The aftermath of the September 11, 2001, attacks in the United States led to more than 1.9 million American troops deployed worldwide, creating a generation of veterans who would see more combat deployments and redeployments than any previous cohort of service members. Many of those individuals are now falling through the cracks of the U.S. criminal justice system, having failed to receive the support they need.
Since 2020, the prevalence of suicidal thoughts among U.S. veterans has increased by nearly 50%. Yet for the roughly 181,000 veterans currently incarcerated in the United States, access to U.S. Department of Veterans Affairs (VA) mental health services remains limited—a gap that a bipartisan bill introduced on March 24, the Get Justice-Involved Veterans BACK HOME Act, aims to close.
The legislation would create a pilot program allowing the VA to provide mental health services to incarcerated veterans, with priority given to those having a service-connected disability for posttraumatic stress injuries (PTSD), traumatic brain injury (TBI), or military sexual trauma (MST). Beyond the pilot program, the legislation includes practical reforms to improve reentry into society and long-term health outcomes, including the automatic resumption of disability compensation and survivor benefits upon release from prison and improved data collection on incarcerated veterans. The legislation also encourages prison facilities to establish dedicated veteran-housing units, where possible, to provide an environment more conducive to the discipline, structure, and order familiar to veterans and to facilitate more effective treatment, peer support, and rehabilitative efforts.
Although more permanent reforms are yet to be defined, the program has potential to expand mental health services for incarcerated veterans and improve their long-term health outcomes
Although more permanent reforms are yet to be defined, the program has potential to expand mental health services for incarcerated veterans and improve their long-term health outcomes. As of March, the bill remained in discussion draft form as policy details continue to be negotiated before reaching a formal vote. The bill is one of more than two dozen veterans' health and accountability measures that Congress is considering merging into a single omnibus package, a strategy that could accelerate its passage or put it in competition with other legislative priorities. Cost is also likely to be a point of friction. During a hearing of the House Veterans' Affairs Committee, VA officials raised "significant concern" about implementation costs for comparable veterans' health expansion measures. Whether the bill advances may depend less on the bipartisan support it currently enjoys and more on whether Congress can resolve how to fund a VA already weighed down by ongoing budget pressures.
A Population Falling Through the Cracks
Of the nearly 19 million veterans that served in the U.S. military, one-third have been arrested at least once in their lifetime. That number stands in contrast to one-fifth of the nonveteran population. According to the most recent available data, an estimated 181,000 veterans are incarcerated in federal, state, or local correctional facilities—disproportionately representing an estimated 9% of incarcerated individuals, despite composing about 5.9% of the general population age 18 and over.
Driving those numbers is the fact that veterans are more likely to interact with the criminal justice system than civilian populations because of multiple risk factors that exist before, during, and after military service. Service members are more likely to have socioeconomic disadvantages, adverse childhood experiences, and behavioral tendencies that increase their risk of criminal justice involvement. Combat exposure, and the PTSD, TBI, and substance use disorders that can follow from it, compound that risk significantly. Veterans themselves have also identified [PDF] alcohol and drug use, difficulty adjusting after the service, and economic disadvantage as main contributors to criminal justice involvement. Substance use in particular has been shown to be caused or exacerbated by service-related trauma.
Without targeted intervention, these factors, and the associated physical and mental health disorders, are significantly associated with increased risk of incarceration. That pattern, however, should not be interpreted as military service leading to increased risk of criminal behavior but instead as a failure of the U.S. health system's ability to sufficiently support those who have served in their country's military.
Although diversion programs such as Veterans Treatment Courts (VTC)—a program offering mental health treatment, housing, and substance abuse services—exist to route veterans away from incarceration earlier in the justice pipeline, research shows they are inaccessible for a greater portion of the population because of the gatekeeping role of VTC prosecutors, who often have unilateral veto power on program admission, and rigid eligibility requirements. No equivalent mechanism is currently in place for those already behind bars, a gap the BACK HOME Act can target.
A study [PDF] of military veterans housed by the Minnesota Department of Corrections found that 42% of incarcerated veterans suffered from mental health disorders, whereas only 16% of incarcerated nonveterans did. Similarly, 76% of veterans suffered from PTSD or TBI, but only 12% of the nonveteran incarcerated population did. Incarcerated veterans have also been identified as among the most vulnerable groups for suicide—having a 264% higher risk than their veteran counterparts not involved in the justice system.
Furthermore, veterans convicted of a felony and sentenced to more than 60 days have their disability compensation payments reduced during their imprisonment, compounding barriers of access to specialized care tailored to the experiences of service members while in correctional facilities.
Underlying these statistics is a 1999 administrative rule change that prohibited the VA from providing hospital or inpatient services to incarcerated veterans who are patients or inmates in an institution of another government agency with a duty to provide care or services, such as prisons. The argument hinged on the fact that prisons already have a duty to provide care, yet most prison facilities are inadequately equipped with resources or staff trained to address service-related conditions.
During the post–September 11 period in which veterans were more likely to experience risk factors associated with criminal justice involvement, VA coverage was pushed out of reach.
Improving Care for Incarcerated Veterans
The BACK HOME Act requires that incarcerated veterans be tracked separately, addressing the foundational problem of inability to identify and reach the incarcerated veteran population. The Bureau of Justice Statistics would be required for the first time to collect and analyze comprehensive data specifically on this population, and provide annual reports to Congress.
"How people define what a veteran is, and how you ask the question when someone comes in [a corrections facility], is really important. Prisons and jails are trying to identify anyone that's had military service—and they don't always have the tools to do it," says Sandy Mullins, senior research scholar at New York University's Marron Institute. "That matters more now than ever, because correctional facilities are actually an excellent intercept point to find people who are eligible for VA benefits but don't know it yet."
The automatic resumption of benefits upon release addresses one of the largest gaps in the current system. Under existing VA policy, benefits do not restart automatically: veterans should apply for reinstatement and submit official release documentation. The reentry point is a particularly high-risk window for formerly incarcerated veterans—a moment where risk factors can quickly compound as mental health medications lapse, housing becomes uncertain, or benefits take weeks to reinstate—and the administrative burden falls of reinstating benefits falls on individuals at a highly vulnerable moment.
Furthermore, current VA language states, "once a Veteran is released from prison, compensation benefits may be reinstated based upon the severity of the service connected disability(ies) at that time," implying that reinstatement is conditional, not guaranteed. Medicaid's Reentry 1115 waiver program—currently operating in 19 states and covering services up to 90 days before release—offers a useful template for the VA to adopt to ensure that care initiated inside a facility carries into reentry.
One notable absence in the bill is a formal evaluation requirement that would compel the pilot to flesh out failure and success and create a legislative hook for further steps.
"It sometimes feels like you're checking a box with legislation like this," says Mullins. "But it can't just be a pilot, it has to be a learning experience that is going to lead to further expansion of support."
