Posttraumatic stress disorder (PTSD) in the criminal justice system

The number of veterans in the criminal justice system has been described as a national crisis (Aprilakis, 2005; Daniel, 2008). Precise numbers of veterans in various stages of the criminal justice are difficult to report, as many states do not collect that information. From information that is available, approximately nine percent of the national prison population is composed of veterans (American Corrections Association, 2013). This number is alarming when we consider that only seven percent of the U.S. population is veterans. To bring this into clearer perspective, there are approximately 300,000 veterans from the conflicts in Iraq and Afghanistan who have been diagnosed with PTSD (Tanielian et al., 2008). Daniel (2008) reported a high rate of veterans' contact with the criminal justice system. Forty percent of veterans who suffer from PTSD are noted to have committed a violent crime since their completion of military service. This would be 120,000 criminal acts by veterans with PTSD.

This surge has an apparent link to certain symptoms of PTSD (Hafemeister & Stockey, 2010), specifically hyper-vigilance and hyper-aggression (Begic, 2001). Though PTSD can be caused by any traumatic event, a meta-analysis revealed that hostility related to PTSD is greater in samples with combat experience compared to other traumatic events (Orth & Wieland, 2006). Other research has shown that veterans with PTSD and subthreshold PTSD endorse aggression in response to social stimuli more than non-PTSD subjects (Jakupcak et al., 2007). Veterans acting out aggressively are likely to end up in the judicial system. Therefore, the judicial system is working to address the specific needs of veterans in this system.

Judge Robert Russell established the first Veterans' Treatment Court to address this problem. These courts are based on the “drug treatment courts” and follow an agenda of addressing the problems that led to the criminal behavior. After the success of Judge Russell's court, other jurisdictions followed suit. By 2012, 27 states had established Veterans' Treatment Courts. Though this growth is encouraging, most jurisdictions do not have a Veterans' Treatment Court, which inhibits a defendant who is a veteran suffering from PTSD from accessing curative and supportive treatments.

There has been little research examining veterans in the criminal justice system. One notable study examined prosecutors' willingness to offer treatment options to veterans with PTSD instead of criminal charges (Wilson, Brodsky, Neal, & Cramer, 2011). This research showed that prosecutors were generally willing to extend curative treatment options over criminal charges to veterans with PTSD. This illustrates that there is some effort to addressing the national crisis. Other research has examined the impact on verdicts when curative options are available to a jury (Smith, 2014). This research showed that there is a “bias toward treatment” for veterans with PTSD when a curative verdict option is available. When the only verdict options were “guilty” or “not guilty,” there was a clear guilt-bias. These results demonstrate the need for Veterans' Treatment Courts to address a clear problem in our criminal justice system.

The previously reported prison population demographics point to a serious problem. The bulk of the research on PTSD and crime has identified two of the typical symptoms as particularly problematic. The membership of the Society for Military Psychology, and related associations, are well suited in talent, skill, and motivation to examine veterans as a unique social group that is experiencing serious impediments to reintegrating into civilian society.

Though there are several initiatives (public and private) that are attempting to serve our veterans, the size of the problem is staggering. The establishment of Veterans' Treatment Courts is a strong, positive step to take to remedy the issue. These courts have been established in several jurisdictions. There are still far too many jurisdictions that do not have such a court. We should encourage the development of a Veterans' Treatment Court in all jurisdictions, municipal, state, and federal. The Veterans' Treatment Courts that are currently in operation each works in its own way—there is no central governing practices. Div. 19 can aid these courts by initiating a “best practices” study. This will allow the courts to learn from each other and to share their own best practices with other courts. Further, a best practices study would provide a template for other jurisdictions to begin a Veterans' Treatment Court, drawing on the successes and experiences of courts already established.

A Veterans' Justice Initiative would reach across all areas of behavioral science, integrating the best of clinical, applied, and theoretic research. To remedy the growing problem of veterans with PTSD in the criminal justice system, treatment should not wait until after a veteran becomes involved in the criminal justice system. Early intervention, before deployment to hostile environments, would serve as a prophylactic factor in dealing with PTSD. This would require more research to identify personality, social, and professional factors that improve resilience. Postdeployment treatment would enhance this effort by providing the psychological and social support. At the completion of military service, programs designed to fully reintegrate the veteran into civilian life would allow earlier identification of PTSD, and related disorders, so that treatment can begin sooner. Finally, expanding the Veterans' Treatment Courts to all jurisdictions would provide another level of protection and intervention for veterans that are suffering from PTSD.

There are several stages of the military life that warrant intervention to better prepare veterans for what they will experience and to ensure their continued psychological health. Developing programs to aid military families in their support of their family members who serve in the military would aid the strongest social support network that our troops have. Researching and aiding in the development and implementation of training that improve our troops' resiliency as a prophylactic measure to protect them from the long-term, psychological effects of repeated deployments is another area of research that deserves even more attention. Finally, after the military member's service is completed, we need to develop better means to reintegrate that veteran into civilian society. This is necessary so that we will not need Veterans' Treatment Courts in the future. This can be seen as an opportunity for the psychology community to make a strong and positive impact on society. The Society for Military Psychology is the best vehicle to communicate these ideas that combine experimental, applied, and clinical psychological science.

Summary of Recommendations

• Encourage all levels of the criminal justice system to begin collecting demographic information pertaining to the veteran status of inmates.
• Initiate a best practices study on the Veterans' Treatment Courts to provide a mechanism by which current courts can share their practices while learning the best practices of other courts.
• Provide a catalog of practices for new Veterans' Treatment Courts to ease the process of establishing new courts with the best practices available.
• Establish a Veterans' Justice Initiative to study issues of veterans' mental health care predeployment, postdeployment, and after completion of military service.

References

American Corrections Association. (2013, May 22). Criminal Justice Veterans Initiative. Retrieved from www.aca.org

Aprilakis, C. (2005). The warrior returns: Struggling to address criminal behavior by veterans with PTSD. The Georgetown Journal of Law & Public Policy, 3, 541–566.

Begic, D. (2001). Aggressive behavior in combat veterans with post-traumatic stress disorder. Military Medicine, 166, 671–676.

Daniel, D. L. (2008). Post-traumatic stress disorder and the causal link to crime: A looming national tragedy (AY 2007-2009). Leavenworth, KS : School of Advanced Military Studies, U.S. Army Command and General Staff College.

Hafemeister, T. L., & Stockey, N. A. (2010). Last stand? The criminal responsibility of war veterans returning from Iraq and Afghanistan with posttraumatic stress disorder. Indiana Law Journal, 85, 87–141.

Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H. A., Felker, B., et al. (2007). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress, 20, 945–954.

Orth, U., & Wieland, E. (2006). Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: A meta-analysis. Journal of Consulting and Clinical Psychology, 74, 698–706. doi:10.1037/0022-006X.74.4.698

Smith, B. A. (2014). Juror preference for curative alternative verdicts for veterans with PTSD. Unpublished manuscript.

Tanielian, T., Jaycox, L. H., Schell, T. L., Marshall, G. N., Burnam, M. A., Eibner, C., . . . the Invisible Wounds Study Team. (2008). Invisible wounds of war: Summary and recommendations for addressing psychological and cognitive injuries. Santa Monica, CA: RAND.

Wilson, J. K., Brodsky, S. L., Neal, T. M.-S., & Cramer, R. J. (2011). Prosecutor pre-trial attitudes and plea-bargaining behavior toward veterans with posttraumatic stress disorder. Psychological Services, 8, 319–331. doi:10.1037/a0025330