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Research highlights transformation of mental health care for US soldiers, families

Mental health care delivered during wartime has significantly transformed in recent years, according to a recent review.

“War has historically been a crucible that catalyzes advances in medical care. The recent wars in Afghanistan and Iraq are no exception, producing the highest survival rates for wounded service members with breakthroughs in acute hemorrhage management, forward surgical support and rapid air evacuation,” Charles W. Hoge, MD, of Walter Reed Army Institute of Research, Silver Spring, Maryland, and colleagues wrote. “These wars have also generated unparalleled efforts compared with past conflicts to mitigate the immediate and long-term neurological and psychological effects of war.”

Charles W. Hoge

Mental health care delivered during the Iraq and Afghanistan wars significantly differs from care delivered during previous wars in two ways: directly informed care and consolidated management of services, according to Hoge and colleagues.

These differences are the result of programmatic changes made by the U.S. Army Medical Command to ensure high-quality standardized mental health services, including:

• centralized workload management;
• consolidation of psychiatry, psychology, psychiatric nursing and social work services in integrated behavioral health departments;
• satellite mental health clinics in brigade work areas;
• incorporation of mental health providers into primary care;
• routine mental health screening throughout soldiers’ careers;
• standardization of clinical outcome measures; and
• improved services for families.

Following these changes, psychiatric hospitalizations have decreased and continuity of care has improved, according to Hoge and colleagues.

However, challenges remain. Services are underutilized by soldiers who need them most.

Substance use disorder treatments require improvement, according to researchers, and opioid medications are overused.

The structure of care for postdeployment symptoms, such as postconcussion, warrants concern.

Further, there are ongoing questions regarding cause of historically high suicide rates, efficacy of resilience training initiatives and research priorities.

“The Army Medical Command’s recognition of the complexity of mental health problems, combined with increased resources and continuous research investment to inform policies and practices, has supported the transformation to a more responsive, standardized, and evidence-based structuring of mental health care, offering promise for improved outcomes for soldiers and families. However, many challenges remain, and it will be critical to ensure that persisting gaps are addressed and knowledge gained during the current wars is retained and further evolved,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.