The Military Health System (MHS) and Veterans Health Administration (VHA) provide care to tens of millions of service members, military retirees, their beneficiaries, and veterans each year. The MHS provides both direct care at its military treatment facilities and clinics, as well as purchased care through TRICARE[ Reference 1 ].
Over the past decade, the MHS has examined ways to improve access to mental health care for service members and their families. In 2007, the Department of Defense (DoD) Task Force on Mental Health initiated a renewed focus on removing barriers and improving access to health care within the DoD. The task force report along with the July 2007 report, President's Commission on Care for America’s Returning Wounded Warriors, highlighted several recommendations to improve access to mental health care and create culture change to improve the psychological health of service members and their families. Further attention was placed on this issue in the 2011 White House report “Strengthening Our Military Families ” and the resulting 2012 Executive Order – 13625 Improving Access to Mental Health Services for Veterans, Service Members, and Military Families. In 2014, the secretary of defense ordered a comprehensive review of the MHS with a specific focus on access to and quality of care issues, as well as patient safety. The review identified several issues regarding access to and quality of mental health care for service members and veterans. The secretary of defense responded to the review findings by requiring facilities identified as having challenges with meeting access to care standards to establish an action plan under the supervision of their respective surgeon general and the Defense Health Agency (DHA) to improve their performance in ensuring timely access to the integrated system of direct and purchased care.
Despite DoD’s focus on improving access to care, research indicates that a large percentage (up to 60 percent) of service members needing mental health care still do not seek treatment [ Reference 2 ] .Reviews by the MHS and ongoing research have identified barriers to care to include perceived stigma in seeking treatment; negative attitudes about mental health treatment; and seeking help from friends and family first, with mental health treatment often thought of as a last resort. Barriers to care include both cultural barriers such as internalized stigma and negative health beliefs and logistical barriers such as availability of mental health care and transitioning care. Realizing logistical issues also create barriers to care, DoD has begun to examine ways to reduce these barriers by expanding access to mental health care, and access to evidence-based treatments. The department has also initiated increased focus on training community–based providers and providing geographically-expanded coverage through telehealth.
DoD along with the Departments of Veterans Affairs (VA) and Health and Human Services (HHS) are committed to reducing these barriers for service members and veterans who could benefit from mental health treatment and support. The 2012 Executive Order established an interagency task force (ITF) that improved access to care, through policy, suicide prevention efforts, enhanced partnerships, increased mental health services staffing, and research and development. In March 2014, the Cross-Agency Priority Goal on service members and veterans mental health (CAPG) launched, building on the successes of the ITF, with the aim of accelerating progress in ensuring that all service members and veterans have access to high quality, effective, and evidence-based mental health care. The CAPG is focused on reducing barriers to care (including negative perceptions of mental health issues, lack of confidence in systems of care, lack of psychological health literacy and lack of awareness of resources) and increasing access to care. As part of this initiative, DoD and partner agencies are working to reduce negative perceptions and increase awareness of mental health resources including the Real Warriors Campaign; evaluating the quality and effectiveness of Military OneSource; and evaluating the quality and effectiveness of the Military Crisis Line.