Most community-based mental health providers are not well prepared to take care of the special needs of military veterans and their families, according to a new study by the RAND Corporation that was commissioned by United Health Foundation in collaboration with the Military Officers Association of America.
The exploratory report, based on a survey of mental health providers nationally, found few community-based providers met criteria for military cultural competency or used evidence-based approaches to treat problems commonly seen among veterans.
"Our findings suggest that community-based mental health providers are not as well prepared as they need to be to address the needs of veterans and their families," said Terri Tanielian, the study's lead author and a senior social research analyst at RAND, a nonprofit research organization. "There is a need for increased training among community-based providers in high quality treatment techniques for PTSD and other disorders that are more common among veterans."
Although the Department of Defense and Veterans Health Administration in recent years have increased employment of mental health professionals, many veterans may seek services from practitioners in the civilian sector, often because they are located closer to their homes. In addition, policymakers have expanded veterans' access to community-based health providers as a way to meet demands, given capacity constraints in the VA health system.
"Our veterans have served and sacrificed for our nation and deserve the very best care," said Kate Rubin, president of United Health Foundation. "We hope this study will focus attention on the opportunity that exists to better prepare our mental health workforce to meet the unique needs of veterans and their families."
Recent military veterans are more likely than the general population to suffer from major depressive disorder and posttraumatic stress disorders, two conditions prevalent among those who have deployed to battle zones.
RAND researchers surveyed a convenience sample of 522 psychiatrists, psychologists, licensed clinical social workers and licensed counselors to determine whether they used evidence-based methods to treat major depressive disorder and PTSD, and whether they had the training needed to be sensitive to the needs of veterans.
Just 13 percent of the mental health providers surveyed met the study's readiness criteria for both cultural competency and delivering evidence-based care. Providers who worked in community settings were less prepared than providers who are affiliated with the VA or military health system.
Only one-third of psychotherapists reported receiving the training and supervision necessary to deliver at least one evidence-based psychotherapy for PTSD and at least one for depression.
While 70 percent of those providers working in a military or VA setting had high military cultural competency, only 24 percent of those participating in the TRICARE network, the Department of Defense's health insurance program, and 8 percent of those without VA or TRICARE affiliation met the threshold for cultural competency.
"Veterans and their family members face unique challenges, and addressing their needs requires understanding military culture as well as their mental health challenges," said retired Navy Vice Adm. Norb Ryan, president of the Military Officers Association of America. "It's crucial that our civilian mental health providers acquire the training and perspective they need to guide their practice in the care of our military and veteran population."
The study recommends that organizations that maintain registries or provider networks include information about mental health practitioners' ability to properly treat the special needs of military and veteran populations.
In addition, researchers encourage policymakers to expand access to effective training in evidence-based treatment approaches and to create incentives to encourage providers to use these strategies in their routine practice.
The study, "Ready to Serve: An Assessment of Community-Based Provider Capacity to Deliver Competent, Quality Care to Veterans and Their Families," is available at http://www.rand.org.
Other authors of the study are Coreen Farris, Caroline Epley, Carrie M. Farmer, Eric Robinson, Charles C. Engel and Michael William Robbins and Lisa H. Jaycox.