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Research Questions

  1. How do AC and RC personnel who have been diagnosed with PTSD, depression, substance use disorder, or a combination of these conditions compare demographically and in terms of service characteristics?
  2. To what extent do AC and RC personnel receive recommended treatment for these behavioral health conditions, and how do they differ in their patterns of behavioral health care utilization?
  3. Are there differences in behavioral health care access and quality between RC personnel who live in areas that are remote from a military treatment facility and those who do not?

The Military Health System (MHS) aims to improve the health of all U.S. military personnel, provide the highest quality of care possible, maintain low per capita health care costs, and support overall military readiness. High-quality, evidence-based behavioral health treatment is central to individual well-being and the overall health of the force. However, there has been little research to date on the behavioral health care that National Guard and reserve personnel—collectively known as the reserve component (RC)—receive from the MHS.

The full-time personnel in the U.S. military's active component (AC) overwhelmingly receive behavioral health care in military treatment facilities and generally from behavioral health specialty providers, RC personnel rely much more heavily on private-sector contracted care (also referred to as purchased care) and primary care providers. MHS administrative data indicate that RC personnel are less likely to receive recommended treatment for PTSD, depression, and substance use disorders. Likewise, RC personnel who live in areas that are remote from a military treatment facility are less likely than who do not to receive recommended treatment for these conditions.

These findings, which focus on behavioral health care access and quality, highlight pathways to improvement for the MHS as part of its ongoing transition to a more centralized model for delivering and overseeing health care across the force.

Key Findings

RC and AC personnel differ in their utilization of behavioral health care and the quality of care that they receive for PTSD, depression, and substance use disorders

  • RC personnel are more likely than AC personnel to receive behavioral health care from primary care and private-sector providers, as opposed to specialists or providers at military treatment facilities.
  • RC personnel are less likely to receive psychotherapy and recommended medication follow-up visits.
  • RC personnel are less likely to receive recommended initial care for PTSD and depression, as well as timely follow-up after a psychiatric hospitalization.

RC personnel who live in areas that are remote from a military treatment facility are generally less likely to receive recommended care than their non-remote counterparts

  • Remote and non-remote RC personnel receive recommended initial care for PTSD and depression at similarly low rates.
  • Remote RC personnel are less likely to receive psychotherapy and timely follow-up after a psychiatric hospitalization.

Recommendations

  • The MHS should monitor and continue taking steps to improve access to high-quality behavioral health care for RC personnel, with a focus on reducing differences in care quality between RC and AC personnel and between remote and non-remote RC personnel.
  • The MHS should seek to clarify the unique barriers that RC service members face in accessing behavioral health care and to identify the drivers of the differences in receipt of recommended care between RC and AC personnel.

This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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