Moving Upstream: Why Rehabilitative Justice in Military Discharge Proceedings Serves a Public Health Interest

摘要

The cultural divide between US military and civilian institutions amplifies the consequences of military discharge status on public health and criminal justice systems in a manner that is invisible to a larger society. Prompt removal of problematic wounded warriors through retributive justice is more expedient than lengthy mental health treatment. Administrative and punitive discharges usually preclude Department of Veterans Affairs eligibility, posing a heavy public health burden. Moving upstream—through military rehabilitative justice addressing military offenders’ mental health needs before discharge—will reduce the downstream consequences of civilian maladjustment and intergenerational transmission of mental illness. The public health community can play an illuminating role by gathering data about community effect and by advocating for policy change at Department of Veterans Affairs and community levels. Although there has been much attention since the attacks of September 11, 2001, regarding the effect of combat on service members and some attention to the effect on military families, there has been scant consideration to the structural components within the military and Department of Veterans Affairs (VA) systems that bar some veterans from VA services because of their discharge status. These components can and should be modified to prevent a public health crisis of great magnitude that will only grow over time. The cultural divide between military and civilian institutions in the United States 1 amplifies the consequences of discharges on the American public health system in a manner that is invisible to a larger civilian society. When a returning service member has posttraumatic stress disorder (PTSD), anger problems, and misconduct, it is easier for the military to criminalize the behavior and to discharge the service member other than honorably than it is to treat the disorder. Military commanders do not want to be burdened by wounded warriors who are problematic. As such, retributive discharge proceedings offer an expedient option to lengthy treatment of the ongoing issue of an unfit service member. Ultimately, many of these service members are left without VA eligibility to address the mental health trauma caused by their service. The effect of the commander’s desire for prompt removal of wounded warriors from the military heavily burdens the community’s public health systems. Accordingly, we suggest that moving upstream—that is, through military rehabilitative justice focusing on the mental health needs of military offenders before discharge—will reduce the downstream consequences of civilian maladjustment and intergenerational transmission of mental illness. Moreover, we argue that the military justice system has the obligation to address the issues before they translate into risk and danger in the community. We provide a brief overview of postdeployment health problems, combat and criminal behavior, and effect of military justice on postmilitary treatment access on family and occupational functioning; outline the rationale for the rehabilitative military justice as an alternative to punitive systems to reduce the negative social and consequent public health outcomes for combat-traumatized service members; and encourage review and adoption of policy options and public health advocacy.