KAREN FRIEDMAN: Hi. I am here with Brian. Brian, if you could please introduce yourself.
DR. BRIAN MEYER: Sure. I'm Brian Meyer and I am a Clinical Psychologist and a Traumatologist and I work for the Veterans Health Administration.
KAREN FRIEDMAN: We're here to talk about veterans' treatment courts. What components help create a successful veterans' treatment court?
DR. BRIAN MEYER: Well, it's very interesting because if you look at regular courts, they have a 50% recidivism rate. If you look at drug courts, they have a 30% recidivism rate. If you look at veterans' treatment courts, they have a 13% recidivism rate, which means that veterans' treatment court literally are the most successful courts there are.
So what makes that happen? I think there's several things. First of all, people who work in veterans' treatment courts are very committed to veterans and the service that they provided this country. And having that kind of support system is really critical. The key person in that support system is actually—and I'm sorry to say this to the judges and clinicians—but it's actually the mentor. That's what's different.
If you're looking at the secret sauce, all treatment courts have certain things, but there are two things that veterans' treatment courts have. The key one is they have a veteran mentor. It may be somebody who is essentially a peer and has been through the same kinds of things or it may be somebody who is older and really is committed to helping other veterans. And those people are critical and there's nothing like that in any other court.
The other thing is that there is a VJO, Veteran's Justice Outreach worker, who works to connect the veteran with services. And that is really critical because the VA has an array of services that is not seen anywhere else. So, for example, yes, we have substance abuse residential treatment and there are lots of those, but we have post-traumatic stress disorder residential treatment, which doesn't exist anywhere else outside of the VA. And there are lots of programs within the VA, suicide prevention programs and other kinds of things that don't exist anywhere else. And that's especially important ‘cause some of the people who come into veterans' treatment courts actually aren't allowed to go to the VA because of their discharge status. And what happens then is the VJO can help them upgrade their discharge status so that they can then access all these other levels of treatment. So all of those things are going on that don't happen in other treatment courts.
KAREN FRIEDMAN: Hmm. Okay. So how do—how do treatment courts help veterans deal with trauma?
DR. BRIAN MEYER: So, first of all, treatment courts, and especially veterans' treatment courts, tend to be, at the minimum, trauma-sensitive. They're very aware. You know, there's military sexual traumas, there’s combat trauma, there's accident trauma, there's childhood trauma. There's so much trauma that veterans can have experienced in their lives. And so veterans' treatment courts tend to be much more sensitive to it than other kinds of courts.
There are two other levels. One is what we would call a trauma-informed court, where they really know a lot about trauma. And I would say almost all veterans' treatment courts really are trauma-informed. There is a new level that we've been working on and that level is what we're calling trauma-responsive courts. And there are trauma-responsive courts where judges are already doing this, clinicians are already doing it, the VJOs, the peers, etc.
But it's sort of the next level. It's like now that you know all this stuff, okay, what do you do about it so that—for example, you know that these folks with post-traumatic stress and post-traumatic stress disorder come in with, really, a brain injury. And part of the brain that gets injured is the amygdala, which goes on overdrive. And that's our threat response system. And the threat response system goes into overdrive. And there are three options there: fight, flight, freeze. And so when people are actually coming into the court, it's not a conscious decision. They're either in fight mode, so they're angry. They're in flight mode and they may want to avoid or even flee, abscond out of the court, which could get them in big trouble in many courts. So would fighting.
And then there's the freeze part of it. And the freeze part of it usually has to do with a lot of guilt and shame and shutdown as a result. And in veterans' treatment courts, people understand this. They're prepared and they learn how to respond to anger not with anger, but rather with empathy. They learn how to respond to the urge to flee or the actual flight not by control—which is what is feared—but by reaching out and inviting. They respond to freezing with warmth, an interpersonal warmth, so that the person gets unfrozen.
And so all of that is what happens and it happens in the veterans' treatment court. And so veterans' treatment courts can be these kind of trauma-responsive courts that really lead the whole treatment court movement in what they're doing.
KAREN FRIEDMAN: Hmm. Very interesting. Why do you think that treatment courts are so essential to providing justice in our communities nationwide?
DR. BRIAN MEYER: That's a great question. So one thing is that justice can be a somewhat malleable concept, and so the question is what angle on it are we taking? And so one piece that goes to veterans' treatment courts, I think, is social justice. And social justice says, "We are doing the right thing." And in veterans' treatment courts, we're working with people who—we honor their service to our country. These people gave and lost as a result and sometimes were harmed by their service to this country. We owe them because we don't have any freedoms without them. So we owe them.
A second thing is that if we want to do justice, one of the things that we want to do is we don't want people to come back. And so we measure the effectiveness of these courts by seeing, what is their recidivism rate. And veterans' treatment courts, as I said, have the best—the lowest recidivism rate of all kind of courts of any kind. And what that means is that people aren't doing it again. And that's because we're providing them with an essential component, or two of them. One is all the support that the court does and the other is treatment.
And so we're saying, "If you have a mental health problem or you have post-traumatic stress disorder or you have a substance use problem or you have all of those, we're going to treat you for it. We're not going to punish you for it." Those things are as a result of the service you gave and what we need to do is to undo and heal the negative effects that came with it.
KAREN FRIEDMAN: What role do treatment courts play in an individual's journey to recovery from substance use?
DR. BRIAN MEYER: They're central. I mean, you—they're not going to get it without the treatment courts. And the reason we know that is those people have tried other ways. They've tried to do it on their own. They've tried to do it in other treatment and—you know, maybe individual treatment, maybe group treatment, maybe residential treatment. And they've already tried all those things and they haven't worked.
And so what needs to happen is something where somebody has treatment with accountability. And so the essential other side and other critical piece is, there's a kind of accountability there. So people, for example, will have random urine drug screens. And then if their drug screen turns out to be positive, then there will be discussion of that and there'll be discussion of, "Okay. So you relapsed? What happened on the way to your relapse? What happened before that? Let's see if we can figure that out so that then maybe we can figure out a way not to do it next time."
And so that's a very different response than saying, "We're going to throw you in jail for two weeks." Because we know that doesn't work. Actually, there's research by Dr. Shannon Carey which indicates that, for every day that is more than six days of jail time, people actually recidivate more.
KAREN FRIEDMAN: Wow.
DR. BRIAN MEYER: So it's—it drops when you're three, four, and five days. And so the recidivism rate is lower than, much lower than average, and then it rises precipitously. So it goes to a hundred and forty percent, and it goes to a hundred seventy-percent, and two hundred and some odd percent. And I'm not sure that those are—those are actual—those are the actual numbers but it's just—it's a straight up line. And so what we find is that jail as a sanction is not an effective sanction beyond a certain point. It's effective for a little while, but you go beyond that and it's not effective anymore. So—and, by the way, that's another thing that's been tried. These people have been in jail before, okay? It's not like...
KAREN FRIEDMAN: It doesn't work.
DR. BRIAN MEYER: It doesn't work either. And they've been—so what needs to happen is you need this combination of treatment and accountability. I mean, really, the two of those together, that brings success.
KAREN FRIEDMAN: What makes veterans' treatment court so unique and special as compared to other treatment courts?
DR. BRIAN MEYER: Well, I think that when we're in veterans' treatment courts, there are a number of different facets to it, but the—one of the key facets to it is honoring the veteran's service, because a lot of people—certainly all the veterans who came back from Vietnam—you know, they were hated and people threw rotten vegetables at them and called them baby killers and all of those kinds of things. And that's not why they went to Vietnam. I mean, half of them were drafted to go to Vietnam. It wasn't something necessarily that was their choice.
But what they did was serve our country, okay? And there are very few people, less than one percent now of the country, who go into military service and literally are willing to give up their health, their mental health, and their lives to protect our freedoms. And we owe those people. All the rest of us, we haven't done that service. But those people have made it possible for us to be free. And we owe them a debt in any way that if they have been harmed by their military service—and, of course, when you're in a war, people get harmed. I'm not saying that this is something that, you know, was done intentionally in any way. But it happens.
And when it happens and somebody gets a terrible traumatic brain injury, somebody loses their leg, somebody develops post-traumatic stress disorder or a serious depression or a serious substance use problem, we have a responsibility to make that right, because they were giving their lives for us. They were giving their health and their mental health. The sacrifice can never be fully repaid but it can be healed. And that's a responsibility that we all have.
