260065 Working toward peace by providing civilian health and mental health services to active duty military personnel

Monday, October 29, 2012 : 1:24 PM - 1:42 PM

Howard Waitzkin, MD, PhD , Department of Sociology and Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque, NM
Razel Remen, MD , Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque, NM
Mario Cruz, MD , University of New Mexico, Albuquerque, NM
Objective: The increasing health and mental health problems of military personnel have emerged as a major public health epidemic. We attempted to identify social variables that mediate health and mental health disorders among active duty GIs and to assess whether civilian services offered a viable alternative to military services.

Methods: Our sample was drawn from the clients of a nationwide network of civilian physicians and mental health service providers (the Civilian Medical Resources Network) who offered their services to active-duty military personnel. Using a multi-method approach, we conducted quantitative and qualitative analysis of data collected during intake and follow-up interviews.

Results: Among clients, 40% identified themselves as belonging to a minority group. Depression, anxiety, and PTSD were the most common diagnoses. No consistent relationship between race/ ethnicity and mental disorders emerged. In multivariate analyses, lower rank (p=0.002), pre-military physical health conditions (p=0.000), and history of self harm (p=0.000) were significantly associated with the presence of suicidal ideation. Few clients (3.6%) reported no suicidal ideation. Qualitative analyses showed that clients tended to view military health and mental health personnel as unwilling or unable to address their needs, mainly due to the professionals' conflicting responsibilities to clients and to the military command (the problem of “double agency”). In follow-up interviews, clients generally expressed satisfaction and gratitude for the civilian services.

Conclusion: These largely favorable results provide a rationale for further assessment of civilian services for military personnel.

Learning Areas:
Provision of health care to the public

Learning Objectives:
1. Describe the conditions that lead active duty GIs to seek civilian health and mental health services. 2. Discuss the characteristics of GIs who use such civilian services. 3. Analyze the rationale for civilian services as an alternative to the contradictions inherent in military services for active duty GIs. 4. Analyze how such services may contribute to peace.

Keywords: Access to Health Care, Veterans' Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I organized and coordinated the project and took the initiative in reporting the research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.