Watchdog Reports Troops May Not Be Receiving Adequate Health Care
Watchdog Reports: Troops and Families May Not Be Receiving Adequate Mental Health Care
Even before the COVID-19 pandemic, military families were having trouble getting the mental health care they needed, according to new data from an online survey conducted in late 2019. Whether they are active-duty families, military retiree families or veteran families, about half reported they were satisfied with their ability to get mental health appointments, according to the Military Family Advisory Network’s family support programming survey. The survey was open online from Oct. 7 to Nov. 11, and 7,785 people participated. About 42 percent of those were active-duty members and spouses. Most respondents — 83 percent — said they had not used mental health crisis resources; those who had used such resources were more likely to be spouses of veterans or retirees. Of the 7,785 people who participated, about 4,000 answered health questions when they were directed based on earlier answers, and even fewer answer the mental health questions.
According to an article by Militarytimes.com, thousands of troops and their family members may not be getting the mental health care they need because of a variety of issues with the Defense Department health care system, according to a new report from DoD auditors. Auditors with the DoD Inspector General found that DoD is not consistently meeting the requirements under law and by DoD policy, for access to outpatient mental health care, causing patients to experience delays. Generally, the wait time for an urgent care visit must not exceed 24 hours; a routine visit must not exceed one week, and a specialty care referral must not exceed four weeks. Auditors also found that — pre-COVID-19 — 53 percent of all active duty service members and their families who got referrals to TRICARE because they needed mental health care did not receive the care. It is not known why, because health officials do not track the reasons. That represented an average of 4,415 out of 8,328 per month at those 13 MTFs who did not receive that care.
At one military treatment facility, a psychiatrist specializing in child and adolescent care gave auditors three examples of how delayed treatment may have contributed to patient safety issues, including second suicide attempts, and hospitalization. Another mental health provider said it could take up to seven weeks for a follow-up visit and the clinic is not tracking how well they can treat a patient once the patient is in the clinic. Nine of the 13 MTFs reported they were not able to meet evidence-based treatment guidelines or monitor treatment dosage for patients.
Auditors found that seven of those 13 military treatment facilities or their supporting TRICARE networks did not meet the access standards for special mental health care each month.
“Our survey, which was fielded before COVID-19, found that military families experienced difficulty scheduling mental health care appointments,” said MFAN’s Executive Director Shannon Razsadin. “That’s something we never want to hear, and we are concerned about the additional barriers caused by COVID-19.”
Top obstacles for getting mental health care for currently serving families were lack of available appointments, time to attend appointments and concerns about negative career implications, according to the survey. The report, which adds statistics to back up what military families have long known, recommends exploring telehealth as an option for providing more access to mental health care. Another reason for problems with access to care was inadequate staffing. In interviews during site visits to the 13 MTFs, staff members at 11 of the MTFs said they would need more staff to meet standards for access to mental health care, or to care for both active duty members and their families. The Military Health System does not have a system-wide model to identify the appropriate levels of staffing needed in MTFs and in Tricare, auditors found. The auditors recommended that health officials develop a single system-wide staffing approach for the behavioral health system of care, that estimates the number of appointments and number of personnel needed.
As recommended by IG auditors, DHA will establish a standard process for mental health assessments, but the elements of that assessment will be tailored to each patient’s needs, officials stated in their response. Some MTF providers told auditors they were concerned with the adequacy of the Tricare network in their area, in terms of enough mental health care providers, which has long been a concern of Tricare beneficiaries.
During the pandemic, telehealth through Tricare has indeed increased. Tricare has covered telehealth for several years for certain medically necessary services. Most of the families who participated in the survey had never used telehealth, but the good news, Razsadin said, is that more than one-third of the active-duty families said they would be likely or very likely to use it. Tricare officials have already taken steps to make it easier to use telehealth, such as temporarily waiving cost-shares and co-payments for all covered, in-network telehealth services during the pandemic. They have temporarily relaxed some licensing requirements across state lines to allow providers to treat patients who live in a different state. There has long been a shortage of mental health providers across the country. Tricare officials have temporarily expanded some types of care eligible through telehealth and allow coverage for telehealth consultations by telephone. Officials have said they will evaluate whether to make some of the expansions permanent.
That may be an example of a silver lining in the COVID-19 pandemic, said Razsadin. “It’s given us an opportunity to get more flexible in how we provide different types of support. I think this is an eye-opening experience… This is an opportunity to also look at what works and what could work longer term as we support military families.
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