Expanding Access to Mental Health Care

Expanding Access to Mental Health Care
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Expanding Access to Evidence-based Treatments

The Center for Deployment Psychology (CDP) and the U.S. Army Medical Department Center and School (AMEDDC&S) offer training workshops for DoD providers (AMEDD emphasizes Army providers) in the use of evidence-based therapies. Established in 2006, CDP provides training to both military and civilian providers in treatments such as prolonged exposure (PE), cognitive processing therapy (CPT), cognitive therapy for insomnia (CBT-I), and cognitive therapy for depression (CBT-D). AMEDDC&S also offers training in eye movement desensitization and reprocessing (EMDR). To expand their reach, CDP has a network of training sites at 11 military medical centers and has partnered with organizations such as STAR Behavioral Health Providers to offer continuing education in evidence-based treatments. To date, CDP has trained thousands of DoD and civilian providers in evidence-based therapies and military culture.

Expanding Military Culture Training to Community–based Mental Health Providers

In recent years, both DoD and VA have expanded community-based mental health and substance abuse partnerships. Both agencies along with the Substance Abuse and Mental Health Services Administration (SAMHSA) are working to provide community mental health providers with training in military culture through programs and courses highlighted in the Education and Training section.

DoD and VA have created a four module course entitled “Military Culture: Core Competencies for Healthcare Professionals”. Each module is a stand alone course that offers free continuing education credits to professionals who complete a course. During fiscal year 2015, 2,625 unique users completed one or more of the modules earning more than 5,000 continuing education credits. VA and DoD are currently developing three additional military cultural competence and sensitivity courses that will be disseminated in fiscal year 2016.

Providing Geographically-expanded Coverage through Telehealth

According to the 2015 RAND report “Far From Care: Increasing Access to Behavioral Health Care for Remote Service Members and Their Families,” almost 36,000 active-duty service members and more than 230,000 National Guard and reserve members were designated as “distance-challenged” meaning they live 30 minutes or more from behavioral health care services[1]. The Institute of Medicine (IOM) report Returning Home from Iraq and Afghanistan: Readjustment Needs of Veterans, Service Members, and Their Families 2013 also explored access and barriers to mental health care and highlighted several concerns related to the distance that service members and veterans have to travel for specialized services. The report found that remote service members and veterans:

  • Are less likely to access mental health services (compared to urban counterparts)
  • Have more physical comorbidities and worse health-related quality of life
  • Visit their providers less frequently
  • Are less likely to remain in alcohol abuse treatment (travel distance was a predictor of poor compliance)
  • Are at an increased risk of suicide

As a result, the MHS and VA have aimed to expand coverage to these individuals through innovative measures including telehealth. Telehealth helps service members, veterans and their families to reach specialty care providers, including behavioral health providers, regardless of their distance from these providers. VA Telehealth Services uses health informatics, disease management and telehealth technologies to target care and case management to improve access to care. DoD telehealth care is delivered through the health care components of the individual Military Services, as well as through Field Commands in cases of Operational Deployment. The DoD's Military Health System (MHS) is currently working to build a common, cross-Service, approach to telehealth needs assessment and planning. The National Center for Telehealth and Technology (T2), a component center of DCoE, supports these efforts through health informatics; policy, clinical, business, and technical analyses and planning; education and training; and consultation with providers and leaders at all levels of the MHS.

Across the MHS, there were approximately 31,000 “real time” psychological health telehealth encounters during fiscal year 2013. The services have each implemented their own telehealth programs[2]. The Army established a global tele-mental health (TMH) system with Army providers conducting approximately 30,000 TMH encounters per year. The Navy Medicine telehealth program office has begun TMH services at several Navy health care facilities and expansion of telehealth initiatives are planned for enhanced services with regard to mental health, traumatic brain injury, substance abuse, pain management, and consultative services. The Air Force telehealth program office, working collaboratively with the Air Force Medical Operations Agency, has established TMH initiatives leveraging video teleconferencing and are developing desktop internet protocol technologies to enhance, expand and augment the delivery of care in a more cost effective and efficient manner to our service members and their families.

References

[1] Brown, R.A., Marshall, N., Breslau, J., Farris, C., Osilla, K.C., Pincus, H.A., Ruder, T., Voorhies, P., Barnes-Proby, D., Pfrommer, K., Miyashiro, L., Rana Y., Adamson, D.M. (2015). Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S. Santa Monica: RAND.

[2] Department of Defense Personal and Readiness. (15 April 2015). DoD/VA Report to the Congress in Response to Senate Report 113-44, pg. 133, Accompanying S. 1197, the National Defense Authorization Act for Fiscal Year 2014 Mental Health Counselors for Service Members, Veterans, and Their Families. Retrieved from http://www.health.mil/Reference-Center/Reports/2015/04/17/Mental-Health-Counselors-for-Service-Members-Veterans-and-Their-Families