Unhappy with the quality of care and worried about reprisals, active duty US military personnel are seeking mental health care services outside of the military, a new study shows.
The finding suggests military healthcare and mental health care services do not meet the needs of active duty service members.
“Current wars have led to a devastating public health epidemic of suicide and mental health problems among veterans and active duty GIs,” said the study’s coordinator, Howard Waitzkin, MD, PhD, distinguished professor emeritus at the University of New Mexico, Albuquerque, in a statement.
“The military should encourage and support GIs’ use of civilian-sector services that do not involve the ethical conflicts inherent in military medicine and mental health care. Such civilian services should be based in not-for-profit organizations that do not benefit financially by restricting their services,” he added.
The study was published online February 27 in Military Medicine.
Previous research has investigated the health and mental health problems of military personnel, but there is little information about personnel who seek care outside the military, the investigators note.
The purpose of the study was to clarify the personal characteristics, mental health diagnoses, and experiences of active duty US military personnel who sought civilian sector services because of unmet needs for care.
The researchers collected qualitative and quantitative data for 233 active duty service members who sought care outside the military between 2013 and 2016 through the Civilian Medical Resources Network (CMRN), a national collaborative network of volunteer healthcare and mental health care professionals.
The majority of the CMRN clients were male (82%), between 18 and 26 years of age (58%), and white (62%). Most were in the Army (64%), were of lower rank (82%), and had completed high school or had spent some time in college (78%).
High Psychiatric Burden
Psychiatric disorders were very common. Almost half (48%) reported suicidal thoughts, 72% met criteria for major depression, 62% had posttraumatic stress disorder, 20% had generalized anxiety disorder, 25% had panic disorder, and 27% had an alcohol use disorder. About a quarter of participants (24%) had a received some mental health treatment before entering the military.
Several qualitative themes emerged in clients’ CMRN intake interviews regarding reasons for seeking civilian services. The most frequent themes were insufficient and unresponsive services (93%), fear of reprisal for seeking services (56%), mistrust of command (48%), preexisting mental health disorders (22%), military sexual trauma (22%), and cost as a barrier to receiving healthcare (19%).
“This study and the work and experiences of the Civilian Medical Resources Network, the GI Rights Hotline, and our own experiences at the Center on Conscience & War all reveal that our culture and the military are failing to address the health needs and particularly the mental health needs of our service members,” Maria Santelli, executive director, the Center on Conscience & War, Washington, DC, said during a media briefing on the study.
Waitzkin noted that healthcare and mental health care professionals in the military have a responsibility both to clients and to the military command. As result of this “double agency,” problems of trust and confidentiality become barriers to care.
He noted that in his experience, active duty military personnel who seek mental health care outside the military “often arrive in a state of severe depression, suicidality, almost unable to speak, and as soon as they realize that there’s this individual at the other end of the phone whose only obligation is to them, they tend to really open up. It’s actually one of the most gratifying experiences I’ve had in medicine.”
He emphasized that this is not an argument to privatize either military or US Department of Veterans Affairs services.
“What we are arguing is that GIs should have the right to access mental health professionals without barriers that include being discouraged to do so and just ‘suck it up,’ or financial barriers,” he said.
The study was supported by a grant from the Robert Wood Johnson Center for Health Policy at the University of New Mexico and by donations from the Allende Program in Social Medicine. The authors have disclosed no relevant financial relationships.
Military Med. Published online February 28, 2017. Full text
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