“The military’s health program falls significantly short in providing mental-health care to service members, according to a Rand study published last week.
The study focuses on depression and post-traumatic stress disorder, the two most common mental-health conditions experienced in the armed services.
It finds some good news: The Military Health System, which is operated by the Defense Department, is effective at contacting active-duty personnel diagnosed with one of the conditions. In addition, a vast majority of those diagnosed with PTSD or depression receive at least one session of talk therapy, the study finds. In that regard, the military system outperforms civilian health services.
But the system faces difficulties ensuring that patients continue with treatment, either by continuing to see a psychotherapist or following up with a doctor after being prescribed medication.
“It’s essential to provide excellent care for these service members because of how much we ask of them,” said Kimberly Hepner, the study’s lead author and a senior behavioral scientist at Rand.
The study examined medical records for service members diagnosed with one of the two conditions between January and June 2012. About 15,000 had PTSD, and about 30,000 had depression. About 6,000 had both.
About 1 in 3 patients newly diagnosed with PTSD got the appropriate follow-up care — typically, that’s at least four visits to a psychotherapist within two months. For those with depression, less than a quarter completed those four visits.
Only about 40 percent of patients who were prescribed medication followed up with a doctor afterward. Those visits are essential, Hepner said, because the physician can make sure patients take their medication and help them manage side effects. A physician’s involvement also ensures that medication doesn’t counteract other drugs being taken.
“Service members received a tremendous amount of medical treatment,” she said. “That’s why it’s even more critical to make sure that it’s a successful experience.”
Combat can contribute to mental health problems, according to the Department of Veterans Affairs. Meanwhile, research has found that suicide attempts seem to be more common in service members than in civilians, though it can be difficult to make such comparisons.
The study is the first part of an overarching project to assess mental-health care in the military. The research, which was commissioned by Defense, hasn’t yet delved into such questions as why patients stop their therapy and medication.
Potential explanations could include insufficient access to mental-health professionals, said Joe Davis, a spokesman for the Veterans of Foreign Wars. Many service members might also fear judgment from their peers for asking for help.
“It’s very easy for senior leaders to say there is no stigma, but far different on the ground at the small-unit level, where everyone relies on their buddy . . . and vice versa,” he said in an email.
Service members might also have been unhappy with the care they got, he added, and therefore chose not to return.
The shortage of providers is one of the biggest barriers to continuous mental-health care, said Elspeth Cameron Ritchie, a former military psychiatrist. As the number of service members deployed to Iraq and Afghanistan has increased, she added, the need for doctors has grown.
It may also be true that appointments are not available at convenient times, Hepner said. “We ask a lot of service members, and they have a lot of demands on their jobs.”
Because they travel a lot, it can be difficult for them to keep up good, continuous access to care, Ritchie said. That difficulty can compound reluctance to keep up with mental-health care. Many, she added, worry about others’ perception if they are seen regularly visiting a psychiatrist.
“If you need to go to the doctor all the time, people will think, ‘Oh, what’s wrong with that person?’ ” Ritchie said. “There’s a lot of talk about how we should treat this as a broken leg, and there shouldn’t be a stigma. But there is a stigma.”
The Defense Department’s commissioning of the study is encouraging, Hepner said, because it suggests an interest in trying to improve mental-health care and access to it. DOD could build on efforts to publicly measure how good its providers are, she said. The department has begun doing that, but Hepner said the public needs more information about quality of care.
The Rand findings may have understated the difficulty of obtaining mental-health care, Hepner added. The study focused on patients who had been diagnosed, but it probably missed some who either hadn’t seen a doctor at all or who had but hadn’t been diagnosed.
Even when they go to the best doctors, service members must ask for help, which can be difficult, Davis noted.
For instance, everyone in the Rand study had been identified as needing help. That makes it easier to connect them with care, which may have influenced the high proportion who had an initial visit, Hepner said.
“The real risk here is the people we are not addressing,” she added.”