Many service members who experience symptoms of stress following a deployment are below the threshold for a mental health diagnosis and need care at a lower level of intensity. And stigma—in particular the fear that a record of a mental health clinic visit might one day jeopardize their careers—is what keeps some service people from seeking care, says Lt. Col. Tracy Neal-Walden, PhD, an Air Force psychologist.

To address that concern, psychologists have re-energized the Behavioral Health Optimization Program, which places psychologists and social workers as behavioral health consultants in primary-care clinics in Air Force medical facilities. The program allows increased access and continuity of care and aims to provide early intervention. "The goal is providing the right service at the right time," says Neal-Walden, who managed the program last year.

For patients, the hope is achieving better outcomes in terms of decreasing problems that can lead to trouble functioning, such as insomnia, as well as better managing physical conditions, such as diabetes and headaches. Because the behavioral health consultants are located within the primary-care clinic, waiting times are reduced.

The program was piloted in 1997, but after 9/11, psychologists were frequently deployed to help service members in Afghanistan and Iraq, so the program couldn't maintain a consistent training schedule and did not become well-established. Today, psychologists working through the program help patients with a wide range of problems.

"We try to send the message that we're a regular part of the health-care team," says Jeff Reiter, PhD, a psychologist who helped with the renewed training effort last year.

Consultations with patients last up to 30 minutes and clients typically come for no more than four visits. Those who need a more intense therapy are referred to an Air Force mental health clinic.

"This approach allows us to focus on prevention," Neal-Walden says.

—C. Munsey