Military Behavioral Health
Services
Alan Ogle, Maj, USAF, BSC
Military Psychology PSY4990
University of West Florida, Spring 09
Integrity - Service - Excellence
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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)
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204 Active duty
9 Fellowships
22 Residents
Current approx 70% manned
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Postdoctoral Fellowships
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Child Psychology
Neuropsychology
Clinical Health Psychology
Forensic
Combat/Aviation Psychology
Psychopharmacology
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Scope of Practice
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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
ADAPT
Health Clinic
Family
Advocacy
Program
Psychotherapy: individual, marital, family,
group
Suicide
Prevention
Program
Command
consultant on
substance
issues
BHOP
SNIAC
DDR
Consultation
in med clinic
Family
relocation
clearances
Drug
testing
program
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
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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:
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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
General Mental
Health Problems
Stress
Anxiety/Fears
Depression
Anger
Relationship Problems
Grief or Bereavement
Clinical Health Problems
Insomnia, Headache
Chronic Pain
GI Problems (reflux, IBS)
COPD, Diabetes, ETOH use
Chronic Illness Management
Tobacco Use, Exercise, Diet
Medication Adherence
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Family Advocacy Program
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Family Advocacy Program
• OPR for the prevention and treatment of domestic violence
– Works to reduce the number and severity of family maltreatment incidents
• Prevent where possible…treat where needed
• All DoD personnel are mandatory reporters of domestic violence
• Assess and intervene: physical abuse, emotional abuse, neglect of
spouse or child
• Promotes alliance between leadership, agencies and community to:
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Facilitate an atmosphere of nonviolence in work and home
Encourage member and family asset and skill development
Enhance victim safety
Build member and family strengths
• Services provided through Outreach Prevention Program; New Parent
Support 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 Positives
FY03 % personnel with positive drug test(s)
DoD
Air Force
1.26% 0.41%
Army
1.76%
Navy
1.21%
Marines
1.26%
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Community Education:
Red Ribbon Campaign 2006
“Stand Up and Be Counted!”
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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
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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
TribaseI nUnited
t e g r i t Against
y - S e r v iDrugs
c e - E x&
c eAlcohol
l l e n c e Abuse
Traumatic Stress Response Team
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Team of Mental Health, Chapel, and AFRC personnel
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Provide support to units and community after traumatic
events
Pre-Exposure
Training
Pre-Incident
Command
Consultation
During Operations
On-Scene
Support
Demobilizations
Debriefings
Post-Incident
Defusings
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Command Consultation
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Mental Health Issues
Suicide Prevention
Violence Prevention
Family Maltreatment Prevention
Hostage Negotiation Team Consultant
Community Issues
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Alcohol Prevention SME
INDIVIDUAL LEVEL
• Pre-Screening • Education
• Discipline
• Treatment
BASE
LEVEL
• Awareness
• Education
• Prevention
• Intervention
• Alternatives
LEADERSHIP
CULTURE
OF
RESPONSIBILITY
COMMUNITY
LEVEL
• Collaboration
• Responsible
Alcohol
Service
• Disciplinary
Control
Board
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Community Surveys
How important to
you/your family?
Very
Family Advocacy
Parenting Classes
Couples Counseling
Anger Management
Airman/ Family
Readiness
Center
Air Force Aid
Newcomers Briefing
Deployment Classes
Mental Health &
ADAPT
Individual Counseling
Marriage Counseling
Substance Abuse Treatment
Chapel
Counseling
Youth Services
Spiritual Services
Services
Youth Center
CDC
Family Day Care
Medical Clinic
Somewhat
Not at all
Appointment system
Medical Care
Pharmacy
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If used, how was it?
Excellent
Good
Fair
Poor
Survey Results Example—Community
Needs Assessment
Top Community Concerns—issues in red targeted for intervention:
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#1 Transportation when arrive (90 people)
• #2 Long work hours (71)
• #3 Finding housing (68)
• #4 Sense of Community (67)
#5 Fitness facilities for parents with young children (60)
• #6 Lack of childcare (59)
• #7 Sponsorship program (56)
• #8 Deployments (41)
• #9 Heavy drinking (36)
• #9 Marital problems (36)
• #10 English culture (35)
• #11 Financial management (30)
• #12 Working in Joint environment (29)
• #13 Fighting (23)
• #13 Parenting Skills (23)
• #14 New parents support (13)
Items not CCAP targets referred to applicable agency
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Community Action Plan Progress
Check
Sponsorship training includes need for
transportation
Housing staff member assigned to provide
transportation to find housing
Develop directory of local area info POCs
Develop UK adjustment seminar
Educate community regarding current services
for couples, parents, and families
Community Capacity Action Plan
RAF Alconbury / Molesworth /
Upwood, UK
SMART Marriages will be offered at least once
per year, funding permissible
Mental health/family therapy services will be
made available on RAF Alconbury
SVS will train 2 home childcare providers
SVS will educate base on childcare options
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Deployments
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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
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