Military shortage of mental health workers leads to longer waits for care

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A shortage of mental health workers in the military and increased demand for care have forced soldiers to seek help off base and sometimes wait up to a month for appointments, according to a Government Accountability Office report released Feb. 6, 2024 .

A shortage of mental health workers in the military and an increase in demand for care forced soldiers to seek help off base and sometimes wait up to a month for appointments, according to a Government Accountability Office report released Feb. 6, 2024 Is. (Department of Defense)

A shortage of mental health workers in the military and increased demand for care are forcing soldiers to seek help off base and sometimes waiting up to a month for appointments, according to a new government report.

The Government Accountability Office found that 43% of authorized behavioral health care jobs at the Army’s Defense Health Agency were unfilled by January 2023, the authors of the report titled “Defense Health Care: DoD should monitor immediate referrals to civilian behavioral health providers” Alyssa Hundrup said. To ensure timely care,” which was released on Tuesday.

“We also heard that facilities are facing hiring challenges, such as slow hiring processes or not being able to offer competitive salaries compared to the private sector or other agencies,” he said.

Mental health workers may include psychiatrists and nurse practitioners as well as clinical social workers, licensed professional counselors, substance abuse counselors, physicians and nurses who do not prescribe medications but are trained to make diagnoses and provide counseling. Are there.

The staffing shortages found by GAO run contrary to the recommendation of the Suicide Prevention and Response Independent Review Committee, created last year by Defense Secretary Lloyd Austin. The committee called for increased mental health services and appointment availability.

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The goal of the Defense Health Agency is to generally keep medical care for soldiers within military treatment facilities. When that is not available, DHA will refer troops to civilian providers that accept TRICARE, the military’s health insurance.

According to the report, officials at selected military treatment facilities reported taking several steps to reduce the impact of vacancies in mental health care jobs, including more referrals to off-base facilities and prioritizing initial appointments over follow-ups. Giving is involved.

When service members go into the local community for care, Hundrup said DHA is not doing enough to monitor how quickly people with urgent referrals are being seen. Without doing so, the agency cannot identify and resolve the cause of the delay in care.

In response to GAO’s findings, DHA Director Lieutenant General Telita Crosland said that when service members are sent off base, they are responsible for making their own appointments, giving DHA less control over whether the standard is met. Appointments are made for them in military facilities.

Looking at fiscal year 2022 data, GAO found that initial regular appointments at military facilities were scheduled within an average of 16 days and at bases within approximately 30 days. Hundrup said in a GAO podcast about the report that the Defense Department is mandated to make these appointments within 28 days.

The army is not alone in its shortcomings. According to the National Institute for Health Care Management Foundation, there are not enough mental health workers to meet demand nationwide. Nearly half of Americans live in an area that lacks enough mental health workers.

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It also could increase off-base wait times, Hundrup said.

“For the Tricare network, we heard that some service members were having difficulty finding people who would accept Tricare or who had availability,” she said.

Immediate appointments at military bases were made on the same day, while at civilian facilities it could take two to three weeks. However, there is no set standard for how quickly urgent referrals should be seen in its citizen network, he said.

“(The Department of Defense) has explained to us that they don’t have that because it really can depend, can vary depending on the clinical need and what the provider indicates,” she said. “We certainly appreciate that clinical needs vary, but with a timescale of no more than two and three weeks, it is difficult to see why this should be expedited or How will it be considered necessary?

Hundrup said he has seen the DHA make progress in improving wait times. The agency has launched a physician recruitment team, is running a program to move some patients to non-medical settings like consultations, and is preparing to expand telehealth appointments.

However, Carl R. Lt. Col. Chris Penn, chief of behavioral health at Darnall Army Medical Center, said during an interview in October that triage programs to send soldiers to chaplains or targeted counseling services only work in the short term. Duration. In the end, the soldier has to choose, and many prefer the medical health care worker.

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“No one really goes to a cardiologist and says, ‘I have a heart problem.’ You go to primary care, primary care does an assessment and then based on that assessment, they will refer you to a specialty service,” Penn said.

To normalize mental health care, the Army has directed soldiers to go directly to medical staff, he said.

“In some ways, we got what we asked for and then some. The system is just trying to adapt to that influx,” Pine said.

He also participates in a DHA working group to reduce the time it takes to hire new mental health care workers. Across DHA, it can take more than four months to hire a new employee. “This can go on for a long time in mental health,” he said.

“The fundamental problem is that we are hiring people at a faster rate than the timely process allows us to backfill them. Several initiatives are being taken to try to fix this. We haven’t fixed it yet,” Penn said. “It is at an all-time low because we do not have leaders who can afford it anymore. “We have nowhere to go but up and I really believe that.”

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