Military readiness is a critical measure to ensure that service members are both physically and mentally prepared to carry out their duties. As was highlighted in last week’s blog, readiness assessments are vital for maintaining operational effectiveness and helping to ensure that the military is taking care of its service members by identifying problems early and ensuring access to treatment. These evaluations consider both physical and behavioral health; however, today’s post will focus on the behavioral health portion and what specific domains are assessed. Readiness evaluations are conducted by providers within the DoD due to ever-changing rules and regulations. If you are a civilian network provider, know that these assessments will not be demanded of you; however, your input is imperative to ensure the relevant factors are considered when making a readiness determination. Therefore, it is good to have background knowledge of these assessments if you are a provider working with service members. The current guideline that regulates Military Readiness assessments is the Department of Defense Instruction (DoDI) 6130.03 Vol 2. This specifies the criteria for all readiness evaluations within the Department of Defense, in other words, each branch of service. It outlines three main domains within the Behavioral Health section of a readiness evaluation that will be reviewed today, as well as one additional topic: psychotropic medications. These domains are safety, symptom severity, and specific diagnoses. Once the assessment has been completed providers will establish if any duty limitations are needed. One thing to note, before the readiness assessment domains are reviewed, are the options for the final disposition. Readiness assessments conclude with a decision about the need for duty restrictions for service members. Sometimes during treatment, duty limitations are initiated to help the service member focus on treatment and recovery. Upon the conclusion of readiness assessments, providers will notate one of three dispositions: no temporary duty limitations, temporary duty limitations, or permanent duty limitations which would require a medical evaluation board. Temporary duty limitations would mean that the service member is put on a profile, if they are in the Army or Air Force, or put on Limited Duty (LIMDU) if they are in the Navy or Marines. To ensure clarity, it is important to state that if a service member is on profile or LIMDU they most likely are considered temporarily non-deployable. This status would also warrant a discussion with the service member’s Command team (see our next article in the blog series for further information). Your role is to provide the necessary treatment to the service member with the ultimate goal of being returned to duty with no limitations; however, that will be determined by a military provider following the completion of treatment or potentially at a midpoint in treatment. Now that the conclusions of readiness assessments have been reviewed, the next step is to discuss the domains evaluated within these assessments.
1. Safety: To Self and Others
Service members are often placed in high-stress, dangerous, and complex situations, therefore, safety is paramount. The evaluation of safety includes two important facets: safety for the individual service member and safety of others. These are complex assessments with multiple factors considered, the scope of which is beyond this blog for today, but a summary will be given.
Self-Safety: The first domain to be evaluated in readiness assessments is the risk of suicide. Suicide risk assessments are vital for all behavioral health patients, but within the military, they have a different lens due to patients having consistent access to lethal weapons as part of their daily jobs. Service members who are considered higher risk for suicide (please see DHA AI 6025.06 for breakdown of appropriate risk levels within the Defense Health Agency care) are given temporary duty limitations that would limit their access to weapons for work and allow them to access treatment consistently (helping minimize any occupational barriers that might prevent this) as well as, access multiple levels of resources (intensive outpatient programs, inpatient care, residential care) until their risk of suicide consistently decreases. With temporary duty limitations, such as a profile or LIMDU, due to high risk for suicide, patients are able to access treatment on a routine basis, have access to case managers, and higher levels of consultation and review, as well as any other required care.
Safety to Others: Equally important to assess for in readiness evaluations, is the risk of harm to others. If a service member’s current mental health symptoms manifest as wanting to hurt or kill others, then that person will be evaluated to see if duty restrictions are warranted. This evaluation would help determine if limiting access to their occupational weapons is needed as well as inpatient services or if legal action would be required at that time. Individuals who may exhibit impulsive, unpredictable, or violent behavior pose a risk to the safety of those around them.
In summary, providers assessing for readiness are examining risk factors of harm to self or others to determine if duty limitations are necessary.
2. Symptom Severity
Beyond ensuring safety, military readiness assessments focus heavily on the severity of symptoms related to mental health conditions. Providers within the DoD system assess for symptom severity because it can directly affect service members' ability to perform their duties.
Mild to Moderate Symptoms: Service members with mild symptoms of conditions, like anxiety or depression, will likely not require any change of duties since their symptoms are manageable and do not significantly impair their work. Counseling or other forms of treatment can be prescribed to help them cope with the stresses of military life while maintaining their duties. A moderate symptom presentation does not always require duty limitations either. A moderate symptom presentation that would require duty limitations would be determined based on the type of impairment experienced, symptoms manifested, service member occupational demands, and if any safety concerns are present.
There is one exception to the rule for moderate symptoms. Substance use that rises to the level of diagnosis, and has demonstrated any type of impairment, does lead to temporary duty limitations to help the service member start and work through a substance treatment protocol.
Severe Symptoms: Service members with severe symptoms that cause significant impairment socially and/or occupationally can be viewed as warranting temporary duty restrictions. These duty restrictions limit what the individual can do occupationally, temporarily, while facilitating consistent access to care. For example, if a service member is in the middle of treatment for Major Depressive Disorder while their unit comes on orders for a month-long training exercise, that is away from home, these duty limitations allow the service member to remain at their normal duty location (at home), and continue to receive their needed treatment. In summary, during brief readiness assessments, service members in treatment often have mild to moderate symptoms requiring no need for duty restrictions. When conditions result in significant impairment, then temporary duty limitations are placed. Finally, if any of these conditions require a year or more of treatment (or they have been in treatment for a long time and expect treatment to continue for a long time), a permanent profile may be issued. The permanent profile would initiate a medical review board, which would determine if a service member can be rehabilitated in the near future or would need a medical retirement due to their conditions.
3. Specific Diagnoses: Psychotic Disorders and Bipolar I Disorder
The nature of being in the military and having access to weapons make for an environment that is unsustainable for certain diagnoses. Psychotic disorders, like Schizophrenia and Schizoaffective disorder, as well as Bipolar I Disorder, require permanent duty limitations and service member’s will be referred for a medical review board upon initial diagnosis. The nature of these diagnoses and their treatment requirements are beyond the scope of the Active Duty component (however, it is very much integral to the Veteran Affairs medical which is not limited to medicine, but also housing assistance and career assistance). These diagnoses often warrant long-term treatment with medication, therapy, and case management services that are not available in all geographic locations and specifically within an austere environment of a deployed setting or long training mission. This would significantly impact the training, location, and job abilities of the service member, therefore permanent duty limitations are placed and a medical evaluation board is initiated.
4. Specific Medications: Antipsychotics and Mood Stabilizers
Each military branch has its own regulations on specific types of psychotropic medications, especially those prescribed for long-term mental health management, such as antipsychotics and mood stabilizers. The differing regulations stem from the different constraints placed on various occupations and the availability of medications and services. An example of differing medication requirements can be seen when looking at the occupational requirements for a pilot versus a supply specialist. With that said, psychotropic medications are frequently used within the military services. Service members, once having established there are no significant side effects upon initial use, oftentimes do not require duty limitations and can work as usual. When considering a deployment, different geographic locations have different mandates on medications due to the availability of services in that region. Prior to deployments, service members undergo readiness screeners to ensure that their medications fall within the parameters of that region or see if there is a possibility to obtain a waiver for those medications. A good rule of thumb for any military service is if antipsychotics and mood stabilizers are required for stabilization and long-term care, then permanent duty limitations would be placed and a medical retirement is likely warranted. These medications carry potentially significant side effects, require consistent monitoring, and would be difficult to store and dispense in austere environments. In summary, each military branch has its own regulations governing medication use within their services. Also, psychotropic medications are commonly used within the DoD’s Behavioral Health system. Screeners are therefore conducted by their behavioral health personnel to help determine if duty limitations are required due to the service member’s specific job constraints and deployment needs.
Conclusion
Military readiness assessments occur consistently throughout the DoD/DHA Health Services. These evaluations help determine if service members require temporary or permanent duty limitations, which impacts overall mission readiness for commanders. The behavioral health aspect of these evaluations considers safety, symptom severity, diagnoses, and medications as crucial pieces for determining duty limitations. These evaluations not only protect the individual service member but also ensure the safety of their peers and the overall success of the mission. By carefully balancing the need for mental health treatment with the demands of military service, the Armed Forces strive to maintain a force that is both healthy and ready for the challenges they may face.
Click here for Part 1: "What is Readiness and Why is it So Important?"
Click here for Part 3: "Private Sector Providers and Readiness"
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Amanda McCabe, Psy.D., is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and delivers training on a variety of evidence-based therapies. Prior to the CDP, Dr. McCabe served as a clinical psychologist in the Army from 2013 to 2024.