Staff Perspective: A Behavioral Health Force Multiplier - Leveraging the Chaplain Corps to Bridge the Mental Health Access Gap
There’s no question the level of need for mental health care surpasses the number of providers available in both civilian and military behavioral health care systems. We’ve seen the impact of the growing need for care on clients ever increasing wait times for initial and follow-up appointments as well as the impact on providers who are experiencing burnout and other occupational hazards at unprecedented rates. So, what is it that we can do?
Providers are working tirelessly to meet the current demand and it still hasn’t been enough to overcome the level of need that exists. We hear recommendations for evidence-based psychotherapies (EBP), which use time-limited models of care where clients seek treatment for a presenting concern, complete an EBP, and then return to care later should additional issues arise. This operates in comparison to the historical psychotherapy model of clients remaining in care for indefinite time periods while receiving supportive counseling. EBPs are a great tool for ensuring the highest quality provision of services, while also serving the greatest number of clients that one can. However, the resounding message heard on the calls that I have with providers, both civilian and military, from across the nation is that they continue to have an insurmountable demand that has not stopped or slowed.
During the COVID-19 pandemic, I was activated on Title 32 federal orders as a Behavioral Health Officer in the Indiana Army National Guard. When it became clear our mission would be sustaining for a long period of time and we were serving virtually every community within Indiana, there became a need to formalize the team that would support the behavioral health of National Guard soldiers and airmen who were activated within the state. Out of this need, the Resiliency and Emotional Support Team (REST) was established. On our joint team, we had Army and Air Force Chaplains, Religious Affairs Specialists, and Behavioral Health Officers. We would conduct battlefield circulation, visiting soldiers and airmen in locations all over the state to check on their health and welfare and connect service members to behavioral health or other resources that were needed. Some days this meant driving 8+ hours to assist a service member in accessing urgent care. Other days this would be connecting with soldiers providing support to prisons and discussing the challenges they were facing coping in a new environment. One thing that became clear rather quickly was the need to leverage the strengths of each of the team members to serve such a wide geographic region and variety of needs most effectively.
At first glance, one might expect chaplains and mental health clinicians to perform very different functions. However, when explored deeper, the complementary approaches between the two disciplines start to emerge. A recent article published in February 2023 by Cooper, et al. highlights the unique and specialized role military chaplains have in the spectrum of care for service members and the benefits and potential opportunities for collaboration with mental health clinicians. The authors discuss how chaplains incorporate the component of spiritual care into the overall health and wellness of service members which can be a critical area that is missed in traditional mental health care. Chaplains in military settings also have the benefit of offering complete confidentiality for service members which can encourage their willingness to seek out care for both acute and chronic concerns (Cooper, et al., 2023). In contrast, military behavioral health providers have limits of confidentiality requiring them to report concerns of risk of harm to self or others, a threat to the mission, and abuse or neglect. Due, in part, to the variability in confidentiality requirements, chaplains can serve as a trusted entry point into receiving supportive services for a myriad of concerns (Cooper, et al., 2023).
Chaplains serve a variety of roles in military settings, at times offering faith-based life skills training, advising commanders on the impact of military operations on spiritual health, and providing supportive counseling to enhance resiliency and coping skills (Cooper, et al., 2023). Chaplains are required to complete theological training and be endorsed by a religious organization however when they function in a military capacity, they provide care to all, regardless of whether a service member has a differing or even an absence of religious affiliation (Cooper, et al., 2023). Chaplains can use approaches similar to mental health clinicians such as empathic listening, engaging individuals in problem-solving, and cognitive-behavioral techniques (Cooper, et al., 2023). Chaplains, however, are not mental health providers and refer to more specialized care when encountering issues outside of their training and scope of practice (Cooper, et al., 2023).
An important consideration when assessing the impact of the Chaplain Corps is a finding outlined in DoD’s Health-Related Behaviors Survey which has shown an increased willingness among service members of color to pursue care with a chaplain over traditional mental health providers (Cooper, et al., 2023). With the framework of intersectionality and diversity, equity, and inclusion in mind the intentional integration of Chaplaincy into the mental health spectrum of care is critical to ensure service members of color have trusted resources available to access.
In a recent, unprompted, encounter with MAJ James Noll of the Indiana Army National Guard, a fellow Behavioral Health Officer (BHO), he stated, “I like having chaplains as a safety net before Behavioral Health. A lot of times, they just need an ear and not necessarily a BHO.” A key difference Cooper et al. (2023) identified was, in keeping with the message from MAJ Noll, which states that the mental health clinician’s primary role is in the assessment, diagnosis, and treatment of mental health conditions. It is not always the case that service members need this level of intervention. The presence of a well-trained military chaplain who can provide supportive counseling to service members in times of crises can help enhance resilience and potentially mitigate more severe issues (Cooper, et al., 2023). As I quickly learned when I was providing COVID support, the Chaplain Corps regularly deals with day-to-day life crises and are well equipped to assist service members in managing these issues.
After consistently working together on REST, our team cohesion and understanding of each of our unique skill sets strengthened allowing us to seamlessly refer service members to the most appropriate point of contact. Sometimes that meant me, as the BHO, referring service members who were concerned about confidentiality to a trusted chaplain for support. I knew when making these referrals, if the chaplain encountered issues outside of their skill set, they would reach out for support and guidance. I also knew, based on multiple experiences, that the chaplain may in fact be able to develop trust with the service member to the point that they could, quite literally, walk alongside them through the process of accessing behavioral health care. This connection, on many occasions, kept service members from falling through the proverbial cracks.
Thanks to the phenomenal team who opened my eyes to the benefits of collaborating with the Chaplain Corps, I was able to confidently implement my belief that I want service members to get access to the care they need, even if it’s not with me. I encourage military behavioral health providers to seek out opportunities to connect with and invite chaplains into conversations about care for service members. Civilian providers also serve an important role and can have conversations with military-connected clients about leveraging the well-honed support of military chaplains. It may just be the link we need to increase access to care for people in need while also supporting mental health providers in their efforts to meet the growing demand for care.
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.
Jennifer Nevers, LCSW, is a Program Associate for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of the Star Behavioral Health Providers Program (SBHP). SBHP trains civilian behavioral health providers to work with service members, veterans, and their families.
References
Cooper, D. C., Evans, C. A., Chari, S. A., Campbell, M. S., & Hoyt, T. (2023). Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities. Psychological Services, 20(1), 56–65. https://doi.org/10.1037/ser0000661
There’s no question the level of need for mental health care surpasses the number of providers available in both civilian and military behavioral health care systems. We’ve seen the impact of the growing need for care on clients ever increasing wait times for initial and follow-up appointments as well as the impact on providers who are experiencing burnout and other occupational hazards at unprecedented rates. So, what is it that we can do?
Providers are working tirelessly to meet the current demand and it still hasn’t been enough to overcome the level of need that exists. We hear recommendations for evidence-based psychotherapies (EBP), which use time-limited models of care where clients seek treatment for a presenting concern, complete an EBP, and then return to care later should additional issues arise. This operates in comparison to the historical psychotherapy model of clients remaining in care for indefinite time periods while receiving supportive counseling. EBPs are a great tool for ensuring the highest quality provision of services, while also serving the greatest number of clients that one can. However, the resounding message heard on the calls that I have with providers, both civilian and military, from across the nation is that they continue to have an insurmountable demand that has not stopped or slowed.
During the COVID-19 pandemic, I was activated on Title 32 federal orders as a Behavioral Health Officer in the Indiana Army National Guard. When it became clear our mission would be sustaining for a long period of time and we were serving virtually every community within Indiana, there became a need to formalize the team that would support the behavioral health of National Guard soldiers and airmen who were activated within the state. Out of this need, the Resiliency and Emotional Support Team (REST) was established. On our joint team, we had Army and Air Force Chaplains, Religious Affairs Specialists, and Behavioral Health Officers. We would conduct battlefield circulation, visiting soldiers and airmen in locations all over the state to check on their health and welfare and connect service members to behavioral health or other resources that were needed. Some days this meant driving 8+ hours to assist a service member in accessing urgent care. Other days this would be connecting with soldiers providing support to prisons and discussing the challenges they were facing coping in a new environment. One thing that became clear rather quickly was the need to leverage the strengths of each of the team members to serve such a wide geographic region and variety of needs most effectively.
At first glance, one might expect chaplains and mental health clinicians to perform very different functions. However, when explored deeper, the complementary approaches between the two disciplines start to emerge. A recent article published in February 2023 by Cooper, et al. highlights the unique and specialized role military chaplains have in the spectrum of care for service members and the benefits and potential opportunities for collaboration with mental health clinicians. The authors discuss how chaplains incorporate the component of spiritual care into the overall health and wellness of service members which can be a critical area that is missed in traditional mental health care. Chaplains in military settings also have the benefit of offering complete confidentiality for service members which can encourage their willingness to seek out care for both acute and chronic concerns (Cooper, et al., 2023). In contrast, military behavioral health providers have limits of confidentiality requiring them to report concerns of risk of harm to self or others, a threat to the mission, and abuse or neglect. Due, in part, to the variability in confidentiality requirements, chaplains can serve as a trusted entry point into receiving supportive services for a myriad of concerns (Cooper, et al., 2023).
Chaplains serve a variety of roles in military settings, at times offering faith-based life skills training, advising commanders on the impact of military operations on spiritual health, and providing supportive counseling to enhance resiliency and coping skills (Cooper, et al., 2023). Chaplains are required to complete theological training and be endorsed by a religious organization however when they function in a military capacity, they provide care to all, regardless of whether a service member has a differing or even an absence of religious affiliation (Cooper, et al., 2023). Chaplains can use approaches similar to mental health clinicians such as empathic listening, engaging individuals in problem-solving, and cognitive-behavioral techniques (Cooper, et al., 2023). Chaplains, however, are not mental health providers and refer to more specialized care when encountering issues outside of their training and scope of practice (Cooper, et al., 2023).
An important consideration when assessing the impact of the Chaplain Corps is a finding outlined in DoD’s Health-Related Behaviors Survey which has shown an increased willingness among service members of color to pursue care with a chaplain over traditional mental health providers (Cooper, et al., 2023). With the framework of intersectionality and diversity, equity, and inclusion in mind the intentional integration of Chaplaincy into the mental health spectrum of care is critical to ensure service members of color have trusted resources available to access.
In a recent, unprompted, encounter with MAJ James Noll of the Indiana Army National Guard, a fellow Behavioral Health Officer (BHO), he stated, “I like having chaplains as a safety net before Behavioral Health. A lot of times, they just need an ear and not necessarily a BHO.” A key difference Cooper et al. (2023) identified was, in keeping with the message from MAJ Noll, which states that the mental health clinician’s primary role is in the assessment, diagnosis, and treatment of mental health conditions. It is not always the case that service members need this level of intervention. The presence of a well-trained military chaplain who can provide supportive counseling to service members in times of crises can help enhance resilience and potentially mitigate more severe issues (Cooper, et al., 2023). As I quickly learned when I was providing COVID support, the Chaplain Corps regularly deals with day-to-day life crises and are well equipped to assist service members in managing these issues.
After consistently working together on REST, our team cohesion and understanding of each of our unique skill sets strengthened allowing us to seamlessly refer service members to the most appropriate point of contact. Sometimes that meant me, as the BHO, referring service members who were concerned about confidentiality to a trusted chaplain for support. I knew when making these referrals, if the chaplain encountered issues outside of their skill set, they would reach out for support and guidance. I also knew, based on multiple experiences, that the chaplain may in fact be able to develop trust with the service member to the point that they could, quite literally, walk alongside them through the process of accessing behavioral health care. This connection, on many occasions, kept service members from falling through the proverbial cracks.
Thanks to the phenomenal team who opened my eyes to the benefits of collaborating with the Chaplain Corps, I was able to confidently implement my belief that I want service members to get access to the care they need, even if it’s not with me. I encourage military behavioral health providers to seek out opportunities to connect with and invite chaplains into conversations about care for service members. Civilian providers also serve an important role and can have conversations with military-connected clients about leveraging the well-honed support of military chaplains. It may just be the link we need to increase access to care for people in need while also supporting mental health providers in their efforts to meet the growing demand for care.
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.
Jennifer Nevers, LCSW, is a Program Associate for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of the Star Behavioral Health Providers Program (SBHP). SBHP trains civilian behavioral health providers to work with service members, veterans, and their families.
References
Cooper, D. C., Evans, C. A., Chari, S. A., Campbell, M. S., & Hoyt, T. (2023). Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities. Psychological Services, 20(1), 56–65. https://doi.org/10.1037/ser0000661