Lessons Learned for Provisioning and Delivering U.S. Military Behavioral Health Care, 2003–2013

by Kristie L. Gore, Ryan Andrew Brown, Kathryn O'Connor

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Research Questions

  1. How did the military health system respond to the mental health demands of service members in operations Iraqi Freedom and Enduring Freedom?
  2. What actions worked? What did not work?
  3. What lessons should be carried forward to prepare providers and the health system for future wartime needs?

The behavioral health demands stemming from the longstanding wars in Iraq and Afghanistan led to significant changes in the provision and delivery of behavioral health care in the U.S. military. The focus in this report is on the 2003–2013 period. The authors reviewed publicly available material to identify the events and circumstances that prompted the changes. This review informed the selection of candidates for a series of interviews to capture lessons they had learned that could help prepare future military behavioral health providers. This report highlights selected events and the insights of the 17 experts the authors interviewed. One overall lesson seems to have been the need for a pipeline for hiring providers and appropriate incentives, particularly when demand surges, as it did in this period.

Key Findings

Manpower shortfalls during the period made it difficult to meet the demand for behavioral health services

  • The problems stemmed both from the inability to estimate requirements and the difficulty of accessing providers.
  • The overall lesson is that it is possible to surge to meet new demands on the behavioral health system, but doing so requires avenues for hiring and appropriate incentives.

Behavioral health providers need to be prepared to practice in military treatment facilities, in theater, and in different roles

  • Integration of behavioral and nonbehavioral health care is critical. Behavioral health providers need to be able to articulate their role and value to commanders, understand confidentiality policies, and communicate the minimum necessary information to address the information commanders need to know to maintain unit readiness.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Contextual Events

  • Chapter Three

    Provisioning Military Behavioral Health Care

  • Chapter Four

    Delivery of Military Behavioral Health Care

  • Chapter Five

    Reflections

  • Appendix A

    Interview Procedures

  • Appendix B

    Interview Protocol

  • Appendix C

    Interview Release Form

  • Appendix D

    Biographies of the Interviewees

This research was sponsored by the USUHS CDP and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division.

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