Veteran's Post-Jail Treatment Engagement: Does Provider Type Matter?

Background: An estimated 8% of individuals in jails are Veterans (Bronson et al., 2015), half of whom have unaddressed behavioral health needs (Blonigen et al., 2016). In 2009, the Veterans Health Administration (VHA) started the Veterans Justice Outreach (VJO) program to link Veterans in the criminal/legal system to behavioral health treatment. Studies have shown a positive impact on Veterans who participate in VJO programs, through linkage to Veterans’ courts and behavioral health treatment in the VA (Finlay et al., 2014), and that Veterans in jails were equally likely to receive jail-based mental health services as their non-Veteran counterparts but less likely to receive discharge planning services before release (Comartin et al., 2022). However, less is known about post-jail treatment engagement by Veterans. The current study, which is the first to combine Medicaid and Veterans Health Administration (VHA) data, assesses whether Veterans gain access to services after a jail stay. This study evaluated where Veterans receive their post-jail mental health care and compares post-year treatment and recidivism outcomes between those who received services from a VHA provider to those who did not.

Methods: In 2019, 145 Veterans were booked into 8 jails in a Midwestern state. A screening instrument was delivered as they were booked into each jail that asked demographic, behavioral health and criminal/legal history questions. This sample was then linked with Medicaid, VHA, and recidivism (jail data) events in the one-year period after the jail stay when the screening instrument was taken. Bivariate (chi-square and one-way anova) and multivariate analyses were conducted. Logistic regression analyses were used to assess the impact of post-jail treatment provider type on recidivism.

Results: Of 145 Veterans, 44.1% (n=64) received behavioral health treatment from either the VHA or both VHA and non-VHA providers, 42.8% (n=62) received care from only non-VHA providers, while 13.1% (n=19) did not receive care from either VHA or non-VHA providers. Veterans who received care from VHA providers were significantly more likely to receive mental health treatment in the year following jail release (53.1%, n=34; Χ²(2)=19.458,p=.000,V=.366) and were less likely to recidivate (29.5%, n=18; Χ²(2)=7.365,p=.025,V=.239), compared to Veterans who received care from non-VHA providers (30.6%, n=19 and 47.2%, n=25, respectively). After controlling for differing factors between Veterans and non-Veterans, the regression model showed that Veterans who received care from a VHA provider had lower odds of recidivating (AOR:16.60,p<.05) compared to Veterans who did not.

Implications: The findings from this exploratory study show that Veterans in jails who receive mental health care from VHA providers are more likely to receive care and less likely to recidivate. These findings can be used to inform the VHA, county jails, and community mental health providers about the behavioral health needs and service gaps for justice-involved Veterans. Establishing formalized, coordinated systems of care that link Veterans to culturally-appropriate services could improve treatment and recidivism outcomes for Veterans. Risk for suicide, relapse, and overdose increases after jail release; therefore, understanding and improving these systems of care is critical for Veterans to successfully return to the community.