Civilian health and mental health services for active duty and veteran military personnel

Objective: The increasing health and mental health problems of military personnel have emerged as a major public health epidemic. Our team, the Civilian Medical Resources Network (CMRN) developed and implemented a telehealth, web-based program for active duty GIs and veterans. We present information on the characteristics of CMRN treatment seekers and their views and opinions on why they seek services via CMRN and the quality of services. Methods: Our sample (N=75) included CMRN clients served between October/2010 and August/2011. Using a multi-method approach, we conducted quantitative and qualitative analysis of data collected during intake and follow-up interviews. Data collected included demographic information, the presence or absence of pre-military health and mental health conditions, whether military health or mental health services were denied or perceived as inadequate, whether the client was mistrustful of the military to meet their health and/or mental health needs, whether individuals suffered combat or non-combat related trauma, and mental health diagnoses using the Patient Health Questionnaire and recommended diagnostic criteria. Results: Among clients, 36% identified themselves as belonging to a minority group, 20% were female, 25% were Absent Without Leave (AWOL) at the time CMRN services were provided, 32% reported combat related trauma, 38% reported non-combat related trauma, 69% reported receiving inadequate care by the military, 16% reported being denied care by the military, and 42% reported mistrust. Depression (71%), PTSD (55%), other anxiety disorder (45%), and Alcohol Use Disorder (31%) were the most common diagnoses. No consistent relationship between race/ethnicity and mental disorders emerged. In multivariate analyses, male gender was significantly and positively associated with an other anxiety disorder diagnosis (p=0.028) while pre-military physical health conditions (p=0.015) and mistrust of the military (p=0.019) were significantly associated with the presence of suicidal ideation. Many clients reported suicidal ideation (88%). Qualitative analyses supported the quantitative finding of mistrusting the military command to address their health and mental health needs. In follow-up interviews, clients generally expressed satisfaction and gratitude for the civilian services. Conclusion: CMRN, a unique telehealth web-based service for active duty GIs and veterans, serves individuals who report previous negative experiences with military health and/or mental health services. In addition, CMRN clients may seek civilian services as a consequence of mistrusting the military to provide care that is in their best interest. The largely favorable results provide a rationale for further assessment of civilian services for military personnel.