Plan Calls for Sweeping Changes to Mental Health Care Services

By Fred W. Baker III
American Forces Press Service

Sept. 26, 2007 - Servicemembers and their families can expect sweeping changes throughout the Defense Department's mental health care services during the next year. A plan submitted to Congress this month details hundreds of proposed actions that officials hope will make the system more patient-focused. Many of the major changes are slated to be in place by as early as May 2008.

The plan is based on 95 recommendations for change that the department's Task Force on Mental Health reported to Congress in June.

Congressionally directed and funded last year, the task force reported that stigma attached to mental health care, difficult access, bureaucracy and a lack of resources contributed to a lack of adequate care for servicemembers and their families.

Congress provided $900 million for improvements in mental health care services, some funds specifically for advancements in traumatic brain injury and psychological health research, development and services.

The department responded by partnering with the departments of Veterans Affairs and Health and Human Services to develop a plan to work through each of the recommendations, in many cases crossing the bureaucratic borders of each organization, to refocus the delivery of care to the patient's point of view.

This is a paradigm shift for military medicine, said Ellen Embrey, deputy assistant secretary of defense for force health protection and readiness.

"Patient centered-care is a standard of practice in some of the more effective health systems around the country. For large federal systems like the Department of Defense and the Department of Veterans Affairs, patient-center care being imposed on a large number of specialty departments requires a significant commitment to understanding what the patient has to go through and making sure that the providers in that system keep that in mind," Embrey said. "We are absolutely committed to doing what's best for the patient."

The changes also call for a shift in how the department has traditionally focused its mental health care, she said.

"If you look at how the department is currently organized to provide care, ... overall our focus in the past has been on diagnosis and treatment. The shift ... is to help people understand that prevention, and helping people maintain their health, is as important," Embrey said.

This calls for education and training for leaders, providers and patients, she said. The new plan also includes more research.

"That shift requires everyone in the system to understand what psychological health is, how to recognize when it's starting to falter, and what you can do yourself or what resources are available to you," Embrey said.

Probably one of the most visible changes in the system will be streamlined mental and physical evaluation board processes that will offer more consistency between Defense Department and VA assessments, Embrey said. A pilot of the new system will be conducted in the next few weeks, she said. A final system is to be in place by May.

Also key in the plan is ensuring servicemembers and their families receive a full continuum of care during transitions, especially from military to civilian life. Most of the changes have to do with recordkeeping and working to improve provider "hand-offs" of patient information. This is critical, officials said, as patient information often is recorded on the battlefield and passed successfully to military hospitals for care, but sometimes there are gaps as the patient transitions to Veterans Affairs or to a civilian provider.

Officials are also working to bring mental health care access policies more in line with those of primary care access policies. For example, officials want policies across the system to provide initial mental health care services to a patient within seven days of contact, or fewer if the situation requires. This is the standard for primary care access. But in the past, mental health care was always perceived as specialty care, and the standard for receiving an appointment was 30 days.

"Psychological health and fitness must be placed on an equal footing with physical health and fitness," Embrey said. "We have a responsibility to effectively identify and treat all psychological health conditions and ill effects of war, and are committed to accomplishing that through a consistently excellent standard of care across DoD."

Many changes will revise department policies to reflect a more current knowledge of psychological health. And part of the plan is an anti-stigma public education campaign targeting servicemembers and family members who neglect or postpone treatment.

The aggressive timeline for implementing the changes reflects the department's commitment to timely change to the mental health care system, Embrey said.

"This has the attention of our senior leadership, and they are committed to making these necessary changes," she said. "Our families and our servicemembers are the most important part of our ability to do our mission and they deserve the very best treatment."

Since the initial recommendations went to Congress in June, senior Defense Department officials have met weekly. Many changes were already implemented as officials developed the overall plan, officials said.