This article explores aspects of psychology and mental health and contains conversation about suicide. Please read with care and dial 988 if you need help: https://988lifeline.org/.
Service member concerns drive bipartisan conversation and change. To this end, we’d like to see Congress leverage COVID-19 infrastructure to remove barriers to mental health care for our active duty service members, and make telemedicine a reliable way to deliver care. The “return on investment” is likely to be repaid by increases in military readiness and resiliency; and, importantly, will signify to service members that their mental health needs, including the provision for continuity of care, are a priority.
Mental health care needs in the military
Members of the armed services are at high-risk for mental illness. Demands of military service, which include prolonged separation, combat stressors, frequent relocation and reintegration, have created mental health challenges for service members that hamper our forces’ resiliency, agility and readiness; and can lead to devastating self-inflicted loss of life.
Federal agencies have recently made lasting commitments to veteran suicide prevention; interagency initiatives that focus on crisis-intervention and will save veteran lives. However, in practicality, the programs stop short of addressing the mental health of service members whose concerns are not elevated to the level of suicidality. Personalized mental health resources focused on prevention, resiliency and keeping service members ‘fit for duty’ are much less accessible.
One success story piloted by the military is embedded mental health, or EMH, care, which can offer service members quick, easy and personalized provider access. Unfortunately, EMH is not widespread, plagued by staffing shortages and doesn’t address continuity of care, which is essential for quality mental health care.
This is not to say that military leaders and lawmakers have not prioritized mental health programs. Service members and their families have access to military treatment facilities, or MTFs, and online platforms, such as Military OneSource and Telemynd.
Unfortunately, in-person mental health appointments lag by upwards of 6 months, and telehealth platforms do not offer continuity between duty stations or facilitate transitions of care. Experience shows that this results in service members shying away from establishing care or forming relationships with mental health providers.
Realistic solutions
1. To address the present-state lack of provider-based mental health care across state lines, one solution includes federal protection to expand telehealth-enabled services. The Public Readiness and Emergency Preparedness Act, or PREP Act, could be leveraged to authorize Health and Human Services, or HHS, to provide immunity from liability in additional emergency circumstances, outside the current scope of biosecurity threats.
Additionally, HHS’s Amendment 4 (2020), which precludes state and local governments from enforcing more restrictive policies, could be advanced to allow for interstate practice of telemedicine. The social determinants of health that make access to mental health care for service members should be classified as an emergency, and the telemedicine framework established for COVID-19 applied for service members in need of resources under The PREP Act and Amendment 4. Thus, paving the way for existing telemedicine providers to offer expeditious, long-term access to care across stateliness and irrespective of changes in regional insurance provider.
2. Streamline telemedicine credentialling and licensing for mental health professionals across states, cementing protections that allow providers to practice across state lines. Establish an electronic nationwide credentialing system to compile data, forms, and rules for professionals that meet federal and state requirements. A nationwide system could fast-track credentialing, simplifying regulation at the state level. In the end, mental health professionals would have a manageable and rapid way to understand and meet credentialing requirements across states, broadening the pool of providers eligible to serve military members.
Is it feasible?
Access to telemedicine for veterans and active duty service members has been top of mind. In 2018, the Department of Veterans Affairs expanded telehealth coverage to better serve patients ‘anywhere’ in the country. This initiative was life-changing for geographically-isolated veterans, but is limited to VA providers vs. mental health professionals providing care to active duty service members. Furthermore, Congress recently passed the Veterans Mental Health Care Improvement Act, which acknowledges that telehealth resources improve access to care, assesses barriers to care, and earmarks funds to expand capabilities. These examples showcase the appetite to improve access to mental health care via telemedicine within our Armed Services.
States and professional jurisdictions are also beginning to address these challenges. In 2019, Arizona passed a landmark law to recognize out-of-state occupational licenses, including behavioral health specialists. The Nurse Licensure Compact, an organization that helps nurses receive licenses valid throughout the country, has also navigated the complicated landscape of uniform licensure requirements, and lobbies to grant nurses opportunities to practice across stateliness, particularly in support of crisis care and telemedicine.
Time to act
Beyond the military, telemedicine has been shown to be a legitimate way to relieve stress on the national health care system. Efforts made to reduce telemedicine barriers for mental health care in the military could lay the foundation for improving access to mental health care for all Americans.
Courtney “Stiles” Herdt is an active duty naval aviator and is currently a military fellow with the International Security Program at the Center for Strategic and International Studies in Washington, D.C. Ian Porter is an active duty flight surgeon and physician currently stationed in Jacksonville, Florida. The views expressed do not reflect the official position of the Departments of Navy or Defense.
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