Better Behavioral Health Care for Remote Service Members

Three main priorities

The primary goal of the military health system (MHS) is to ensure that soldiers suffering from behavioral disorders, such as post-traumatic stress disorder (PTSD), depression and substance use disorders, receive effective treatment. Soldiers who live geographically far from a military treatment center may have particular difficulty accessing quality care, which can compromise their treatment outcomes.

The treatment of PTSD, depression, and substance use disorders received by remote and non-remote soldiers differs in some respects. These differences highlight three key priorities for the U.S. Department of Defense to consider in improving care for deployed soldiers.

Main Priority 1

Reduce disparities in the quality of care for deployed and active duty soldiers with behavioral health problems.

Improve access to psychotherapy for service members deployed away from home

Service members deployed away were less likely to receive psychotherapy at the onset of a new treatment episode, but access to medication was similar to that of other service members.

Health care providers should increase their efforts to ensure that remote service personnel have access to recommended treatment options that best meet patients' needs, while reducing barriers to psychotherapy.

Fewer remote service members received psychotherapy after initiating new treatment.

Improve follow-up rates of remote service members after initiating substance abuse treatment

Remote service members were less likely to receive timely follow-up treatment after initiating substance abuse treatment, particularly for alcohol- and opioid-related disorders. Strategies to reduce these disparities could include greater use of primary care, specialty care, and telehealth services for medication management.

Fewer remote service users received a follow-up visit within 30 days of starting a new medication treatment.

Improved timely follow-up after psychiatric hospitalization of remote service users

Military personnel may be at increased risk after discharge from a psychiatric hospital. Timely follow-up-in the form of an outpatient visit-may reduce these risks. Military personnel were significantly less likely to receive timely follow-up than uncontrolled personnel. Given the risks associated with their referral, reducing this disparity should be a health care priority.

Among those discharged from psychiatric hospitals, the proportion receiving timely outpatient follow-up visits was lower.

Main Priority 2

Implement effective strategies, including telemedicine, to meet the needs of service users living at a distance.

Telehealth is the use of audiovisual technology for communication between providers and service users to deliver care. Telemedicine-particularly synchronous telemedicine, in which the provider and patient interact in real time-is a possible solution to the needs of telehealth professionals.

Few recruits (less than 3%) received care (medical or behavioral) through synchronous telemedicine, suggesting the need to expand telemedicine options to all recruits. Greater use of telemedicine services could be especially helpful in improving access to psychotherapy and follow-up visits for service members who live farther away.

Main Priority 3

Improve methods of tracking access to purchased health care for behavioral disorders.

Service members who live farther away are more likely to receive their behavioral health care from a civilian provider in the community with whom TRICARE contracts (known as “purchased care”). MHS routinely tracks access to appointments at military treatment facilities, but does not similarly track access to purchased care providers.

This may mask access differences for military personnel who live far away. MHS should consider requiring purchased care providers to submit data to support the use of access to care measures similar to those used to track access to behavioral health care at military treatment facilities.

Differences between absent and non-absent service members with behavioral health care needs

Remote service members tend to be older and are more likely to be white, non-Hispanic, and married than non-remote service members. They are also more likely to be members of the reserve or national guard.

Survey Methodology

RAND researchers identified more than 93,000 service members (active duty, National Guard, and reserve) who had been diagnosed with PTSD, depression, or a substance use disorder. Remote service members included those who were eligible for TRICARE Prime Remote.

Researchers used administrative data to compare the availability and quality of care provided in 2016-2017 to remote (n = 11,669) and non-remote (n = 81,648) service members with one of three target conditions within six months of diagnosis.