Career Impacts and Referral Patterns: Army Mental Health Treatment in the Combat Theater

Abstract

This study examined the relationships between referral source, career impacts, and diagnostic severity among service members seeking mental health intervention in a deployed setting. Data were drawn from the mental health records of 1,640 Army service members presenting for outpatient mental health services while deployed in Afghanistan. Results suggested that self-referrals were significantly less likely to have contact made with their command or to experience potentially career impacting recommendations. Overall, greater than 80% of military personnel were returned to duty with no limits and 60% were assigned either no diagnosis or a mild/moderate diagnosis. These findings indicate that seeking psychological services is much less likely to impact a service member's career when self-initiated. Given the significant concerns about career impacts among many service members in need of psychological services, these findings should be incorporated in information campaigns to promote early help seeking.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps

“…The specific aim in Phase 2 was to compare the career trajectories of Marine outpatients who had received care at military mental health facilities to those of a matched sample of personnel who had not received such care. Consistent with prior research [ 17 , 18 , 19 ], we expected that Marine outpatients who self-referred would be less likely to receive career-impacting provider recommendations. We also expected that compared with matched controls, Marines who received care at military treatment facilities would be more likely to experience disruptions to their military careers [ 19 ].…”

“…This study aimed to replicate and expand upon previous studies that had examined mental health treatment-seeking patterns and military career-related impact among USAF and Army SMs [ 17 , 18 , 19 ] by investigating these variables among United States Marine Corps (USMC) personnel. This study was conducted in two phases: Phase 1—retrospective chart review, and Phase 2—prospective analysis.…”

“…A retrospective chart review of U.S. Air Force (USAF) personnel indicated that 6% of SMs who sought mental health treatment in 2002 received potentially career-impacting treatment recommendations including duty restrictions (e.g., weapons-bearing status) and retention recommendations (e.g., administrative separation or referral to a medical evaluation board) [ 17 ]. Among Army personnel deployed to Afghanistan in 2006 and 2007, 19% of Soldiers who sought mental health treatment received career-impacting recommendations [ 18 ], and among USAF SMs seeking treatment in 2010, 29% received career-impacting treatment recommendations [ 19 ]. This last study included a prospective, case-controlled comparison of the career trajectories of USAF personnel who did and did not seek mental health treatment.…”

“…It is also important to note that treatment-seeking SMs were no more likely than controls to experience a change in level of security clearance, consistent with research indicating that less than 0.2% of clearance denials and revocations are due to mental health issues [ 20 ]. In all three studies mentioned above, SMs who self-referred to treatment were less likely than SMs who were encouraged by their superiors or command-directed to receive career-impacting recommendations [ 17 , 18 , 19 ]. While these studies suggest that commanders are appropriately using command-directed evaluations to identify SMs who have identifiable duty limitations, they also suggest that early and voluntary care is critical for suicide prevention and improved mental health, as well as operational readiness and lessened career impact for SMs.…”

Common mental disorders among US army aviation personnel: Prevalence and return to duty

“…Many barriers to getting treatment exist, including concerns about treatment harming the career of the service member, concern over how the service member will be reviewed by peers, and negative attitudes toward treatment (Britt et al, 2016;Kim, Britt, Klocko, Riviere, & Adler, 2011;Rowan, Varga, Clayton, & Martin Zona, 2014).…”