Deployment related mental health care seeking behaviors in the U.S. military and the use of telehealth to mitigate their impacts on access to care

Abstract

Interviewees report that groups of service members returning from Iraq and Afghanistan often require substantial amounts of mental health care, causing surges in demand at military hospitals. These hospitals have difficulty keeping up with demand during the busiest periods. The exact patterns of demand during surges are difficult to measure because the military records utilization, but not actual need for services. This thesis analyzes the care seeking behaviors of service members and their families across the deployment cycle using historical data. This analysis shows that service members and their families seek more care after each deployment. More importantly, it shows that service members seek care at higher rates in predictable intervals following their deployments. New patient arrival rates are projected for several installations by multiplying actual installation populations by newly calculated care seeking rates. These projections show deployment related care seeking behaviors generate surges in demand and thereby validate qualitative findings from field work. A simulation of the military's system of care uses these demand projections to specify patient arrival patterns. Comparison of several simulated scenarios shows that surges make it very difficult for individual military hospitals to offer access to care using only their own mental health care providers. Allowing hospitals to share their providers with one another offers little improvement. As hypothesized, using a group of dedicated telehealth providers to support the most overburdened installations can offer a substantial improvement in access to care. This insight leads to four policy recommendations. First, a service wide or joint scheduling system should be created. Second, telehealth can best support overburdened hospitals when some providers are dedicated solely to surge support. Third, the services should take responsibility for meeting access to care goals instead of delegating the burden to installations. Lastly, hiring actions should be tied directly to an accurate measurement of excess demand.