Identifying Promising Prevention Strategies and Interventions to Support Justice-Involved Veterans

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An estimated 8 percent of the 2.2 million people incarcerated in jails and prisons in the United States are veterans, and an unknown number of veterans have had other types of contact with the criminal justice system. A better understanding of these justice-involved veterans can help military leaders, policymakers, and veteran-serving organizations identify promising interventions to prevent veterans from entering the criminal justice system and to support formerly incarcerated veterans as they reintegrate into their communities.

Veterans make up approximately 8 percent of the 2.2 million people incarcerated in jails and prisons in the United States—a share similar to that of veterans in the general U.S. adult population (7 percent) (Bronson et al., 2015; Vespa, 2020). This represents a decline in the proportion of incarcerated veterans compared with prior generations of veterans. In the 1970s and 1980s, veterans were overrepresented in jails and prisons. For example, in 1978, only 19 percent of U.S. adults were veterans, but veterans accounted for a quarter of the incarcerated population (Bronson et al., 2015).

There is some evidence that veterans who served after the U.S. military's transition to an all-volunteer force (i.e., in the post–Vietnam War era) have been less likely to come into contact with the criminal justice system (Greenberg and Rosenheck, 2009, 2011), but it is difficult to know whether this is indicative of a shift in military culture, changes in the criminal justice system, or selection-related factors, such as the implementation of more-stringent military accession standards. Veterans with posttraumatic stress disorder (PTSD) are also more likely to be arrested for violent offenses and to be involved with the criminal justice system compared with veterans without PTSD (Taylor et al., 2020); it is possible that the recognition of PTSD as a diagnosis (in 1980) and advances in its treatment (Watkins, Sprang, and Rothbaum, 2018) have also helped prevent veteran criminal justice involvement over the years by addressing PTSD as a potential common risk factor.

The research on veterans who have come into contact with the criminal justice system—whom we refer to as justice-involved veterans—is extremely limited. Over the past decade, there have been very few rigorous studies with large sample sizes. It has been historically difficult to secure funding for research on the needs of incarcerated and formerly incarcerated populations (Boch et al., 2023). However, there has been renewed interest at the national level in how military service and military-to-civilian transitions affect the risk of justice system involvement, as well as the specific needs of formerly incarcerated veterans as they reenter their communities. In 2022, the Council on Criminal Justice launched the nonpartisan Veterans Justice Commission, chaired by former Secretary of Defense Chuck Hagel, to explore these questions and issue evidence-based recommendations for policy change (Council on Criminal Justice, undated).

A Look at the Incarcerated Veteran Population

Not all justice-involved veterans are incarcerated in jails and prisons. There are no reliable statistics on the total number of justice-involved veterans (Council on Criminal Justice, 2022). Across the population of justice-involved veterans, we have the clearest picture of the differences between incarcerated veterans and their nonveteran counterparts, in part because the Bureau of Justice Statistics conducts periodic surveys and publishes reports specific to incarcerated veterans. These survey data are among the best sources of information about justice-involved veterans. The bureau's most recent survey, conducted in 2016, showed that 98 percent of veterans in state and federal prisons were men and that they were older and more likely to be White and serving longer sentences than incarcerated nonveterans (Maruschak and Bronson, 2021). Figure 1 provides an overview of demographic and military service characteristics of incarcerated veteran men as of 2016 and shows how they compare with incarcerated nonveteran men in terms of age and with veteran men overall in terms of race/ethnicity.

Although these data provide insight into the characteristics of incarcerated veterans, it is important to note that this is just a subset of the larger population of justice-involved veterans. Although data specific to veterans are not available, research suggests that around 75 percent of the correctional population in the United States is on probation or parole (Blodgett et al., 2015). Therefore, it is likely that a substantial proportion of justice-involved veterans are also on community supervision. Non-incarcerated justice-involved veterans also include those who are awaiting trial, enrolled in court-mandated rehabilitation or treatment programs, or completing community service requirements, and still others continue to owe court fees and fines for criminal offenses. Any type of justice system involvement has potential consequences for a veteran's ability to find employment and housing, and a criminal record could be a disqualifying factor in veterans' eligibility for some types of support services. For veterans who are convicted of a crime during military service, the consequences could include an other-than-honorable discharge and loss of benefits from the U.S. Department of Veterans Affairs (VA). Veterans who are classified as fugitive felons after evading a warrant or violating their parole are barred from receiving VA health care benefits (VA, 2019). This highlights the importance of better estimating the size of the population of justice-involved veterans.

The Prevalence of Mental and Behavioral Health Conditions and Homelessness Among Justice-Involved Veterans

From a clinical perspective, the needs of justice-involved veterans are consistent with those of justice-involved adults overall—namely, mental health and psychosocial support, such as housing. However, studies have shown that justice-involved veterans are more likely to live with a mental health condition than the general veteran population (Blodgett et al., 2015). A recent systematic review reported the prevalence of mental health concerns across studies of justice-involved veterans, finding that as many as two-thirds of justice-involved veterans are estimated to have alcohol or substance use disorders, and mental health diagnoses are common, including depression (affecting an estimated 14–51 percent of this population), PTSD (4–39 percent), and psychotic disorders (4–14 percent) (Blodgett et al., 2015). As a point of comparison, VA estimates that rates of PTSD were approximately 2–15 percent among the general veteran population (VA, 2023). There is also evidence that—similar to trends among nonveterans—justice-involved veteran women are more likely to have a mental health disorder than justice-involved veteran men. However, while incarcerated nonveteran women have comparable rates of substance use disorders to incarcerated nonveteran men, incarcerated veteran women are actually less likely to have a substance use disorder than incarcerated veteran men (Finlay et al., 2015; Fazel, Yoon, and Hayes, 2017).

Many justice-involved veterans and nonveterans have a history of trauma exposure (Blodgett et al., 2015). Research has suggested a link between combat exposure and both justice system involvement and violent behavior, although this has not been supported by all studies (see, e.g., Elbogen et al., 2010; Elbogen et al., 2012; Finlay et al., 2019). Very few studies have looked at the prevalence of combat-related PTSD among justice-involved veterans, but estimates range from 5 to 27 percent (Blodgett et al., 2015) (see light blue bar in Figure 2).

Figure 2 shows the widely varying estimates from prior research on rates of mental and behavioral health conditions among justice-involved veterans from Blodgett et al.'s (2015) systematic literature review. These ranges, as well as the fact that the review included articles as far back as 1987, highlight the uncertainty about how prevalent these conditions are among justice-involved veterans. This uncertainty poses a potential roadblock to identifying risk factors and promising interventions to better support this population.

In addition, veterans are overrepresented in the U.S. homeless population at 13 percent, compared with 7 percent among U.S. adults (National Coalition for Homeless Veterans, undated). Justice-involved veterans are significantly more likely to experience homelessness than veterans overall, although estimates of this risk have varied across studies (Blue-Howells et al., 2019). This cycle of incarceration and homelessness is also observed in nonveterans, and research indicates that incarceration is associated with a 20-fold increase in the risk of homelessness (Bashir et al., 2021). VA data suggest that although rates of homelessness among veterans have been declining—by 11 percent between 2020 and 2022 and by more than 55 percent since 2010—around 33,000 veterans still lack stable housing (VA, 2022c).

Together, these data highlight the significant psychosocial needs that justice-involved veterans might have. Although mental health conditions are especially prevalent in justice-involved populations, this is not to say that these conditions necessarily increase the risk of criminal behavior. Rather, research indicates that people with mental health conditions are actually at a greater risk of being victims of interpersonal violence (Ramchand and Ayer, 2021). Two possible explanations for the prevalence of mental illness in criminal justice settings are a lack of sufficient community-based mental health services, such that the justice system becomes the default treatment setting, and that people with mental health problems have secondary characteristics that do increase the risk of criminal behavior (e.g., unstable work history, substance use disorders) (Bonfine, Wilson, and Munetz, 2020).

There have been studies investigating whether there are military-specific experiences that uniquely contribute to veterans' risk of justice involvement. Some researchers argue that factors that predispose a veteran to come into contact with the criminal justice system (e.g., a history of conduct problems in childhood, family instability, abuse) usually predate military service; however, at least one study demonstrated that although childhood factors are associated with criminal justice involvement after military service, they are only a part of the equation (Tsai and Rosenheck, 2013). Therefore, it is still unclear whether military service increases the risk of justice system contact.

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Veteran-Specific Programs to Prevent Criminal Justice System Involvement and Facilitate Reentry Following Incarceration

Although questions remain about veterans' pathways to criminal justice involvement, the public is generally supportive of rehabilitative approaches for these individuals (Atkin-Plunk and Sloas, 2019). A National Institute of Corrections report referenced the frequent refrain that offering alternatives to incarceration for veterans was the "right thing to do" (Edelman, Berger, and Crawford, 2016); the country has an obligation to address the enduring effects of military service, and this sense of responsibility has led to innovative interventions. Indeed, over the past 15 years, there have been three noteworthy, large-scale efforts to provide justice-involved veterans with the services and support they need.

Outreach Programs

VA operates two programs to address the health care needs of justice-involved veterans, including mental health and substance use disorders:

• The Veterans Justice Outreach (VJO) program facilitates access to VA health care and other VA supports (e.g., case management, vocational rehabilitation for veterans in court or jail settings). Although the program does not provide legal services, it can refer veterans to community-based legal assistance, and VA facilities have hosted free legal clinics staffed by non-VA specialists (VA, 2022a).
• The Health Care for Reentry Veterans (HCRV) program connects incarcerated veterans with VA services, including health care and other supports, as they prepare to return to their communities (VA, 2022b).

Studies have shown that these programs have been effective in connecting veterans to VA health care. One study found that, of the more than 36,000 veterans who received an outreach visit from a VJO specialist in 2010–2012, 88 percent had a subsequent in-person VA health care appointment (Finlay et al., 2016). Nearly all the veterans in this group who were diagnosed with a mental health or substance use disorder went on to use VA behavioral health care (i.e., mental health or substance use disorder services). A study of the more than 32,000 veterans who received HCRV outreach in a five-year period found that 56 percent had a VA health care visit in the next year (Finlay et al., 2017). Rates of engagement in mental health and substance use treatment among veterans who participated in the HRCV program were lower, suggesting that VJO may be more effective in reaching veterans with these services. It is also notable that homeless veterans who participated in the VJO program had an even higher likelihood of initiating and engaging in mental health and substance use treatment than VJO participants overall (Finlay et al., 2016).

Although it is critical to ensure that veterans have access to the health care services that they need, it is important to note that these services will not necessarily address the factors that contributed to a veteran's involvement in the criminal justice system. For example, research on nonveteran populations has demonstrated that such factors as affiliations with peers who are also engaged in criminal activity, poor impulse control, and aggressive tendencies are some of the stronger predictors of future criminal activity (Bonta and Andrews, 2017). However, VA medical centers are not necessarily equipped to address these factors, perhaps because providers have not been trained in evidence-based treatments to address these issues or due to the perception that these issues cannot be addressed through traditional behavioral health treatment (Blonigen et al., 2017).

Treatment Courts

Perhaps the most well-researched intervention for justice-involved veterans is the veteran treatment court (VTC) model. VTCs follow a similar model to other problem-solving courts, such as drug courts and mental health courts, where the emphasis is on providing treatment to justice-involved individuals with substance use or mental health needs rather than incarcerating them. However, VTCs are unique in that, rather than identifying their population based on the common nature of their treatment needs (e.g., defendants' need for substance use treatment), the unifying characteristic of VTC participants is their history of military service. Ultimately, though, the VTCs' goal is to connect veterans with needed behavioral health treatment and other supportive services (Slattery et al., 2013; Shannon et al., 2017).

The number of VTCs has expanded significantly since the first court was founded in 2008, and recent estimates suggest that there are more than 620 operating across the country (VA, 2022a). However, there is substantial variability in policies and practices across VTCs (Baldwin, 2015; Henderson and Stewart, 2016; Douds et al., 2017; McCall, Tsai, and Gordon, 2018), making it difficult to know what models are most effective. Some studies have yielded promising findings (Hartley and Baldwin, 2019), but most have been limited by their small scale, focus on a single court, and lack of a comparison group (e.g., Derrick et al., 2018; Shannon et al., 2017). Estimates of recidivism rates following VTC participation range widely, from 2.5 percent to 56 percent (McCall, Tsai, and Gordon, 2018). And beyond recidivism, there is also a need for research on ongoing treatment engagement and clinical outcomes associated with court participation.

Pressing Issues

Despite increases in the services available to justice-involved veterans, significant gaps in the research limit understanding of their impact. This shortfall means that there is also little empirical support for policy and programmatic changes to better address the needs of justice-involved veterans and prevent future criminal justice system contact. Based on our review of the existing literature and practice, we have identified three key pressing issues.

Why are veterans more likely to come into contact with the criminal justice system for certain types of charges?

Although veterans are now incarcerated at lower rates than their nonveteran counterparts, a higher proportion of veterans than nonveterans have a history of sexual offending behavior (Bronson et al., 2015; Culp et al., 2013). For example, Bureau of Justice Statistics data from 2016 indicated that 12 percent of nonveteran men incarcerated in state prisons had been convicted of a violent sexual offense, compared with 26 percent of veteran men (Maruschak and Bronson, 2021). Moreover, this disproportionate rate of incarceration for sexual offenses has been observed for nearly 30 years (Seamone, Holliday, and Sreenivasan, 2018). Recent efforts have attempted to determine whether there are veteran-specific risk factors for sexual offending, including studies focused on both general incarcerated populations (e.g., Brooks Holliday et al., 2022) and samples of individuals civilly committed under sexually violent predator statutes (e.g., Paden et al., 2021), but this remains a poorly understood issue. Veterans who have committed sexual offenses are likely to encounter additional barriers to community reintegration (e.g., challenges finding housing and employment) (Simmons et al., 2022; Seamone, Holliday, and Sreenivasan, 2018), and therefore may be especially in need of supportive services. Further investigation of the risk factors and psychosocial needs in this subpopulation of justice-involved veterans is important.

What are the key risk and protective factors for criminal justice involvement among veterans?

Although the behavioral health and housing needs of justice-involved veterans are clear, these needs may be distinct from the factors that increase their risk of contact with the criminal justice system. It may be that those risk factors are similar for veterans and nonveterans—including a lack of employment opportunities, substance misuse, attitudes that are supportive of crime, and involvement with family members or friends who have been involved in the criminal justice system (Bonta and Andrews, 2017). However, there has been limited research into whether these same factors pose a risk in veteran populations (Blonigen et al., 2016). There may also be risk factors that are unique to veteran populations. For example, the presence of PTSD in combination with anger or alcohol misuse has been identified as a risk factor for violent behavior in veterans (Elbogen et al, 2012; Elbogen et al., 2014).

There has also been limited exploration of the role of military culture and the risk of criminal justice system involvement. Some researchers have suggested that aspects of military culture, such as an emphasis on hypermasculinity, can contribute to sexually assaultive behavior (Turchik and Wilson, 2010). That said, there is also some evidence that VTCs have been able to leverage aspects of military culture to engage and motivate veterans (Ahlin and Douds, 2016), suggesting that military culture may have some protective effects.

Answering questions about what factors increase risk specifically in veterans is crucial, because identifying the most-salient risk factors can directly inform risk-reduction efforts. It is equally important, however, to explore how military experiences or veteran status could help buffer or protect against justice system involvement. For example, does a sense of belonging within the veteran community or access to quality health and substance use care and insurance enable early intervention?

How and where do veterans access the services needed to mitigate the risk of future criminal justice system involvement?

As noted, VA's VJO program has seen a great deal of success in connecting veterans with VA services, including mental health and substance use disorder treatment. The HCRV program is similarly designed to link veterans with VA health care. The lower rates of treatment engagement following HCRV outreach could be a function of the more substantial reintegration challenges that veterans face after incarceration in prison compared with a court contact or jail stay, which is typically shorter. Therefore, one important goal might be to better support veterans who are reentering their communities from prison to ensure that they do not fall through the cracks.

Another important point is that VA medical centers are designed to address health-related issues, not necessarily recidivism risk. Blonigen et al. (2017) crosswalked VA services with the central eight risk factors described by the risk-need-responsivity model, which are a set of factors that have been shown to be associated with recidivism in nonveteran populations. They found that some risk factors can be addressed through traditional VA services, including substance use treatment, family relationship support, and engagement in prosocial activities. However, VA facilities do not typically offer services that would target other risk factors, such as services to increase contact with prosocial peers or address aggressive or impulsive tendencies. However, this may be changing: There is research underway to explore the implementation and effectiveness of Moral Reconation Therapy (an established cognitive-behavioral intervention that addresses antisocial beliefs and behaviors) in a VA context (Blonigen et al., 2021). It will be important to examine how these treatments are received, both by VA staff and veterans.

How can the effectiveness of VTCs be maximized?

VTCs have expanded rapidly across the country since the first court was established in 2008. However, the growth of these programs has outpaced the empirical research, and there are several reasons to conduct a rigorous evaluation of VTCs. First, VTCs can vary substantially with respect to eligibility criteria, referral and screening processes, what services they provide, and for how long the program monitors participants (Henderson and Stewart, 2016; Baldwin, 2015; Baldwin and Hartley, 2021; VA, 2022a; Matto, 2017). The literature has yielded a range of findings regarding the effectiveness of VTCs, and it may be that certain elements are more effective than others. Another key gap is the lack of research on subgroups of veterans, such as women and veterans of color (Grohowski and Jones, 2019; Jalain and Grossi, 2020). VTCs hold substantial promise, but more-rigorous empirical research is needed to determine what works and for whom.

Directions for Future Research

Despite the increasing interest in justice-involved veterans, there is still much that we do not know about this population. As a result, there are ample opportunities for future research, and the following recommendations can help inform allocation of research funding and identify and prioritize policy changes as the research base grows.

• Leverage existing data sources to answer questions about justice-involved veterans. The Bureau of Justice Statistics conducts periodic surveys of individuals incarcerated in jails and prisons across the United States that include more-robust questions related to military service than other national epidemiological surveys (e.g., the National Health and Nutrition Examination Survey fielded by the Centers for Disease Control and Prevention). The surveys collect information about veterans' service era, branch of service, combat exposure, length of service, and discharge status. This type of dataset can be leveraged to test basic hypotheses about justice-involved veterans, and, in turn, form the foundation for new questions and data collection.
• Expand beyond VA when researching justice-involved veterans. Many studies of justice-involved veterans have been based on data from VA's veteran justice programs. However, not all veterans are eligible for VA services, including those who have other-than-honorable discharges. Veterans who are ineligible for VA services due to the nature of their discharge may be more likely to come into contact with the criminal justice system (Bronson et al., 2015), (to reduce repetition) as a function of preexisting risk factors and because they may encounter more challenges both in transitioning from military to civilian status and in reintegrating into their communities following incarceration, including finding employment. Therefore, it is important to include these veterans in research on criminal justice involvement.
• Integrate established criminological and forensic psychological frameworks into research on justice-involved veterans. There is substantial literature on individual and community-level factors that can lead to criminal justice involvement. Although some studies of justice-involved veterans have drawn on this literature (e.g., Blonigen et al., 2017), it is critical to better understand whether and how these frameworks apply to veteran populations.
• Examine connections between justice system involvement and other psychosocial outcomes, including employment, suicide, and health. To date, much of the research on justice-involved veterans has focused on mental health, substance use, traumatic brain injury, and homelessness. By contrast, there is very little research on suicide in this population, despite the fact that both justice-involved individuals and veterans are at increased risk for suicide (Holliday et al., 2021). Similarly, a 2015 review highlighted the need for more research on employment in this population (McDonough et al., 2015)—an especially important avenue for research, given that employment is a key challenge during reentry following incarceration and may reduce recidivism risk. However, research on this topic remains limited.
• Explore other innovative alternatives to incarceration among veterans. One key strength of the VTC model is that it keeps veterans out of jails and prisons and places them in community-based treatment settings. However, for nonveteran populations, there has been increased attention paid to interventions that take place earlier in the criminal justice system—for example, pre-plea diversion programs, which allow people to have their cases dismissed if they complete treatment programs. These types of interventions, which occur more "upstream," can help individuals avoid new charges and the collateral consequences that come with criminal justice system involvement, such as difficulty finding employment or housing. Therefore, exploring veteran-specific programs that focus on earlier stages of a veteran's involvement in the criminal justice system could be beneficial.

References

Topics

• Criminal Justice
• Incarceration
• Military Veterans