As the military and the nation deal with a shortage of mental health providers and delays in getting appointments, defense and service officials outlined steps they’re taking to address concerns.
Defense officials will start a pilot program this fall to test a behavioral health staffing model that matches “supply with demand,” said Seileen Mullen, acting assistant secretary of defense for health affairs. They’re adding psychiatric physicians assistants, licensed mental health counselors, professional counselors and marriage and family therapists.
“We will also significantly increase our telebehavioral health, including 63,500 visits this year,” she said, during a May 25 hearing on the military health system before the House Appropriations defense subcommittee. “We’re also trying to lower the referral and approval Tricare barriers. While there are shortages in certain areas, we are tackling them, and we understand that this will not be an easy or a quick fix.”
Most military treatment facilities meet the mental health care access standards of appointments within 28 days, she said , but each month “one or two MTFs are out of compliance.” Patients who require immediate care “are being seen — absolutely — immediately.”
In general, the average wait time is between 11 and 13 days for an initial behavioral health evaluation, said Army Lt. Gen. Ronald Place, director of the Defense Health Agency. Follow-up appointments are based on the individual and their behavioral health care requirements, he said. There are variances in some areas, including remote locations. Officials are also contracting with other behavioral health facilities that offer telebehavioral health to meet the needs of service members as well as families.
The Army is working with the Defense Health Agency, looking at locations where it’s difficult to hire the needed behavioral health professionals, and shifting uniformed personnel to go those locations to fill the gaps to help with the workload, said Army Surgeon General Lt. Gen. R. Scott Dingle.
The Air Force is looking at two key ways to increase access to mental health care, said Air Force Surgeon General Lt. Gen. Robert Miller. It’s working with the Defense Health Agency to consider authorizing licensed professional counselors and licensed marriage and family therapists to practice in certain locations that might be more remote, where there are difficulties finding enough psychologists, social workers and other mental health workers.
The service is also using a “targeted care model,” he said, “where we are looking at ensuring that patients are getting to the right care at the right time.
“The question is, does everyone need to be seen at the MTF in mental health or, through a triage process, would someone be better served in other means, working through a chaplain, working through marriage family life counselors,” he said. The service also looking at the potential benefits of group appointments.
“It’s a pilot [program] that’s ongoing and has been successful and increased access for those patients in highest need,” he said.
Navy Surgeon General Rear Adm. Bruce Gillingham said the sea service prioritizes mental health support at the deck plates, with embedded mental health providers. Some 36% of active duty mental health providers and 30% of behavioral health technicians are assigned to those billets. These providers are embedded on aircraft carriers, submarines, amphibious assault and surface combatant ships, and within naval expeditionary combat units, naval information forces, Marine Corps ground combat, logistics and command element units, Navy and Marine Corps special operations, and various training commands, according to his written testimony.
The Navy has seen significant increases in the use of virtual services for mental health as well as primary care, he stated. In fiscal 2021, almost 20% of mental health appointments for sailors and Marines were conducted virtually.
Gillingham noted that the Navy, like the other services, also focuses on prevention.
“Beginning in boot camp, all of our recruits are taught stress reduction and meditation techniques,” he told lawmakers. The service is also teaching leaders about identifying those at risk “so we can get them to care.”
Several lawmakers expressed unease about the recent suicides aboard the aircraft carrier George Washington, and the overall issues of mental health in the military.
“This is a concern to all of us,” said Rep. Ken Calvert, R-Calif. “We see a rise for a number of reasons, not just in the military but throughout society, in mental illness, and dealing with suicide. I hope all of you focus on that and try to potentially bring us some solutions.”