Understanding the Intersection of Homelessness and Justice Involvement: Enhancing Veteran Suicide Prevention Through VA Programming

Holliday, Ryan; Desai, Alisha; Gerard, Georgia R.; Liu, Shawn; Stimmel, Matthew

doi:10.12788/fp.0216

Cited by 5 publications

(8 citation statements)

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“…, vocational rehabilitation) and, in turn, promote recovery. Importantly, Veterans Justice Programs facilitate access to health services, including mental health care (Holliday et al, 2022a). As such, these services may function as a critical intercept for identifying personality disorders and engaging justice-involved veterans in evidence-based care.…”

Section: Discussionmentioning

confidence: 99%

“…Data were collected through a retrospective chart review of veterans accessing VA care from January 1, 2005, to December 31, 2018. Cohorts of veterans using (i.e., justice-involved) and not using VA justice-related services were identified based on outpatient stop codes (Health Care for Reentry Veterans: 591; Veterans Justice Outreach: 592; see Holliday et al, 2022a for additional information regarding these services). As the cohort of veterans not using VA justice-related services was substantially larger, a random sample of 20% of veterans with no history of justice-related services was generated.…”

Section: Data Source and Participantsmentioning

confidence: 99%

“…Because the Department of Veterans Affairs (VA) offers services focused on meeting the psychosocial needs of justice-involved veterans ( i.e. , Veterans Justice Outreach, Health Care for Reentry Veterans; Holliday et al, 2022a), better understanding the prevalence of personality disorders is a pragmatic first step to identifying the clinical presentation of veterans accessing these services. This information can be used to inform salient programming to offer as part of VA justice-related services and pragmatic referrals for VA using justice-involved veterans.…”

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confidence: 99%

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Personality Disorder Diagnosis Among Justice-Involved Veterans

et al. 2023

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Justice-involved veterans are more likely to experience myriad mental health sequelae. Nonetheless, examination of personality psychopathology among justice-involved veterans remains limited, with studies focused on males within correctional settings. We examined Department of Veterans Affairs (VA) electronic medical records for 1,534,108 (12.28% justice-involved) male and 127,230 (8.79% justice-involved) female veterans. Male and female veterans accessing VA justice-related services were both approximately three times more likely to have a personality disorder diagnosis relative to those with no history of using justice-related services. This effect persisted after accounting for VA use (both overall and mental health), age, race, and ethnicity. Augmenting and tailoring VA justice-related services to facilitate access to evidence-based psychotherapy for personality psychopathology may promote optimal recovery and rehabilitation among these veterans.

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Section: Discussionmentioning

confidence: 99%

Section: Data Source and Participantsmentioning

confidence: 99%

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confidence: 99%

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Personality Disorder Diagnosis Among Justice-Involved Veterans

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“…The VA has prioritized integrating mental health into primary care through the Primary Care-Mental Health Integration (PC-MHI) model,28 which delivers quality mental health treatment to a larger patient population 29,30. However, PC-MHI was designed for common psychiatric conditions 31 and likely not as effective for CLS-involved patients with multimorbidity mainly driven by psychiatric disease and SUDs and who also experience other challenges, including homelessness 2,32–34. Furthermore, stigma and discrimination related to incarceration, SUD, mental illness, and homelessness 18,19,35–38 may prevent patients from engaging in primary care or a Patient Aligned Care Team (PACT).…”

Section: Discussionmentioning

confidence: 99%

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

et al. 2023

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Background: Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. Objectives: To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. Research Design: Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. Subjects: Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). Methods: Mental illness, SUD, medical multimorbidity. Results: An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35–5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04–2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01–1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35–2.49). Conclusions: Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population

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“…Effective clinical intervention is particularly important because psychiatric symptoms and psychosocial stressors—including substance use; family dysfunction; limited education and employment; lack of recreational activities; and antisocial personality traits, peers, and thinking styles—serve as criminogenic risk factors underlying recidivism (Bonta & Andrews, 2007). Therefore, the VA has developed programming specific to justice-involved veterans (i.e., Veterans Justice Programs [VJP]) that facilitates access to medical and mental health care to enhance functioning and reduce recidivism risk (Holliday, Desai, et al, 2022). The VJP consists of the Veterans Justice Outreach (VJO) and Health Care for Reentry Veterans (HCRV) programs.…”

Section: Racial and Ethnic Disparities Among Justice-involved Veteransmentioning

confidence: 99%

Racial, ethnic, and sex differences in psychiatric diagnosis, mental health sequelae, and VHA service utilization among justice-involved veterans.

Desai¹,

Holliday²,

Borges³

2023

Law and Human Behavior

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Objective: Intervening in the cycle of symptom exacerbation and recidivism among justice-involved veterans is critical given elevated rates of psychiatric diagnoses and mental health sequelae. To responsively and effectively address justice-involved veterans' needs, it is essential to examine distinct groups who are at heightened risk (e.g., marginalized communities). Although racial and ethnic disparities within the justice system are well established, veteran-focused research remains limited. Hypotheses: We hypothesized that significant differences exist in service utilization, psychiatric diagnoses, and mental health sequelae among Black, Indigenous, and people of color (BIPOC) and White/non-Hispanic justice-involved veterans, for both male and female cohorts. Method: We examined a national data set of veterans accessing U.S. Department of Veterans Affairs (VA) justice-related services (i.e., justice-involved veterans) between 2005 and 2018 (N = 183,880; n BIPOC = 73,863, n White = 110,017) to elucidate racial and ethnic differences across clinical characteristics documented in the VA electronic medical record. Using linear and logistic analyses, we analyzed male (n = 173,487) and female (n = 10,393) justice-involved veterans separately to capture intersectionality. Results: In general, BIPOC justice-involved veterans were more likely than White/non-Hispanic justice-involved veterans to be diagnosed with schizophrenia and other psychotic disorders and to use homeless services, p < .001. They were less likely to be diagnosed with mood, anxiety, personality, and opioid use disorders, p < .01. Separate examinations of Black and Hispanic justice-involved veterans, compared with their White/non-Hispanic counterparts, demonstrated some divergent trends (e.g., frequency of use of Veterans Health Administration [VHA] services). Our findings also revealed nuanced sex-related differences in terms of service use and diagnoses. Descriptive characteristics for each racial and ethnic category are reported. Conclusion: These findings provide support for race and ethnicity as a key social factor of health associated with distinct psychiatric diagnoses and mental health sequelae among justiceinvolved veterans. We discuss practice and policy implications, including how to adapt existing VHA programming and practices to meet the needs of BIPOC justice-involved veterans. Public Significance StatementBlack, Indigenous, and people of color veterans who interact with the justice system may benefit from adaptations to Veterans Health Administration programming and clinical practices that effectively meet the distinct needs of this at-risk subset.

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Understanding the Intersection of Homelessness and Justice Involvement: Enhancing Veteran Suicide Prevention Through VA Programming

Cited by 5 publications

References 12 publications

Personality Disorder Diagnosis Among Justice-Involved Veterans

Personality Disorder Diagnosis Among Justice-Involved Veterans

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans

Racial, ethnic, and sex differences in psychiatric diagnosis, mental health sequelae, and VHA service utilization among justice-involved veterans.

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