Month: December 2022
Opinion: New Yorkers shouldn’t have to choose between food and other basic needs
Food Insecurity on the East End
NY should fund free school lunches for all students (Guest Opinion by Rachael Ray)
NYHealth Testimony on Veterans Treatment Courts
On December 13, 2022, the New York City Council Committees on Veterans and Mental Health, Disabilities, and Addiction held a joint hearing on Veterans Treatment Courts. NYHealth President and CEO David Sandman submitted the following testimony highlighting the value of these life-saving courts and opportunities to continue strengthening them:
Thank you to Chairpersons Holden and Lee and distinguished members of the Committees for the opportunity to testify today. I thank you for this opportunity to submit written testimony to the New York City Council about the importance of Veterans Treatment Courts (VTCs).
I am pleased to provide testimony on behalf of the New York Health Foundation (NYHealth), a private, independent, statewide foundation dedicated to improving the health of all New Yorkers, including the more than 100,000 veterans who call New York City home. NYHealth has been investing in the evaluation, replication, and strengthening of VTCs across New York State since 2009, and that work is ongoing.
New York’s Veterans
New York State is home to more than 600,000 veterans, the eighth-largest veteran population of any state in the nation. Approximately one-quarter of the State’s veteran population (133,383 veterans) live within the five boroughs of New York City. Most veterans return from deployments and transition to civilian life relatively smoothly; they’re healthy, ready to work or go to school, and eager to settle back into life at home. But for some, the adjustment isn’t so easy. They struggle with the invisible wounds of war: PTSD, traumatic brain injury, depression, substance use, and more. A survey of New York State’s veterans by the RAND Corporation revealed that 22% of returning post-9/11 veterans have a probable mental health diagnosis.[1] The number of veterans being treated for mental illness and substance use has increased 38% since 2004.[2]
The burdens of mental health and substance use issues are associated with related problems such as homelessness, unemployment, and strained personal relationships. Sometimes these challenges lead to involvement with the criminal justice system. Nationally, about 8% of those incarcerated in jails or prisons are military veterans.[3] An estimated one in three veterans report having been arrested and booked into jail at least once.[4]
The Value of Veterans Treatment Courts
For veterans who encounter the criminal justice system, VTCs offer a lifeline. VTCs are a type of problem-solving court that provide an alternative to incarceration for eligible justice-involved veterans who have mental health or substance use disorders.
It is a point of pride that the very first VTC in the nation was established in Buffalo, in 2008, by the Honorable Judge Robert Russell. New York State is the national leader for this type of social justice reform; its model is the national standard and blueprint for VTCs.
Veterans who participate in VTCs are offered mental health and/or substance use services and can be linked to veteran-specific community-based services and agencies. VTCs maintain the traditional partnerships and practices of highly successful drug courts. Rather than focusing on punishment, VTCs present a non-adversarial approach in which the judge, prosecutor, defense, probation, law enforcement and case manager work together with representatives from the U.S. Department of Veterans Affairs, as well as the state’s department or commission of veterans’ affairs, Vet Centers, community mental health and substance use treatment providers, veterans service organizations, and volunteer veteran peer mentors. This multi-disciplinary team ensures every veteran receives an individualized treatment plan and is connected to the service benefits he or she earned.
The evidence is clear: VTCs work. Participating in VTCs is associated with reduced recidivism, lower alcohol and drug use, more stable housing, increased opportunities for employment, stabilized relationships with friends and family, and improved mental health.
By addressing the underlying cause of criminal behavior in a highly structured and closely supervised environment, VTCs strike the proper balance between accountability and compassion. The restoration of veterans’ sense of honor allows them to re-engage with their communities as productive, law-abiding citizens.
The Pandemic Renewed Urgency for Addressing Veterans’ Needs
The COVID-19 pandemic exacerbated veterans’ mental health issues; veterans have experienced social isolation, unemployment, food insecurity, and other factors that are associated with poor mental health outcomes. In a 2020 national survey of post-9/11 veterans and service members who incurred a physical or mental injury or illness while serving, 52% of veterans reported that their mental health had worsened during the pandemic.[5] Last year, more than half of those surveyed said they currently suffer from moderate to severe depression; half experience moderate to severe post-traumatic stress disorder; and more than two-thirds experience moderate to severe anxiety. Nearly one-quarter reported having suicidal thoughts in the last 12 months; of those, 70% had had them in the prior two weeks. Moreover, about 20% of those surveyed report experiencing barriers to receiving mental health care.[6]
Further, there has been an increase in alcohol and other substance use during the pandemic. Numerous studies have shown increased risk of involvement in the justice system for veterans with substance use issues and PTSD.
Given these growing risk factors, VTCs are as critical as ever to ensure that justice-involved veterans get the support and treatment they need for mental health and substance use issues. It is also essential that programs and services are in place to meet veterans’ behavioral health needs before they lead to encounters with the justice system. Adequate systems must be in place to support veterans during these vulnerable times.
Addressing Veterans’ Behavioral Health Needs Prior to Justice System Involvement
Once veterans become involved in the criminal justice system, VTCs offer support and rehabilitation rather than incarceration. However, earlier interventions are necessary. The Committees should also consider opportunities to address veterans’ behavioral health needs before they encounter the criminal justice system.
Community-based peer mentoring programs are a proven and effective factor in mental health promotion and suicide prevention interventions. NYHealth has made numerous investments in these programs that are starting to bear fruit. For example, the Joseph P. Dwyer Peer Support Program—which takes a confidential, peer-to-peer approach to reduce isolation, increase social connectivity, and connect veterans with community-based resources—is slated to be expanded statewide with an increased State budget allocation. The Steven A. Cohen Military Family Center at NYU Langone works to provide high-quality telemental health services and peer support to post-9/11 veterans; this year alone, they served nearly 400 New York veterans. New York Cares recruited and trained 126 volunteers to provide “buddy checks” through telephone outreach to veterans in need. And the Expiration of Term of Service (ETS) Sponsorship Program, which connects service members leaving active duty and transitioning to veteran status with peer mentors and community resources, is expanding the reach of its peer mentor program into New York City this year.
Programs like these, in tandem with VTCs, create a comprehensive community safety net for veterans both before and after they encounter the criminal justice system.
Gaps in VTC Evaluation Data
While available data largely show positive outcomes of VTCs, more robust and longitudinal evaluations are needed. In fact, even the most basic data such as the numbers of New York veterans who have participated in VTCs are hard to come by. The latest figures are seemingly from January 2017, when VTCs had helped more than 4,500 New York State veterans. More recent data do not appear to be publicly available.
To ensure the effective and equitable implementation of VTCs, ongoing and granular data collection and program assessment are imperative. A firmer grasp on how many veterans have used VTCs in New York, who they are, and the rate of successful graduations will help legal professionals, researchers, advocates, funders, and policymakers better understand not only how well these courts are performing, but also what prevents success and who is still slipping through the cracks. Researchers have called for an independent, multi-disciplinary approach to evaluating New York’s efforts so as to further strengthen VTCs, now and in the future.
Conclusion
New York State set a national standard when it established the first VTC more than a decade ago. VTCs offer the best pathway to rehabilitation for veterans, help those who served their country reintegrate successfully in their communities, and maintain law and order. The challenge and the imperative now is to ensure that VTCs continue to operate effectively and give justice-involved veterans a meaningful opportunity to get their lives back on track. Understanding VTCs’ reach and impact, identifying opportunities for improvement, and making needed course corrections will require reliable, timely data for researchers, advocates, and policymakers to analyze. And ultimately, more must be done to ensure that veterans have the proper care and services to meet their behavioral health needs before they enter the justice system.
I hope you will look to the New York Health Foundation as a resource and a partner in your work to continue to strengthen Veterans Treatment Courts and ensure that all of New York’s veterans have the care and services they need and deserve.
[1] Schell et al., “A Needs Assessment of New York State Veterans: Final Report to the New York Health Foundation.” Santa Monica, CA: RAND Corporation, 2011. https://www.rand.org/pubs/technical_reports/TR920.html.
[2] Henderson K and Stewart K. “Veterans Treatment Courts,” American University, 2016. https://www.american.edu/spa/jpo/initiatives/drug-court/upload/fact-sheet-on-veterans-treatment-courts.pdf.
[3] Bronson J, Carson EA, Noonan M, and Berzofsky M, “Veterans in Prison and Jail, 2011–12,” The U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2015. https://www.bjs.gov/content/pub/pdf/vpj1112.pdf.
[4] Snowden, D. L., Oh, S., Salas-Wright, C. P., Vaughn, M. G., & King, E. (2017). Military service and crime: New evidence. Social Psychiatry & Psychiatric Epidemiology, 52(5), 605-615. http://doi.org/10.1007/s00127-017-1342-8; Timko, C., Nash, A., Owens, M. D., Taylor, E., &Finlay, A. K. (2020). Systematic review of criminal and legal involvement after substance use and mental health treatment among veterans: Building toward needed research. Substance Abuse: Research & Treatment, 14, 1-13. https://doi.org/10.1177/1178221819901281
[5] Wounded Warrior Project and Westat, “2020 Annual Warrior Survey,” https://www.woundedwarriorproject.org/media/zojlzv53/2020-annual-warrior-survey.pdf.
[6] Wounded Warrior Project, “2021 Annual Warrior Survey, Longitudinal: Wave 1,” https://www.woundedwarriorproject.org/media/4ptekte3/2021-report-of-findings.pdf.
A Wish List for 2023
As another year winds down, it is a natural time for reflecting on what was and looking ahead to the possibilities on the horizon. In that spirit, it’s become an annual tradition for me to share a wish list for each year.
My 2022 wishes haven’t fully come true, but there’s been progress on all of them. Most importantly, the worst of the COVID-19 pandemic is behind us. We still need to be vigilant about protecting ourselves and others from the virus. But with vaccines, testing, and treatments widely available, COVID looks and feels much different than it did two years ago and even one year ago. Things feel better and safer; it feels “normalish,” as I’ve taken to calling it. And while there is no doubt that we live in troubled times, there are other developments to feel optimistic about too.
Here are some wishes for 2023:
1. A rebalanced health system built on primary care. This was on my list last year, and we made substantial progress. But it’s not over the finish line yet, so it’s staying at the top of the list. A mountain of evidence tells us that primary care is both associated with better health AND saves money. It’s among the best bangs for the buck in health care. Yet we underinvest in it; only about a nickel of every health care dollar is spent on primary care.
New York should join the growing number of states that have increased their investment in primary care without increasing total spending on health care. In fact, Rhode Island increased the share of its commercial insurers’ primary care expenditures by 5% and their total health care expenditures fell by 14%. I’d call that a very good deal.
Both houses of the New York Legislature passed bills to establish a primary care reform commission to define and measure our baseline spending on primary care, set targets for enhanced investments in primary care, and test out pilot programs to identify the most promising models. 2023 should be the year that such an effort gets going.
2. Free meals in every New York public school. For two school years during the COVID-19 pandemic, a federal policy ensured that every student in the nation had access to free school meals. It was a lifeline for kids and families; a New York Health Foundation survey on food and health found that 87% of families that participated in the program found it helpful. But that policy expired, and families are again worrying about their kids going hungry. With food prices at record highs, the timing could not be worse. And too many students must contend with the shame and bullying that can come with not being able to afford school lunch.
An estimated 30% of public school students in New York State lack access to free school meals. Hungry children cannot be healthy and learn. Absent federal action, many states are implementing universal free school meals statewide. New York should join their ranks.
3. Expansion of overdose prevention centers (OPCs) statewide. Crises require courage, and I’m proud that New York is home to the first OPCs in the nation, established by OnPoint NYC about a year ago in East Harlem and Washington Heights. OPCs are clinical, safe, hygienic spaces where people can use drugs under the supervision of trained professionals to prevent deaths and get connected to care and drug treatment. They are co-located in existing needle exchange programs and provide medical and social services like free meals, counseling services, and showers. Last week, I visited the center in East Harlem to see firsthand the literally life-saving work it is doing. I was impressed by the professionalism and compassion the staff demonstrated and in awe of the difference they’re making. In the first 12 months of operation, the two centers have been used more than 45,000 times by more than 2,000 participants. Most significantly, the centers have prevented more than 600 potentially fatal overdoses.
Communities throughout New York State would benefit from having OPCs in place to address the ongoing opioid crisis. The U.S. Department of Justice is expected to drop its opposition to OPCs, but it has repeatedly delayed its decision. If the DOJ does eventually agree that OPCs are permissible, it would pave the way for more centers and for public dollars to flow their way. I hope that New York builds on its willingness to be bold in establishing the first OPCs in the country by supporting additional centers statewide.
I know I’m swinging for the fences with these three wishes. And there’s no genie in sight to grant them — making them come true will require hard work, patience, financial resources, political will, and some luck. Turning wishes into reality takes commitment.
As always, I wish you and your loved ones a healthy and peaceful new year. May all your wishes come true.
By David Sandman, President and CEO, New York Health Foundation
Published in Medium on December 12, 2022