ASF (Aeromedical Staging Facility)Enhanced Mental Health Support Initiative for Returning Wounded Warriors

Title: ASF (Aeromedical Staging Facility) Enhanced Mental Health Support Initiative for Returning Wounded Warriors Description:
Wounded, ill, and injured service members experience multiple stressors related to their deployment experience and the medical evacuation process. While 28.8% of medical evacuations are classified as mental health casualties, those that suffer physical injuries and illness often face concomitant mental health issues. For these reasons, we at the Aeromedical Staging Facility, Malcolm Grow Medical Clinic, Joint Base Andrews, have begun implementation of the Enhanced Mental Health Support Initiative. ASF Background: Mission: Plans, directs, evaluates clinical and administrative coordination of remain overnight (RON) care and accommodations for in-transit patients and medical attendants. Vision: A superb cadre achieving the highest readiness standards in support of any contingency while creating the premier facility for our transient patients. Mental Health Issues at the ASF: The number of mental health related medical evacuations has increased over the past decade. Data collected at Landstuhl indicates that between Nov 2001 and July 2004 a total of 1,264 mental health patients were evacuated (10% of all aeromedical evacuations). In contrast, data from December 2011 to Oct 2012 collected at the ASF indicates that mental health patients accounted for 28.8% of all medical evacuations. This dramatic increase in the percentage of mental health patients indicated a need for improved mental health care within the medical evacuation system. The Initiative: Objectives of the Enhanced Mental Health Support Initiative are to promote the ease of consultation when needed, ensure the mental health needs of wounded warriors are met when transitioning through the ASF, improve training and readiness of mental health personnel in rapid assessment and triage, and provide mental health residents training in issues relevant to deployed mental health issues. To meet these objectives, mental health residents have been integrated into the ASF team and now accompany ASF staff on missions. Mental health residents function as consultants to the flight surgeons regarding mental health patients, and medical patients with significant concomitant mental health issues. Residents meet with each mental health patient and conduct brief assessments regarding safety, stabilization, and comfort. For those patients endorsing significant psychiatric distress, residents are available for brief intervention. Innovativeness: The function of the medical evacuation system is to stabilize patients and provide quick and efficient transportation back to their home medical centers and clinics. Until now, mental health care has not been integrated into this system, despite the large number of mental health causalities. The Enhanced Mental Health Support Initiative is therefore innovative in its shifting of existing resources to address a significant need. Mental health providers in the ASF prevent mental health decompensation and provide early intervention for those experiencing acute crisis. This initiative is therefore innovative in that it improves care of the wounded, ill, and injured, reduces demands on medical personnel in the care of mental health patients, avoids unnecessary psychiatric hospitalization while simultaneously increasing access to mental health care overall and reducing cost. Cost Effectiveness: The cost of the Enhanced Mental Health Support Initiative within our facility has been minimal. By including a mental health provider in ASF missions, the Mental Health Clinic has lost two patient care hours per week. These providers have, however, seen approximately 14 ASF patients per week during that time. More patients are contacted, therefore, as a result of this initiative.
Ease of Implementation: The Enhanced Mental Health Support Initiative has been relatively easy to implement. The initiative required training mental health providers on the ASF system and training ASF staff on how to appropriately utilize mental health personnel on the ASF missions. In addition, the attached consultation and hospitalization system had to be developed.
Scalability: While the current proposal focuses most specifically on the medical evacuation system, we believe this model of mental health integration has applicability MHS-wide. In contrast to existing mental health integration programs (such as the Behavioral Health Optimization Program [BHOP]), the Enhanced Mental Health Support Initiative functions in a relatively acute environment. The implications of such a program may point toward utility of mental health integration into emergent and intensive care settings.
Tri-Service: Among deployers, all services are represented. Similarly, the medical evacuation system represents a tri-service integration of material and personnel resources. Impact: Readiness: Mental health residents gain first hand experience working with deployed mental health issues and functioning in the medical environment. ASF staff gain a greater understanding of the role of mental health in managing psychosocial stressors. Population Health: While difficult to document, we believe that having mental health residents integrated in the ASF team functions as a preventative mental health measure for many ASF patients. Increased access to mental health care means that patients can readily find resources to cope with the stressors they face. Experience of Care: The mental health care experience of residents exceeds that of most medical personnel and therefore provides an improved mental health care experience for the 28.8% of ASF patients classified as mental health patients, as well as many more with concomitant mental health issues. Per Capita Cost: The consultant model implemented in the Enhanced Mental Health Support Initiative increases the number of patients seen by mental health residents. In addition, access to mental health care in the ASF likely reduces costly psychiatric inpatient hospitalizations.

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