Manny Welch, 54, served on a naval aircraft carrier in the four years immediately following the Vietnam War. The resulting stress helped fuel his substance abuse, a pattern that was to haunt him for the next 30 years.

His drug habit brought him in and out of the correctional system for crimes like petty larceny and drug possession. After many failed attempts at kicking the habit, four years ago he heard about a new kind of criminal court in his hometown of Buffalo, N.Y.—one aimed at helping veterans in the correctional system get their lives back on track by offering them counseling and support rather than just punishment.

"It helped turn things around for me," says Welch. "A lot of times I wanted to get out of treatment because I didn't think I could make it. But [the judge and court staff] stood by me and helped me get through it."

As it turns out, Welch benefitted from the country's first veterans treatment court—an entity that works within the criminal justice system to comprehensively address veterans' mental health and substance abuse issues. The courts are similar to drug and mental health courts, but designed specifically for veterans, who have both substance use and mental health issues. Many are "dockets," a day or more set aside each month to address these cases.

Since the launch of that first court in January 2008, versions have cropped up across the country. There are now about 88 veterans courts in 26 states, according to Justice for Vets, a branch of the National Association of Drug Court Professionals, or NADCP, that is dedicated to the establishment of veterans treatment courts.

"For many veterans, the time they spent in the military was the high point of their adult lives—they had jobs where they did important work, had a lot of responsibility, and felt they did their jobs well and were good at what they did," says Sean Clark, JD, national coordinator for Veterans Justice Outreach at the Department of Veterans Affairs, the program overseeing the VA's involvement in these courts. "But a lot of them feel they've become very disconnected from that sense of accomplishment and community."

It makes a big difference for veterans to have a community wrap itself around them, help them adhere to treatment and gently hold them accountable for their actions, adds Welch, who now mentors other veterans through the court. "It took me a few times to get it right," he says. "But the judge, the court staff and the mentors wouldn't give up on me. They said, ‘You're going to complete this and you're going to succeed.'"

Psychologists are working in these courts in the position of veterans justice outreach coordinator, a job created by the VA to ease veterans' access to services and benefits, says psychologist Rachael Guerra, PhD, an outreach coordinator with the Palo Alto VA Health Care System.

"My aim is to make sure there are clear lines of communication between the courts and the VA, so that each understands the other in terms of recommended treatments and the veterans' court-mandated legal obligations," Guerra says. Those obligations range from paying fines to attending DUI classes to showing up for treatment. She also enrolls veterans in the VA, and assesses them so she can route them into appropriate VA services, whether mental health, substance abuse or other.

The role is similar to the one many psychologists play within the VA, except there's more travel, Guerra adds. "We're going to court, we're going to jail—we're doing a lot of our work in places outside the VA as opposed to in the office."

Meeting veterans' needs

In keeping with Guerra's role, the courts work with the VA to help veterans access VA benefits and services. They also use community workers and volunteers—particularly veteran mentors—to help defendants navigate the practical and emotional obstacles to finding housing, complying with medication regimens and dealing with post-traumatic stress symptoms or other mental health problems.

Say a veteran is in court for alcohol-related problems, and suffers from post-traumatic stress disorder and traumatic brain injury. Even before his case heard, members of his support team meet to gain an understanding of his status and to discuss solutions to existing problems, whether it's finding a way to get to treatment, a place to live or something else.

"Everybody hears what's going on, so the veteran is not alone in trying to navigate a system and figure out how to get things done," Guerra says.

On the day the vet's case is heard, the courtroom is filled with people to help him sort out his problems—physical health, mental health, legal and practical. The team may include the judge, the veteran's attorney, the prosecutor, psychologists and other providers who serve as veterans justice outreach coordinators, a treatment compliance officer, VA health benefits specialists, community treatment providers and fellow veterans. If the veteran has problems finding a job or housing, people are there to connect him with VA and community programs and services as well. In addition, thanks to computers linked to the VA's electronic health records system, the veterans justice outreach coordinator can work on the spot to set up needed health appointments.

Central to the process are the veteran mentors: service men and women who have sometimes been through treatment themselves and are available to support other veterans. Some of these courts are now pairing veterans with mentors who served in the same conflict they did and who are similar in age and gender, and who have expertise in the benefits the veteran may need, says NADCP spokesperson Chris Deutsch. "The issues and experiences some of these folks are dealing with are so unique that it's extremely helpful for them to talk to someone who understands exactly what they've been through," he says.

The mentors can significantly increase the chances the veteran will stick to treatment, adds VA psychologist Giovanna Delgado, PsyD, outreach coordinator for the Miami VA Medical Center. "In my opinion, a lot of times when a veteran gives another veteran advice, they're more likely to respect and follow it than they are from a traditional treatment provider," she says.

The process isn't always perfect. Judges who have run drug and mental health courts are already familiar with the treatment court model and therefore may be better prepared than newcomers to run these courts, at least initially. And, it can take time for veterans to comply with court mandates. "Often these folks are dealing with substance abuse disorder, and relapse is part of that process," says Clark. The courts handle any setbacks through a defined set of sanctions that may require veterans to come to court more often, stay in court after their case is heard to observe other cases, or even serve brief jail time if noncompliance continues, for example.

Given how quickly the courts are growing and the large numbers of troops returning home, funding issues are still being worked out, adds NADCP's Deutsch. That said, many courts have been able to get up and running without additional funds, and they can apply for grants available generally for drug courts through the Department of Justice and the Center for Substance Abuse Treatment. In addition, the NADCP offers training and mentoring programs for courts wishing to adopt the model or improve on their current systems.

"Great strides have been made to make funding available to these programs, but with troops continuing to surge home, we expect the need for funding to grow substantially," says Deutsch.

Who is served

The veterans who come to these treatment courts are a diverse group. Many are Vietnam-era veterans, but an increasing number are service members returning from Iraq and Afghanistan, says Clark. Common charges include drug- and alcohol-related offenses such as driving while intoxicated and drug possession, and theft that is often linked to supporting a substance-use habit. Other charges include aggressive behaviors such as bar fights and domestic violence, and possession and sometimes illegal use of weapons.

While there are no firm numbers on the exact relationship between such criminal actions and war-related traumas and problems, it's likely that many are connected, says Delgado. A study conducted by the Rand Corporation in 2008 estimated that approximately one-fifth of Iraq and Afghanistan veterans return home with symptoms of PTSD or depression, but only slightly more than half of those people seek treatment. Of that group, only half again receive even minimally adequate care, the report states.

"Sometimes mental illness plays a role in the crimes committed by veterans, often because it's untreated," Delgado says. "And untreated PTSD and depression can lead to poor judgment, drug abuse and getting arrested for committing some sort of crime. So it's really important to be able to give these veterans access to the treatment the VA offers, so we can prevent or stop that from happening."

Psychologists working in the system add they're surprised by the number of veterans they meet with who hadn't previously accessed any VA services or benefits, including older veterans.

"As more veterans treatment courts become established and the word gets out," says Delgado, "I think more veterans will begin to see that there is help out there."

The VA is now evaluating outcomes for veterans seen by its Veterans Justice Outreach program, including those seen in these courts. An informal assessment of the Buffalo program by Judge Robert Russell, an associate judge in Buffalo's City Court who helped found the courts, already shows the promise of these systems (see sidebar). Of the 200 veterans Russell has seen in his court, about 65 have graduated from their treatment programs, and none to his knowledge have been re-arrested.

For Russell, the courts are about doing the right thing by the men and women who have served the country, while maintaining legal obligations and public safety. "If veterans who have put themselves in harm's way find themselves going through challenges at home," he asks, "then shouldn't we as a society be doing more to help them become stable?"

Tori DeAngelis is a writer in Syracuse, N.Y.

More information on Buffalo's Veterans Treatment Court is available online. For more information on veterans courts in general, visit Justice for Vets.