Integration Officer, BUMED, U.S. Navy

Mental and behavioral health have always been a topic of great concern and are just as critical as an Active Duty Service Member’s (ADSM) physical health.

Today, there is greater focus on preventative education and providing early intervention and support to those exhibiting signs of mental illness. However, the public stigma surrounding mental health remains a barrier for many Sailors and Marines to reach out for treatment, although the likelihood for them to experience mental health disruptions at some point in their career is formidable.

According to the Defense Health Agency’s Psychological Health Center of Excellence, unique barriers exist for service members who seek treatment. These barriers include the fear that seeking treatment will affect their career, the fear of losing support from their command, a culture of "toughing it out," which can interfere with the perception of need, and the fear of being separated from military service due to 

Navy Medicine is taking much-needed steps to reduce or eliminate those fears, bringing health care to a global community with a Virtual Mental Health Program designed to cross borders and drastically reduce or eliminate the stigma.

Military service can be challenging for families as well as the ADSM. According to the National Council for Behavioral Health, 46% of adults will experience a mental illness during their 

. From 2017 to 2019, the percentages of active duty Sailors and Marines with mental health issues have remained relatively close in comparison ranging from 5.5% to 6.1%.

In fiscal year 2019, nearly 6% (Table 1) of Active Duty Service Members (Navy/Marines) received a diagnosis of a mental health disorder. Remote hazardous locations, traumatic events, changing environments, and other pressures present ever-increasing dangers to the mental health of Sailors and Marines.

Additionally, many active duty Sailors and Marines are outside “access to care” regions - located more than 60 minutes of drive time to a military medical treatment facility in the continental United States or more than 40 miles from a military medical treatment facility outside the continental United States. This further demonstrates a need for virtual mental health services which can operate efficiently in real-time (synchronous) or at “store and forward” delayed communications which are stored then later routed (asynchronous) depending on the case presented.

Mental Health (New Patients) by Fiscal Year

In the past, addressing mental health issues has been dependent on the number of health care providers and the needs of the location. ADSMs scheduled an appointment and in some locations, had to wait weeks to see a behavioral health specialist. For instance, if ADSMs are on smaller combatant ships, in remote locations, or on an assignment without direct access to a clinician, this wait time may be even longer.

If the presenting case required immediate intervention and treatment, then transporting to the emergency room or military medical treatment facility via medical evacuation would allow access to care. Early access to mental health support (whether virtually or in-person) can lead to fewer instances of mental health disruptions that may lead to suicide; thereby improving mission readiness.

The National Defense Authorization Act of 2017 (NDAA 2017) requires the Department of Defense to increase the use of telehealth services, making it possible to have virtual health encounters. NDAA 2017 allows for the maximization of the use of such services to provide real-time interactive communications between patients and health care providers and remote patient monitoring.

Recognizing the barriers to mental health treatment in the global organization, the U.S. Navy’s Bureau of Medicine and Surgery (BUMED) Operational Virtual Mental Health Work Group was established in October 2018.

The work group strategized and standardized the delivery of virtual mental health care services to ensure that Sailors and Marines are able to receive the most appropriate mental health care anytime and anywhere. This work group sought to find a solution to answering the question: In what ways can Navy Medicine contribute and make an immediate impact to overall reductions in suicides, depression, stress, anxiety, and the divorce rate so commonly associated with our Nation’s military?

The group focused on strategy and foundational objectives to develop a test plan and design a Virtual Mental Health Program that provides care and support when and where needed, especially in remote, austere locations.

In August 2019, Navy Medicine completed a pilot program designed to test the effectiveness of mental health care provided both virtually and in person within two different geographic regions. During the pilot which spanned a six-month period, more than 800 ADSMs held virtual visits with a behavioral health/mental health provider. Some patients received a virtual visit and follow up care from a provider located 90 miles away via a secure video teleconference connection.

Benefits to both patients and providers were immediately realized as patients didn't have to drive to see a provider, and patients were less reluctant to have a conversation virtually than in person. Providers also recognized the efficiencies of working in a virtual environment, such as reduced costs by eliminating travel between locations and maximized ability to see more patients in virtual visits. Based on experience with the pilot, it is ideal to have a clinician be dedicated to providing care to a distant site versus using multiple clinicians to cover a distant site. 

Having 1 dedicated clinician allows the on-site clinical staff more consistency in workflow procedures and more reliability in handling patient concerns that arise outside of scheduled clinical appointments.

Articles

A military service member talks about some of the ways the Navy is implementing new programs to improve mental health conditions.