title: Barriers to Engaging Service Members in Mental Health Care Within the U.S. Military Health System.
abstract: Over the past decade, there has been growing recognition of the mental health consequences associated with deployment and service by military service personnel. This study examined potential barriers to mental health care faced by members of the military in accessing needed services.
  
  
  
  This qualitative study of stakeholders was conducted across six large military installations, encompassing 18 Army primary care clinics, within the context of a large randomized controlled trial. Stakeholders included patients recruited for the study (N=38), health care providers working within site clinics (N=31), and the care managers employed to implement the intervention protocol (N=7).
  
  
  
  Issues raised across stakeholder groups fell into two main categories: structural factors associated with the Army medical system and institutional attitudes and cultural issues across the U.S. military. Structural issues included concerns about the existing capacity of the system, for example, the number of providers available to address the population's needs and the constraints on clinic hours and scheduling practices. The institutional attitude and cultural issues fell into two main areas: attitudes and perceptions by the leadership and the concern that those attitudes could have negative career repercussions for those who access care.
  
  
  
  Although there have been significant efforts to improve access to mental health care, stakeholders within the military health system still perceive significant barriers to care. Efforts to ensure adequate and timely access to high-quality mental health care for service members will need to appropriately respond to capacity constraints and organizational and institutional culture.
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Terri
authors.initials: T
authors.lastname: Tanielian
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Mahlet A
authors.initials: MA
authors.lastname: Woldetsadik
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Jaycox
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Caroline
authors.initials: C
authors.lastname: Batka
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Shaela
authors.initials: S
authors.lastname: Moen
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Carrie
authors.initials: C
authors.lastname: Farmer
authors.affiliation: Ms. Tanielian, Dr. Jaycox, Ms. Batka, Ms. Moen, Dr. Farmer, and Dr. Engel are with the Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia (e-mail: territ@rand.org ). Ms. Woldetsadik is a doctoral fellow in the Department of Public Policy, Pardee RAND Graduate School, Santa Monica, California.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Engel
mesh_terms: D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D014481:United States; D055815:Young Adult