A recent Government Accountability Office (GAO) report to Congress highlighted the expansion in telehealth use for mental healthcare for military service members during the pandemic.
Telehealth visits made up about 15 percent of outpatient mental health visits before the pandemic (from January 2019 through February 2020) and increased 275 percent from February 2020 to a peak in April 2020 of 118,246 visits. These visits have decreased since but remain above pre-pandemic levels.
The Department of Defense's (DOD) Military Health System told GAO that telehealth was a valuable tool in providing mental healthcare during the COVID-19 pandemic, noting that telehealth facilitated continuity of care. DOD released guidance that allowed the use of programs such as Apple FaceTime and Microsoft Skype for DOD providers and service members to engage in telehealth visits. DOD officials noted that telehealth may not be the best fit for some high-risk patients, but they said it is a valuable tool that will likely remain in use for some mental healthcare services after the pandemic recedes.
GAO examined DOD policies on mental health screening and on the provision of telehealth, reviewed reports about mental health care during the COVID-19 pandemic, analyzed data from the Defense Health Agency on the utilization of telehealth for mental healthcare services between January 2019 and April 2021 (the most recent data available at the time of our review), and interviewed DOD officials from the Defense Health Agency, the military services, and the National Guard.
DOD officials told the GAO that telehealth was a valuable tool in bolstering access and continuity of care. For example, a Navy official noted that the quick rollout of telehealth for mental healthcare ensured that people could still be evaluated and treated during the pandemic. In addition, an Air Force official described how the ability to provide telehealth by remote providers helped offset staffing shortages the Air Force faced in its smaller, more rural areas. An official from the Marine Corps also noted that the Marine Corps is looking for ways to maximize telehealth across health services, and that telehealth is now a routine way for the Marine Corps to deliver mental healthcare.
Officials also described the value of telehealth in mitigating the stigma of seeking mental healthcare. For example, a Marine Corps official noted that by logging on to a telehealth appointment from their barracks, service members could reduce the fear they may have about running into somebody they know in a clinic waiting room. As a result, telehealth may greatly reduce service member concerns about confidentiality. Another official said that service members waiting for mental healthcare appointments in the clinic waiting room were required to be in uniform—uniforms may include information that is identifiable such as a service member’s name, rank, and service branch. This official noted that receiving care through telehealth gave service members confidentiality and eliminated the concern of being seen waiting for mental healthcare services.
Military service officials also explained, however, that the use of telehealth for mental healthcare presented challenges. For instance, telehealth may not be the appropriate modality to deliver certain types of mental healthcare services. Some described the difficulty of conducting group therapy sessions via telehealth. For example, while a provider could ensure privacy for participants in an in-person group therapy session by locking the door and limiting entry, an official noted that a group therapy session conducted via telehealth raises concerns about group confidentiality and may require additional provider training on how to lock down the virtual room to ensure privacy for participants. In addition, Army and Marine Corps officials noted that outdated computer systems and web camera equipment made providing care via telehealth difficult for some mental health providers.
Officials also told GAO that telehealth may not be appropriate for patients with high-risk diagnoses or for those experiencing acute symptoms. For example, a Marine Corps official and provider said that if they are seeing a patient with suicidal thoughts, they prefer to deliver treatment to that patient face-to-face. Another provider noted that if the option was to provide care to a high-risk patient via telehealth or not at all, a telehealth session would be that provider’s preference.
When delivering mental healthcare via telehealth, one official said that additional planning is required for the visit to ensure the safety of the patient. For example, the provider needs to obtain the patient’s location and contact information during the appointment in the event the patient disconnects from the telehealth visit. If the provider cannot reach the patient and has concerns about the patient’s well-being, then the provider can arrange for a welfare check by local authorities.
