Iyiewuare, Terri Tanielian, Asa Wilks, Michael Robbins, Susan M. Data on treatment approaches, session frequency, and barriers are based on responses to a RAND survey of mental health providers who had treated patients at a military treatment facility for PTSD or depression in the 30 days prior to the survey, conducted February-April 2016.įor more information, see Kimberly A. These are some providers' perspectives on barriers to training and providing recommended care.ĭata on the number of active-duty military and government civilian providers are from the Defense Manpower Data Center's Health Manpower Personnel Data System information on contractor numbers was provided by the Army, Navy, Air Force, and Defense Health Agency. Their schedules - or their patients' military duties - also prevent them from seeing patients as often as they would like. Providers often face barriers to receiving training to improve their clinical skills, such as travel limitations or lack of dedicated time in their schedule to attend workshops and seminars. Patients' military duties limit their treatment.Schedule does not include time for workshops/ seminars to improve clinical skills.Don't have time to see patients as often as desired.Travel limitations prevent receiving additional training.Common Barriers to Delivering Recommended Care Limit Provider Training and Time with Patients However, 11% of these providers prescribed a medication that was potentially harmful to their most recent patient with PTSD (e.g., a benzodiazepine). The vast majority of prescribers treat patients with PTSD or depression with medications that are strongly recommended for these conditions, such as specific types of antidepressant medication. 97% prescribed strongly recommended medication.11% prescribed potentially harmful medication.90% prescribed strongly recommended medication.Nearly All Prescribers Follow Strongly Recommended Medication Protocols for PTSD and Depression PTSD Barriers to seeing patients as often as recommended include patients' military duties and therapists' scheduling limitations. Most evidence-based psychotherapies suggest therapists see their patients every week. Fewer Than Half of Therapists Are Able to See Their Patients Weekly Psychiatrists/Psychiatric nurse practitioners (PNPs)Īlthough more than half of providers use an evidence-based psychotherapy as their primary approach to treat service members with PTSD or depression, this rate is lower among psychiatrists and PNPs, particularly for PTSD. Psychiatrists and PNPs Are Less Likely to Use Recommended Psychotherapy Approaches The best screening instruments are evidence-based: They have been empirically evaluated for their reliability and validity. Screening and monitoring allow providers to accurately identify symptoms and help ensure that service members receive the appropriate course of treatment for their condition. Use Validated Instrument to Assess Patient Symptoms and Inform Treatment = 58%.Screen New Patients for Depression with Validated Instrument = 79%.Screen New Patients for PTSD with Validated Instrument = 71%.Most Providers Screen New Patients for PTSD or Depression, But They Are Less Likely to Assess Symptoms over Time to Inform Treatment Government civilians and civilian contractors make up around two-thirds of the MHS workforce. Providers may be employed at MTFs in one of three ways: as an active-duty service member, as a government civilian employee, or as a civilian contractor. Mental health providers who treat service members with PTSD and depression at military treatment facilities (MTFs) include those with prescribing privileges, referred to as "prescribers" (psychiatrists or psychiatric nurse practitioners) and those who traditionally provide non-pharmacologic treatments, referred to as "therapists" (doctoral-level psychologists or master's-level clinicians). Psychiatric nurse practitioners (PNPs) = 8%.Psychiatric nurse practitioners (PNPs) = 4%.Psychiatric nurse practitioners (PNPs) = 5%.Each Service Branch Has Its Own Processes and Policies for Recruiting, Hiring, and Staffing the Provider Workforce at Its Facilities This research brief provides data on various aspects of the MHS capacity to treat PTSD and depression. Ensuring the quality and availability of programs and services targeting two of the most common conditions diagnosed and treated in the MHS - posttraumatic stress disorder (PTSD) and depression - is a key contributor to this goal. The Military Health System (MHS) plays a critical role in maintaining a physically and psychologically healthy force. Military Mental Health: Provider Perspectives on Treating PTSD and Depression
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