In a new RAND Corporation Study that evaluated the quality of mental health care in the United States military, researchers found both areas of excellence and others in need of improvement.
For the study, researchers reviewed the administrative data and medical records of 14,576 active-duty service members who were diagnosed with post-traumatic stress disorder (PTSD) and 30,541 who were diagnosed with depression from January 2012 to June 2012. The review examined whether those service members were receiving evidence-based care in the year after diagnosis.
On the positive side, the military health system appears to perform well in administering crucial follow-up visits with patients after they are discharged from a mental health hospitalization. This is a vulnerable time for newly released patients and follow-up visits are extremely important.
The researchers also found that a large majority of patients with a diagnosis of PTSD or depression received at least one psychotherapy visit, suggesting that these patients have access to at least some mental health care.
However, the findings show a need for improvement in some areas of care. Although most patients received at least one psychotherapy visit, the number and timing of subsequent visits may be inadequate to provide evidence-based psychotherapy, according to the researchers.
Specifically, patients newly diagnosed with either PTSD or depression should have at least four psychotherapy or two medication management visits within eight weeks of their diagnosis. Only one-third of patients newly diagnosed with PTSD and under a quarter of those with depression received this type of care.
The study also looked at differences in health care quality according to service branch — Army, Air Force, Marine Corps, and Navy — and TRICARE region (North, South, West, and Overseas) as well as across service member characteristics. TRICARE is a health care program of the military health system.
While the researchers found differences in the quality of care provided for PTSD and depression, no military branch or region consistently outperformed or underperformed relative to the others. The findings also showed no consistent patterns of variation in the quality of care by patient characteristics, such as age, gender, pay grade, race-ethnicity, or deployment history.
The findings are among the first results from the RAND study that is the largest, most-comprehensive independent look at how the U.S. military health system treats service members with PTSD and depression.
“Regardless of where they serve, where they live or who they are, all members of the U.S. armed forces should receive high-quality mental health care,” said Dr. Kimberly A. Hepner, lead author of the study and a clinical psychologist at RAND, a nonprofit research organization.
“Developing transparent assessments of care that can be routinely reviewed both internally and externally are essential to ensuring excellent care for all service members and their families.”