Philip Berroll

By P.H.I.Berroll

Sol Wachtler had a grim statistic to share with his audience: “After the Vietnam conflict, we had over 200,000 veterans who went to prison.” He added, “We’re determined to see that this doesn’t happen again.”

Judge Wachtler, former Chief Judge of the New York State Court of Appeals, spoke during a panel discussion, sponsored by the Veterans Mental Health Coalition of New York City, at which speakers described efforts to steer nonviolent veteran offenders away from imprisonment and instead offer them support services and mental health treatment. One such program drew a good deal of attention: the Veterans Project, a groundbreaking North Shore-LIJ Health System initiative developed by Judge Wachtler, a lifetime North Shore-LIJ trustee.

The Veterans Project is a collaboration between North Shore-LIJ ‘s Law and Psychiatry Institute, the New York State courts, the Brooklyn, Queens and Nassau district attorneys’ offices and the U.S. Department of Veterans Affairs (VA) New York Harbor Health Care System. It is the first in the state – and the largest in the nation – to create a standardized approach to providing services and treatment to veterans involved with the criminal justice system, with the goal of preventing veterans who land in court or jail for minor offenses from getting into deeper trouble with the law. At a time when many veterans are suffering from post-traumatic stress disorder (PTSD) and depression – 20 percent of Iraq and Afghanistan veterans nationwide (300,000 men and women) have been diagnosed with those illnesses – there is an urgent need to steer them toward treatment rather than jail time.

During the panel discussion, held at Hunter College’s School of Social Work, several people involved in the Veterans Project – including Brooklyn District Attorney Charles J. Hynes, First Assistant D.A. Anne Swern, and veterans outreach specialists from New York Harbor – spoke in detail about their work. Several noted that a frequent challenge they face is convincing veterans to seek treatment; too many fail to do so, either out of embarrassment (they may worry about looking “weak” in front of their comrades) or fear that they will lose their benefits.

One way to counter this is through outreach from other veterans – the Veterans Project offers peer counseling to guide troubled former soldiers into treatment programs.  Another strategy is to reach out to veterans who have been arrested for misdemeanors such as subway fare-jumping. “We want to use the arrest,” said Ms. Swern, “as the opportunity to get them the services they need.”

Judge Wachtler and District Attorney Hynes, both of whom are veterans, spoke movingly of their desire to avoid repeating the tragedy of the Vietnam era.

“What this country did to [Vietnam veterans],” said the district attorney, “was an absolute disgrace – especially the criminal justice system.”

The Veterans Project is one of a number of innovative programs run by North Shore-LIJ’s Office of Military and Veteran’s Liaison Services (OMVLS), whose Director, Army Lt. Col. (Ret.) Randy Howard, moderated the Hunter event. Other OMVLS initiatives include a treatment program for Iraq and Afghanistan veterans suffering from PTSD and/or traumatic brain injury and programs to help returning service members find employment in the health system.

District Attorney Hynes and the other speakers touted the Veterans Project as a model that can – and should – be replicated across the country.

“If you’re in a county rather than Brooklyn, Queens or Nassau, you have a moral imperative to demand from your district attorney why such services aren’t in place,” said Mr. Hynes. “I believe that the day will come when we have district attorneys across the country committed to the proposition that no man or woman who served their country will ever be criminalized again.”

Originally published in the newsletter of North Shore-LIJ Medical Center, 2010.

Download PDF

Every other week, Laura Hoskins, PsyD, leaves her practice at North Shore University Hospital and flies to upstate New York, where she immerses herself in the treatment of wounded Iraq and Afghanistan war veterans at the U.S. Army base Fort Drum. The work of Dr. Hoskins, a neuropsychologist, is part of an initiative under North Shore-LIJ’s Welcome Back Veterans program, a fund of the McCormick Foundation, in partnership with Major League Baseball. Dr. Hoskins spoke with Philip Berroll about her experiences:

Describe your work in your own words. As a neuropsychologist, studying brain-behavior relationships, I’ve specialized in traumatic brain injury (TBI). The conflicts in Iraq and Afghanistan have produced a large increase in TBIs – it’s a signature injury of these wars. The closest parallel would be a severe concussion in football; like football players, many of these soldiers have repeated concussive events – often as many as three to six – because they’re exposed to a lot of blasts from improvised explosive devices (IEDs). And they need proper treatment should there be any long-term negative sequelae – pathological conditions.  I focus on mild TBI; the more severe injuries go to a place like Walter Reed Army Medical Center (in Washington, DC).

What is a typical day at Fort Drum like for you? I see one patient a day, with whom I meet at 8:00 a.m. for about an hour – going through their medical and psychological history, and focusing on the details of the concussive event(s) as they recall them. Then we have a three- to four-hour series of tests to assess cognitive status, memory, attention… get a good sense of how they’re functioning. If they’ve had a TBI, my job is to find out if there’s cognitive impairment as a result – and if so, is it related to the TBI and/or post-traumatic stress disorder (PTSD) or other factors. The good news is that with mild TBI, the vast majority of individuals recover within hours and days, with only about three percent having long-term, protracted sequelae post-injury.

How do you approach this other three percent? I have to look at all the variables that may be playing a role – which can include PTSD, orthopedic injuries or an overuse of pain medication. Then there are the “social” factors: the vast majority of these soldiers have been deployed multiple times; they have years of being away from their families and then coming back and re-integrating, which is often very difficult and is complicated by the strong possibility that they’ll be redeployed – why fully re-engage when you know you may have to disengage again?

What is the next step in the process? I provide my diagnostic conclusions and treatment recommendations, in collaboration with my rehab team. We use a very integrated, individualized treatment approach because no two cases are alike. One soldier may have cognitive issues such as a decline in attention or memory; another may have more behavioral issues – sleep changes, changes in mood; some may have both, as mild TBI often has both neurological and psychological symptoms. After that, the soldier may be referred to a three-week TBI treatment program, or to the Warrior in Transition Unit (WTU). Usually he or she will be considered on active duty, but may be put on a Temporary Duty Profile in which his or her responsibilities may be limited given their medical condition.

What if you feel a soldier isn’t ready to return to duty? I speak to the commander or someone in their unit. Because sometimes soldiers are reluctant to report a problem – they want to be “a good soldier,” they don’t want to let their unit down – and often with a mild TBI, they may look okay on the surface, but something may not be right with their thinking; they may have a slower response time, etc. And the commanders may not have prior training or experience in this area, so you have to explain it to them and say, “This guy should sit out for another week or two weeks or whatever.”

You’ve been working at Fort Drum since November 2009, when the Welcome Back Veterans Initiative started? Yes, I came on as a result of the program. They had received the funding to be able to hire me and cover my trips to Fort Drum and my services there.

Prior to that, were you doing any kind of work with soldiers? I was doing my fellowship at Dartmouth Medical School, and I was in the clinical service. I’d see the occasional veteran, but it was not specific to my job.

So what got you interested in doing this? I specialized in TBI during my fellowship and my clinical research work had focused on that area. So I felt I had a unique service that I could provide; and while I think it’s important to help these soldiers who have served our country, we can also learn a lot from their experiences.  

Has dealing with these men and women affected you personally? All my patients impact me – but especially this group. It’s overwhelming to hear their stories, and to realize that at such a young age – the vast majority of them are between 18 and 25 years old – they’ve left their families to enter this extremely high-stress situation. To me, that level of sacrifice and dedication is awe-inspiring.

Originally written for the newsletter of North Shore-LIJ Medical Center, 2010.

Download PDF