VISN-7 has a long history of reaching out to Veterans who involved with the Justice System. Initially it was mainly the Homeless Programs involvement with the State Departments of Correction, but with the hiring of nine Transition Patient Advocates in August 2008, a unique opportunity was afford the Veteran when this team emulated the VISN 19 Tribal Veterans Representative Program developed by James Floyd and WJ ‘Buck’ Richardson, Jr, Minority Veterans Program Coordinator. Mr. Biro who currently serves as the Southeast Network Director had been the Director in VISN 19 and was the driving force that expanded the tribal outreach program to better meet their needs. He was committed to providing the same intensity and quality of outreach to the Veterans who periodically need assistance in understanding and accessing benefits and healthcare services. One of the target groups that were identified early as need this level of assistance were the Veterans who were involved with the Justice System and their families.
VISN-7, the Southeast Network serves the ninth largest veteran population and encompasses an area containing VA medical centers and outpatient clinics in Alabama, Georgia and South Carolina.It is comprised of three states with Atlanta, Birmingham, Columbia, Charleston, Montgomery, and Savannah being the larger population area, but most of the area is rural with no public transportation and few services.
Each VJO was assigned to map the catchment area of the local Medical Center with the contact information for all Diversion, Mental Health, and Drug Courts, Law Enforcement Agencies and Detention Centers so that we can make contact with each facility.
The Sequential Intercept Model was identified as the a conceptual frameworkfor the Southeast Network to use when designing our Veterans Justice Outreach Program in which we work withthe criminal justice system and both the VA and community mental health systems as we began our efforts to addressconcerns about criminalization of Veterans with mental illness.This model envisions a series of points of interception at whichan intervention can be made to prevent individuals from enteringor penetrating deeper into the criminal justice system. Our goal is that as the program becomes more functional across the system thatmost Veterans will be intercepted at early points, with decreasingnumbers at each subsequent point. The interception points arelaw enforcement and emergency services
Prearrest diversion programs are the first point of interception.Even in the best of mental health systems, some people withserious mental disorders will come to the attention of the Justice system. Since deinstitutionalization "law enforcementagencies have played an increasingly important role in the managementof persons who are experiencing psychiatric crises." The policeare often the first called to deal with persons with mentalhealth emergencies. Law enforcement experts estimate that asmany as 10 percent of patrol officer encounters involve persons with mental disorders. Accordingly, law enforcementis a crucial point of interception to divert people with mentalillness from the criminal justice system if they are trained to appropriately intervene and if they have the infrastructure developed that provides them the back-up resources needed to assist Veterans in a crisis.Historically, the Department of Veteran’s Affairs and law enforcement agencieshave not worked closely together. There has been little jointplanning, cross training, or planned collaboration in the field.Law Enforcement Officers have considerable discretion in resolving interactionswith people who have mental disorders. Arrest is sometimesthe only option when officers lack knowledgeof alternatives and cannot gain access to needed services, they may usearrest as the only available disposition for Veterans who clearlycannot be left on the street.The literature reports several strategies used byLaw Enforcement, with or without the participation of local VAMC, to more effectively deal with personswith mental illness who are in crisis in the community: mobilecrisis teams of mental health professionals, mental health workersemployed by the police to provide on-site and telephone consultationto officers in the field, teaming of specially trained policeofficers with mental health workers from the public mental healthsystem to address crises in the field, and creation of a teamof police officers who have received specialized mental healthtraining and who then respond to calls thought to involve peoplewith mental disorders. The prototype of the specialized policeofficer approach is the Memphis Crisis Intervention Team (CIT) which is based on collaboration between law enforcement,the local community mental health system, and other key stakeholders.A comparison of three police-based diversion models foundthe Memphis CIT program to have the lowest arrest rate, highutilization by patrol officers, rapid response time, and frequentreferrals to treatment.
Pre-arrest is the ideal point of interception and the most desirable, but most of our referrals are coming after the Veteran has been placed in detention or is scheduled for the initial hearing. Currently we are getting referrals from numerous Detention Centers across the VISN. Veterans Advocates, Veterans Justice Outreach Specialists, Reentry Specialists, and the Network Homeless Coordinator are all getting calls requesting that they assist a Veteran who isInvolved with the Justice System. Law enforcement is inviting us in to educate and interview Veterans in the Detention Centers which is a dramatic changes from one year ago. Families are calling and asking us to help Veterans who are incarcerated, but who they feel needs treatment. They have ranged in age from early twenties to late seventies.
In the future our goal is that the majority of Veteran offenders with mental illness who meetcriteria for diversion will have been filtered out of the criminaljustice system in intercepts 1 and 2 and will avoid incarceration. Currently, however, it is clear that both local jails and stateprisons house substantial numbers of Veterans with mentalillnesses. In addition, studies in local jurisdictions havefound that Veteran inmates with severe mental illness are likelyto spend significantly more time in jail than other Veteran inmateswho have the same charges but who do not have severe mentalillness. It is imperative that we set up a system that provides prompt access to Evidence Basedtreatment in local settings to stabilizationand successfully transition the Veteran to the communityAn intercept 3 intervention that is currently receiving considerableattention is the establishment of a separate docket or courtprogram specifically to address the needs of individuals withmental illness who come before the criminal court, so-calledmental health courts or Diversion Courts. These special-jurisdictioncourts focus on problem-solvingstrategies and linkage to community treatment to avoid furtherinvolvement in the criminal justice system of the Veteranswho come before them. The National GAINS Center estimates thatthere are now 114 mental health courts for adults in the UnitedStates.
Judge Bethel is the Chief Magistrate State Court Judge in Dekalb County, Ga. Stand Down Court was introduced to Judge Bethel as a needed intervention due to the continued increased number of Veterans who have been arrested and the profound effect on Veterans not being able to receive treatment and to the continued episodes of homelessness due to outstanding warrants and pending court hearings. Judge Bethel embraced the concept and networked with the court system within the county to set up the first Stand Down Court in the Southeastern Region.There were a total of 13 Veterans who had there cases heard. 8 out of 13 cases were resolved. The remainder of the cases were reset and the Dekalb attorneys are continuing to work with the Veterans.
Opening of the first Veteran’s Court in Forsyth, Georgia
Currently we have 1452 Veterans in State Prisons in SC and 3000 in State Prisons in Georgia. Continuity of care between corrections and VA health systems for Veterans with mental illness wholeave correctional settings. Typically, communication betweenthe two systems is limited, and the Reentry Specialist must communicate to the Veteran about services available and the health system as the VA systemmay be unaware when Veterans are incarcerated or scheduled for release. The VA rarely follow their clients once theyare incarcerated. In a recent survey of jails in New Jersey,only three jails reported providing release plans for a majorityof their inmates with mental illness, and only two reportedroutinely providing transitional psychotropic medications uponrelease to the community.Nationally, the issue of facilitating continuity of care andreentry from correctional settings is receiving increasing attention.In part, these efforts are fueled by class action litigationagainst local corrections and mental health systems for failingto provide aftercare linkages. In addition,pressure is increasing on corrections and mental health systemsto stop the cycle of recidivism frequently associated with peoplewith severe mental illness who become involved in the criminaljustice system . Our reentry program is breaking new ground with its focus on assessing, planning,identifying, and coordinating transitional care. Some stateshas implemented a forensic transitional program for offenderswith mental illness who are reentering the community from correctionalsettings The Reentry program provides "in-reach" into correctionalsettings six months before release and follows individualsfor up to four months or until referred to another case manager after release to provide assistance in makinga successful transition back to the community.
Some people may argue that the basic building blocks of an effectivemental health system are lacking in many communities, and thereforeefforts to reduce the overrepresentation of people with mentalillness in the criminal justice system are futile. This argumentis not persuasive. Even the most under funded mental health systemscan work to improve services to individuals with the greatestneed, including the group of people with serious and persistentmental disorders who have frequent interaction with the criminaljustice system. Such efforts require close collaboration betweenthe mental health and criminal justice systems.The Sequential Intercept Model provides a framework for communitiesto consider as they address concerns about criminalization ofpeople with mental illness in their jurisdiction. It can helpcommunities understand the big picture of interactions betweenthe criminal justice and mental health systems, identify whereto intercept individuals with mental illness as they move throughthe criminal justice system, suggest which populations mightbe targeted at each point of interception, highlight the likelydecision makers who can authorize movement from the criminaljustice system, and identify who needs to be at the table todevelop interventions at each point of interception. By addressingthe problem at the level of each sequential intercept, a communitycan develop targeted strategies to enhance effectiveness thatcan evolve over time. Different communities can choose to beginat different intercept levels, although the model suggests more"bang for the buck" with interventions that are earlier in thesequence.
Veteran's Justice Outreach: A Team Approach
Veteran’s Justice Outreach: A Team Approach<br />Patricia A. Bradford<br />Robin Anderson<br />Jenifer Turner-Reid<br />
Mapping<br />VJO has identified:<br />Courts<br />Law Enforcement<br />Detention Centers<br />With Points of Contact<br />Address: Location and Email<br />Telephone Number<br />
Sequential Intercept Model<br />Basic Framework on which program was designed.<br />Points of Intercept<br />Law Enforcement and Emergency Services<br />Initial Detention and Initial Hearings<br />Jail, Courts, Forensic Evaluation and Forensic Commitments<br />Reentry from jails, prisons and forensic hospitalization<br />Community Corrections and Support<br />
Law Enforcement and Emergency Services<br />VISN-7 Patient Safety Officer established a dynamic partnership with EES and NAMI to provide training to Law Enforcement and VA Staff.<br />Georgia CIT Advisory Board<br />Mission: Train Law Enforcement to effectively assist individuals with mental illness and brain disorders who are in crisis, thereby advancing public safety and reducing the stigma commonly associated with Mental Illness.<br />
Initial Detention and Initial Hearings<br />Respond to referrals from Law Enforcement, Families and Veterans.<br />Veteran Advocates visit in the Detention Centers<br />Veteran Advocates provide education to Detention Center and Law Enforcement Staff<br />Veteran Advocates attend the Initial Hearings with the Veterans<br />
Jail, Courts, Forensic Evaluation and Forensic Commitments<br />Veterans Justice Outreach Specialist contacts the Diversion, Mental Health and Drug Courts.<br />Form letter of introduction<br />Follow-up telephone contacts<br />Visits to the Courts meeting with staff<br />
Veterans Court at Stand Down in Atlanta<br />Staff talked with Judge Bethel and introduced the idea of a Veteran’s Court.<br />Staff met with staff from the Court and discuss the concept.<br />Court Staff expressed interest and invited Judges, Pretrial Intervention, Solicitors Office and<br />Planned a VISN wide training by Steve Binder<br />
First Veteran’s Court<br />Forsyth, Georgia<br />Result of a positive experience of a Veteran and his family<br />First Veteran was a success story<br />Chief MH-RRTP and the Court are working on a transition process for referral.<br />
Additional Veterans Courts<br />Savannah, Georgia<br />Richmond County (Augusta Georgia)<br />Columbus, Georgia<br />Montgomery Alabama<br />Phenix City, Alabama<br />Tuskegee, Alabama<br />
Reentry from Jails, Prisons and Forensic Hospitalization<br />Two VISN level Reentry Specialist who visit all State and Federal Prisons meeting with the Veterans and assessing those within 6-months of release. <br />Screened 700 FY2009<br />161 State Prisons/9 Federal Prisons<br />NHC is working with the DMH Forensic Unit to schedule a training program and develop a system of both communication and referrals.<br />
Community Corrections and Support<br />Probation and Parole<br />Individual contacts<br />Meetings with State Office Staff<br />Participate in State Training Conferences<br />Presentations at Annual State Conference<br />Member of State and DeKalb County Advisory Boards<br />
Current Projects to Improve Services<br /><ul><li>One point of entry into the Health Care System to monitor number of enrollees
Initial Assessment Instrument to be completed to initiate more appropriate referrals.
A Review Process to address any Veteran identified as not receiving indicate services in a timely manner.
Network Homeless Coordinator function as Resource Person for the VISN
V-TEL as an option.</li></li></ul><li>Discussion<br />What Progress have we made toward delivering much needed services?<br />What are the Major Barriers for Implementation?<br />What do we need to do to improve our delivery of services/<br />