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• Remote service members — who were more likely to be White, Army, and senior enlisted — received more of their behavioral health care from primary care providers and from the private sector, and they were less likely to receive psychotherapy.
• For appointments at military treatment facilities, remote service members had shorter average wait times than non-remote service members for routine and specialty direct care.
• Few service members (less than 3 percent) received synchronous (i.e., real-time) telehealth at a military treatment facility, and fewer remote service members received synchronous telehealth than non-remote service members.
• Remote service members were less likely to receive psychotherapy or other psychosocial interventions, and they were less likely to receive at least a minimally adequate amount of initial care when starting a new episode of treatment for PTSD or depression.
• Rates of adequate duration of medication were similar for remote and non-remote service members, but remote service members were often less likely to receive timely follow-up after initiation of medication treatment.
• Remote service members were less likely to receive a timely outpatient follow-up visit following discharge from a mental health hospitalization or emergency department visit.
• Overall, the MHS showed strong performance on duration of pharmacotherapy and follow-up after mental health hospitalization or emergency department visit, but performance was lower for other measures.

Geographic location can be a barrier to accessing and receiving high-quality behavioral health care for both civilians and military personnel. As a consequence, service members who reside far from military treatment facilities may be at higher risk for poorer clinical outcomes than those who are less remotely located.

The authors evaluate remote service members' access to Military Health System (MHS) care for those with posttraumatic stress disorder (PTSD), depression, or substance use disorder (SUD) and assess the quality of the behavioral health care they received. The report highlights how quality-measure performance varies by remote status, focusing on differences in quality of care that are large and potentially clinically significant. The authors also discuss policy implications and offer recommendations for how the military can use new strategies — including synchronous telehealth or technology-enabled interventions — to ensure access to high-quality care for all service members, regardless of location.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Remote Versus Non-Remote Differences in Demographics and Behavioral Health Care Utilization

• Chapter Four

  Access to Direct Care for the Behavioral Health Cohort

• Chapter Five

  Quality of Behavioral Health Care: Initial Care

• Chapter Six

  Quality of Behavioral Health Care: Medication Management

• Chapter Seven

  Quality of Behavioral Health Care: Transitions of Care

• Chapter Eight

  Summary and Recommendations

• Appendix A

  Sensitivity Analyses of Remoteness Definition

• Appendix B

  Technical Specifications for Access and Behavioral Health Quality of Care Measures

• Appendix C

  PTSD, Depression, and SUD Cohort Demographic and Service Characteristics

• Appendix D

  Cohort Descriptive Data by Diagnostic Cohort

• Appendix E

  Summary of Remote Versus Non-Remote Differences in Behavioral Health Quality Measures