There have been some new ideas coming out the VA Mental Health Summits currently being conducted by the Veterans Health Administration (VHA) across the United States. One that is particularly impressive to me is the Oklahoma County, Oklahoma, Veteran’s Diversion / Treatment Court. This program goes a few steps further than the more common “Veteran’s Courts” modeled after the program developed by Judge Russell’s court in Buffalo, New York. Most of the Vet Courts under the Judge Russell model coordinate services through their local VA Veterans Justice Outreach coordinator and utilize the local VHA mental health providers and services. The Oklahoma County model has created a partnership with a local community based mental health provider to support their program. It utilizes community resources for drug and alcohol treatment, support group meetings, job or vocational counseling as well as education and community supervision.
The Oklahoma model makes sense for many reasons. One reason is the high number of OIF/OEF/OND veterans being diagnosed with combat related mental health issues and traumatic brain injuries. According to a recent government report, only 56 percent (899,752) of veteran’s of OEF/OIF/OND separated from service from 2001 to December 31, 2013 have used VA health services. There should be concern with this number considering Honorably Discharged veterans (National Guard, Reservists and Active Duty) of OEF/OIF/OND were eligible for VA Health Care services for 5 years after discharge. All that was required was enrollment into the VA Health program. Of this number 519,721 or 57.8 percent of those serviced are reported to be experiencing musculoskeletal conditions (TBI, neck and back trauma’s, etc.). Another 486,015 or 54 percent are dealing with mental disorders. An additional 478,267 or 53.2 percent are experiencing “conditions that do not have an immediately obvious cause or isolated laboratory test abnormalities”. Per the report a veteran could be counted under more than one diagnosis. Based on these numbers there is a possibility that there are 404,000 individuals with unidentified musculoskeletal conditions; 378,000 with undiagnosed mental health disorders, and 372,000 in the undefined combat related trauma category.
There is also a strong perception that, like other wars, veterans of the current conflicts are not comfortable utilizing VHA mental health programs and services. The most common feedback from the veterans I have personally served has been fear of losing their military career and as one veteran described, fear of becoming a “Pharmacological Zombie”. Another concern according to other recent studies, from the year 2008 through 2011 there were approximately 21,000 Marine and Army veterans discharged from the service under “Less Than Honorable” conditions. Many reports indicate a number of those discharged could have tested positive for TBI and mental health diagnoses. Soldiers with “Less Than Honorable” discharges do not qualify for VA health care services, lose their VA educational benefits and in a majority of cases would not qualify for the Veteran Court programs supported by the Veterans Justice Outreach teams. With this in mind, the probability of the number of unidentified veterans with musculoskeletal, mental health problems and undefined unexplained conditions could be even greater.
The VA is conducting the Mental Health Summits because the magnitude of combat trauma issues is overwhelming their system physically and fiscally. The need for community partnerships cannot be denied. The creation of the “Ending Veterans Homelessness” initiative by Secretary of the VA, General Shinsecki , the creation of the “Veteran Justice Outreach” program and the VA HUD-Veterans Affairs Supportive Housing (VASH) over the past few years are indicators of where local communities will experience the greatest impact. Rather than treat the symptoms, the next steps need to include community partnerships in addressing the causes. As the numbers indicate, there are a lot of veterans either not utilizing or ineligible for services. Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) are being cited as the most recognized problems, or “Signature Wounds” resulting from OEF/OIF/OND. Collaboration with local providers can provide an alternative healthcare environment for veterans who might hesitate to utilize the VA programs. It also provides the VA with partnerships to “Best Practice” approaches and alternative treatment plans for more difficult PTSD and TBI situations. Another valuable aspect to these community relationships involves the veteran’s family. Traditionally the VA only serviced the veteran. Though they are making efforts to work with families, most community providers already implement family and community education and outreach into their clinical programs.
These are just a few of the reason’s true “Jail Diversion” programs like the one working in Oklahoma County should be considered in the evolution of the VA Vet Court models. As veterans of OEF/OIF/OND with undiagnosed (and possibly misdiagnosed) TBI and mental health disorders move beyond their 5 year eligibility windows, the burdens of care will be transferred to local and state entities and the veteran’s family. The burden of treatment of the combat trauma veterans directed out of the military under “Less Than Honorable” conditions also shifts the responsibility to the family or solely to the individual. When the family and the community reach the breaking point, the problem is handed over to the court systems, homeless shelters, prisons or in extreme cases mortuaries to handle. From my professional experience it is so much easier to case manage a veteran with community service and family support over the homeless shelters, working with probation and parole obstacles, and counseling them in prison. The Oklahoma County Courts Veterans Program is educating the local community on the value of treatment over incarceration. Hopefully, this will serve as a successful model to be adopted in other locations across our country.