Study: Integrating Legal Aid With Medical Care Improves Veterans’ Lives

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Veterans’ mental health and housing improved when they accessed free legal services in a Veterans Affairs facility, according to a study of veterans in Connecticut and New York City.

The more legal services they had, the better they fared, experiencing reduced symptoms of Post-Traumatic Stress Disorder (PTSD) and psychosis, spending less money on abused substances and having better housing situations, the study found. In addition, the study concluded that mental health was improved even if veterans lost their legal battles.

The study analyzed the legal/medical partnerships between the nonprofit Connecticut Veterans Legal Center (CVLC) and VA Connecticut Healthcare and between New York Legal Assistance and two VA hospitals. It looked at free legal help given to 950 veterans from 2014 through 2016 and its effects on the mental health, housing, and income of 148 of those veterans followed closely for a year. Income improved from VA benefits, but not from employment, the study reports.

“We are really thrilled,” said Margaret Middleton, executive director of the CVLC. She said the study confirms “an anecdotal sense that we are providing real relief for our clients.”

Desirea Still Photo.

Jack Tsai, an associate professor of psychiatry and researcher with Margaret Middleton, head of CVLC.

The veterans’ most prevalent legal needs related to: VA benefits; housing, such as evictions; family issues, such as child support and divorce; and consumer problems, including credit card debt.

Sidley Cousins, 38, a Navy veteran with bipolar disorder, said his mental health improved after getting free legal help and that he is planning to be married. Cousins, who works in security in East Hartford, said the Connecticut Veterans Legal Center helped him obtain a divorce, VA disability benefits and a settlement after his car was stolen. “They helped me tremendously,” said Cousins, of New Britain, who served from 2000 through 2004.

Nationally, there are 15 medical/legal partnerships between the VA and legal services organizations, according to the study by lead author Jack Tsai, an associate professor of psychiatry at the Yale School of Medicine and a core investigator for Veterans Affairs, New England. The study was published in Health Affairs on Monday. There are 168 VA medical centers and 1,053 VA outpatient clinics nationwide.

The study shows a need for more partnerships and for proposed federal legislation that would provide funding toward legal services given at VA facilities, said Middleton, whose legal center is based at the VA Errera Center in West Haven. Her organization helps veterans who have faced homelessness and mental illness with legal problems related to health care, housing, and income.

U.S. Sen. Richard Blumenthal, D-Conn., a co-sponsor of a bill to provide funding for VA legal services, said that “access to expert legal services within the VA could mean the difference between a safe, stable home and homelessness.”  He called the fact that 1 in 10 veterans is homeless, “a searing, staggering national failure.”

The VA has issued guidance to its medical centers on working with community legal providers, but it has put “little focus on civil legal problems that can affect health and impede recovery,” the study states, adding that in surveys, veterans consistently report legal help among their top unmet needs.

The study suggests a potential savings in medical care and housing services for veterans when they access legal services, but didn’t do an analysis on it. However, it states that the two legal organizations estimated the average cost of each resolved legal issue ranged from $207 to $405. The study calls this “a small amount relative to the average annual direct costs of $10,000 to $60,000 to provide care to a person who is chronically homeless, has a severe mental illness, or both.”

Middleton said, “This could mean a relatively low-cost intervention that improves people’s lives.”

Meanwhile, she said the finding that mental health improved even when a case is lost was “unanticipated.” She said it means that “the very fact that you have a lawyer talk to you about your legal issue or have someone work with you on it, may have value.”

Of the 705 Connecticut veterans included in the study, most were single or divorced, white males earning less than $21,000 annually. Twenty percent served in Iraq or Afghanistan.

Middleton said the study, funded by the Bristol-Myers Squibb Foundation, is “really a starting point for trying to understand how integrating legal services into medical care works, what the mechanism is for how people’s health may improve, and how we can best provide those services to make them the most effective.”

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