PTSD in Veterans Treatment Courts: Correlates and Effects on Perceptions of Justice

Although veterans are incarcerated less often than non-veterans (Bronson et al., 2015), we know that combat exposure, PTSD and of pre- and post-military factors are associated with veteran arrest (Elbogen et al., 2012; Fontana & Rosenheck, 2005). The association between PTSD and justice-involvement has helped justify the emerging veterans treatment court (VTC) intervention (Russell, 2009). While many have more liberal requirements, some VTCs restrict eligibility to combat veterans or those with mental health diagnoses related to military service (McGuire et al., 2013). Although the population is different, VTCs have adopted the approaches of drug and mental health courts. These courts have relied on Tyler’s theory of procedural justice (Tyler & Huo, 2002) to increase positive views of our legal system’s legitimacy and reduce recidivism through fair treatment.  Although the intervention is spreading rapidly, VTC research is limitted. Few studies have explored correlates of PTSD among participants and none have examined how this diagnosis affects perceptions of court processes and our legal system. The present study utilizes an exploratory approach to 1) identify correlates of PTSD among VTC participants and 2) examine how PTSD is associated with perceived procedural justice and legal legitimacy.

The cross-sectional survey was administered in two VTCs in 2016 with approximately 80% of eligible participants participating (N=191). The sample was diverse on many demographic, military, socioeconomic, and legal factors and resembled local and national VTC populations on many measures. Probable PTSD was evaluated with the 4-item PC-PTSD (Prins et al., 2003) and 41% of the sample screened positive. Other administered measures included military homecoming (Vogt et al., 2013), civilian reintegration difficulties (Sayer et al., 2011), legal legitimacy (Jackson et al., 2011) and a modified procedural justice instrument (Tyler et al., 2007). Individual items assessed demographics, housing, employment, age at first arrest, and total lifetime arrests. The exploratory analysis had two phases. First, logistic regression was used to regress probable PTSD on military, demographic, socioeconomic and legal variables. Second, probable PTSD, along with significant covariates from the first phase, were used to regress procedural justice and legal legitimacy.

In Phase I, the overall logistic model was significant (Wald X²(1)=4.09, p=.043) with a Cox and Snell pseudo R² of .34. The following variables were significantly associated with probable PTSD with their odds ratio: combat exposure (13.64), civilian reintegration difficulties (1.63) and homelessness (.16). In Phase II, neither legal legitimacy (F(3,184)=.79, p=.499) nor procedural justice (F(3,183)=0.42, p=.998) were significantly associated with probable PTSD and the significant covariates from Phase I.  

The study begins exploring what factors are associated with probable PTSD in an emerging intervention for justice-involved veterans consistent with the Smart Decarceration initiative. It highlights the importance of the social supports measured in the civilian reintegration measure. Most importantly as VTCs across the country wrestle with eligibility criteria and operating decisions, it suggests that that probable PTSD does not impact how veterans perceive VTC employees and our larger legal system. The presentation will conclude with a discussion of the study’s limitations and implications for research, policy and practice.