Barriers to Engaging Service Members in Mental Health Care Within the U.S. Military Health System

Published in: Psychiatric Services, 2016

Posted on RAND.org on April 01, 2016

by Terri Tanielian, Mahlet Atakilt Woldetsadik, Lisa H. Jaycox, Caroline Batka, Shaela Moen, Carrie M. Farmer, Charles C. Engel

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Research Question

  1. What barriers do members of the military face when trying to access mental health care through the military health system?

OBJECTIVE: Over the past decade, there has been growing recognition of the mental health consequences associated with deployment and service by military service personnel. This study examined potential barriers to mental health care faced by members of the military in accessing needed services. METHODS: This qualitative study of stakeholders was conducted across six large military installations, encompassing 18 Army primary care clinics, within the context of a large randomized controlled trial. Stakeholders included patients recruited for the study (N=38), health care providers working within site clinics (N=31), and the care managers employed to implement the intervention protocol (N=7). RESULTS: Issues raised across stakeholder groups fell into two main categories: structural factors associated with the Army medical system and institutional attitudes and cultural issues across the U.S. military. Structural issues included concerns about the existing capacity of the system, for example, the number of providers available to address the population's needs and the constraints on clinic hours and scheduling practices. The institutional attitude and cultural issues fell into two main areas: attitudes and perceptions by the leadership and the concern that those attitudes could have negative career repercussions for those who access care. CONCLUSIONS: Although there have been significant efforts to improve access to mental health care, stakeholders within the military health system still perceive significant barriers to care. Efforts to ensure adequate and timely access to high-quality mental health care for service members will need to appropriately respond to capacity constraints and organizational and institutional culture.

Key Findings

  • Reported barriers to care were both structural and organizational in nature.
  • Structural issues cited included whether there are enough providers to meet care needs, whether clinic hours are sufficiently accessible, whether providers and patients have enough time to discuss mental health concerns, and whether service members can take time off from work to meet appointments.
  • Cultural issues included the stigma associated with seeking mental health care among other soldiers and superiors, and the possibility of negative effects on one's career.
  • Patients and providers both noted that a "tough it out" ethos among Army leaders substantially interferes with help-seeking behavior.

Recommendation

Efforts are needed to ensure that commanders act as facilitators, not barriers, to mental health care access for service members.

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