Mental health treatment access and quality in the army: survey of mental health clinicians.

Abstract

The goal of this study was to identify factors affecting timely, quality mental health and substance abuse treatment for service members and characterize patients at the greatest risk of having problems accessing treatment. An electronic survey was emailed to 2,310 Army mental healthcare providers. After providers with undeliverable emails and who self-reported not being behavioral health providers were excluded, 543 (26%) of the remaining 2,104 providers responded. This represented approximately a quarter of all Army behavioral health providers at the time of the survey. Of these 543 providers, 399 (73%) reported treating at least one service member during their last typical work week and provided clinically detailed data on one systematically selected service member. The majority of the clinicians reported being able to spend sufficient time with patients (91.8%) and schedule encounters to meet patients' needs (82.4%). The clinicians also identified services where treatment access was more limited and patient subgroups with an unmet need for additional clinical care or services. Specifically, a significant proportion of clinicians reported that they were "never, rarely, or sometimes" able to provide or arrange for mental health treatment for the sampled service member's children (52.0%), provide or arrange for marriage and family therapy (40.1%), coordinate care effectively with primary care (36.7%), provide or arrange for care/case management (28.3%), or provide or arrange for substance abuse treatment (24.9%). Patients with more severe symptoms and diagnostic and clinical complexity had higher rates of problems with treatment access. Our findings highlight opportunities to improve access to timely, quality treatment for service members and their families.