What we can learn from nights

 If a serviceperson on nightshift deployment or nightshift military work returns to a civilian life, what does this transition look like? How much does it matter which country he or she returns to, what type of negative experiences they encountered or what type of daytime work they now hold? And what if they have work responsible to attentive certification or classification, such as trucking? What if they have compounded stress with new first response work? What should we anticipate for his or her behavioral and mental health needs? And what about those who have sleepless nights, those with substance abuse, those with PTSD, those with other neuropsychiatric conditions?

The big issues in military health aren’t the easy ones.

Arguably, this is all the more reason to align global effort. The right international breezes know how to navigate the most challenging complexities.  Military behavioral health, and all the imperfections along the way, are the most challenging of complexities.

Let’s try to organize a very, very complicated portfolio. International researchers already work together in various academic institutions on behalf of behavioral health, with military data in tow. Organizing it formally is the logical next step. Perhaps by identifying a couple areas for cohesive advancement, we can gain traction.

 

1)      The wide range of behavioral health topics for military and veteran populations, including for PTSD, anxiety, substance abuse, suicide and family behavioral health, needs to be organized for public consumption.

 

The consumption of the information, needs, improvements, research and healthcare delivery opportunities around military and behavioral health should be organized and clear for the average member of the public. This is particularly true for the populations involved in deployment and deployment decision-making, and to be honest that’s all of us.

Crosswalks of research, current operations and policies should be available to the public by funded responsible parties. This should be centered on the population (military, veteran), not on the agencies of deliverables. It is a public health issue that should be available by country.

There should be a repository of literature, synthesis and an easy translation tool for those without science backgrounds. There should be an easy to digest synthesis of where we are at in behavioral health, delivery by country, outcomes by country and aligned research strategies. Consumer language should also be considerate of military and VA medicine consumers. 

Once it is initiated, with current global projects acknowledged, we could focus on several points of interest. These may include:

 

* An agreement on behavioral health definitions for cross country comparison. 

* The main foundations of various interventions, how they compare against one another, and where the international conversation needs to go. It could be as simple as identifying the main programs and literature basis. Here is one of many interventions, and it would be helpful to view a detailed list of all main programs https://www.rand.org/pubs/research_reports/RR2030.html

* An outline of partnerships in current behavioral health work. Evolving needs in substance abuse for veterans, including tele-health options and self-help strategies, require greater social partnerships. Assuring resources, IT infrastructure, external occupational wellness (for the large population that does not stay in military long term) and self-help/recreational affordability could be detailed.  https://www.rand.org/news/press/2020/07/22.html

* Comparative analytics in behavioral health, disclosed publicly. For example, differences in PTSD among troops from different countries with similar deployment persist. What is being done to standardize tools, training, examine interventions and include healthcare utilization data? When think tanks and third-party research is funded, why not ask how much it would cost to include other countries and then ask for public health funding to connect to DoD and other funding contribution?  Literature such as https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3013423/ and https://www.tandfonline.com/doi/abs/10.1080/08039488.2016.1201529 could be addressed in major reports. Additionally, with world health funding, concepts such as resilience wouldn’t need to be stand alone. https://www.rand.org/pubs/research_reports/RR2436.html

 

 

2)      There are a wide range of behavioral health assessment and research tools used, and this needs to become organized for public consumption.

 

* There should be standardization to classification for assessment of behavioral health burdens, including substance use disorders, and we are likely nowhere near definition standardization. https://www.ncbi.nlm.nih.gov/books/NBK207276/

 

* There should be an assessment of advantages, disadvantages and crossover of the tools used for forward alignment. Using hundreds of assessment techniques is an outdated strategy for today’s advanced military and research infrastructures (including infrastructure of global consideration).

 

* There should be application of these 5 key findings for research improvement, applied to military behavioral health. https://www.rand.org/pubs/research_briefs/RB10036.html

 

* There should be an alignment of behavior assessment tools, including for sleep science. Note the differences in these studies. Assessment tools shouldn’t be all over the place.  

https://academic.oup.com/sleep/article/36/7/1009/2453855 

https://link.springer.com/article/10.1007/s11606-017-4250-4 

The alignment could be assisted by requiring primary care and other providers to ask the questions, even through telehealth and or pre-visit online submission. Why not standardize, and why not require primary care assessments inclusive of items such as sleep quality?

 

* The definition of high quality care for PTSD should be clear across similar militaries, especially as we begin the journey here in the US.  https://www.rand.org/pubs/research_reports/RRA337-1.html

 

* Quality metrics specific to behavioral health quality of life should be clear, for comparison between VA, non-VA and eventually a little more globally. Standard metrics comparison literature such as this one could be expanded: https://link.springer.com/article/10.1007%2Fs11606-018-4433-7

 

 

3)      There are new units and divisions for behavioral health that can shoulder some responsibility to the publicly available data in this military behavioral health synthesis.

 

*There should be built-in advances for professional research and data aggregation. Military behavioral health research should be respected for the professional science it is. Concepts like reaching out for veterans via Facebook and flyers do not serve the greater community best.

 

*There should also be requirements to research and publication, so that previously known data is incorporated. This inclusion should respect international data, too.

 

*Recommendations in reimbursement for substance use and other behavioral health issues in the military should be reported on (why they were accepted, why administrations rejected the recommendation, how it’s going). Additionally, military respect to research and recommendation uptake percentage is an indicator and could be recorded in the global health effort.

Reference on the topic: https://www.rand.org/pubs/research_briefs/RB10132.html

               

*Compensation with disability and/or career trajectory should be supported by ongoing analytics. This should be funded, to better calculate disability and funding related to mild TBI, PTSD and other poorly understood trajectories. Here’s a start at PTSD and career trajectory, which could be applied in serviceperson compensation if the analytics were funded better: https://www.rand.org/pubs/rgs_dissertations/RGSD343.html – and the information available for public consumption should include rejected disability claims.

 

* Reservist requirements for behavioral health check in could be available and compared internationally. Reference on the topic: https://www.tandfonline.com/doi/abs/10.1080/09638237.2019.1581348

  

 

4)      A publicly available repository for organized military behavioral health research and care should include worldwide efforts.

 

* Global consideration to military families has resulted in standardization research with NATO: https://jmvfh.utpjournals.press/doi/full/10.3138/jmvfh.2019-0009. Expectations with standardization, and adherence to it, can be assisted with organized military behavioral health science. 

 

* World health work in military mental and behavioral health could be advanced by examining the WHO epidemiological work already undertaken. https://www.cambridge.org/core/journals/psychological-medicine/article/epidemiology-of-traumatic-event-exposure-worldwide-results-from-the-world-mental-health-survey-consortium/F06E14BA4DF09A29CCA81909C285ABE9

 

* The title “worldwide” and “global” should be reserved for research that is inclusive of more than one military. Note that the United States “worldwide” substance abuse and behavioral assessments only incorporate the US. https://apps.dtic.mil/sti/pdfs/ADA264721.pdf

 

* Recommended concepts, such as application of mental health item banks in research, could be an international effort. https://www.rand.org/pubs/research_reports/RR1762.html

 

* Behavioral health scientists should be tapped for accuracy improvements, worldwide. The accuracy of military suicide rate comparisons, as well as trajectories, across countries, could be funded https://www.rand.org/blog/2018/04/comparing-suicide-rates-making-an-apples-to-apples.html - For a second ask, accuracy around military mental health therapeutic alliance between service persons/veterans and providers could also be improved https://www.rand.org/pubs/research_reports/RR2829.html

 

* Efforts to incorporate other militaries’ recommended health research should be noted, with collegial liaison planning. When military research strives for global adoption, such as some applied US military concepts in this Chinese military study, why not incorporate the data in larger picture? Additionally, why not fund for broader quantitative analyses, considerate of healthcare delivery model? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811367/

 

* Efforts at synthesis review across many militaries should be met with additional funding. Here’s an example of effort and paucity: https://academic.oup.com/milmed/article/170/10/886/4577693

 

* Efforts to examine best military practices across adversarial and less than collegial countries should be met with research liaisonship and diplomacy. Here’s an example of opportunity in liaison work between Iranian research, differences in Russia, UK and USA: http://militarymedj.ir/article-1-1667-en.pdf

 

5)      A publicly available military behavioral health repository fastens accountability to physical correlations and considerations. This should eventually steer a strategic plan for physical and behavioral health co-science.

 

           *Pain management could be a health service research metric, with guidelines adherence and opioid management training included. How does this compare internationally?

 

*Sleep science, shift work science, biological and other interventions and biomarkers could be held to a strategic plan. Where is the greater scientific community in partnership? https://academic.oup.com/sleep/article-abstract/43/10/zsaa065/5815720  https://www.sciencedirect.com/science/article/abs/pii/S0012369218324140

 

*Where is the data around care needs, with consideration of how this contributes to psychosocial and behavioral issues?

 

           *Biomarkers are researched in international academic research centers. These experts                 should be at a roundtable global conversation regarding military mental and behavioral                 health. https://jmvfh.utpjournals.press/doi/full/10.3138/jmvfh.2019-0036

 

The big issues in military healthcare aren’t the easy ones. This is all the more reason for global efforts to align on behalf of military mental and behavioral health.