Even before the COVID-19 pandemic, military families were having trouble getting the mental health care they needed, according to new data from an online survey conducted in late 2019.

Whether they are active-duty families, military retiree families or veteran families, about half reported they were satisfied with their ability to get mental health appointments, according to the Military Family Advisory Network’s family support programming survey.

“Our survey, which was fielded before COVID-19, found that military families experienced difficulty scheduling mental health care appointments,” said MFAN’s Executive Director Shannon Razsadin. “That’s something we never want to hear, and we are concerned about the additional barriers caused by COVID-19.”

Top obstacles for getting mental health care for currently serving families were lack of available appointments, time to attend appointments and concerns about negative career implications, according to the survey. The report, which adds statistics to back up what military families have long known, recommends exploring telehealth as an option for providing more access to mental health care.

During the pandemic, telehealth through Tricare has indeed increased. Tricare has covered telehealth for several years for certain medically necessary services. Most of the families who participated in the survey had never used telehealth, but the good news, Razsadin said, is that more than one-third of the active-duty families said they would be likely or very likely to use it.

Tricare officials have already taken steps to make it easier to use telehealth, such as temporarily waiving cost-shares and co-payments for all covered, in-network telehealth services during the pandemic. They’ve temporarily relaxed some licensing requirements across state lines to allow providers to treat patients who live in a different state. There’s long been a shortage of mental health providers across the country.

Tricare officials have temporarily expanded some types of care eligible through telehealth, and also allow coverage for telehealth consultations by telephone. Officials have said they will evaluate whether to make some of the expansions permanent.

That may be an example of a silver lining in the COVID-19 pandemic, said Razsadin. “It’s given us an opportunity to get more flexible in how we provide different types of support. I think this is an eye-opening experience… This is an opportunity to also look at what works and what could work longer term as we support military families.

“Rapport is such an important part of the success of mental health care. If we could learn different and more flexible ways to deliver that care, we will ultimately be helping military families in the long run.”

The survey was open online from Oct. 7 to Nov. 11, and 7,785 people participated. About 42 percent of those were active-duty members and spouses. The majority of respondents — 83 percent — said they had not used mental health crisis resources; those who had used such resources were more likely to be spouses of veterans or retirees. Of the 7,785 people who participated, about 4,000 answered health questions when they were directed based on earlier answers, and even fewer answer the mental health questions.

Asked whether they’d had thoughts of suicide in the past two years, 80 percent said they had not; 12.5 percent said they had thoughts; and 6 percent did not answer.

The biggest issue MFAN is seeing now is in availability of mental health care outside the continental U.S., Razsadin said. “That’s something we’ve been raising with [the Defense Health Agency] and they’ve made some progress getting more providers approved, but we’re still hearing from families that have not been able to see their provider who they’ve established rapport with during the COVID 19 crisis — because they can’t go in person.”

Emily Gerson, an Air Force spouse, said it was difficult to even get referrals for mental health care set up after she arrived in England last fall. Then, “when COVID hit and my local providers began doing appointments only via telehealth, they said Tricare won’t reimburse them for telemedicine due to HIPAA issues, so they couldn’t see me until it was resolved.” In the meantime, the providers said they weren’t getting information from Tricare on what they needed to do to meet their requirements, she said.

A big challenge has been communication from DHA and Tricare and through the providers, Razsadin said. “There’s been a lot of confusion as far as what is approved and what isn’t approved, and different modes of delivery.”

“We look forward to an expanded dialogue on how we can reduce red tape for military families globally so that everyone has access to the mental health support they want and need.”

“Access to mental health care is always important, but it’s especially crucial during this unprecedented crisis,” Gerson said.

Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.

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