The Military as a Teacher in Mental Health Care Delivery

Robert Accordino, MD, MSc.Quartet

Blog | Healthcare | Stories | Aug 2, 2019

Prior to becoming Quartet’s Chief Mental Health Officer, I was fortunate enough to be appointed to the White House Fellowship by President Barack Obama. I spent 15 months in this non-partisan program that affords young professionals the incredible opportunity to participate in democracy and experience leadership at the highest levels.

As the Fellow to the Secretary of Defense, I had the opportunity to learn from some of the nation’s most brilliant and innovative leaders, including the 25th Secretary of Defense, Ash Carter, as I focused on leading new initiatives in healthcare delivery for military service members and their families.

As shown by the military’s development of such quintessential goods as the internet and the air conditioner, it is clear that military innovations can spawn substantial improvements in civilian quality of life. The military’s innovation in the delivery of healthcare—specifically, mental health care— can be similarly instructive for how to improve mental health care in the general population.

Through Carter and other leaders like Secretary of the Army Eric Fanning, Vice Chairman of the Joint Chiefs of Staff General Paul Selva, United States Surgeon General Vice Admiral Vivek Murthy, Army Surgeon General Lieutenant General Nadja West, Air Force Surgeon General Lieutenant General Mark Ediger, I learned how the Army delivers mental health care, and examined where that care is located and how it’s carried out: maximally leveraging measurement-based care for psychiatric conditions to track symptom improvement in patients.

One result of this these learnings is a paper titled, “Soldier as Teacher: the Impact of the Army’s Innovations in Behavioral Healthcare Delivery on the Training of All Psychiatrists,” which was published with Dr. Christopher Ivany, Naomi Stark and Dr. Millard Brown in May of 2019 in Academic Psychiatry.

This paper demonstrates that having mental health providers embedded in small, versatile care teamsin clinics that are easily accessible for soldiersresults in better quality care. While this evidence-based, collaborative approach provides a nice foundation for improving health outcomes, its key to effective implementation depends on training psychiatrists appropriately to care for patients in this way.

In “Soldier as Teacher,” we outline how psychiatrists must be willing to collaborate strategically with other stakeholders—such as primary care providers, nurses, family, and coacheson patient health, as well as the importance of utilizing objective clinical measurements.

My hope is that these learnings will help guide innovation in improving access to mental health care for the civilian population, especially as value-based care is increasingly implemented across the nation.

We have a lot of work to do to make sure mental health conditions are treated the same as any other medical condition. But, if there are any doubts to staying the course, a key first step is to learn from innovations within the U.S. Military.

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