Civilian Clinicians Need More Specialized Training to Help Vets

The civilian mental health workforce needs preparation to shoulder the burden of care for America’s returning veterans, reported the authors of a RAND Corporation study at a Capitol Hill briefing in October.

A national survey of 522 psychiatrists, psychologists, social workers, and counselors found significant deficits in their knowledge of evidence-based therapies to treat posttraumatic stress disorder and major depressive disorder, how often they deliver such care, and their comfort and familiarity with military culture.

The research was sponsored by the United Health Corporation in collaboration with the Military Officers Association of America.

Aaron Levin

The survey results indicated that 65 percent were not trained in providing evidence-based treatments geared for the particular needs of veterans, first author Terri Tanielian, M.A., a senior research analyst at RAND, said at the briefing. Merely receiving training, she added, “does not guarantee that patients are treated with evidence-based therapies.”

In fact, only 41 percent of those trained in evidence-based treatments such as cognitive-behavioral therapy or prolonged exposure therapy actually provide such care to their patients.

“There is a high need for these services—billions of dollars have been invested, and the emphasis has been on hiring in the [Veterans Health Administration],” she said. “But we know little about the ... civilian community’s readiness to work with this population.”

Self-reported levels of competency in military-culture issues among the respondents varied widely, depending on their experience working with military populations. About 70 percent of those who worked in a military or Veterans Health Administration (VHA) setting reported high competency, compared with just 8 percent among those without such experience, suggesting room for improvement.

“You are not likely to find providers with both cultural sensitivity and an adequate knowledge of evidence-based treatments,” said Tanielian.

Just 13 percent of providers were ready to deliver culturally competent, evidence-based care to veterans and their families, she said. Only 18 percent of psychiatrists met this readiness standard, and that was the best of all provider categories included in the study. However, having had proximity to veterans overcame some of this deficit. About 46 percent of providers (of any type) who worked in VHA or military health care settings were ready to treat these patients.

A first step to improving the care system for veterans in the community requires learning more about the size and characteristics of the mental health workforce in the United States. It is not clear if universities and training programs are producing enough mental health professionals in general or if stepped-up recruitment efforts by the VHA or the Department of Defense have simply shifted providers out of the civilian workforce.

Training in therapies and cultural competence are important for community providers, but “seeing and interacting” with military and veteran populations is also critical.

“Expanding access to high-quality care will take some creative thinking,” Tanielian stated. Beyond expanded training opportunities, positive steps might include establishing a registry of trained providers, system- or practice-level monitoring, quality-improvement techniques, or boosting reimbursement rates for delivering evidence-based care.

“Many vets believe that mental health care isn’t effective, so we must provide good care that works so that patients will spread the good word,” said Tanielian. ■