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More Than 1.3 Million Service Members and Dependents Are Geographically Remote for Behavioral Health Care

• Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care.
• Remoteness is not a static property but a risk that any service member or dependent could encounter over time.
• Active component service members are more likely to be remote if they are older, higher ranking, more educated, and married; this pattern was not found for the National Guard/Reserves.

Remoteness Reduces Use of Behavioral Health Care

• Remote active component service members made fewer visits to any specialty behavioral care provider and made fewer psychotherapy visits than non-remote service members.
• There is some evidence of a substitution of non-specialist care for specialist care in the active component.

No Monitoring of Existing Policies and Programs Exists, but Some Promising Solutions Do

• Department of Defense maintains guidelines for access to care but there is no evidence of monitoring adherence to those guidelines.
• Two promising pathways for improving access to care among remote military populations are telehealth and collaborative care that integrates primary care with specialty behavioral care.

With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.

• Chapter One

  Introduction

• Chapter Two

  Scope of the Problem: How Many Service Members and Dependents Are Remote, and Who Are They?

• Chapter Three

  Effects of Remoteness on Civilian Behavioral Health Care Use

• Chapter Four

  Effects of Remoteness on Military Behavioral Health Care Use

• Chapter Five

  Barriers and Gaps in Policy and Practice

• Chapter Six

  Clinical and System Approaches for Improving Access for Remote Populations

• Chapter Seven

  Recommendations

• Appendix A

  Defense Enrollment Eligibility Reporting System Personnel Data

• Appendix B

  Driving Distance to Military Treatment and Veterans Affairs Facilities

• Appendix C

  Community Provider Shortage Areas

• Appendix D

  ZIP Code File for Geospatial Analysis

• Appendix E

  TRICARE Plans

• Appendix F

  National Study of Drug Use and Health Utilization Analyses

• Appendix G

  TRICARE Claims Data

• Appendix H

  Review of the Effectiveness of Telemental Health

• Appendix I

  Structures, Processes, and Outcomes Framework