Although it is a well-recognized problem in civilian and veteran populations, geographic remoteness from health care among service members and their dependents has not, until recently, received the same attention. With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Anecdotal reports describe particularly difficult conditions for some service members seeking behavioral health care, as well as the tremendous difficulties faced by families of reintegrating service members who do not receive adequate behavioral health care....

It is well established for civilian populations that persons farther away from medical care are less likely than others to seek or use health care services, including behavioral health care services (White, 1986; Beardsley et al., 2003)—that is, treatment for mental, behavioral, or addictive disorders. The same is true of veterans (Fortney et al., 1998; Schmitt, Phibbs, and Piette, 2003; McCarthy et al., 2007; Pfeiffer et al., 2011). For example, sharp reductions in care-seeking are evident at a distance of five miles or more from providers (U.S. Government Accountability Office, 2011). The response of the Department of Veterans Affairs...

Before we can evaluate interventions to improve access among remote service members and their families, we need to understand the size and scope of the problem. Determining how many service members and dependents are remote from behavioral health care requires: (1) finding data sources that identify the location of potential patients (service members and their families) and the location and availability of providers, (2) developing a working definition of remoteness that incorporates these data sources, and (3) using this remoteness definition in analyzing empirical data to estimate the number and location of various remote military populations. We use a variety...

While little is currently known about access to behavioral health care among remote service members and their families, there is a long history of research on these issues in the civilian population (Marsella, 1998; Eberhardt and Pamuk, 2004; New Freedom Commission on Mental Health, 2004; Smalley et al., 2010), which provides important context. In the civilian literature, remoteness is generally studied as an issue of rural versus urban residence. Researchers have attempted to determine whether people in rural areas are more or less likely to have behavioral health problems and/or use behavioral health services than people in urban areas. In...

In Chapter Two, we examined how many individuals relying on the military for health care find themselves in remote locations. In Chapter Three, we explored the effect of remoteness on behavioral health care use in the civilian population and suggested possible explanations for observed patterns. In this chapter, we use administrative data routinely collected by the TRICARE Management Activity (TMA) to address whether being in a remote location affects the amount and type of behavioral health care that service members and their families receive. These data are particularly valuable because they include information on all medical encounters for TRICARE beneficiaries...

The previous chapter focused on the effects of remoteness on service member and dependent access to high-quality behavioral health care. In this chapter, we attempt to identify remoteness-related barriers to receiving quality behavioral health care that are rooted in organizational policies and practices aimed at providing services. To do this, we (1) conducted telephone interviews with key experts and (2) reviewed the policy literature. In the sections that follow, we describe the process of identifying and interviewing key experts as well as the findings of those interviews. We then present our policy research methods and results.

In consultation with our...

At least two promising strategies exist to help address access and availability barriers to behavioral health care use for military personnel and their families in rural areas. Each strategy may also increase the acceptability of using behavioral health care. The first is establishing better links between behavioral health care and primary care. The second is harnessing and strengthening telehealth technologies to better meet the behavioral health needs of residents of rural and remote areas.

In this chapter, we first discuss integrating behavioral health treatment into primary care. We then describe the evidence base supporting the use of telehealth technologies to...

We offer several suggestions for improving access to behavioral health care among geographically remote service members and dependents.

Require contractors to share information about providers with DoD. Our research indicated that DoD currently does not systematically or regularly monitor drive times to MTFs or community providers for service members or dependents. In contrast, VA maintains an interactive data portal that allows VA employees to obtain up-to-date counts of veterans in the VA system within a 30-minute drive of VA facilities (Economic and Social Research Institute [ESRI], 2013). VA medical planners can also use the portal to experimentally place hypothetical new...