The visualizations here describe trends in utilization of outpatient services in the Military Health System (MHS) among active duty service members (ADSM) diagnosed with mental health disorders within either direct or purchased care settings (depicted separately in the two dashboards below). To assess outpatient utilization for each mental health condition, we calculated three metrics of interest:
Total encounters with a diagnosis
Encounters per patient (EPP) for each disorder of interest
Purchased care settings include civilian facilities that accept TRICARE. Providers are civilian providers and are neither directly employed nor managed by the MHS.
ADSMs are prioritized for care in direct care settings and therefore receive the vast majority of their care there. With that in mind, we can expect more utilization metrics for Service members within the purchased care realm (immediately above) to be much lower than those seen in the direct care setting.
All mental health conditions displayed showed some amount of increase in the number of encounters per diagnosed patient across the time period of interest.
Encounters are included if they had a diagnosis code for a mental health disorder in the first or second diagnostic position, and patients are
included if they had at least one encounter meeting the above criteria in the year of interest. Care is delivered in the MHS in two settings: direct
care (i.e., military treatment facilities) and purchased care (i.e., civilian facilities). To understand where ADSMs are seeking care for mental health
disorders, outpatient utilization metrics are separated by setting: direct care in the first set of graphs and purchased care in the second set of graphs.
Diagnosis codes for each disorder were identified using the Armed Forces Health Surveillance Branch case definitions which use
International Classification of Diseases (ICD) codes.
Utilization metrics reported here are derived from raw counts of mental health encounters in the MHS. All metrics are represented by crude numbers and unadjusted rates. Comparison between services or components should be made with caution.
Administrative health care data only capture information when medical services are used and its accuracy is limited by how providers record medical encounters. The utilization
estimates only describe patients who both seek care and receive a diagnosis for a given condition. Patients who seek care but do not receive a particular diagnosis, as well as
those patients who do not seek care at all, are not represented in these estimates. Consequently, the true impact of a particular condition on both patients and the MHS is likely
underestimated by the data shown here.
Psychological Health Center of Excellence (2018, December). Psychological Health by the Numbers: Outpatient Utilization of Mental Health Care among Active Duty Service Members, 2005-2017. Available at: https://www.pdhealth.mil/utilization_outpatient. Defense Health Agency: Falls Church, VA.