Jan 5, 2015
Concerns about access to behavioral health care for military service members and their dependents living in geographically remote locations prompted research into how many in this population are remote and the effects of this distance on their use of behavioral health care. The authors conducted geospatial and longitudinal analyses to answer these questions and reviewed current policies and programs to determine barriers and possible solutions.
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With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.
Scope of the Problem: How Many Service Members and Dependents Are Remote, and Who Are They?
Effects of Remoteness on Civilian Behavioral Health Care Use
Effects of Remoteness on Military Behavioral Health Care Use
Barriers and Gaps in Policy and Practice
Clinical and System Approaches for Improving Access for Remote Populations
Defense Enrollment Eligibility Reporting System Personnel Data
Driving Distance to Military Treatment and Veterans Affairs Facilities
Community Provider Shortage Areas
ZIP Code File for Geospatial Analysis
National Study of Drug Use and Health Utilization Analyses
TRICARE Claims Data
Review of the Effectiveness of Telemental Health
Structures, Processes, and Outcomes Framework