Report at a Glance

Provision of Mental Health Counseling Services under TRICARE

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. War fighters are vulnerable to a range of complex and sometimes difficult-to-diagnose conditions, such as posttraumatic stress disorder and traumatic brain injury that may not be recognized until months or years after the precipitating event.

The Department of Defense’s (DoD) 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. Such needs are met by a set of professionals with varied education, training, and expertise. They 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. This requirement distinguishes them from some other mental health professionals, who practice without such restrictions.

In the National Defense Authorization Act for Fiscal Year 2008, Congress requested that the Institute of Medicine (IOM) convene a committee to examine the credentials, preparation, and training of licensed mental health counselors. In this report, sponsored by DoD, the IOM committee makes recommendations for permitting counselors to practice independently under the TRICARE program. In addition, the committee recommends that TRICARE implement a comprehensive quality management system for all of its mental health professionals.

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