The Department of Defense recently updated a policy on command notification requirements regarding the private nature of mental health care services that outlines confidentiality guidance.

The goal is for service members to seek mental health care services or substance misuse treatment as easily and comfortably as all other medical services, without fear of command notification or professional penalty.

“If you need or want help, please go see someone. You have lots of options” within the DOD, said U.S. Navy Capt. (Dr.) Kenneth Richter, director for mental health policy and oversight, office of the Assistant Secretary of Defense for Health Affairs.

On Sept 6, 2023, Gilbert R. Cisneros, Jr, then-undersecretary of defense for personnel and readiness, approved the release of DOD Instruction 6490.08. It sets out procedures for maintaining the confidentiality of those seeking mental health or substance misuse treatment and “promotes reducing stigma in obtaining mental health care services by balancing patient confidentiality with a commander’s need to know certain information for military operational and risk management decisions.”

‘No Wrong Door’ Approach to Mental Health Care

“The DOD has a ‘no wrong door approach’ to behavioral health services to foster a culture of support,” said Dr. Donald Shell, acting executive director, health services policy and oversight, office of the Assistant Secretary of Defense for Health Affairs.

The Brandon Act enables service members to initiate a referral for a mental health evaluation through a self-report to a supervisor or commanding officer. The military services recently implemented phase one of the act.

While service members may have misperceptions about mental health care, McConnell Air Force Base, Wichita, Kansa, clinic professionals serve to support airmen and improve their quality of life and performance through comprehensive counseling and guidance programs. McConnell’s mental health clinic is available to all airmen and is part of the Department of Defense enterprise effort to destigmatize mental health care. (U.S. Air Force photo by Senior Airman Nilsa Garcia)

The Defense Health Agency has many avenues for accessing mental health services and support. Covered services include outpatient and inpatient behavioral health treatment for emergency and non-emergency mental health needs. Care is offered through in-person or virtual appointments at military hospitals and clinics and through the TRICARE network of civilian providers.

Behavioral health services are medical and non-medical. At military hospitals and clinics, service members have access to primary care behavioral health, specialty outpatient behavioral health, alcohol and substance use programs, inpatient hospitalization, and intensive outpatient programs.

Outside military hospitals and clinics, service members can receive support through military and family life counseling provided by Military OneSource embedded behavioral health, Family Advocacy Programs through each of the military services or through Military OneSource, Military Family Readiness provided through Military OneSource, the inTransition program, and chaplains.

Perceptions about Mental Health Care are Changing

Data indicate an increasing demand for mental health services, which can be interpreted as an increase in help-seeking behavior, Shell said.

A fiscal year 2023 report to Congress on TRICARE showed the increasing demand for behavioral health services across the DOD. The report found that:

• Fifty-one percent of behavioral health providers accept new TRICARE patients
• 1,311 behavioral health facilities accepted TRICARE in FY 2022 and 2,295 were projected for FY 2023

“As we continue to address stigma and promote help-seeking, the DOD and civilian sector will need to address new challenges associated with demand outpacing supply of behavioral health providers,” Shell said.

How DHA Integrates Mental Health Care

To improve access and outcomes for those in behavioral health treatment, the DHA direct care system integrates “specialists in primary care medical homes to provide more continuous, comprehensive care in the primary care setting and to facilitate coordinated care,” the TRICARE report states.

The majority of health care facilities serving adult TRICARE enrollees have integrated behavioral health specialists. “Directly integrating behavioral health providers ensures the integrated specialists are able to work closely in partnership with the patient, principal care management, and patient-centered medical home team; moreover, because the specialties share a location, it helps to destigmatize the care received,” the report states.

“The Uniformed Services University for the Health Sciences determined that being seen by a behavioral health specialist integrated into a PCMH results in a statistically significant improvement in mental health status,” according to the report.

The Real Warriors Campaign, established in 2009, was expanded in 2023 through collaboration between the Psychological Health Center of Excellence and the Defense Suicide Prevention Office to augment suicide prevention initiatives. The RWC is a public health campaign that promotes a culture of support, emphasizing that mental health is health, and is designed to decrease stigma, increase psychological health literacy, and promote help-seeking behavior.

DOD Actions to Reduce Stigma

On Sept. 28, 2023, Secretary of Defense Lloyd J. Austin III issued a memo directing 24 urgent actions to address suicide in the military community that build upon two years of significant work toward suicide prevention across the DOD.

The actions cross five lines of effort:

• Foster a supportive environment
• Improve delivery of mental health care
• Address stigma and other barriers to care, including stigmatizing language
• Revise suicide prevention training
• Promote a culture of lethal means safety

The actions are in line with Austin’s Taking Care of Our People initiative and emphasize DOD’s commitment to the well-being of the Total Force, a DOD press release states.

DOD aims to have full implementation of each line of effort by the end of FY 2030.

“Suicide prevention is a long-term effort,” said Austin. “Change will not happen overnight, but we have no time to spare.”

“We must foster trust and connection in the workplaces and communities under our care,” Austin said. “We must integrate prevention into all our efforts. And, we must reach out to those who are struggling and make it easier to seek help. Taking care of our people is a sacred obligation, and we will continue to undertake it with the resolve and moral clarity that our teammates deserve.”

“Over time, seeking help will become a sign of strength to more people and eventually mental health care services will be widely considered as a critical element of individual performance,” he said.

DOD’s message is clear, Shell said. “The department is committed to protecting service members and families. It will continue to address behavioral health challenges and promote help-seeking behavior through a public health approach using evidence-based and evidence-informed methods to provide quality care, with the best outcomes, to a ready force.” 

Resources

For anyone experiencing a mental health crisis, needing immediate assistance, or simply wanting to talk to someone, confidential help is available 24/7.

Military OneSource is a 24/7 gateway to trusted information for service members and families that provides resources and confidential help. Call 800-342-9667.

Chaplains also provide confidential counseling and are important in promoting spiritual readiness and resiliency.

The Psychological Health Resource Center is available 24/7 for service members, veterans, and family members with questions about psychological health topics. Trained mental health consultants can help you access mental health care and community support resources in your local area. Call 1-866-966-1020, start a live chat, or visit www.health.mil/PHRC.

The inTransition program has 20 FAQs that are a helpful introduction to the program. You can call 800-424-7877, or at 800-748-81111 in Australia, Germany, Italy, Japan, and South Korea only. You can also email the program directly at:dha.ncr.j-9.mbx.inTransition@health.mil.

The Military Health System, DOD, and the Department of Veterans Affairs have many other mental health resources available to any service member, families, or veteran beneficiaries who are struggling with mental health challenges. Read Mental Health is Health Care for a complete list of resources for immediate assistance or to make appointments.

To set up a mental health appointment through TRICARE, visit: www.tricare.mil/MentalHealth.