By Ms. Patricia Deal (Army Medicine)December 6, 2011
FORT HOOD, Texas--With more than 13,000 Warriors still expected to return to Fort Hood over the next few months, Carl R. Darnall Army Medical Center is up to the challenge of an increasing demand for behavioral health care.
Darnall's commander, Col. Patrick Sargent, said the medical center has been preparing for months to make sure Soldiers have access to behavioral health care.
"The most common question I'm asked is, 'Darnall has all these great services to help me deal with PTSD (Post Traumatic Stress Disorder) and other issues, but how long will it take before I (or my spouse) get to see someone?'" said Sargent. "I want to assure our patients that we can, and will continue to, provide world-class health care--physical and mental--to our patients, in a timely fashion."
The medical center has ramped up its resources to handle the expected surge of Soldiers and family members needing behavioral health services for both triage and out-patient care, according to Sargent. More staff has been added within many departments, and more than 200 providers in the community have been contracted for support.
Behavioral health specialists from within the Medical Command will come to the Soldier Readiness Processing site to help with the behavioral health needs when processing returning Soldiers.
All Soldiers and their families, not just the returning ones, who seek help for behavioral health issues, will be given the best care available, Lt. Col. Sharette Gray, chief of CRDAMC Behavioral Health, added.
"I want to reassure everyone that we do have the resources to get you the help you need, either on-post or through the TRICARE network," she stated. "Actually, we are proactive when it comes to addressing the Soldiers' behavioral health needs, from re-deployment to deployment, and all the time in between."
Before deploying, each Soldier must be screened for behavioral health issues to determine deployability status. As part of the re-deployment process, every Soldier is screened for any behavioral health issues within 5 -- 30 days of returning. Then within 90-180 days after that initial re-deployment screening, Soldiers must complete another behavioral health screening as part of the post deployment health re-assessment.
"We do thorough assessments before, shortly after, and again several months after that," Gray said. "Not many companies are as diligent with their employees' behavioral health needs."
In addressing concerns about CRDAMC's access to care standards, Gray said she feels that Darnall does well overall. "There may be some isolated cases where someone may have a long wait for an appointment, but in most instances, access to care is within standards," she said.
Access to care standards for behavioral health are hard to define as they do not fall into easily defined categories as in the case of primary care visits, according to Chuck Lauer, CRDAMC TRICARE administrator.
"Generally speaking, non-urgent referrals are managed locally to get the patient to the appropriate behavioral health provider with the least amount of waiting time for a first appointment," he explained. "Waiting times will vary, depending on the type of care needed. For instance, wait time to the first appointment for a psychiatrist is going to be more than 28 days, due to a regional shortage of licensed psychiatrists. Referrals to counselors such as psychologists, social workers, and others are generally done within the 28 day access to care standard timeframe. For situations determined to require crisis (urgent) treatment, providers will arrange for immediate care."
There is a nation-wide shortage of qualified, licensed behavioral health providers, according to a 2011 National Alliance on Mental Illness Policy Brief, which states that 55 percent of U.S. counties have no practicing psychiatrists, psychologists or social workers. In some areas with available providers, less than half can accept new patients, and the average wait time for individual, non-emergency mental health services appointments ranges from six to 12 weeks.
While they have been affected by the shortage of providers somewhat, Gray said that the behavioral health department's access to care standards fare better than in some civilian sectors. Appointment times at some of the different clinics are made within a much shorter timeframe, averaging two to four weeks for certain services.
"For instance, an individual appointment can be made within three to four weeks at our outpatient social work clinics," she said. "Appointments for Marriage/Couple and Family therapy are now being booked two to three weeks out."
For behavioral health and substance abuse issues, Soldiers referred to the Intensive Outpatient Program can expect to begin at the start of the next four-week cycle. There's currently no waiting list for the next few cycles, Gray added.
"Some clinics, such as the R&R (Resilience and Restoration) Center, offer an initial triage assessment which can be done on a walk-in basis and performed the same day for acute issues," she continued. Initial triage assessments determine whether the patient requires urgent or non-urgent care, the type of care needed and then which clinic or service will best help the patient.
The one area where patients may experience longer wait times for appointments is the Child and Adolescence Psychiatric Evaluation Service (CAPES), Gray said, where it may take five weeks for a comprehensive therapy evaluation and six weeks for a comprehensive medication evaluation.
"The advantage still goes to Darnall as our access to care standard for most services is better than the nationwide average, plus, some of the unique services we offer are not available at all in some areas," she said. "We also promote overall behavioral health well-being through our many educational and support group programs and classes that run on a regular basis--all with open availability."
Soldiers' can also get free, readily available behavioral health care and support through several different organizations and help lines, both locally and nationally, Gray added.
The Comprehensive Soldier Fitness Center (formerly the Resiliency Campus) offers a unique program for Soldiers and their families directed toward achieving optimal physical, spiritual and mental fitness. All services are readily available, and its spiritual fitness center is open 24-hours a day.
Military Family Life Consultants offer confidential, non-medical family life counseling services to help Soldiers and their families with behavioral health issues. According to one local consultant, appointments can usually be made as soon as the next day.
Military One Source also provides Soldiers and family members free telephonic support and arranges referrals for face-to-face counseling with a licensed professional counselor in the caller's local community.
Soldiers and their families can also seek immediate assistance from numerous help lines.
"This is just a sampling of what's available to help Soldiers and their families. When you take into account all of our services and programs, I find it hard to believe the claims that Soldiers can't get the help they need," she said. "I think the hundreds of Soldiers and family members that we do help everyday shows that we readily provide world-class health care to every patient."