Communities on the Front Lines: Innovative Models for Addressing Veterans’ Mental Health and Reintegration Needs

Statement of Randye Retkin, New York Legal Assistance Group, October 1, 2014

My name is Randye Retkin and I am the Director and founder of LegalHealth, a division of the New York Legal Assistance Group (NYLAG). We partner with health care professionals at 24 hospitals across New York City to address the non-medical needs of low-income people with serious health problems. I became interested in working with veterans when I realized that the legal services we were providing in hospitals across New York City were not serving this vulnerable population.

NYLAG and the Connecticut Veterans Legal Center (CVLC) were fortunate to receive a grant from Bristol-Myers Squibb Foundation that funds a two-year study evaluating the impact of legal services on veterans’ mental health and well-being at four VA hospital and clinic sites in New York and Connecticut. The Connecticut Veterans Legal Center helps veterans recovering from homelessness and mental illness overcome legal barriers to housing, healthcare and income.

Both LegalHealth and CVLC are medical-legal partnerships — which integrate the expertise of health care and legal professionals in the health care setting to address patients’ health-harming social and legal needs. By working together, health care and legal institutions are transforming the health care system’s response to social determinants of health, which include income, education, race/ethnicity and the physical structure of communities. Health care providers are trained to identify patients’ health-harming legal needs and work with attorneys to address them before they become a crisis. Programs designed to address these social determinants are not always effective and are difficult to navigate. When people are homeless, live in substandard housing, and are poor or near-poor, their mental and physical health suffers. This is especially true for veterans who often have post-traumatic stress disorder (PTSD) and other serious mental health problems. Legal expertise is critical for them.

The annual CHALENG Survey conducted by the Department of Veterans Affairs consistently shows that legal needs are among the top unmet needs for homeless and low-income veterans. And, providing legal assistance through medical-legal partnerships is cost-effective. Preliminary outcome data collected by CVLC show that for every $100 CVLC spent providing legal help, veterans received over $200 in increased income and decreased debt. Sixty-five percent of veterans who worked with CVLC on landlord-tenant issues improved their housing stability, and sixty percent of those working on child support issues improved their financial stability.

The following case example illustrates how Medical-Legal Partnerships in New York and Connecticut help veterans in need. Fred is a 64 year-old veteran who suffers from depression and anxiety whose sole source of income is Social Security Disability and service-connected disability benefits from the VA. He was homeless but now receives a Section 8 housing subsidy through the HUD-VASH program. Fred was referred to an on-site attorney because his landlord filed suit for nonpayment of rent. He was facing homelessness and the loss his housing subsidy, both of which would inevitably have damaging effects on his mental health. The attorney represented Fred in housing court and successfully negotiated a settlement with the landlord.

Because of legal intervention, Fred was able to remain in his home and his housing voucher was preserved.

We are grateful to the BMS Foundation for funding this study. It will be one of the first scientific, peer-reviewed studies that will analyze the impact of Medical-Legal Partnerships, and the only one looking at the impact on veterans. The study will analyze whether providing legal services to veterans results in improved mental health status, reduced substance abuse, improved physical health status, stabilized housing and community adjustment, and income stability – as well as improving overall quality of life. From these results, we will develop best practices that can be used in communities throughout the United States to replicate the medical-legal partnership model and better serve our country’s veterans. We believe that every VA hospital and clinic that serves veterans should provide onsite legal services to ensure that veterans’ legal problems are not adding another barrier to improved health and  wellbeing.

To adequately address the intertwined health and legal needs of Veterans and to improve their overall quality of life, we ask Congress to authorize and appropriate the VA to fund legal services provided through the medical-legal partnership model. This simple action could make a major difference in the lives of veterans by keeping them healthy, living in their own homes, and supported in their recovery. Thank you.