Increasing Availability of Mental Health Care

Increasing Availability of Mental Health Care
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In fiscal year 2014, the MHS averaged 343,000 behavioral health outpatient visits a week (61,000 direct care; 282,000 purchased care). In fiscal year 2013, the MHS employed 60,389 civilians and 86,051 military personnel[1].

DoD established a mental health recruiting and retention strategy called the Psychological Health Risk Adjusted Model for Staffing (PHRAMS) to assess the current and future mental health provider staffing needs in 2010. Since then, the MHS has increased its mental health staffing level by 34 percent[2]. Each service continues to examine future health care needs and forecast the staffing needs of mental health specialty providers embedded into operational units and integrated into primary care clinics.

Standards of Care Across the MHS

  • 30-minute drive time for primary care
  • 60-minute drive time for specialty care
  • Routine appointments within one week
  • Initial specialty care appointments within four weeks
  • Urgent care appointments generally not to exceed 24 hours
  • Emergency room access available 24hrs/7 days per week
  • Office wait times should not exceed 30-minutes unless emergency care is being rendered to another patient

Further detailed information regarding DoD and VA mental health staffing can be found in an April 2015 DoD/VA report to congress titled, “"Mental Health Counselors for Service Members, Veterans, and Their Families", and a January 2015 Government Accounting Office (GAO) report titled “Additional Information Needed about Mental Health Provider Staffing Needs”.

Table: DoD Staffing Status as of December 31, 2013. Source: DoD/VA Report to Congress "Mental Health Counselors for Service Members, Veterans, and Their Families"

DoD-wide Needs/Authorized Assigned Delta % Filled
Psychologist 1,984 2,048 64 103.2%
Psychiatrist 903 774 -129 85.7%
Social Worker 2,588 2,445 -143 94.5%
Mental Health Nurse (RN) 529 548 19 103.6%
Mental Health Nurse (Nurse Practitioner) 159 178 19 111.9%
Other Licensed MH Provider 119 93 -26 78.5%
Tech/Counselor 3,731 3,339 -392 89.5%
TOTAL 10,012 9,425 -587 94.1%

Mental Health in Primary Care

In an effort to increase access to mental health providers and adhere to the Patient-Centered Medical Home model,[3]  the MHS has begun embedding licensed mental health providers in primary care. The tri-service Primary Care Behavioral Health (PCBH) program aims to improve access to quality mental health services, increase dispersal of posttraumatic stress disorder (PTSD) and depression best practices, and promote a focus on prevention. PCBH combines two collaborative primary care models, the PCBH consultative model of service delivery and the care management model. In the integrated model, psychologists and social workers called internal behavioral health consultants (IBHCs) provide focused interventions to improve primary care treatment of a wide range of mental health conditions (e.g., depression, anxiety, adjustment disorders, and relationship problems, as well as interventions on a number of health psychology issues such as weight control, smoking cessation, pain management and diabetes. Registered nurses called behavioral health care facilitators (BHCFs) provide care management services to improve recognition, management and follow-up of depression, anxiety and PTSD. Find more information in the PCBH section.

Mental Health Embedded in Deployable Military Units

The goal of embedding mental health providers within deployable units is to increase access to these providers and destigmatize their role in maintaining health and readiness of the force. By working closely with unit leaders, embedded mental health providers can educate service members and leaders and identify and address mental health issues early. Similar to the PCBH model, the goal is to meet service members where they are. This concept is currently used by the Special Operations Command Preservation of the Force and Family Program, the Army’s Embedded Behavioral Health model, and the Navy and Marine Corps’ Operational Stress Control and Readiness (OSCAR) Program.  

References

[1] Military Health System Review-Final Report (August 2014), p. 19 Retrieved from http://archive.defense.gov/pubs/140930_MHS_Review_Final_Report_Main_Body.pdf 

[2] Government Accounting Office. (January 2015). Additional Information Needed about Mental Health Provider Staffing Needs. Retrieved on April 29, 2015 from http://gao.gov/assets/670/668208.pdf

[3]The Patient-Centered Medical Home (PCMH) is a team-based model built around the premise that the best health care begins with a strong primary care foundation. Retrieved from http://armymedicine.mil/pages/pcmh.aspx