Geographic Barriers to Behavioral Health Care May Put Remote Service Members at Risk

Remote service members may face challenges accessing and receiving high-quality behavioral health care through the Military Health System (MHS), putting them at a greater risk for negative outcomes related to behavioral health issues, according to a new RAND Corporation report.

The report examines more than 93,000 service members diagnosed with posttraumatic stress disorder (PTSD), depression or substance use disorder (SUD) and finds that service members who live more than 40 miles from a military treatment facility are often less likely to receive recommended behavioral health care than those who live nearby.

“The MHS aims to provide excellent behavioral health care to all service members, as we know that mental health conditions can directly impact force readiness,” said Kimberly Hepner, lead author and a senior behavioral scientist at nonprofit, nonpartisan RAND. “We see a number of differences in care between remote and non-remote service members, with remote service members often less likely to receive recommended care for their PTSD, SUD, and depression. These differences could put service members at risk for poorer outcomes.”

Specifically, remote service members are less likely to receive an adequate number of visits when starting a new treatment and less likely to receive a timely follow-up visit after starting a new medication or being discharged from a mental health hospitalization.

The research also shows that remote service members are more likely to receive behavioral health care from primary care providers rather than behavioral health specialists, which may limit their treatment options. In fact, the authors note they are half as likely to see a psychiatrist and 30% less likely to receive psychotherapy, a recommended treatment that is typically unavailable in primary care settings.

The report also evaluates the overall performance of the MHS in providing recommended behavioral health care for both remote and non-remote service members. The MHS performs well in areas such as providing recommended medication for an adequate period of time, but the authors note that there are areas for improvement. Specifically, it should increase the amount of care service members receive when they start treatment and ensure service members receive timely follow-up after starting new medication treatment.

“We continue to see areas of high performance, but we also highlight areas where the MHS can continue to improve behavioral health care for service members. There should be an increased focus on the needs of remote service members,” Hepner said.

The authors recommend monitoring the care delivered to remote service members and continuing to expand the use of telehealth to reduce access barriers. Further, because remote service members often receive care from community contracted providers instead of military facilities, the MHS could increase efforts to monitor the care delivered by these providers.

The report, “Behavioral Health Care in the Military Health System: Access and Quality for Remote Service Members,” and related research brief, “Improving Behavioral Health Care for Remote Service Members: Three Key Priorities,” are available at www.rand.org. Other authors are Ryan Brown, Carol P. Roth, Teague Ruder, and Harold Pincus.

This report was sponsored by the Defense Health Agency and conducted by the Forces and Resources Policy Center of the RAND National Defense Research Institute.