The Crisis Intervention Team International (CITI) Conference August, 2012 Las Vegas

1. Police Encounters with Returning Veterans Dan Abreu, SAMHSA National GAINS Center Thomas Kirchberg, PhD ABPP The Crisis Intervention Team International (CITI) Conference August, 2012Las Vegas

2. New Challenges?New Responses?

3. CIT Officer Intervenes I do not even know how to begin to "Thank You" for your class/session "Improving Police Encounters with Returning Veterans" at the CIT Conference in Atlanta.  I have been home just over a week and was already confronted by a Marine OIF with PTSD. !  Your video helped me interpret reckless driving and anger as possible PTSD symptoms ...It saved us from having to go hands on because I was able to reach out with the verbal skills I learned in your class and this situation did not escalate.  In fact, because of that same video and that scenario where the VET had the handgun, I was able to ask the right question "do you have any weapons?".  He looked me straight in the eye and began to weep and asked me to take the weapon for safekeeping until he felt he was ready to have it back.  What a heart wrenching sight to have this honorable Marine hand over his weapon to me.    I gave him and his wife the Veteran Suicide phone number that I put in my contacts during your class/session.    On Monday, I will contact the VA in my area and have them follow-up.  THANK YOU with all my heart.

4. New Mexico Incident1/13/2011 March 10 - 16, 2011News/Opinion Archive • Peace Officer Could APD crisis training have saved a veteran’s life? • By Patrick Lohmann • Negotiations with were short or nonexistent, according to those at the scene. Most recount hearing only shouts of “Drop the gun!” from multiple officers throughout the ordeal, which, of course, culminated in (his) death. “I’m really surprised that we’ve been in Iraq and Afghanistanfor greater than 10 years, and we don’t already have this training (CIT).” Veteran’s sister

6. Engagement Questions • How long were you in the military? Are you active? • What was your military specialty? • Were you ever deployed? How many times? • What was it like for you? • How long have you been back? What is it like to be back? • Are you in contact with fellow veterans?

7. LE Veteran Specific Response • In Massachusetts, Norfolk County District Attorney William Keating developed “Beyond the Yellow Ribbons: PTSD and Veterans,” a training video for first responders. • Enhanced CIT Training • The International Association of Chiefs of Police,, issued guidelines - or helpful hints – supporting police officers who are veterans. • Virginia Wounded Warrior Program-Veteran Peer Specialists

8. The National Post-Deployment Adjustment Survey (NPDAS) • N=1388 completed the survey, yielding a 56% corrected-response rate. This rate is among the highest achieved in national surveys of U.S. Veterans • No gender ratio or geographic regional differences between responders and non-responders were detected.

9. Post-Deployment Arrests • 9% reported arrest since last deployment • 1% reported incarceration beyond two weeks. • 2% reported arrests for violent crimes • Bivariate analyses show arrest linked to: • Younger Age • Male Gender • Combat Exposure • Homelessness • Alcohol Misuse • PTSD • Drug Misuse • Arrest History • Active Duty

11. Jail Diversion Trauma Recovery, Priority to Veterans

14. JDTR Non-Military Trauma (N=387) Kristin Stainbrook, AHP Steve Sullivan, Cloudburst Consulting Group

15. Trauma in Incarcerated Veterans (2) PTSD Group: • More arrests • More MH symptoms • More substance abuse • Poorer health

16. What you should know • PTSD has delayed onset • Many do not recognize TBI/PTSD symptoms • Military Culture/Warrior Mentality precludes seeking help • External Barriers to Care • Trauma Combat or otherwise correlates with arrest risk • Substance abuse increases arrest risk • Domestic violence, motor vehicles and weapons are special considerations.

17. Characteristices of Justice Involved Veterans

18. National Vietnam Veterans Readjustment Survey (NVVRS) Source: National Center for PTSD, Fact Sheet: Findings from the National Vietnam Veterans’ Readjustment Study, 1988 ~

19. Veterans Diagnosed With PTSD in VA Specialty Mental Health Programs Rosenheck et al., 2007; from VA administrative workload databases. Slide Courtesy of Paula Schurr, PhD, VA National Center for PTSD

20. Trauma in Incarcerated Veterans • N=129 28% Combat • Trauma 112 87% • PTSD 51 39% Differentiating Trauma Events: • Witnessed death or injury • Life threatening accident • Physically assaulted • Witness bad event to someone close • Childhood physical abuse • Sexual molestation/rape Saxon, et. al., 2001

21. Travis County Charges 679 charges filed against 458 Veterans • 32% arrested 2 or more times • 27% felony charges • 10% Assault • 22% of felony charges included a weapon Motor Vehicle Charges • 19% DWI • 43% Motor Vehicle related charges in top ten misdemeanors • 12 % Motor Vehicle related charges in top ten felonies • 34% overall rate Travis Co Jail Incarcerated Veterans Survey, 2008

22. Combat Theater • 54% Non combat zones • 18% OEF/OIF • 13% Viet Nam Travis Co. Data

23. Discharge Status Travis Co. 86% (396)Honorable 9% (39) Less than Honorable 5% (23) No response

24. JDTR Military Discharge Status of Clients N=335 Kristin Stainbrook, AHP Steve Sullivan, Cloudburst Consulting Group

25. JDTR Military Era (N=335)* 87% of JDTR Enrollees had served in the military Kristin Stainbrook, AHP Steve Sullivan, Cloudburst Consulting Group

26. JDTR Point of Diversion N=454 Kristin Stainbrook, AHP Steve Sullivan, Cloudburst Consulting Group

27. Veteran Specific Response? Veterans Courts Diversion Legislation Sentencing Mitigation DUI Laws (RI) Domestic Violence Laws (RI)

28. Veteran Mentors • These volunteers are veterans • who have served in Vietnam, Korea, Operation Desert Shield, Operation Enduring Freedom, and Operation Iraqi Freedom. • These men and women volunteer their time to work directly with the Veterans Treatment Court Participants. • Mentors serve a variety of roles, including coach, facilitator, advisor, sponsor, and supporter.

29. Vet/Peer Involvement • Definitions used at sites include: • JDTR target population (vets with trauma and/or mental health histories and justice involvement) • Any veteran • Veteran status + other criteria (but not target pop.) • Some include family members • Most definitions lead with veteran status and other criteria are secondary

30. JDTR Initiative 2008-10

31. Brownfield v United States

32. Denver Post Article Police Stories. • After returning from Iraq, Jason Harvey, a combat soldier with the Fort Carson-based 2nd Brigade Combat Team, raced his car at speeds of more than 100 mph on Squirrel Tree Road and played paint ball to replicate battle situations. It might sound strange, but for me, when I was driving fast, it made me calm again.” Harvey was kicked out of the Army after he was found driving with a loaded gun on Fort Carson

33. Denver Post Article Police Stories. • Vietnam veterans had a 7 percent higher death rate after discharge than veterans who did not serve in a theater. The federal Centers for Disease Control and Prevention found higher rates of motor vehicle crashes, homicides and suicides during the first five years after deployment to Vietnam.

34. New Mexico Incident12/29/10 • Pecos grad, Marine Corps vet dead after firing at police on I-25 • “We don’t know what happened that led up to all this, and when he saw those police lights, something might have triggered that made him do what he did. This doesn’t define him and isn’t what he’ll be remembered for. He was a husband, a father, a brother and a great friend — and this is just a difficult situation for all involved.”

35. Oregon Incident • Anthony Leo McDowell, 50, was killed Jan. 31 at a home in the 24000 block of Southeast Oak Street. Police were dispatched to the location after a woman called 9-1-1 and said her husband -- McDowell -- was suicidal and armed with a gun.

36. And in some cases, no alternative is available. In Platte County, Mo., which has no special court, the veteran with post-traumatic stress disorder who had a faceoff with the police is scheduled to stand trial on Sept. 12 on charges including felonious assault on a police officer, though no shots were fired. He had called 911 for help. • A call to deal with “a man with a gun” is one of the most dangerous that police officers face. Entering an unpredictable situation, they are trained to act to protect their own safety and the public’s. • When the suspect is a soldier, the situation grows more complicated. In Gresham, Ore., a veteran was killed by the police when he stepped out onto his front porch carrying a rifle; his family had called 911 saying he was suicidal. In Glendale, Ariz., a soldier newly returned from Afghanistan shot a man in a bar and then fired at a police officer, who killed him.

37. The fatality rate among sailors and Marines in off-duty motor vehicle accidents is 25.6 per 100,000 personnel - the highest since the war started and nearing the highest rate in more than 14 years, when the rate was 25.74 per 100,000 personnel in 1992. For the Army, the number of off-duty soldiers killed has risen since the war started, with 150 off-duty deaths reported in 2005, compared with 135 deaths so far this fiscal year, statistics show. After Desert Storm, in a 1996 article in Injury Prevention magazine, Dr. Niki Bell proposed possible explanations for increases in injuries, including depression, PTSD and symptoms of other psychiatric conditions developed after the war. Traumas experienced during the war may result in the postwar adoption of “coping” behaviors that also increase injury risk (for example, heavy drinking) and others, she said.

38. Vietnam veterans had a 7 percent higher death rate after discharge than veterans who did not serve in a theater. The federal Centers for Disease Control and Prevention found higher rates of motor vehicle crashes, homicides and suicides during the first five years after deployment to Vietnam. • So far this fiscal year, 156 sailors and Marines have died in off- duty accidents, said Cmdr. Edward Hobbs, a CDC spokesman.“This has been one of the worst years in recent history,” Hobbs said.The fatality rate among sailors and Marines in off-duty motor vehicle accidents is 25.6 per 100,000 personnel - the highest since the war started and nearing the highest rate in more than 14 years, when the rate was 25.74 per 100,000 personnel in 1992.

39. National Veteran Sample • The National Post-Deployment Adjustment Survey (NPDAS) involves a random selection of over one million veterans who served in the U.S. military on or after September 11, 2001, and were separated from active duty in the Armed Forces or served as a member of the National Guard or Reserves.

40. National Veteran Sample • N=1388 completed the survey, yielding a 56% corrected-response rate. This rate is among the highest achieved in national surveys of U.S. Veterans • No gender ratio or geographic regional differences between responders and non-responders were detected.

41. Discussion • Logistical concerns about getting time off work for counseling and being able to schedule appointments at convenient times were also expressed by participants in the current study. • Recognition of these treatment barriers will be critical as VA policymakers undertake efforts to improve access to mental health care for Veterans, especially for those at higher risk of criminal justice involvement.

42. Discussion • Veterans with criminal justice involvement were more likely to endorse items such as, “It's up to me to work out my own problems." • This pattern of responding is consistent with the results of research on civilians with mental health problems, which showed that the risk of criminal arrest was elevated for those individuals who perceived that treatment did not have benefit or was not needed (Elbogen, Mustillo, Van Dorn, Swanson, & Swartz, 2007).

43. Discussion • Misuse were significantly related to elevated risk of post-deployment arrests among Veterans. • Veterans who were arrested after returning home were more likely to perceive hurdles • difficulties taking time off work • a lack of transportation to a mental health clinic, which they report prevented them from obtaining treatment for mental health problems.