This report describes trends in utilization of direct care inpatient and outpatient mental health services among active duty service members (ADSMs), including active Guard and reserves, in fiscal years 2005 through 2016. Utilization metrics include the number of: 1) outpatient encounters, 2) inpatient stays and 3) inpatient bed days. These metrics are aggregated and also stratified by mental health disorder and by military service. The mental health disorders assessed in this report include: adjustment disorders, alcohol-related disorders, alcohol abuse, alcohol dependence, anxiety disorders, bipolar disorders, depressive disorders, insomnia, personality disorders, psychoses, posttraumatic stress disorder (PTSD), schizophrenia, substance-related disorders, substance abuse and substance dependence. Case definitions developed by the Armed Forces Health Surveillance Branch were used in these analyses.
As with all administrative health care data, accuracy depends on provider coding practices. Consequently, provider coding that is inconsistent with established definitions used in metric calculation may result in failure of the metric to identify all instances of mental health utilization accurately. Additionally, the inclusion of a mental health diagnosis in the encounter record does not ensure that mental health services were actually rendered during that encounter. Therefore, utilization may not entirely reflect treatment for the mental health condition of interest.
- The total number of direct care mental health-related outpatient visits among ADSMs increased by 168 percent from fiscal year 2005 (949,110) through fiscal year 2012 (2,546,167) and subsequently decreased through fiscal year 2016 (2,382,134). The mean number of mental health-related outpatient visits among ADSMs with at least one mental health-related outpatient visit steadily rose from fiscal year 2005 (4.98) through fiscal year 2016 (8.80). However, the median number of mental health-related outpatient visits only increased slightly, from fiscal year 2005 (2) to fiscal year 2016 (3). The discrepancy between mean and median suggests a small subset of ADSMs utilize a disproportionately high number of mental health-related outpatient services compared to the remainder of the ADSM population seeking mental health care.
- The Army had the highest total number of direct care outpatient visits compared to the rest of the listed services, rising from 460,551 visits in fiscal year 2005 (49 percent of all visits in fiscal year 2005) to 1,519,470 in fiscal year 2012 (60 percent of all visits in fiscal year 2012) and decreasing slightly in the remaining four years of the measurement period. This trend aligns with Army’s large ADSM population and high prevalence of mental health disorder diagnoses. (see PH By the Numbers Report: “Mental Health Disorder Prevalence among Active Duty Service Members in the Military Health System, Fiscal Years 2005–2016" for more details ). However, the mean and median number of mental health-related outpatient visits among ADSMs with at least one mental health-related outpatient visit was only slightly higher among Army ADSMs compared to the remainder of the listed services during the measurement period.
- The total number of direct care mental health-related inpatient stays rose from 8,978 in fiscal year 2005 to 12,695 in fiscal year 2011, declining to 11,821 in fiscal year 2016. Consistent with reported trends in outpatient visits, the total number of mental health-related inpatient stays was highest among Army ADSMs, while the mean and median number of inpatient stays remained relatively similar between the Army and other services.
- The total number of direct care inpatient mental health-related bed days rose from 51,571 in fiscal year 2005 to its highest level of 74,403 in fiscal year 2014. The average number of bed days among ADSMs remained fairly stable throughout fiscal years 2005 to 2016, hovering around seven. Consistent with reported trends in outpatient encounters and inpatient stays, the total number of mental health-related inpatient bed days was highest among Army ADSMs, whereas the mean and median number of inpatient bed days fluctuated among all listed services during the measurement period.
*Please refer to the report for findings specific to each mental health disorder.