Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S

Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S

Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S

Access to Behavioral Health Care for Geographically Remote Service Members and Dependents in the U.S

Synopsis

With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.

Excerpt

It is well established for civilian populations that persons farther away from medical care are less likely than others to seek or use health care services, including behavioral health care services (treatment for mental, behavioral, or addictive disorders). With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care has risen. There is limited data on how many service members and dependents reside in locations remote from behavioral health providers and the resulting impact on their access to and utilization of care. Similarly, little is known about the effectiveness of existing policies and other efforts to improve access to services among this population. This report seeks to fill that gap.

The RAND National Defense Research Institute (RAND NDRI) was asked to assess how many service members and dependents are geographically distant from behavioral health care, as well as the characteristics of this population and the effects of remoteness on their use of behavioral health care. RAND NDRI was also asked to assess existing efforts to improve access for remote service members and dependents and to make recommendations for addressing gaps in current policy and practice.

This report summarizes our findings. It will be of particular interest to Department of Defense policymakers and command and line leadership, as well as planners, managers, and providers of behavioral health care.

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