Trauma and Recovery
For generations, military veterans have struggled in silence through the minefields of mental and emotional damage resulting from their service. With a growing awareness, more Ohio specialty courts are coming to their aid.By Csaba Sukosd | November 2021
Post-traumatic stress disorder (PTSD) is a common condition that leads many military service members – past and present – into trouble with the criminal justice system.
The complexity of the disease and how it can vary inside each person has necessitated a wider approach to identifying and treating it, especially since as many as 500,000 service members have been diagnosed over the past 20 years. That necessity is heightened by the higher concentration of PTSD among veterans who end up in treatment courts.
Armed with more awareness and a will to take action, Ohio's veterans treatment courts are addressing the issue in a growing variety of ways.
At-Risk Population for PTSD
The U.S. Department of Veterans Affairs (VA) cites research that estimates around 6% of the entire U.S. population will suffer from PTSD at some point in their lives. Studies have found veterans from the wars in Iraq and Afghanistan have screened positive for PTSD at rates anywhere from 13.5% to 30%.
Photos of 2021 Warren County Veterans Intervention Court graduates Robert Dunson (left) and Richard Buckland (right) during their time in the United States Army.
Among Warren County Court Judge Gary Loxley's current participants in his veterans treatment court, 25% have been identified with PTSD, although there are many instances where symptoms – troubling memories, avoidance issues, negative thoughts, and emotional changes – don't appear when these soldiers and sailors first come home from war.
Some judges estimate 50% or more of those on their veterans dockets have PTSD.
Pair that with national statistics that report an average of nearly 18 veteran suicides per day. In 2019, Ohio accounted for 4% of that sum with 257 deaths, according to the 2021 National Suicide Prevention Annual Report released by the VA.
Given those figures, it becomes clear why the number of veterans treatment courts in Ohio has risen to 29 – either fully certified by the Ohio Supreme Court or those working through the certification process.
"There's a need for our help, and we're going to continue providing it," said Judge Loxley, a retired military veteran with 36 years of service in the U.S. Army and Army Reserve, and Ohio Army National Guard.
Assessment and Acceptance
A condition for acceptance into each court's program, which is standardized by the Supreme Court's Specialized Dockets Section, is to be screened by a clinician. If symptoms of PTSD are diagnosed, the veteran is referred to a medical professional for further evaluation.
All treatment programs collaborate with a local office of the federal VA. Some, such as Cleveland Municipal Court's Veterans Treatment Docket, work exclusively with the VA to address veterans' underlying issues – such as mental health and substance use – that can lead to criminal offenses.
A universal approach for all the specialized dockets is to emphasize interpersonal communication – through group and individual sessions. Those meetings take place weekly or biweekly with judges and court staff, as well as outside of judicial settings with treatment providers and peer mentors – veterans with shared experiences, including some who've had criminal missteps.
"Five of my graduates have become peer mentors," said Warren County Common Pleas Judge Timothy Tepe, referring to his Veterans Intervention Court (VIC). "I can't even begin to tell you how valuable that is."
Warren County Common Pleas Judge Timothy Tepe handing Robert Dunson a diploma at a Veterans Intervention Court graduation ceremony in January.
Mind Games
The court setting, even though it's quiet and full of familiar faces, can be challenging for those with combat experience.
When Judge Tepe began his treatment court three years ago, participants asked to speak would stand in the center of the courtroom. He soon realized how uncomfortable that made veterans feel due to lingering effects from their military experiences.
"These men and women are more aware of their settings, and some are very fearful of people standing behind them," said Judge Tepe. "So, we started putting them next to me in the witness box."
One psychological approach clinicians use to untangle triggers is cognitive behavioral therapy. The process involves relearning and reframing one's thoughts around a traumatic event, helping a person understand more about what happened, and how to respond when those thoughts and feelings reoccur.
Many programs have incorporated medication-assisted treatment as part of substance-use prevention practices to eliminate destructive coping mechanisms from prolonged trauma. Such methods limit the effects of PTSD, but they don't address concerns regarding triggers activated from real-world exposure and interaction.
"I don't think most people in the military want to share whatever bad thing they experienced," said Hamilton County Common Pleas Judge Terry Nestor, who oversees the Veterans' Felony Treatment Court program.
In order to help participants become more at peace with their environments and other people, approaches also focus on connecting the mind and the body.
"As an experiment, some of our participants started taking yoga classes," said Cleveland Municipal Judge Charles Patton, a veterans court judge since 2012. "Our treatment team saw that physical activity combined with mental relaxation helped."
Warren County VIC graduate James Bear (left photo) immersed in equine therapy at Brushy Creek Reserve in southwest Ohio. A new law ensures service dogs (right photo) can be provided to veterans suffering from mental illness who don't have a mobility impairment. (Courtesy: Texas A&M University Libraries)
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