Top Enlisted Sailor Says Service Members Should Be Able to Access Mental Health Care Without a Referral

A room plaque for mental health facility.
A room plaque for the 341st Operational Medical Readiness Squadron mental health flight is pictured inside the base clinic June 23, 2021, at Malmstrom Air Force Base Mont. (U.S. Air Force photo by Heather Heiney)

The Navy's top enlisted sailor thinks service members should be able to directly access mental health treatment without having to wait for a referral from their primary care provider.

Addressing a House Appropriations subcommittee Tuesday during a hearing in Washington, D.C., Master Chief Petty Officer of the Navy James Honea said that, while mental health services under Tricare are expanding, active-duty service members still must get an appointment with their regular doctor to get a referral.

That requirement means "increasing the wait time, therefore missing the intent of more accessible health care," he said.

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Honea noted that, while military family members can directly access mental health through programs such as Doctor on Demand and Telemynd through Tricare, active-duty personnel don't have that benefit.

Active-duty service members may seek mental health service at a military treatment facility without a referral, but they cannot directly access private care or telehealth without one.

He called on Congress to give service members similar immediate access to mental health care via telemedicine.

"They make that first appointment to try to sit down with their primary care provider," Honea told members of the Subcommittee on Military Construction, Veterans Affairs, and Related Agencies.

"That will be some amount of time, and then add that to the referral approval process, and then they can make an appointment."

Last year, 77 active-duty and Reserve Navy sailors died by suicide, according to Honea. At least three have died since the start of the year -- all sailors assigned to aircraft carriers undergoing retrofits.

In the six months that he has had his job, Honea said he has signed 56 condolence letters to families of sailors who died by suicide.

"One life lost is too many. I want to invest more energy into prevention tools and resources that create positive climates that improve sailors' lives both personally and professionally," Honea said.

The number of suicides across the services declined in 2021 by 15%, according to data released in October. The Army had 176 deaths by suicide, up 2 from the previous year, while the Marine Corps saw 43, down from 63 in 2020; the Navy, 58, down from 65 the previous year; and the Air Force, a 40% decline -- 51 vice 82 the previous year.

Chief Master Sergeant of the Air Force JoAnne Bass, testifying alongside Honea, attributed her service's drop to decisions to change policies that fostered stigma against mental health treatment. She also pointed to efforts, in the face of a shortage of mental health providers, to lean on other agencies and increase access to telehealth appointments while promoting leaders who have the "interpersonal skills to actually be the leaders we need them to be."

The COVID-19 pandemic spurred broad expansion of telehealth in the Defense Department's military health system and through the Tricare health program, which serves 9.4 million active-duty members, retirees and family members.

Lawmakers said they understood the strain placed on the services and their need to expand mental health care treatment options, as well as improve other quality-of-life issues -- housing, pay and child care -- to relieve stress on troops and their families.

"Services such as Doctor on Demand and telemedicine are highly requested, but the services still struggle with long wait times and service members' need for referrals before they can access mental health services. This is a big deal," said Rep. David Valadao, R-Calif.

"We don't yet have the president's budget," said Rep. Debbie Wasserman Schultz, D-Fla., ranking member of the subcommittee. "But I'm hopeful it will include a strong request for military construction funding that addresses many of the quality-of-life issues."

Editor's note: This story has been updated to clarify that service members can get mental health treatment at military hospitals or clinics without a referral from their primary care physician.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime.

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