High rates of mental health issues among service members and a reluctance to access mental health services together represent one of the greatest ongoing threats to U.S. military readiness. Concerns about the confidentiality of mental health services received within the military have been documented as a significant barrier to service members obtaining needed treatment. At times, disclosing mental health information to commanding officers may be necessary so that informed decisions can be made about duty assignments, needed accommodations, unit resources, or deployments. The challenge the U.S. military faces is how to optimally protect service members’ confidentiality so that mental health services are sought and needs are not driven underground — while also ensuring the successful execution of the military mission.
In this RAND report, the authors examine the potential impact of existing U.S. military mental health confidentiality policies on service members seeking assistance for mental health issues. The authors conducted a multimethod investigation involving key-stakeholder interviews with military mental health providers, commanding officers, and enlisted service members and a survey of the active component regarding knowledge, understanding, and practices associated with mental health confidentiality policies.
Findings shed light on the perceptions held by service members on the limits to mental health confidentiality and how policy implementation influences service members’ decisions regarding mental health care. The authors recommend steps that the U.S. Department of Defense could take to improve military personnel’s understanding of confidentiality policies, strengthen processes to ensure that policies are implemented as intended, and mitigate the consequences associated with the limited confidentiality afforded to mental health services within the military.
Key Findings
- A substantial proportion of active component survey respondents indicated misperceptions about confidentiality policies, including believing that command notification is required whenever a service member misses a mental health treatment appointment (56 percent), is prescribed mental health medication (32 percent), receives mental health services for any reason (23 percent), and is undergoing a marital separation (20 percent).
- Interviews revealed that stakeholders’ perceptions regarding what types of information can be disclosed from providers to commanding officers ranged from circumscribed details (e.g., diagnosis, treatment plan) to anything that might be considered helpful (e.g., childhood trauma).
- More than half of survey respondents (58 percent) and 80 percent of respondents with unmet mental health needs (i.e., documented mental health need but did not receive treatment) viewed service members as being often or always unsure of what information might be released to commanding officers.
- Training and education on confidentiality policies and practices are insufficient for providers, commanding officers, and service members at large.
- Current policy implementation processes may compromise confidentiality (e.g., informal mechanisms employed by providers and commanding officers to convey service members’ mental health information).
- Monitoring and enforcement of mental health confidentiality policies, particularly commanding officers’ communication about service members’ mental health information throughout the chain of command, are lacking.
- Perceptions of limited mental health treatment confidentiality affect service members’ decisions regarding mental health treatment, and the perceived negative consequences of getting mental health care continue to be a pervasive barrier to care for military service members.
- Confidentiality concerns were more prevalent among service members with mental health needs (and even more so among the subset who had not obtained treatment) compared with service members with no mental health needs.
Recommendations
- Improve understanding of mental health confidentiality policies. For example, the Department of Defense should clarify aspects of policies that are unclear and susceptible to provider and commander discretion and variability in implementation and make those policies widely accessible.
- Strengthen supports and accountability measures to ensure that mental health confidentiality policies are implemented as intended. For example, the Department of Defense should enforce mandatory education and training for all military personnel on mental health confidentiality policies and practices and should revise guidance for clarity.
- Mitigate consequences associated with limited mental health treatment confidentiality in the military. For example, the Defense Health Agency should explore the feasibility of expanding treatment options that afford greater privacy to service members (such as telehealth and services during nonwork hours).
– Published courtesy of RAND.
