Mental health leaders across the Air Force met virtually for an annual conference, August 9-13, to discuss military mental health care, telehealth, the impact of COVID-19 and embedded mental health support.
Lt. Gen. Robert Miller, U.S. Air Force Surgeon General, presented a welcome message emphasizing the critical role mental health care plays in the readiness of Airmen and Guardians, especially amid the ongoing transition of military treatment facilities to the Defense Health Agency and the current situation in Afghanistan.
"Our mental health care is service-focused and has a direct impact on our operational mission," Miller said. "Even with the Defense Health Agency having authority, direction and control of all military treatment facilities, the way we support our Airmen and Guardians will not change."
Col. Scott Sonnek, psychological health director, also emphasized the important role mental health providers play in support of the Air Force mission.
"We have seen an increase in mental health utilization the last few years," Sonnek said. "So, it is important our Airmen and Guardians have access to the resources they need."
Along with an increase in mental health services being used, so has the reliance on telehealth.
"COVID, which is going to be with us for a while, has changed the way we practice medicine forever," Miller said. "Telehealth has become even more important, and in the future there are going to be other causes for using virtual medicine."
Col. Jennifer Chow, Air Force Medical Readiness Agency chief mental health officer, explained that while there has been a gradual increase in virtual mental health care, there are challenges providers should consider when conducting virtual visits.
"While telehealth does improve access to care, there are challenges such as connectivity issues, and the very real issue of protecting patient privacy," Chow said. "There are even concerns on how providers who work from home present themselves virtually and how that may impact the virtual visit. These are things we are taking into consideration to provide the best care."
The COVID-19 pandemic not only changed the delivery of mental health care, but also the demand for mental health care support for frontline providers who were deployed to overwhelmed civilian hospitals across the country.
Chow described how providers across the globe experienced high levels of psychological distress during the initial months of the pandemic. Studies identified things like increased contact with affected patients and prolonged quarantine were key risk factors for mental health effects among providers.
Behavioral health specialists with the 60th Medical Group at Travis Air Force Base, California, deployed between June 2020 and February 2021 as part of the Coronavirus Disease Theater Hospital-1 Task Force. The team presented their experience supporting frontline providers, the challenges they faced, and what they did to best support these providers. They found that frontline providers were experiencing a range of mental health concerns, including acute stress and burnout.
Staff Sgt. Martina Shannon-Young, a behavioral health technician with the 60th Medical Group, noted that providers who had to deliver end-of-life messages to family who could not be with the patient experienced high amounts of compassion fatigue.
"I had one nurse tell me he had to hold the iPad for one of his patients so the family could say goodbye," Shannon-Young said. "So you have this instance where, as a provider, you are being overly empathetic and giving so much of yourself. This is where this compassion fatigue sets in. This is on top of the burnout with long hours, working in layers of personal protective equipment, and seeing a high volume of patients."
To mitigate some of the psychological consequences frontline providers were experiencing, these behavioral health specialists began using some of the tactics used in a deployed environment. This included command consultations, psychological first aid, operational stress control, post-traumatic stress prevention and leveraging technicians as provider extenders in this environment.
The behavioral health team led meditation classes and provided limited scope counseling on sleep hygiene, grief counseling, acute stress and healthy coping skills. Maj. Jeffrey Smith, a licensed clinical social worker with the 60th Medical Group, spoke about the use of battlefield acupuncture.
"I had a lot of requests to administer battlefield acupuncture to physicians and nurses who spent long hours in personal protective equipment or experienced tension headaches," Smith said. "There are several studies that have shown the effectiveness of battlefield acupuncture for sleep, stress and post-traumatic stress and trauma. We saw considerable success when we provided this procedure."
Embedded mental health care was another significant theme of the weeklong conference. Col. Leigh Johnson, Mental Health Integrated Operational Support chief, presented on the Integrated Operational Support concept, which is a term used to describe all embedded medical assets within squadrons across the Air Force. There are currently more than 30 IOS programs across the Air Force.
"Our mission is to contribute to the greater Air Force mission," Johnson said. "We are responsible for extending medical support into operational environments for missions with special performance requirements or operational health concerns."
By embedding, mental health providers can improve their understanding of operational demands by being more connected to units, reducing stigma associated with seeking mental health care and addressing mental health concerns early.
Mental Health providers stressed the importance of evolving to best use current mental health assets to meet future demands. One idea was to use a targeted care model to direct service members to the appropriate support, whether it is a mental health care provider, using mental health technicians or directing them to non-medical support.
"We need to rethink and change the way we operate as a mental health system," said Lt. Col. Aaron D Tricht, Air Force Medical Readiness Agency clinical psychologist. "We won't meet forthcoming demands if we don't start changing how we operate. With targeted care, we meet the patient with the most appropriate resource. This empowers clinicians to drive the best course for care and support."
