Online Program

Civilian health and mental health services for active duty and veteran military personnel

Monday, November 4, 2013 : 1:10 p.m. - 1:30 p.m.

Mario Cruz, MD, University of New Mexico, Albuquerque, NM
Howard Waitzkin, MD, PhD, Department of Sociology and Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Loves Park, IL
Objective: The increasing health and mental health problems of military personnel have emerged as a major public health epidemic. Our team, the Civilian Medical Resources Network (CMRN) developed and implemented a telehealth, web-based program for active duty GIs and veterans. We present information on the characteristics of CMRN treatment seekers and their views and opinions on why they seek services via CMRN and the quality of services. Methods: Our sample (N=75) included CMRN clients served between October/2010 and August/2011. Using a multi-method approach, we conducted quantitative and qualitative analysis of data collected during intake and follow-up interviews. Data collected included demographic information, the presence or absence of pre-military health and mental health conditions, whether military health or mental health services were denied or perceived as inadequate, whether the client was mistrustful of the military to meet their health and/or mental health needs, whether individuals suffered combat or non-combat related trauma, and mental health diagnoses using the Patient Health Questionnaire and recommended diagnostic criteria. Results: Among clients, 36% identified themselves as belonging to a minority group, 20% were female, 25% were Absent Without Leave (AWOL) at the time CMRN services were provided, 32% reported combat related trauma, 38% reported non-combat related trauma, 69% reported receiving inadequate care by the military, 16% reported being denied care by the military, and 42% reported mistrust. Depression (71%), PTSD (55%), other anxiety disorder (45%), and Alcohol Use Disorder (31%) were the most common diagnoses. No consistent relationship between race/ethnicity and mental disorders emerged. In multivariate analyses, male gender was significantly and positively associated with an other anxiety disorder diagnosis (p=0.028) while pre-military physical health conditions (p=0.015) and mistrust of the military (p=0.019) were significantly associated with the presence of suicidal ideation. Many clients reported suicidal ideation (88%). Qualitative analyses supported the quantitative finding of mistrusting the military command to address their health and mental health needs. In follow-up interviews, clients generally expressed satisfaction and gratitude for the civilian services. Conclusion: CMRN, a unique telehealth web-based service for active duty GIs and veterans, serves individuals who report previous negative experiences with military health and/or mental health services. In addition, CMRN clients may seek civilian services as a consequence of mistrusting the military to provide care that is in their best interest. The largely favorable results provide a rationale for further assessment of civilian services for military personnel.

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Social and behavioral sciences

Learning Objectives:
Describe the conditions that lead active duty and veteran GIs to seek civilian health and mental health services. Discuss the characteristics of GIs who use such civilian services. Analyze the rationale for civilian services as an alternative to military services for active duty and veteran GIs. Assess the impact of civilian services on improving access to health and mental health care.

Keyword(s): Access to Care, Veterans' Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principle of federally funded grants focusing on mental health service delivery and healthcare disparities. Among my scientific interests has been the characterization of difficult to reach and underserved populations as well as incorporating information technology into healthcare service delivery. In addition, I was principally involved in analyzing and interpreting the data for this presentation.
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.