5 - (SYM 5) Adapting DBT for Veterans with Criminal-legal Involvement

In In the 2023 National Veterans Suicide Prevention Report published by the Department of Veterans Affairs, Veterans with involvement in the criminal-legal system (frequently referred to as “justice-involved Veterans” or “JIVs”) were identified as at exceptionally high risk for suicide. From 2019 to 2021, suicide rates for JIVs increased by roughly 50%, from 102 to 151 per 100,000 person-years (compared to 40 per 100,000 person-years in 2021 for Veterans without criminal-legal involvement). Ensuring adequate suicide prevention efforts for this population is therefore of utmost importance. In comparison to their non-legally involved peers, JIVs often present with unique clinical and behavioral challenges, including comparatively higher rates of antisocial behavior, trauma exposure, interpersonal difficulties, cognitive deficits, and treatment-interfering behaviors. These challenges have direct implications for understanding suicide risk within this population and demand accompanying adaptations to traditional suicide prevention strategies.

In this presentation, we outline common challenges experienced by JIVs and the implications of these challenges on JIV suicide prevention efforts. We also introduce an adapted Dialectical Behavior Therapy (DBT) protocol designed to address the needs of at-risk JIVs. Specific adaptations, such as those that tailor the DBT protocol to common cognitive, emotion processing, interpersonal skill, and behavioral regulation skill deficits among JIV samples, are detailed. Preliminary efficacy data from two pilot trials and an ongoing large-scale randomized clinical trial are also presented, which suggest participation in this adapted DBT protocol is associated with notable improvements in various indicators of suicide risk.