Hello, I am Lt. Cmdr. Derek Miletich, and I am the Commander Submarine Force Pacific Force, Psychiatrist. I am excited to discuss the recently created embedded Mental Health Program (eMHP) which started in 2016. It is a sincere passion of mine to provide mental health care for our Sailors and personnel assigned within the COMSUBPAC. Due to the newness of this program, many people don’t know a whole lot about it, and they don’t know about the huge benefits it offers should they need mental health help. Here are some common questions that I have received about eMHP:
Q: What is the embedded Mental Health Program (eMHP) anyway?
A: The embedded Mental Health Program (eMHP) is a new mental health care delivery model that was started at SUBPAC in 2016. The goal of eMHP is to give Sailors and personnel attached to SUBPAC commands expeditious access to mental health care in an effective manner that addresses the unique concerns related to each case, with the expectation of returning patients to “Full Duty.” Several important factors set eMHP apart from the typical Military Treatment Facility (MTF) mental health clinic that many Sailors have experienced or heard of in the past:
1.) Unlike at MTFs, eMHP providers are assigned to the same military unit as the Sailors they care for. This allows for a very personalized care system, where the Sailors at the command can build a relationship with the eMHP provider. The eMHP provider “breaks bread” with them, just like other staff at the command do, such as chaplains and supply staff. Sailors know that should they ever need help, the eMHP provider has “got their back”. In addition, the eMHP providers are able to create a “team-centric” approach and work closely with other command support elements such as Chaplains and Fleet and Family Support Centers (FFSC) to create a tailored care plan that best meets the patient’s needs. This is a stark contrast to the typical MTF mental health clinics, where the mental health providers often care for service members from an entire military region (tens of thousands of patients) from several branches of military services (Navy, Army, Air Force, etc.). At an MTF, it can be hard to build these relationships seen in the eMHP model due to the fact that the Sailor and MTF provider never see each other besides when they have a medical appointment. Coordination with command elements such as Chaplains and FFSC can be challenging as well, due to the lack of regular contact.
2.) eMHP providers are organic to the operational unit to which they are assigned. This means that they are truly a part of the crew, just like any other member of the unit. The eMHP provider is able to obtain “cultural competence,” in that they truly understand the stresses and strains that are unique to the submarine community they serve, and because of this, they are able to care for their patients better. They ride on submarines and they visit the waterfront and the boats to assess if there are any mental health concerns arising from any members of the crews. Because of this, the eMHP provider is able to take more of a preventive approach through early identification and early treatment. In addition, they perform briefings to commands and crews on topics such as improving resiliency, education on self-care and coping with stress, with the intent of optimizing Sailors’ performance to the maximal extent possible. This is a big difference from the MTF mental health clinic, where providers only work in the clinic, never being able to go to the waterfront to perform these functions.
3.) (This one should actually be #1 on the list) The role of eMHP is to do whatever is possible to SAVE SAILORS’ NAVY CAREERS AND KEEP THEIR QUALIFICATIONS. Literally, eMHP providers will bend over backward to keep Sailors on full duty while they are receiving mental health care. If a Sailor has symptoms severe enough to warrant placement on Limited Duty so they can receive effective treatment, the eMHP provider’s #1 goal is to effectively treat the Sailor and obtain a waiver to return them to Full Duty as soon as possible. One of the big perceptions and stigmas often associated with the “MTF mental health” approach, is the perception that if a Sailor goes to the mental health clinic for help, he/she will be removed from their job, lose any special qualifications they have (such as being disqualified for Submarines), and they will possibly be separated from the Navy. With eMHP, this couldn’t be further from the truth!
4.) Because eMHP is located within the operational unit, they are able to deliver care in a very effective method that utilizes the factors of being “Close, Quick, and Known.” This method has been tried and tested in battlefield combat care dating at least as far back as World War I as one of the best ways to help service members overcome stress and mental health symptoms. This is in direct contrast to some perceptions of MTF mental health as being “in a clinic far away, that it takes forever to be seen for an appointment, with patients having to deal with traffic and parking issues, and Sailors don’t know what to expect when they see the mental health provider---i.e. “Will I be separated???”, “Will I be disqualified from Subs???” With eMHP, all of these problems are improved:
Close: Sailors are seen by the eMHP provider at the waterfront eMHP clinic (for example, at Pearl Harbor, it is located in proximity to the NSSC Medical Department) rather than the Sailor having to travel long distances to be seen by mental health at an MTF. The eMHP provider team manages most, if not all, mental health care directly at the waterfront clinic. In rare circumstances where further evaluation for psychological testing or certain medication evaluations are needed, Sailors may be referred to an MTF for a few visits, but the eMHP is always the “primary” case manager and the “go-to” person to talk to if Sailors have any questions or concerns about their care. Sailors won’t “get lost in the shuffle” like what some may perceive happens at large medical centers.
Quick: Because the eMHP provider is organic to the unit, patients can be seen much quicker than at MTF mental health clinics which can have a wait time of 4+ weeks to be seen due to the large populations they provide service for. With eMHP, based on the circumstances of the specific patient case, wait time ranges from the same day to about 1 week.
Known: Because he/she is organic to the operational unit, goes on boat rides, and makes boat visits, the eMHP provider is known by the crews and the crews also know what to expect when they see the eMHP provider (i.e., that the eMHP provider is truly there to SAVE SAILORS’ CAREERS). The eMHP provider has the goal to keep and return Sailors to Full Duty as expeditiously as possible and the crews know this!
Q: Has eMHP been shown to actually work?
A: Yes!!! The military eMHP concept has been around for almost 20 years. The results are overwhelmingly showing that eMHP has had a huge impact in SAVING SAILORS’ CAREERS because eMHP providers can quickly get Sailors the help they need in a convenient manner and because Sailors know and expect that they will return to duty. The military eMHP model started out in aircraft carriers in the late 1990’s. They saw a decrease in MEDEVACs by 85% and a decrease in administrative separations by 93%. Surface Forces started eMHP in the early 2010’s and showed similar results of MEDEVACs decreasing year by year (zero MEDEVACs on the most recent USS Boxer 2016 deployment). Due to these successes, Submarine Forces started an eMHP pilot program at CSS-6 in Norfolk in 2013, and showed a very impressive decrease in unplanned losses from 22 per year to only 2 in 2016!
Q: Who can I talk with if I want to be seen by an eMHP provider?
A: Either talk with the Independent Duty Corpsman on your boat and let them know that you would like to be scheduled to be seen by eMHP or stop by the waterfront medical clinic (NSSC Medical) and let them know that you would like to be seen by eMHP. In some SUBPAC sites such as at Pearl Harbor, you can also directly talk with the Psychiatric Technicians who are visiting boats about once per month. You can also call directly to the medical clinic and request to be scheduled to be seen by eMHP.
Q: So then, what will happen once I’ve been scheduled to see an eMHP provider?
A: The eMHP provider will meet you and do an intake evaluation which typically takes about 1-2 hours. During this encounter, they will get to know you as a person and they will find out what mental health challenges you have been facing. They will ask you comprehensive questions on all of the symptoms you’ve been experiencing so that they can find the best treatment approach to give you the quickest and most effective relief from what you have been suffering. Based on your specific needs, the eMHP provider will then design a personalized treatment plan and follow-up schedule, usually ranging from being seen once every couple of days to once every couple of weeks.
Q: Will the eMHP provider force me to take psychiatric medications? If I take psychiatric medications, does that mean I’ll be disqualified from being on Submarines? Will my career be over???
A: NO! If it is determined by the eMHP provider that your condition would best respond to psychiatric medications, they will discuss this option with you first. If they are discussing this option with you, it is likely because the mental health symptoms you are experiencing are so severe that you will not be able to adequately perform your duties and will likely need to be taken off from Full Duty status because of this. The eMHP provider will give their recommendations to you, but they will not force you to take psychiatric medications against your will.
If you agree to start psychiatric medications, you may need to be placed on Limited Duty for a few months (usually around 3 months) while the mental health condition for which you are treated is being improved by the medication. Once your mental health condition is stabilized and you are no longer experiencing any significant mental health symptoms or side effects from the medications, you will be recommended for a waiver. Once the waiver is approved and finalized you will be returned to Full Duty. This has become a pretty standardized process and waivers are regularly granted. Ultimately, getting early treatment when it is needed will improve the mental health symptoms you have been suffering from, and thus will in all likelihood SAVE YOUR CAREER!
Q: I have other questions about eMHP, who can I talk with about this?
P: Please email me at derek.miletich@navy.mil and I’ll be happy to answer any additional questions you may have and/or direct you to the resources that can help you further.