WASHINGTON -- Army medicine recognizes that providing care for Soldiers with behavioral health conditions is a critical readiness issue. To meet the challenge, the Army has vastly expanded and transformed its system of behavioral health care, said Lt. Col. Dennis Sarmiento.

Program development is focused on reaching Soldiers and Families where they live and work to improve access and reduce stigma, said Sarmiento, a doctor who is chief of the Behavioral Health Division, Office of the Army Surgeon General.

As a result of the system expansion and transformation, outpatient behavioral health utilization by active-duty Soldiers and family members increased from 900,000 encounters in fiscal year 2007 to over 2.25 million in FY17, he said.

Sarmiento attributed this increase to greater capacity and accessibility at the military treatment facilities, a reduction in stigma, and more culturally competent providers at the point of need.

EMBEDDED BEHAVIORAL HEALTH CARE

Teams of embedded behavioral health, or EBH, care providers, including psychologists, social workers, psychiatrists, and advanced practice nurse practitioners, have expanded across the Army since 2012, Sarmiento said. As of December 2017, 61 EBH teams support all operational units, including 31 brigade combat teams and 156 battalion and brigade-sized units.

EBH teams are now present at the brigade level at most locations, with the intent of having an EBH provider aligned down to the battalion level in the supported brigades, he said.

Sarmiento said that's important for a variety of reasons. First and foremost, these providers, although mostly civilian, work closely with the Soldiers and their leaders and understand the total environment they work in, from field exercises to mobilization and deployment. This concept of support enables Soldier readiness before, during, and after deployment, and that is a level of support that cannot be replicated "outside the gate," he said.

A level of trust and a bond between the Soldiers, leaders, and providers can develop quickly and promote help-seeking behavior, he noted.

As a result, Soldiers are more likely to report behavioral health issues to the providers, and with early access and identification, the providers can help intervene before Soldiers develop duty-limiting conditions or more severe problems, he said, adding that leaders have described EBH as "a real game-changer."

OTHER IMPROVEMENTS

There have been a number of other behavioral health care improvements across the Army as well, Sarmiento said. Due in part to improvements in outpatient services, intensive outpatient programs, and case management, there have been almost 66,000 fewer in-patient bed days in 2017 compared to 2012, approximately a 40 percent decrease for all types of behavioral health conditions.

Another improvement in the quality of behavioral health care is that the Army has consolidated its best practices within 11 programs and standardized them across the service so the same deliveries of care are offered at every installation, he said. One recent improvement is the Army's integration of substance use disorder care into behavioral health clinics at all Army medical facilities, enabling better delivery of care for Soldiers with substance use and other behavioral health disorders.

And finally, the Army's Behavioral Health Data Portal, or BHDP -- a web-based program implemented several years ago -- enables precision medicine and enhances quality and continuity of care. BHDP data helps personalize the care of Soldiers in treatment, he said. Soldiers periodically take surveys using the portal, and the results are used to inform individualized treatments for potential issues like post-traumatic stress disorder, depression, substance abuse, stress, depression and suicide risk.

Each of these improvements greatly increases the effectiveness of behavioral health care, Sarmiento said, ultimately enabling "individual Soldier, family, and unit readiness."