Center for Military Health Policy Research A JOINT ENDEAVOR OF RAND HEALTH AND THE RAND NATIONAL DEFENSE RESEARCH INSTITUTE CHILDREN AND FAMILIES The RAND Corporation is a nonprofit institution that helps improve policy and EDUCATION AND THE ARTS decisionmaking through research and analysis. ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE This electronic document was made available from www.rand.org as a public service INFRASTRUCTURE AND of the RAND Corporation. TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS Skip all front matter: Jump to Page 16 NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY Support RAND SCIENCE AND TECHNOLOGY Purchase this document TERRORISM AND Browse Reports & Bookstore HOMELAND SECURITY Make a charitable contribution For More Information Visit RAND at www.rand.org Explore the RAND Center for Military Health Policy Research View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non- commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. This product is part of the RAND Corporation technical report series. Reports may include research findings on a specific topic that is limited in scope; present discussions of the methodology employed in research; provide literature reviews, survey instru- ments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports un- dergo rigorous peer review to ensure that they meet high standards for research quality and objectivity. Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S. Military Servicemembers and Their Families Robin M. Weinick, Ellen Burke Beckjord, Carrie M. Farmer, Laurie T. Martin, Emily M. Gillen, Joie D. Acosta, Michael P. Fisher, Jeffrey Garnett, Gabriella C. Gonzalez, Todd C. Helmus, Lisa H. Jaycox, Kerry A. Reynolds, Nicholas Salcedo, Deborah M. Scharf Prepared for the Office of the Secretary of Defense Approved for public release; distribution unlimited Center for Military Health Policy Research A JOINT ENDEAVOR OF RAND HEALTH AND THE RAND NATIONAL DEFENSE RESEARCH INSTITUTE The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted jointly by the Center for Military Health Policy Research, a RAND Health program, and the Forces and Resources Policy Center, a RAND National Defense Research Institute (NDRI) program. NDRI is a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community under Contract W74V8H-06-C-0002. Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN: 978-0-8330-5236-0 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2011 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. For information on reprint and linking permissions, please visit the RAND permissions page (http://www.rand.org/publications/ permissions.html). Published 2011 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 RAND URL: http://www.rand.org To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface Over the last decade, U.S. military forces have been engaged in extended conflicts that are characterized by increased operational tempo, most notably in Iraq and Afghanistan. While most military personnel cope well across the deployment cycle, many will experience difficul- ties handling stress at some point, will face psychological health challenges, or will be affected by a traumatic brain injury (TBI). Over the past several years, the Department of Defense (DoD) has implemented numerous programs to support servicemembers and their families in these areas. These programs address various components of biological, psychological, social, spiritual, and holistic influences on psychological health along the resilience, prevention, and treatment continuum and focus on a variety of clinical and nonclinical concerns. In response to this proliferation of programs, the Assistant Secretary of Defense for Health Affairs asked the RAND National Defense Research Institute to develop a comprehensive catalog of exist- ing programs currently sponsored or funded by DoD to address psychological health and TBI. This report addresses this objective, providing a definition of what constitutes a program, an overview of these programs, and a description of how programs relate to other available resources and care settings. The contents of this report will be of particular interest to national policymakers within DoD and should also be helpful for health policy officials within the U.S. Department of Veterans Affairs (VA). The remaining activities will be documented in reports to be released at later dates. This research was sponsored by the Assistant Secretary of Defense for Health Affairs and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and conducted jointly by RAND Health’s Center for Military Health Policy Research and the Forces and Resources Policy Center of the RAND National Defense Research Insti- tute (NDRI). The Center for Military Health Policy Research taps RAND expertise in both defense and health policy to conduct research for the Department of Defense, the Department of Veterans Affairs, and nonprofit organizations. NDRI is a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community. For more information on the Center for Military Health Policy Research, see http://www. rand.org/multi/military.html or contact the co-directors (contact information is provided on the web page). For more information on the Forces and Resources Policy Center, see http:// www.rand.org/nsrd/ndri/centers/frp.html or contact the director (contact information is pro- vided on the web page). iii Contents Preface . .......................................................................................................... iii Figures . .......................................................................................................... ix Tables . ........................................................................................................... xi Summary . ......................................................................................................xiii Acknowledgments . .......................................................................................... xxv Abbreviations . ...............................................................................................xxvii ChAPTer One Introduction . .................................................................................................... 1 Psychological Health in the Military . ......................................................................... 1 The Recent Policy Context . ..................................................................................... 2 Department of Defense Task Force on Mental Health . ................................................... 3 Department of Defense Independent Review Group . ..................................................... 3 The President’s Task Force on Returning Global War on Terror Heroes . .............................. 3 The President’s Commission on Care for America’s Returning Wounded Warriors . .................. 4 Congress Passes the Wounded Warrior Act . ............................................................... 4 Mental Health Advisory Teams . ............................................................................. 4 Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces . ...................................................................................................... 5 Department of Defense Response to Prior Recommendations . ............................................ 6 Directors of Psychological Health . .......................................................................... 6 Wounded Warrior Programs . ................................................................................ 6 Wounded, Ill, and Injured Senior Oversight Committee . ...............................................