A new survey by an influential think tank finds that civilian mental health care specialists sorely lack an understanding of military culture and appropriate treatments for service-related health care needs.

A Rand Corp. survey of 522 psychiatrists, psychologists and licensed clinical social workers found that just 13 percent met the study's criteria for "cultural competency," meaning they understood military mores, language and background, and delivered appropriate care for illnesses unique to the military, such as combat-related post-traumatic stress disorder and depression.

The results are important, Rand researcher Terri Tanielian said, because insensitivity and unfamiliarity with proven treatments may keep troops and veterans from getting quality psychiatric care.

"These findings suggest that when service members, veterans or family members seek care from providers not affiliated with the Defense Department or Veterans Affairs, they may encounter providers who are not as well prepared to deliver culturally sensitive care," Tanielian and the other authors wrote.

DoD and VA have broadened their mental health services in the past five years, with VA hiring more 3,300 mental health providers, peer specialists and apprentices since 2011.

But former troops, as well as active-duty service members and their families, often prefer to seek care outside the military and veterans health system for convenience, privacy and other reasons.

But the study found that many civilian providers are ill-equipped to handle the military community's needs.

According to the results, 70 percent of the civilians surveyed who work at a military or VA treatment center had a high degree of military cultural competency, but just a quarter of providers who are registered Tricare providers scored well.

Among those who are not working directly with troops, veterans or family members, just 8 percent scored well for cultural competency.

In terms of familiarity with proven treatments for PTSD and combat-related mental health issues, licensed counselors scored the highest, with roughly half reporting they had been instructed on evidence-based practices.

The study found 6 percent of those surveyed had served in the military and 62 percent of the psychiatrists who participated had worked for VA at some point in their careers. Just a third of psychologists had worked for VA and only a fifth of the social workers had.

According to a new VA study, about 13.5 percent of 60,000 post-9/11 veterans screened positive for PTSD.

Another VA-funded initiative — the National Vietnam Veterans Longitudinal Study — estimated the prevalence of PTSD in combat Vietnam veterans at slightly more than 11 percent, even 40 years after the war.

At a Senate Veterans' Affairs Committee hearing Wednesday, lawmakers said they were alarmed by the report, given that Congress passed a law in August expanding access to non-VA providers for veterans who live more than 40 miles from a VA facility.

"I am very concerned about whether VA and local communities are prepared with the resources, policies and training to help veterans in serious crisis," said Sen. Patty Murray, D-Wash. "While our men and women in uniform have the courage to come forward and ask for help, VA must be there with not only high-quality and timely care but also the right type of care."

Josh Kassel, an intern for Rep. Gwen Moore, D-Wis., spoke at a press conference on the Rand study and said DoD and VA must do more to help civilian providers understand and treat their active-duty and former military patients.

Kassel said three students from his high school class school in Burlington, Wis., died by suicide after returning home from serving in the military, even though all had sought mental health treatment.

"It wasn't like I was in a super-rural town. We definitely had the resources available to help. But what is being and can be done from the Defense Department to reach out to people like my classmates and figure out what help they need and where they can get it?" Kassel asked.

Earlier this year, DoD launched an online course on military culture for health care providers.

Four years in the making, "Military Culture: Core Competencies for Health Care Providers," developed at DoD's Center for Deployment Psychology, covers four subjects: health care provider beliefs and biases; military definitions, language and culture; military functions; and the role of military ethos in health behavior.

A nationwide rollout of the course is underway, according to a Center for Deployment Health official, and health care providers can earn continuing education credits by taking it.

Telemedicine — counseling and therapy provided to patients via a computer link or telephone — also appears to hold promise for veterans in rural areas, according to research published Wednesday in JAMA Psychiatry.

A study of 265 veterans with PTSD found that 55 percent who were engaged with their providers via telemedicine received cognitive processing therapy, an evidence-based treatment for PTSD, compared to 12 percent of patients engaged in "usual care."

The results also showed that those in the Telemedicine Outreach for PTSD group had larger declines in scores on PTS diagnostic tests.

"This trial introduces a promising model for managing PTSD in a treatment-resistant population. Findings suggest that telemedicine-based collaborative care can successfully engage this population in evidence-based psychotherapy for PTSD," wrote John Fortney, a researcher with the University of Washington, and others.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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