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Innovation Update

Testing a Multicomponent Treatment for Justice-Involved Veterans with Co-Occurring Substance Use and Mental Health Disorders Experiencing Homelessness

VA Mental Health Residential Rehabilitation Programs (MH RRTPs) provide treatment and rehabilitation services to Veterans with mental health and substance use disorders that are often complex and co-occur with medical concerns and social determinants of health (SDOH), such as employment and housing needs.¹ A particularly vulnerable, high-need group served by MH RRTPs is justice-involved Veterans (JIVs) – those previously incarcerated or currently under supervision of the criminal justice system. Specifically, up to 60 percent of JIVs have a co-occurring substance use and mental health disorder (COD), which increases their risk for chronic homelessness and unemployment, poor treatment engagement, and, ultimately, reoffending and reincarceration. While MH RRTPs aim to address a number of these issues, they often do not provide criminal-legal support or treatments to support prosocial thinking and behavior. Further, after receiving intensive MH RRTP care, Veterans are often discharged to low-intensity outpatient supports, which is a vulnerable period marked by high risk for substance use and mental health relapses and criminal recidivism.²

Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking, Criminal Justice Version (MISSION-CJ), is a six-month, evidence-based, multicomponent, cross-disciplinary intervention for JIVs with CODs. MISSION-CJ has three core components: 1) Critical Time Intervention, an assertive outreach intervention that addresses SDOH needs, including housing support; 2) Dual Recovery Therapy, a behavioral treatment that addresses mental health, substance use, prosocial thinking/behaviors (20 sessions); and 3) Peer Support (11 sessions) to provide structured recovery support designed to empower Veterans and promote sobriety and community integration.

While the original, non-criminal justice-focused MISSION model has been well-studied among Veterans and civilians, we completed fewer studies with MISSION-CJ4,5 and none in MH RRTPs, which is a natural implementation setting. Therefore, we are currently conducting a randomized controlled trial to demonstrate if having MH RRTP care plus MISSION-CJ (versus Peer Support alone) is effective for reducing risk for criminal recidivism and improving COD and housing outcomes for JIVs. We will also examine implementation facilitators and barriers of MISSION-CJ in MH RRTPs. This study is a close collaboration with VHA’s Homeless Program Office, the Veterans Justice Programs, and the Office of Mental Health & Suicide Prevention. If MISSION-CJ is found to be effective, it will provide our partners with an evidence-based program for one of the most vulnerable, high-need groups of Veterans served by VHA. This study is underway, and we hope to be reporting findings in spring 2025.

References

1. Department of Veterans Affairs, VHA DIRECTIVE 1162.02, “Mental Health Residential Rehabilitation Treatment Program,” July 2019. Retrievable from https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8400
2. Blodgett JC, Fuh IL, Maisel NC, & Midboe AM (2013). “A Structured Evidence Review to Identify Treatment Needs of Justice-involved Veterans and Associated Psychological Interventions,” Veterans Health Administration, Homeless Programs, Veterans Justice Programs, Menlo Park, California.
3. Smelson D, et al. “Integrating a Co-occurring Disorders Intervention in Drug Courts: An Open Pilot Trial,” Community Mental Health Journal 2019; 55:222-31.
4. Smelson D et al. “An Alternative to Incarceration: Co-occurring Disorders Treatment Intervention for Justice-involved Veterans,” World Medical & Health Policy 2015;7(4):329-48.