 2:20Jim Tackett, Connecticut Department of Mental Health & Addiction Services 2:40Nicholas Meyer, Policy Research Associates 2:55Question & Answer Period 3:15Conclusion of Webinar

4. Larke N. Huang, Ph.D.

5. David Morrissette, Ph.D.

6. Henry J. Steadman, Ph.D.

7. Why This Is Different Who Where What

8. Who National Guard and Reserve – 40% Women – Female engagement teams – Cultural support teams – Lioness

9. Where No single frontline

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

11. Los Angeles Jail Study (n=1,676) – 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%)

12. Jim Tackett, B.A.

13. Connecticut Military Support Program Provides free, confidential, statewide counseling services to Reserve Component Service Members And To their families

14. Military Support Program 425 licensed clinicians located throughout the State Accessed through a 24/7 call center

15. 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

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

17. Jail Diversion & Trauma Recovery SAMHSA, Center for Mental Health Services $2 million, 5 year grant – 1 st cohort Target population: – Our newest generation of Veterans returning from the Afghanistan and Iraq Wars – All Veterans experiencing trauma-related problems

18. 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, state’s attorneys, public defenders Partner with Statewide CIT program – Inform/Enlist assistance of police officers

19. Planning: Key Stakeholders Federal VA Regional Office (VBA) VA Connecticut Healthcare System (VHA: CT & VISN) Vet Centers (VR&C) DoD Naval Health Clinic New England, Groton Sub-Base Connecticut Military Department/National Guard Chief State’s 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

20. CT’s Approach: Systems Integration Emphasizes Pre-Booking – Focus on identifying, engaging and referring veterans at the earliest opportunity along the criminal justice continuum

21. Sequential Intercepts for Change

22. CT’s Approach: Systems Integration Integrates Services of Multiple Systems to strengthen access to appropriate and timely treatment/recovery support services Strong Services Coordination

23. CT’s Approach: Systems Integration Total Veteran Treatment Referrals (N=348) 10/1/2009 to 6/30/2011 VA Healthcare System116 Vet Center System25 Community Provider110 DMHAS/SMHA68 Other State Agency29

24. Referrals (N=348)

25. Veterans’ Focus of Treatment (N=128) Substance Abuse81 Mental Health68 PTSD38 Suicide Prevention7 Traumatic Brain Injury7 Gambling4 Family/Intimate Partner Violence5 Veterans Benefits35 Housing Services24 Vocational/Educational Services18 Medical29 Basic Needs15

26. Focus of Treatment/Services (N=128)

27. Connecticut’s 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

28. 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 351;13-22, 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

29. DMHAS Veterans’ Services Serving Connecticut’s Veterans, Citizen Soldiers and Their Families Jim Tackett, Director DMHAS/Office of the Commissioner 410 Capitol Avenue Hartford, CT 06134 860-418-6979

30. Nicholas Meyer, B.A.

31. 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

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

33. Firearms are for Defense and Security The United States Marine Corps “The Rifleman’s 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

34. Ask Our Speakers

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