Improving Access to Behavioral Health Care for Remote Service Members and Their Families

Studies show that people are less likely to seek care the longer they have to travel to receive it. In particular, a 30-minute drive or longer substantially reduces how often people seek and use behavioral health services.

How many service members and families are remote from behavioral health care? How can access to care be improved?

Background

The "invisible wounds" of war — PTSD, depression, anxiety, traumatic brain injury, and drug and alcohol problems — are prevalent among today's warriors returning from Iraq and Afghanistan. Deployed service members' families are bearing the effects of the conflicts, too. Their children, for example, have demonstrated higher rates of anxiety and more emotional difficulties and problems at school than other children their age. Family caretakers of young post-9/11 veterans — more than 1 million to date — experience family tension and problems at work at a greater rate than their non-military caretaking peers.

In response to these needs, the Department of Defense (DoD) sponsors or funds over 200 behavioral health-related programs. For both service members and their families, stigma has been identified as a barrier to getting access to behavioral health care. However, geographic distance may also prevent many from accessing care. Recent analyses as well as anecdotal reports circulating in news and other media outlets have suggested that many returning service members and their families live in areas that are too remote to regularly or easily access needed behavioral healthcare assistance.

Sponsors and Research Questions

The Office of the Assistant Secretary of Defense for Health Affairs, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury asked a team from RAND to address three questions:

1. How many service members and their dependents are remote from behavioral care services?
2. How does geographical remoteness affect access to and use of behavioral health care services?
3. What are the gaps in current policy and practice for improving access to behavioral care among remote service members and dependents?

Findings and Recommendations

RAND identified that roughly 1.3 million military service members and their dependents are geographically remote from behavioral health care. More specifically, approximately 1 million dependents (children and spouses) and 300,000 service members live far from needed care.

The study team describes the composition of this group further in a detailed research brief, and in a series of two research reports:

The study identified clear reductions in the use of behavioral health care due to remoteness; in particular, remote active component service members made fewer visits to any specialty behavioral care provider, and made fewer psychotherapy visits than non-remote service members.

Based on these results, the team's final report includes a series of recommendations on ways the DoD can establish policies to enhance access to behavioral health care among remote service members, ways it can monitor the effects and implementation of these policies, and areas of policy deserving special focus. One of the most pressing recommendations is to delineate clear benchmarks for improvement in access to care, and to establish an interactive data portal in which access to care can be monitored over time.