Story at a glance
- Researchers analyzed psychiatrist shortages in communities with beneficiaries of the U.S. military health care system, TRICARE.
- The military personnel and dependents who faced shortages from 2016 to 2020 tended to live in economically disadvantaged or rural communities.
- Those living in low-income communities with higher income inequality were most likely to live in provider shortage areas.
Thirty-five percent of TRICARE beneficiaries lived in areas with shortages of both military and civilian psychiatrists between 2016 and 2020, new study results show, while six percent of all beneficiaries had no psychiatrists available within a 30 minute drive from their community.
TRICARE, the U.S. military’s health care system, offers coverage to active military personnel, retirees and their dependents. Many active duty service members and their families use military treatment facilities (MTFs) for medical care, though less than 500 of these provide psychiatric care. Others choose to rely on civilian medical services, authors wrote.
Previous research has shown military service members and their families have greater mental health care needs than civilians, and can face unique barriers when it comes to seeking care, including deployments and frequent relocations, researchers explained.
Although the suicide rate among active duty service members declined more than 15 percent from 2020 to 2021, veteran suicide rates continue to increase at a greater rate than the general U.S. population.
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Researchers analyzed over 39,000 zip code communities between 2016 and 2020 to better understand the availability of military and civilian psychiatrists within a 30-minute drive of beneficiaries.
Data showed beneficiaries living in low-income communities with high income inequality were most likely to experience a provider shortage, along with those living in rural communities.
Compared with urban communities, rural areas were more than 6 times as likely to have a shortage of both military and civilian psychiatrists. These areas were more than five times as likely to have no psychiatrist within a 30 minute drive compared with urban communities.
Findings underscore the need for targeted strategies in these areas, as residents cannot rely on civilian psychiatrists to meet their needs, authors wrote.
Psychiatrist shortage areas were based on the Health Resources and Services Administration definition, where the population-to-psychiatrist ratio was greater than 20,000 to 1.
The majority of shortage areas were located in the South, Midwest, and interior West regions of the United States. Just 13 percent of the TRICARE beneficiary population lived in a region with an adequate number of military and civilian psychiatrists.
Alaska and Hawaii were the states most likely to have no psychiatrists within a 30 minute drive of beneficiaries’ communities.
Data also showed communities with a higher presence of retirees had greater risks of experiencing psychiatrist shortages, or no access at all.
Although the access gap identified for military retirees may be partially filled by services from the Veterans Association (VA), researchers note “only 60 [percent] of veterans are eligible for VA health care under the current policy and only 50 [percent] of eligible veterans use VA health benefits.”
“As the military health system considers realignment of its psychiatric capacity, it would be important to develop targeted strategies for shortage areas, since it cannot rely on civilian mental health care professionals to care for the military population in many communities,” they concluded.