Cover Story

Military service members who have endured the stresses of combat in Iraq and Afghanistan--and their family members at home--face barriers to mental health services that include lack of access, availability and acceptability, an APA task force concluded early this year.

In addition, the Department of Defense lacks a coordinated research effort to understand the full scope of psychological distress or the best methods to treat it among service members and their families. It also lacks coordination of mental health resources and programs necessary to meet those needs across all branches of the military.

The Presidential Task Force on Military Deployment Services for Youth, Families and Service Members delivered those conclusions in a preliminary report submitted to APA's Board of Directors and Council of Representatives in February. Based on these conclusions, council voted to establish a two-year follow-up task force to develop a long-term strategic plan for how APA can assist the military, with the goal of helping service members and their families deal with combat aftereffects and repeated cycles of deployment preparation, deployment and homecoming.

Formed last July at the urging of Past-president Gerald P. Koocher, PhD, the task force examined what mental health services are available to service members when they return; what research has been conducted on the effects of experiencing combat in the unique environments of Iraq and Afghanistan; and how APA can help the military form a strategy to meet mental health needs with research and resources, says Ron Palomares, PhD, the lead APA staff member working with the task force.

Problems getting care

Barriers to care cited by the report include:

  • Availability. With 40 percent of the positions for psychologists in the Army and Navy vacant, there are not enough psychologists in uniform, and those that are available are frequently deployed, reducing services at home. Military psychologists are also suffering burnout, leaving the service early and depriving the military of the expertise of more senior psychologists.

  • Acceptability. Service members are still reluctant to seek mental health services, with stigma identified as a significant barrier to seeking care.

  • Access. Service members and family seeking care face long wait times at military treatment facilities, and many National Guard and Reserve service members returning home to rural areas don't have treatment nearby.

The task force did note that numerous individual providers are working hard to provide services and did find some examples of locally developed programs at specific installations. It also cited several past studies surveying service members for symptoms of post-traumatic stress disorder. But it did not find a coordinated effort to spread those programs service-wide, or evaluate the full extent of stress related to combat service-wide, Palomares says.

Solutions in sight

The task force's top recommendations include:

  • Policy and systems. Military mental health service needs a centralized leadership structure to coordinate services; to reduce stigma, military leaders need more education about the value of mental health care.

  • Research. A well-developed and focused research agenda is needed to guide policies, program development and treatment plans for service members and their families.

  • Clinical services and community outreach. Mental health programs should be expanded for service members, both while deployed and at home, and access should be expanded for family members as well.

  • Service providers. An "all-out" effort is needed to retain experienced psychologists in uniform and to strengthen recruitment efforts that bring new psychologists into the military.

  • Professional education and training. Psychologists' sub-specialty training needs to be better matched with their assignments, and more clinical supervision and mentoring is needed for military psychologists.

  • Budget. More resources are needed to pay for mental health services for military personnel and their families.

The task force was co-chaired by Lt. Cmdr. Shannon Johnson, PhD, a Navy psychologist. After meeting at APA's 2005 Annual Convention in Washington, D.C., Johnson and Koocher continued discussing ways APA might help service members and their families. The exchange convinced Koocher to propose a task force to study deployment-related mental health needs.

At the time, Johnson was assigned to Naval Hospital Yokosuka, Japan, overseeing the Navy's Education and Developmental Intervention Services, an agency offering assistance to military families with special needs children throughout Japan. She also supervised the base's drug and alcohol services program. A Navy psychologist and psychiatrist who normally would have helped share the load were deployed to Iraq and Afghanistan, she says.

"I was desperate because there were more needs than I could meet....I just couldn't care for everyone who was needing and wanting and asking for care," she says.

After returning to San Diego and working with Marines at Naval Medical Center San Diego last fall, Johnson deployed to Iraq with an Army combat stress control team in late February. Her own example highlights the service shortages outlined in the report, Johnson says.

"I'm being deployed, and there's no one coming in to take over my job," she says.