I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Military Behavioral Health Services

Alan Ogle, Maj, USAF, BSC

Military Psychology PSY4990

University of West Florida, Spring 09

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• Disclaimer: information in this briefing was compiled from multiple sources in the US military medical services. Many have been modified or shortened to fit the educational purpose, format and training time available. Views expressed are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.

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Why We Do What We Do

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Air Force Psychologists

• 42P Career Field • Clinical Psychologist (AFI 44-119)

– 204 Active duty– 9 Fellowships– 22 Residents– Current approx 70% manned

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Postdoctoral Fellowships

• Child Psychology • Neuropsychology • Clinical Health Psychology • Forensic • Combat/Aviation Psychology • Psychopharmacology

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Scope of Practice

• Clinical interviews and psychological assessment• Diagnose and treat mental disorders• Provide individual, marital, and group treatment• Recommend administrative and medical dispositions• Perform dangerousness assessments• Determine degree of impairment for military service• Serve on competency and sanity boards• Commander’s consultant on behavioral health issues

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Behavioral Health Services

Mental Health Clinic

ADAPT Family Advocacy Program

BHOP SNIAC DDR

Psychotherapy: individual, marital, family, group

Consultation in med clinic

Family relocation clearances

Drug testing program

Suicide Prevention Program

Command consultant on substance issues

Family Advocacy Committee, CRB, HRVRT, CSMRT

Outreach/Prevention/Educational briefings – e.g. stress management, suicide prevention, alcohol use vs misuse, family violence prevention, parenting skills, drug education/prevention

Integrated Delivery Services Team (IDS) – i.e. collaboration of all base helping agencies

Consultant to Community Action Information Board (CAIB)

Installation Traumatic Stress Response Team leadership (TSRT)

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MENTAL HEALTH CLINIC: Voluntary Care

• Talk therapy: individual, marital, families• Education classes: stress, anger, couples communication, seasonal

“blues”, healthy alcohol use, suicide/violence prevention, others upon request

• Special evaluations: Command Directed,

security clearance, fitness for special duty• Confidentiality and limitations

– Risk of harm to self/others

– UCMJ

– Fitness for duty

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Patient Issues

• Depressed Mood• Anxiety• Stress• Work or Life Events• Relationships• Parenting Concerns• Adjustment• Grief• Deployment-related issues

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ALCOHOL AND DRUG ABUSE PREVENTION AND TREATMENT

(ADAPT Program )

• Promote readiness, health and wellness through prevention and treatment of substance abuse

• Minimize negative consequences of substance abuse to individual, family, and organization

• Provide education and treatment for individuals with substance abuse problems

• Return patients to unrestricted duty status or assist them in transition to civilian life

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Substance Misuse: A Clear and Present Danger

• AF average of ~ 5300 Alcohol Related Incidents/Year (e.g. DUI/DWI & underage drinking)

• Alcohol misuse is involved in: – 33% of suicides– 57% sexual assaults– 28.5% domestic violence cases– 20-25% PMV accidents

• “Alcoholism” should not be our sole focus!

Substance misuse directly impacts mission effectiveness… PREVENTION + DETECTION + TREATMENT = SUCCESS

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ADAPT SERVICES: EVALUATION AND EDUCATION

• All Referrals Receive: – Initial diagnostic evaluations– 6-hour Substance Abuse Awareness Seminar (SAAS)– Alcohol Brief Counseling, pilot testing at 15 bases

• 85+% success = No further ARM 

Education Topics- Military and civilian standards -Hazards of binge drinking- Individual responsibilities -Family Dynamics of substance abuse- Legal/administrative consequences -DUI/DWI education - Facts and statistics about alcohol -Drug abuse education- Physical and psychological effects -Values clarification- Impact on self, others, and community -Healthy stress management- Biopsychosocial Model of addiction -Decision-making and goal setting skills

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ADAPT Services: Treatment

Patients with substance use disorder receive treatment

• Alcohol Abuse / Alcohol Dependence• Treatment options: Outpatient, Intensive Outpatient, Partial

or Full Hospitalization Programs as clinically indicated• Family and unit involvement• Duration ~4 - 24 months• Successful completion of treatment is condition for

continued employment• “Treatment failure” AF rate = ~2%

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Behavioral Health in Primary Care

• Act as consultant and member of Primary Care team• Support PCM decision making and build on PCM

interventions• 1-3 brief (~20-30 min) patient consultation sessions:

– Educate patient in self management skills– Improve provider-patient working relationship– Effective triage of patients in need of specialty behavioral health

• Avoid MH stigma—not therapy, no mental health records

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Typical Areas of Consultation

Medication Adherence

Tobacco Use, Exercise, DietGrief or Bereavement

Chronic Illness ManagementRelationship Problems

COPD, Diabetes, ETOH useAnger

GI Problems (reflux, IBS)Depression

Chronic PainAnxiety/Fears

Insomnia, HeadacheStress

Clinical Health ProblemsGeneral Mental Health Problems

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Family Advocacy ProgramFamily Advocacy Program

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Family Advocacy ProgramFamily Advocacy Program

• OPR for the prevention and treatment of domestic violenceOPR for the prevention and treatment of domestic violence– Works to reduce the number and severity of family maltreatment incidentsWorks to reduce the number and severity of family maltreatment incidents

• Prevent where possible…treat where needed Prevent where possible…treat where needed • All DoD personnel are mandatory reporters of domestic violenceAll DoD personnel are mandatory reporters of domestic violence• Assess and intervene: physical abuse, emotional abuse, neglect of Assess and intervene: physical abuse, emotional abuse, neglect of

spouse or childspouse or child• Promotes alliance between leadership, agencies and community to:Promotes alliance between leadership, agencies and community to:

– Facilitate an atmosphere of nonviolence in work and homeFacilitate an atmosphere of nonviolence in work and home– Encourage member and family asset and skill development Encourage member and family asset and skill development – Enhance victim safetyEnhance victim safety– Build member and family strengthsBuild member and family strengths

• Services provided through Outreach Prevention Program; New Parent Services provided through Outreach Prevention Program; New Parent Support Program; Treatment InterventionSupport Program; Treatment Intervention

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Drug Demand Reduction Program

• All military members are subject to drug testing regardless of rank or status – Random selection

– Maintain chain of custody

– DDR supports administrative/UCMJ actions

• All Active Duty Service Members Drug PositivesFY03 % personnel with positive drug test(s)

DoD Air Force Army Navy Marines

1.26% 0.41% 1.76% 1.21% 1.26%

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• Displays at the BX, Commissary, Community Center, Youth Center, Post Office, Medical Clinic, and Library

• OCTOBER 25,  WEDNESDAY– PUPPET SHOW--Kindergarten, grade 1, 2 and 3

• 08:40 -- 9:15 --Mrs.  Mailloux, Mrs. Lerner, Mrs.  Edwards, Ms. Beavers• 9:30 -- 10:00 -- Mrs. Becker, Mr. Becker, Ms. Glass, Mrs. Weiland

– DISCUSSION/Question/Answer time Grade 4 and Grade 4/5• 11:00 - 11:30 -- Dr. Westbrook and Ms. Sullivan• 11:30-1230 High school

– 12:30-1:30 staffed table at high school• OCTOBER 27 FRIDAY

– DISCUSSION/Question/Answer time Grades 5/6• 9:15 -- 9:45 -- Ms. Henderson & Mrs. McVay• 10:00 -- 10:30 --Mrs. Wilson• 11:30-12:30 Middle School

– 12:30-1:30 staffed table at middle school

Community Education:Red Ribbon Campaign 2006

“Stand Up and Be Counted!”

Tribase United Against Drugs & Alcohol Abuse

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Traumatic Stress Response Team

Pre-Incident During Operations Post-Incident

Pre-ExposureTraining

On-Scene Support

Demobilizations

Debriefings

Defusings

CommandConsultation

Team of Mental Health, Chapel, and AFRC personnel

Provide support to units and community after traumatic events

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Command Consultation

• Mental Health Issues• Suicide Prevention• Violence Prevention• Family Maltreatment Prevention• Hostage Negotiation Team Consultant• Community Issues

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INDIVIDUAL LEVELINDIVIDUAL LEVEL

• Pre-Screening• Treatment

• Education• Discipline

BASE BASE LEVELLEVEL

• Awareness• Education• Prevention• Intervention• Alternatives

COMMUNITYCOMMUNITYLEVELLEVEL

• Collaboration• Responsible Alcohol Service• Disciplinary Control Board

Alcohol Prevention SME

LEADERSHIP

CULTURE OF

RESPONSIBILITY

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How important to you/your family?

If used, how was it?

Very Somewhat Not at all Excellent Good Fair Poor

Family AdvocacyParenting ClassesCouples CounselingAnger Management

Airman/ Family Readiness

Center

Air Force AidNewcomers BriefingDeployment Classes

Mental Health &ADAPT

Individual CounselingMarriage CounselingSubstance Abuse Treatment

ChapelCounselingYouth ServicesSpiritual Services

ServicesYouth CenterCDCFamily Day Care

Medical ClinicAppointment systemMedical CarePharmacy

Community Surveys

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Survey Results Example—Community Needs Assessment

Top Community Concerns—issues in red targeted for intervention:• #1 Transportation when arrive (90 people)Transportation when arrive (90 people)

• #2 Long work hours (71)• #3 Finding housing (68)#3 Finding housing (68)

• #4 Sense of Community (67)#4 Sense of Community (67)• #5 Fitness facilities for parents with young children (60)

• #6 Lack of childcare (59)#6 Lack of childcare (59)• #7 Sponsorship program (56)

• #8 Deployments (41)• #9 Heavy drinking (36)• #9 Marital problems (36)#9 Marital problems (36)• #10 English culture (35)#10 English culture (35)

• #11 Financial management (30)• #12 Working in Joint environment (29)

• #13 Fighting (23)#13 Fighting (23)• #13 Parenting Skills (23)#13 Parenting Skills (23)

• #14 New parents support (13)#14 New parents support (13)Items not CCAP targets referred to applicable agencyItems not CCAP targets referred to applicable agency

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Community Action Plan Progress Check

Community Capacity Action PlanRAF Alconbury / Molesworth /

Upwood, UK

Develop UK adjustment seminar

SVS will educate base on childcare options

SVS will train 2 home childcare providers

Mental health/family therapy services will be made available on RAF Alconbury

SMART Marriages will be offered at least once per year, funding permissible

Educate community regarding current services for couples, parents, and families

Develop directory of local area info POCs

Housing staff member assigned to provide transportation to find housing

Sponsorship training includes need for transportation

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Deployments

• Mental Health Rapid Response Team• Combat Operational Stress Control (COSC)• Behavioral Science Consultation Team (BSCT)• SOF Psych~ 6 months duration

• Currently Air Force has 17 mental health deployment missions (12 are Joint Expeditionary Taskings, i.e. for the Army)

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Resource Links

• Defense Center of Excellence for Psychological Health and Traumatic Brain Injury

• Army Behavioral Health page/• Navy mental health information page• Deployment Medicine Research• PDHealth--Deployment/Postdeployment Health• http://www.afterdeployment.org/ • Deployment Health Clinicians Center • Air Force Suicide Prevention Program