Targeted Care for Mental Health Issues Rolling Out Across Department of Defense

[Editor’s note: This article discusses mental health, its challenges, and treatments. If you or someone you know is having a mental health crisis, call the 988 National Suicide and Crisis Lifeline and press “1”, or text 838255, or chat, or contact the dedicated Veterans Crisis Line and Military Crisis Line. For Spanish, press “2”. Remember, mental health is health.]
The Defense Health Agency is introducing a new approach at behavioral health clinics, called targeted care, to help improve access to mental health resources.
Targeted care refers service members and other beneficiaries to the clinical or non-clinical mental health resources best suited to support their needs, offering earlier interventions and promoting force resilience and readiness.
Pivoting off an Air Force Medical Service model with a vision to expand it across all military hospitals and clinics, DHA conducted a six-month targeted care pilot at 10 military behavioral health clinics. The pilot ran from April to October 2023.
Results from the pilot found that about 40% of individuals who contacted outpatient behavioral health clinics at the pilot sites did not require medical intervention or have a diagnosable mental health condition; however, they would benefit from other mental health services.
The results demonstrated that sites were able to use targeted care to successfully connect more than 2,600 individuals to other medical or nonmedical counseling resources.
Given the success of the pilot, targeted care is being deployed to military hospitals and clinics across the Military Health System. All military hospitals and clinics will have targeted care available by 2025.
U.S. Army Maj. Daniel Good has a doctorate in clinical psychology and serves as the deputy director of psychological health at the General Leonard Wood Army Community Hospital, Missouri, which participated in the pilot. He said targeted care was “a wonderful opportunity for our hospital to dramatically revamp our behavioral health service line and restructure and remake it into a much more efficient and well-organized framework.” Targeted care “is helping us do better than would have been possible before we rolled it out.”
Targeted care helps people get the specific care they need in a timely manner.
It starts with a simple, preliminary screening assessment. You can meet with or call a health care professional who will listen to what you’ve been experiencing, assess your needs, and refer you to the best resource to get the help you need, whether it’s specialty mental health treatment at the outpatient behavioral health clinic, other clinical services, or a nonclinical support resource such as a military or family life counselor or chaplain.
You won’t need a referral and you will never be turned away from specialty care. The process allows the behavioral health specialist to focus their efforts on more frequent evidence-based therapy for patients with the most critical needs while offering support and resources to all others.
To provide timely and tailored care, targeted care synchronizes clinical mental health programs with nonclinical resources available in the local military community. This includes chaplains, military and family life counselors, Military OneSource, warrior fitness centers, installation activity centers, embedded mental health providers in a unit, and off-post community resources.

Talking to a Professional Through Targeted Care

Your mental health occurs on a continuum. Where an individual falls on the continuum depends on a number of personal and life circumstances, and there is a clinical or nonclinical resource that can meet your needs at any given point on the continuum.
The initial screening assessment in targeted care is the first step in determining where you fall on this continuum. If your symptoms are found to fall within the clinical range toward a mental health disorder, you will be scheduled for an intake evaluation at the outpatient behavioral health clinic for further assessment and treatment. If your stress levels are within the milder range but steadily increasing, a nonclinical or other prevention resource could address the issue before it reaches clinical levels.
You will be matched to the best resource depending on your responses and immediate concerns or needs.  If your best option is primary or specialty care, you’ll get an appointment at your clinic, or with a behavioral health specialist in the local TRICARE network if no space is available on base.
The DHA website has many frequently asked questions about targeted care.

Successful Implementation of Targeted Care in Pilot Markets

Whiteman Air Force Base in Missouri was the first base within the Air Force Global Strike Command to fully roll out targeted care after a pilot phase, said Whiteman Mental Health Flight Commander U.S. Air Force Maj. Callie Cooper, a doctor of clinical psychology.
Its benefits quickly became apparent, said Cooper, with “notable reductions” in patients receiving off-base mental health referrals. There were 180 airmen referred off base before Whiteman started targeted care in the fall of 2022, and only 40 in the year after implementation. For those patients not referred off base, targeted care assessed the patient’s needs and, where appropriate, referred them to on-base services for immediate support.
Targeted care reduced wait times, created prompt access to specialty mental health services, and lowered provider caseloads, said U.S. Air Force Capt. Oliver Bauer, a doctor of psychology and a staff clinical psychologist in Whiteman’s mental health clinic.
“By decreasing the number of individual patients per provider from over 40 to a more manageable range of 20 to 30, Whiteman has enhanced the quality of care,” said Bauer.
During Whiteman’s early implementation of targeted care, “some service members were accustomed to the traditional model—where seeking mental health support meant being seen in the clinic—and felt turned away when referred to other helping agencies,” Bauer said. To address this concern, “socialization was crucial.”
“It was imperative to have base leadership, mid-level supervisors, and new airmen well-informed and associated with the new model of care,” Bauer explained.
“Service members reported feeling more heard and valued as their needs are thoroughly assessed and matched with the most appropriate resources,” Bauer said. “They also have reported feeling they have received timely and effective care.”
Prior to the rollout, “it was essential to secure not only the buy-in and support from the service members, but also from the personnel within the mental health clinic who are promoting and supporting this initiative,” Bauer pointed out.
DHA’s behavioral health team worked closely with communications experts to develop information materials. Each installation received these products through their public affairs office and military hospital or clinic and used them to educate their beneficiaries on this new service. Behavioral health leads also gave information briefings to senior leaders on the installation and provided newcomer briefings to service members and their families.

Targeted Care’s History

The main principles of targeted care are outlined in a 2023 Air Force Medical Service report titled, Mental Health: An Overview for Service Members.
The report has three main messages applicable everywhere in the MHS:
• Most service members who are struggling with mental health do not have a mental health disorder.
• Most resources to help are nonclinical.
• Getting help early and often prevents the need for clinical mental health care.
Angelica Escalona, who holds a doctorate in clinical psychology with a specialization in neuropsychology, is the clinical director of outpatient behavioral health within DHA’s behavioral health clinical management team.
Escalona said targeted care was developed by the Air Force Medical Service to “address increased mental health utilization and limited access to services.” It was successfully piloted at military hospitals and clinics on nine U.S. Air Force installations in fiscal year 2022 and generated interest on how this process could be applied across the entire MHS.
DHA subsequently hosted a three-day targeted care summit in December 2022 attended by mental health leaders from all military departments and subject matter experts from other agencies. They developed the groundwork for a DHA-wide targeted care model and identified the pilot sites at U.S. Army and U.S. Navy installations.
Escalona said the DHA worked closely with each behavioral health clinic lead, the military community and family program office leads, the chaplain corps, TRICARE, DHA’s Healthcare Optimization Division, and other key stakeholders to refine and develop strategy for targeted care’s implementation at those 10 pilot sites.
Since then, there have been a number of MHS early adopters of targeted care in the U.S. and overseas. These early adopters may serve as models for successfully rolling out targeted care across all MHS hospitals and clinics by 2025.

Resources

For anyone experiencing a mental health crisis, needing immediate assistance, or simply wanting to talk, confidential help is available 24/7/365.
Military OneSource is a 24/7 gateway to trusted information for service members and families that provides resources and confidential help. Call 800-342-9667.

The Psychological Health Resource Center is available 24/7 for service members, veterans, and family members with questions about psychological health topics. Trained mental health consultants can help you access mental health care and community support resources in your local area. Call 1-866-966-1020, start a live chat, or visit www.health.mil/PHRC.

The inTransition program has 20 FAQs that are a helpful introduction to the program. You can call 800-424-7877, or at 800-748-81111 in Australia, Germany, Italy, Japan, and South Korea only. You can also email the program directly at:dha.ncr.j-9.mbx.inTransition@health.mil.

The MHS, DOD, and the Department of Veterans Affairs have many other mental health resources available to any service member, family, or veteran beneficiaries who are struggling with mental health challenges. Read the Mental Health is Health Care website page for a complete list of resources for immediate assistance or to make appointments.

To set up a mental health appointment through TRICARE, visit: www.tricare.mil/MentalHealth.

Public Outreach
Other critical areas of public outreach are available across the armed services. These include:
• Educating and training service members to see signs and reduce suicide risks through the:
o U.S. Army’s Suicide Prevention efforts
o U.S. Air and Space Forces’ Ask, Care, Escort program
o U.S. Navy’s Ask, Care, Treat program
• Increasing service members’ knowledge and comfort for reaching out to help resources via the Resources Exist, Asking Can Help program, or REACH, from the Defense Suicide Prevention Office
• Encouraging supportive language through DSPO’s Your Words Matter campaign, which calls for the end of stigmatizing or negative language when addressing mental health
• Sharing resources to support service members and their families through the Healthy Relationship program, a free, educational consultation designed to strengthen relationships through a series of personalized coaching sessions tailored to help set goals and strengthen communication skills
• Collaborating with the DOD Educational Agency to support school-age children in talking about their feelings via the Acknowledge, Care, Tell program