Veterans, PTSD and Incarceration

Most people have heard of post-traumatic stress disorder, more commonly known as PTSD. Although it can affect anyone, it’s often associated with combat veterans. Trauma during war – on the battlefield, in the sky, even the stress of being on the lookout for the enemy can cause severe distress. Life and death situations can have life-altering psychological effects.

It’s natural to respond to a traumatic event with shock, nervousness, and fear. For most people, these reactions fade. This is not the case for those with PTSD. Symptoms continue over time and last for at least a month. Sometimes symptoms disappear for a while but then resurface. They can continue for months, years, even decades if untreated. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used by professionals to diagnose mental illnesses and disorders. The DSM-5 lists four diagnostic criteria for PTSD: including re-experiencing or intrusion, avoidance, negative cognitions, and arousal. Re-experiencing results in vivid memories, dreams, and flashbacks, as well as a feeling that the person is back in the traumatic experience. Avoidance includes conscious and subconscious efforts to avoid people, places, and things that are reminders of past traumatic events. Negative cognitions consist of a variety of thoughts and feelings such as the belief that a person is unworthy, deeply flawed, at fault, or that others are at fault. Lastly, arousal expresses itself in the form of aggressive and destructive behavior, sleep difficulties, and hypervigilance.

One of the most common symptoms of PTSD is hypervigilance and a heightened “startle response.” It doesn’t have to be a really loud noise to startle. Often it’s something more commonplace and less obvious – simply the sudden opening of a door or being approached and surprised by an unexpected friend. Mood changes are frequent and can include depression, anxiety, guilt, hopelessness, and dissociation (disconnecting from one’s thoughts and feelings). This is often coupled with diminished interest in participating in events that used to be enjoyable. 

The National Institute of Mental Health describes PTSD as being a psychological condition that’s the result of a terrifying occurrence threatening or actually causing harm. Triggering and re-triggering events can include accidents, violent attacks, natural disasters, accidents, and military combat. 

Many articles and news outlets have reported on the increasing rates of PTSD among military personnel. Movies and TV shows depict soldiers who have returned from war, being triggered by the sound of a helicopter flying overhead or a car backfiring. Those are the obvious, typical situations. Yet, especially concerning veterans, there are many possible causes of PTSD and its triggers (a trigger is a current event, person, or situation that sets off the PTSD symptoms). Add to that possible trauma as a child and incarceration as an adult and the odds of the development of PTSD for military personal increase several times over. 

Childhood Trauma and PTSD

Within the general population, anyone who lives through trauma/traumatic experiences in their youth faces the risk of developing mental health challenges into adulthood, especially PTSD. The likelihood of adverse effects from childhood trauma varies from individual to individual depending on the type(s), duration, and intensity of the traumas. Sexual and physical abuse are the most common causes of some of the most intense deleterious effects down the road. Other childhood traumas can include neglect, natural disasters, the death of a family member, and school shootings, for example. 

Experiencing such impactful events and situations early in life often contribute to impaired coping skills as a person grows into adulthood. Living through trauma as a child can result in unhealthy coping mechanisms including risky behaviors, dangerous recreational activities, and alcohol and drug abuse. Just how intensely a person is impacted also depends on the frequency and severity of traumatic events across the lifespan as well as the effectiveness of mental health treatment, if there have been any. (if there have been any).

When it comes to PTSD, it is never a simple case of cause and effect. Childhood trauma has been found to greatly increase the chances that a veteran will experience long-term psychological difficulties tied to PTSD – most often in the form of depression and/or anxiety. 

One study found that “Vietnam veterans with PTSD had higher rates of childhood physical abuse than Vietnam veterans without PTSD (26% versus 7%).” (Bremner, n.d.)

All in all, it has been determined that the examination of childhood trauma among veterans can help with the mental health assessment and treatment of PTSD symptoms. 

Combat and PTSD

Depression and anxiety are increasing for service members returning from combat. Previous studies of PTSD have focused on combat-related traumas, mostly from the Vietnam War. More recently, with the wars in Iraq and Afghanistan, a new generation of veterans is returning. These veterans are at risk of developing acute and chronic mental health problems related to their war experiences. 

No two soldiers react the same way in combat. For those who develop PTSD, there is typically a gradual order to things. What usually hits first is anxiety, confusion, and numbness. Later come responses such as grief, intrusive thoughts, and withdrawal. Reactions for most soldiers take some time to heal, but they usually do heal. However, for other soldiers, a severe stress disorder can develop and become a precursor to PTSD and difficulties in typical functioning. It is diagnosed as PTSD when the symptoms last more than four weeks. 

As these symptoms persist, they can affect physiological, psychological, and behavioral functioning. Some of the more intrusive responses can negatively affect the quality of life and contribute to medical and psychiatric disorders. Complaints include generalized pain and headaches, constant fatigue, poor sleep patterns, withdrawal, marital discord or abuse, and/or sexual dysfunction. There can be intense responses to various stimuli or events, such as flashbacks, severe anxiety, and confrontational or overprotective behavior – sometimes even suicidal ideation. 

A study was done with Army and Marine Corps who were involved in combat while in Iraq and Afghanistan. Interestingly enough, they found that those who had been to war in Iraq suffered more than those who had been in Afghanistan. They studied those who exhibited PTSD, generalized anxiety, and major depression. Within these groups, they found that 15.6 to 17.1% who served in Iraq showed symptoms compared to 11.2% who had served in Afghanistan. (Hoge, 2004.) 

Other studies grouped Iraq and Afghanistan together and found greater numbers, “around 15-20% of military personnel returning from combat duty from tours in OEF (Operation Enduring Freedom in Afghanistan) and OIF (Operation Iraqi Freedom) met PTSD criteria 3 – 4 months later.” In addition, one in six veterans who served in OEF and OIF suffered from a substance use issue. (What is a Veterans Treatment Court, n.d.). 

Avoiding or Seeking Treatment

A PTSD diagnosis becomes more difficult to determine when detaching, avoiding, or numbing out are taking place. With avoidance, people with PTSD may ignore the warning signs and resist proper care. For veterans, there can also be a stigma attached to seeking help for a mental health disorder. And many don’t understand that PTSD is not a psychosis; rather, it’s an anxiety disorder that can be treated.

Veterans face several hurdles that can stand in the way of diagnosis and treatment:

· Prejudices are sometimes had by those who don’t understand. “Just take it,” “suck it up,” and “get on with life.” It’s the idea that real soldiers shouldn’t need help. In reality, real soldiers with PTSD do need help. Trying to handle it alone only exacerbates the problem.

· It may not be clear exactly how and where to reach out for assistance. The quickest and easiest ways to find the best support include calling the VA Veterans Crisis Line at 800-273-8255 or the National Center for Post-Traumatic Stress Disorder at 877-WAR-VETS.

· The veteran may not be aware of or are in denial of the symptoms and warning signs. Listening to loved ones when they notice changes in mood and/or behavior is crucial.

Overall, it’s important to keep in mind that the most effective management of PTSD depends on early detection and treatment. If there is ever a question about mental health, it’s important to seek a professional opinion.

Incarceration and Veterans 

People who end up committing crimes become incarcerated for many different reasons, such as mental health struggles, addiction, poverty, trauma from childhood and/or adulthood, and anger issues, to name a few. Many of the military veterans who are incarcerated suffer from PTSD. Sometimes this can be further complicated if it isn’t treated properly and can lead to substance abuse or severe anger issues. Veterans who need treatment may act out in a variety of ways that lead to jail time. And going to jail is yet another trauma that compounds the problem. 

With regard to Vietnam vets, by 1988, “more than half diagnosed with PTSD reported that they had been arrested; more than one-third reported they had been arrested multiple times.” (From PTSD to Prison, n.d.). It used to be that most of the veterans incarcerated were from the Vietnam war. However, the more current wars have been even stronger contributors to the problem. There are several possible reasons why veterans from the Iraq and Afghanistan wars might be more susceptible to PTSD. “Those theories include:

  • Because of the lack of a formal battlefront, soldiers deal with constant threats and combat uncertainty.
  • Many of the troops are from National Guard units, where soldiers frequently receive much less training than active duty units.
  • Tours of duty are long and they frequently include direct combat exposure.
  • Many military service members face redeployment.” (Shein, M.G., 2010) 

Veterans Treatment Court 

To help veterans avoid incarceration or shorten their sentences, new programs have been developed to provide treatment for mental health problems that might exist. The increase in the number of soldiers who returned from Iraq and Afghanistan exhibiting PTSD symptoms has spurred increased efforts to assist. A conference was held by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA) to find ways to decrease the incarceration of veterans. The conference included federal agencies, members of law enforcement, corrections, the courts, and veterans' advocacy groups. 

From this came recommendations that included the establishment of a Veterans Treatment Court (VTC) similar to the Drug Court and Mental Health Court. The program provides incarcerated veterans with a supportive and healing environment. There are group and individual therapy sessions that take place, typically for eight weeks, helping to manage anger, deal with anxiety, and heal from trauma while working on sobriety from substance abuse when necessary. Job training and help finding new jobs, affordable housing, and transportation are also provided. Veterans are assigned volunteer mentors who are fellow veterans that provide additional support. After finishing this program, many veterans have had their charges reduced or dismissed completely. 

The VTC model requires regular court appearances as well as mandatory attendance at treatment sessions and frequent and random drug testing. This structured environment works well because of how structured the Armed Forces are. Without this environment, these veterans will likely re-offend and stay in the criminal justice system. The VTC can ensure the veterans meet all of the requirements so it is safe for them, and the community, when they are released. 

The main goal of these courts is to resolve criminal cases through treatment and support. The program targets the root causes of each veteran's criminal behavior. Participants meet frequently with a judicial officer, other veterans, treatment providers, mentors, and support teams. 

Having a case moved to a VTC is usually done through a court order from the judge in the case and not by contacting the Veterans Treatment Court directly. Veterans with a criminal case should consult with an attorney to find out about VTC eligibility.

“VTCs accept all military branches – including reserves and the National Guard. Eligibility requirements vary by county, but most VTCs accept certain types of felony or misdemeanor cases and require participants to:

  • Have served in the military,
  • Plead guilty in a criminal case,
  • Be experiencing Post Traumatic Stress Disorders (PTSD), Traumatic Brain Injuries (TBI), Military Sexual Trauma (MST), substance or other diagnosed disorders, and
  • Agree to participate in a 15-18 month program.” (Are You Eligible for Veterans Treatment Court? n.d.).

In general, the goal of the Veterans Treatment Court is to take those veterans with mental health challenges from the typical court system and provide proper treatment to help with re-entry into the community. VTCs have mental health professionals who specialize in PTSD. After all, PTSD is a very real problem for many veterans. Fortunately, it has very real solutions. 

Are You Eligible for Veterans Treatment Court? (n.d.). California Courts. https://www.courts.ca.gov/11181.htm

Bremner, J.D. (n.d.).

 Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/8422073/ 

From PTSD to Prison: Why Veterans Become Criminals. (n.d.). The Daily Beast. https://www.thedailybeast.com/from-ptsd-to-prison-why-veterans-become-criminals

Hoge et al., 2004. Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New England Journal of Medicine. New England Journal of Medicine, 351(1), 13-22. 

Shein, M.G. (Sept. 2010) Post-Traumatic Stress Disorder in the Criminal Justice System:

From Vietnam to Iraq and Afghanistan. The Federal Lawyer, 46. 

What is a Veterans Treatment Court? (n.d.). Justice for Vets. https://justiceforvets.org/what-is-a-veterans-treatment-court/ 

Laurie Campbell, MS, is a counselor, life coach, and writer. She has also worked as a volunteer counselor for the Suicide Hotline. One of her specialties is Post-traumatic Stress Disorder, especially as it relates to substance use. Her Master's Degree is in Mental Health Counseling with an emphasis in addictions.