Serving in the military can have lingering effects on service members and the families that support them, sometimes resulting in physical and mental trauma. Service members report exposure to a wide range of traumatic events, with one study indicating that half of those deployed to Iraq or Afghanistan had a friend who was killed or seriously wounded. The Department of Defense’s health care benefits program, TRICARE, serves all of the uniformed services and their families—a population comprising more than nine million beneficiaries.
The mental health care needs of this population are large and diverse, requiring a skilled group of professionals to diagnose and treat a variety of disorders. These professionals include mental health counselors, who—like clinical social workers, marriage and family therapists, and psychiatric nurse specialists—typically hold masters degrees and are obligated by state licensure and other requirements to have demonstrated clinical experience in order to practice. Under current TRICARE rules, mental health counselors are required to practice under a physician’s supervision, and their patients must be referred to them by a physician in order for their services to be eligible for reimbursement.
At the request of Congress, the IOM examined the credentials, preparation, and training of licensed mental health counselors. In this report, the IOM makes recommendations for permitting counselors to practice independently under the TRICARE program and instituting a comprehensive quality management system for all mental health professionals.