FHP&R Health Policy Work Presented at Annual Conference

By: Matt Pueschel, FHP&R Staff Writer

The 13th Annual Force Health Protection Conference was held August 7-13 in Phoenix, AZ.

The conference was hosted by the U.S. Army Public Health Command with support from Force Health Protection and Readiness (FHP&R), and featured approximately 2,300 attending professionals from DoD, the Public Health Service, Veterans Affairs, academia, nongovernmental organizations and partner countries. The conference included over 700 presentations and 130 exhibits centered on the theme of “Military Preventive Medicine and Public Health.”

Several FHP&R speakers delivered presentations, including important updates on deployment mental health assessments and new studies regarding behavioral health provider retention.

New Person-to-Person Mental Health Assessments

As part of an effort to improve early identification of Service members who suffer from PTSD, depression or risky drinking habits and provide them with timely specialty care if needed, DoD issued new policy guidance in July requiring the Services to implement person-to-person mental health assessments for all Service members who deploy.

The assessments can be administered either face to face, via telephone, or by video conference in a private setting by licensed mental health care professionals or trained medical personnel. Assessments are delivered at four points: within two months prior to deployment; 3-6 months after deployment; 7-12 months after deployment; and again 16-24 months after deployment.

Assessments will now include detailed written questions about mental health history, psychological concerns, medication use, drinking habits, upsetting experiences, and major life stressors. Health care providers will follow a set of guidelines based on current best practices that specify follow-up questions to ask in a person-to-person discussion, and considerations to follow for possible specialty referral. “We’re asking a lot of primary care providers, so we need to give them training and guidance to do a mental health assessment and make appropriate referrals,” said Cdr. Meena Vythilingam, MD, USPHS, Deputy Director of FHP&R’s Psychological Health Strategic Operations (PHSO) directorate.

The new mental health assessments include an additional step where Service members fill out in-depth, validated questions to “drill down” into their PTSD and depression symptoms. For example, as part of the initial PTSD self-reporting written component of the new mental health assessments, Service members are asked to fill out a primary care scale for PTSD (PC-PTSD) that includes whether they have had a frightening or upsetting experience in the past month that caused nightmares, avoidance of situations that reminded them of it, constant vigilance, or made them feel detached. If the Service member answers “yes” to two or more of these questions, they are asked to complete an additional list of 17 PTSD questions that help providers determine the severity of PTSD symptoms. In addition, Service members must indicate if PTSD and depression symptoms are interfering significantly with their ability to function at work, home and in social activities. “It’s not just the severity of PTSD or depression,” Cdr. Vythilingam advised. “It is very important for the primary care provider to assess whether these symptoms affect a Service member’s functioning.”

The provider then conducts a person-toperson dialogue to review all of the written responses, identify areas of concern, assess risks, elucidate details, document the medical record and provide specialty referrals for follow-up appointments if indicated. However, it is important to note that even if Service members answer “no” to all of the initial written questions, they still must speak directly with a provider.

“We bridged that gap between filling [out] a form and [speaking to] a provider. We’ve added detailed training about what followup questions for the primary care provider to ask [regarding] positive responses to initial questions,” Cdr. Vythilingam said. “We’ve come up with very clear training guidelines for health care providers, which include assessment of suicide and violence risks.”

Alcohol-related questions gauge severity of use (maximum drink limits are surpassed if a man consumes more than 14 drinks in a week or four on one occasion, or a woman drinks more than seven in a week or three on one occasion), and management of risky drinking.

In addition to licensed mental health providers, other health care professionals who already administer some of the existing deployment health assessments can be certified to deliver the new mental health assessments through an online training program. For more information, please visit www.pdhealth.mil or www.fhpr. osd.mil.

Improving Behavorial Health Provider Retention

Dr. Jill Carty, PHSO’s Executive Officer, discussed the results of a FHP&Rcontracted survey carried out this spring that was aimed at identifying incentives to improve military retention of active duty psychiatrists and psychologists. The survey results included 338 written responses from psychologists and psychiatrists across the Services.

While 60 percent of all respondents said they were satisfied with their jobs, the rest said they were somewhat or not at all satisfied. Of particular note was the finding that 72 percent of psychologists were satisfied with their jobs compared to just 46 percent of psychiatrists.

The majority of respondents rated increased financial incentives, such as higher retention bonuses, a retirement policy that counts bonus pay toward retirement benefits, and higher base pay as items that would encourage them to extend their stays in the military. Reduced administrative duties, counting medical or graduate school toward time served, shorter and fewer deployments, and promotion criteria that emphasizes clinical skills were also rated among top potential incentives to stay in the service. “What we found is that financial support and education opportunities were the top reasons to join the military for all providers,” said Dr. Carty.

Desire to serve the country was another top reason for joining. “Family tradition and leadership opportunities were the least important for all providers,” Dr. Carty added.

As far as enjoying specific aspects of their military service, 70 percent or more of the survey respondents gave high marks to mental health care treatment practices, camaraderie among mental health providers, professional development opportunities and leadership opportunities. However, only 50 percent or fewer of all respondents had high ratings for provision of administrative and clinical support staff, morale, and mental health care management and administrative policies.

This study arose from a DoD Mental Health Task Force recommendation a few years ago that stressed retention of psychologists and psychiatrists as being critical to serving the needs of active duty personnel and their families.