Courtesy of Godoy Medical Forensics
The following is a fictional scenario in which a veteran client may be arrested and charged with a crime.
Mr. Smith served two year-long tours in Iraq. He experienced a mild traumatic brain injury (mTBI) after an improvised explosive device (IED) exploded on the road where he was traveling by jeep. Some of his fellow soldiers were killed by the blast. He was also engaged in a situation with civilian combatants in which he was told not to return fire and this caused him to feel frustrated and helpless. Mr. Smith had difficulty adjusting to civilian life when he returned home. He was unable to find employment for six months because the skills that he learned in the military were not needed in the job market. He experienced anxiety when he heard loud noises and had frequent nightmares. He used alcohol to cope with his distress. A year after his discharge from the Army, he was observed by a police officer to be driving at an unsafe speed. The officer stopped him and noted a strong odor of alcohol on his breath. Mr. Smith refused a field sobriety test and became hostile and physically aggressive with the officer. He was arrested and taken to prison pending bail. His attorney employed a legal nurse consultant who reviewed his medical records and provided an analysis that was used to have his case transferred to Veterans’ Court.
Several medical issues common to veterans can be identified in the above case study. Mr. Smith was effected by traumatic brain injury. He also demonstrated symptoms of PTSD and substance abuse. A legal nurse consultant might also recommend that he be evaluated for depression.
There are several depression screening tools that professionals administer that are cost effective and provide concrete data that can be used in court.
Symptoms of depression that could affect a veteran’s functioning are:
- Sad or irritable mood;
- Inability to experience pleasure;
- Appetite and sleep changes;
- Feelings of worthlessness;
- Decreased ability to think or concentrate;
- Suicidal ideation.
Suicidal ideation is a serious symptom. Some individuals with depression deliberately engage police because they want to be shot. This is called “suicide by cop.” Veterans are also more likely than civilians to own a firearm. Symptoms of depression can be increased with the use of central nervous system depressants such as alcohol.
Substance abuse can be an issue for returning veterans. The Department of Veteran Affairs (VA) estimates that one in ten veterans seen in the VA system has a problem with alcohol and other drugs. In the example above, Mr. Smith was using alcohol to cope with his symptoms and the stress of adjusting to civilian life. Veterans may use substances to help with sleep disturbance, anxiety and to cope with their memories.
Veterans are at high risk for PTSD. According to the American Psychiatric Association (2013), the diagnosis of Post-Traumatic Stress disorder (PTSD) is based on the development of symptoms following exposure to one or more traumatic events, such as combat. Factors that influence a veteran’s vulnerability to PTSD are continuous operations and survivor guilt when comrades are severely or mortality injured. In recent wars, soldiers do not always know who or where the enemy is. Suicide bombers and IEDs are often hidden. This creates a feeling of continues anxiety and hypervigilance that is brought to civilian life. When the rules of engagement prevent service members from engaging the enemy, as occurred with Mr. Smith, it can also increase their risk for psychological problems.
Symptoms of PTSD that veterans might experience are:
- Recurrent intrusive memories.
- Recurrent nightmares.
- Dissociative reactions. These can range from flashbacks to complete lack of awareness of surroundings.
- Psychological and physical distress. This distress is experienced when they are exposed to stimuli that reminds them of the trauma. Examples would be fireworks, the sight of blood or loud noises.
- Avoidance of memories, thoughts, or feelings that are associated with the traumatic event. They may not wish to talk about their military service.
- Negative beliefs and expectations of self and the world.
- Irritable and angry outbursts with little or no provocation. The individual can be verbally or physically aggressive toward people or objects.
Treatment of PTSD involves therapy and medication to help decrease arousal and process the trauma into long term memory.
Blast injury is the signature wound of the war in Iraq and Afghanistan. It is always wise to ask a veteran client who has served in the Middle East if he or she was ever exposed to a blast. Blast exposure can cause instant death, immediate neurological symptoms, or injuries with delayed symptoms. Traumatic brain injury (TBI) can also occur from fragments, bullets, motor vehicle crashes and falls. TBI is characterized as mild, moderate, or severe. Mild TBI as experienced by the veteran in the case scenario is also known as a concussion. See our newsletter on concussion here. There are research studies that show that veterans will usually have residual symptoms 18 to 24 months after the injury (Summerall, n.d.). Chronic post concussive symptoms that may affect the veteran’s behavior are:
- Poor judgment and impulsivity
- Personality changes
The symptoms of mild TBI do respond to time, rest, and treatment. A legal nurse consultant can provide research that demonstrates that veterans who experienced TBI have problems with emotional regulation and decision-making.
The purpose of veterans’ court is to assist veterans who are accused of crimes that occurred as they are adjusting to civilian life. There is an extensive screening process for veterans who apply. The courts in most communities share the guidelines that the veteran served on active duty, received an honorable discharge, and is charged with a probation-eligible crime. Megan’s Law offenses and murder cases would not be eligible. In Mr. Smith’s community, consideration is given to the seriousness of the crime, his prior record, his service record, victim impact, and police opinion. Aside from an attorney, veterans are assigned a mentor—another veteran who has been home for a longer time period. The veteran is required to submit to random drug screenings and participate in rehabilitative services through the VA or civilian programs. It is likely that Mr. Smith will be required to participate in a substance abuse treatment program.