Workforce Planning for Embedded Mental Health Care in the U.S. Navy.

INTRODUCTION: Embedding mental health providers directly into operational units provides opportunities for holistic individual and population focused mental health support. To effectively provide clinical mental health care to a large number of Sailors and Marines while supporting the larger command, it is crucial to arrive at an optimal number of mental health (MH) care staff. In response to an increasing demand for MH care by operational units distributed globally, the U.S. Navy (USN) critically analyzed the current MH staffing levels, estimated future demand for MH care providers, and evaluated several staffing options. The following article illustrates a case study of workforce planning for the USN's embedded MH delivery model. MATERIALS AND METHODS: Several existing data sources were used to calculate current number of MH care staff across all USN platforms and to estimate demand for MH care. An open source Linear Programming application was used to estimate staffing solutions that meet business requirements in the most efficient manner possible. RESULTS: Results suggested different conclusions for embedded mental health staffing across USN communities. Depending on existing staffing levels and the number of Sailors or Marines anticipated to require care, the Linear Programming algorithm estimated needed staffing levels to address demand. CONCLUSION: The current project represents the first systematic workforce planning initiative designed to help staff the USN's global demand for community focused MH care. The results of this project have identified areas where additional embedded mental health resources should be made available. By systematically documenting all services and capabilities and carefully examining the operational demands of each community, the current solution was able to identify precisely what type of MH resources should be allocated to a given community.

Sexual Assault and Disabling PTSD in Active Duty Service Women.

INTRODUCTION: Sexual assault in the military is a major concern and may result in significant health problems, such as post-traumatic stress disorder (PTSD). Those developing disabling PTSD symptoms may require a disability evaluation. We examined disability evaluation trends for service women with PTSD to better understand characteristics associated with inability to continue Active Duty service. METHODS: This is a retrospective review of disability reports and electronic medical records for 322 Active Duty women diagnosed with and treated for PTSD by psychiatrists and psychologists at a large military treatment facility between 2011 and 2014. Service women requiring medical disability evaluation for PTSD (n = 159) were included in the study as "IDES cases" (Integrated Disability Evaluation System - IDES). A similar number of women, randomly selected from those seeking care for PTSD but not requiring disability evaluation during the same period, were included in the "control" group (n = 163). Analyzes done to evaluate differences between groups (IDES cases vs. controls) included demographic and service-related characteristics, history of chronic pain, and PTSD index trauma types, such as pre-military trauma and military sexual trauma (MST). Logistic regression was performed to identify the factors associated with inclusion in IDES. RESULTS: MST was the most frequent PTSD index trauma in the IDES group (73.6% vs. 44.8% of control group) and the most significant factor associated with IDES inclusion (OR 2.6, p = 0.032). Those in the IDES group had significantly greater number of mental health visits for PTSD (IDES: m = 68.6 vs. controls: m = 29.6) and more frequent chronic pain history (IDES 40.9% vs. controls 19.6%) than those in the control group. Approximately 65% of women in both groups had a history of childhood abuse, but childhood abuse, as a PTSD index trauma, was negatively associated with IDES inclusion (OR 0.293, p = 0.006). CONCLUSIONS: Active Duty service women with PTSD and a MST index trauma are much more likely to require disability evaluation (IDES) than those with PTSD due to other trauma types. IDES evaluation for conditions such as PTSD may result in early termination of military service and is a potential downstream consequence of MST. Service women requiring greater numbers of mental health visits for PTSD treatment may benefit from a multidisciplinary approach to treating concurrent health conditions, such as chronic pain. Those providing care for service women should evaluate for MST, chronic pain and pre-military trauma, such as childhood abuse; and aggressively treat these conditions to prevent PTSD and disability.

Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for Building Resilience Among Service Members.

The present study investigates the role of psychological resilience in protecting against the development of post-traumatic stress disorder (PTSD), depression, and comorbid PTSD and depression; and estimates the percent reductions in incidence of, and associated treatment cost savings for, each condition as a function of increasing resilience. A retrospective cohort of mental health care-seeking service members (n = 2,171) completed patient-reported outcome measures approximately every 10 weeks as part of the Psychological Health Pathways program. Patients with low resilience were at significantly greater odds for developing physical, behavioral, and mental health conditions, particularly sleep disorder (adjusted odds ratio [AOR] = 2.60, 95% confidence interval [CI] = 1.81-3.73), perceived stress (AOR = 2.86, 95% CI = 1.05-7.75), and depression (AOR = 2.89, 95% CI = 2.34-3.57) compared to patients with moderate/high resilience. Increasing resilience across services by 20% is estimated to reduce the odds of developing PTSD, depression, and comorbid PTSD and depression by 73%, 54%, and 93%, respectively; the incidence by 32%, 19%, and 61%, respectively; and save approximately $196, $288, and $597 million in annual treatment costs, respectively, or approximately $1.1 billion total (a 35% reduction in costs). Using resilience as a preventive model may reduce health care utilization and costs in an already overtaxed health care system.