| The purpose of this study was to examine the need and use of outpatient mental health services by active duty members and active duty family members and to determine if the so-called "offset effect" could be detected in this population. Using a subset of the worldwide 1994-95 Department of Defense Health Beneficiary Survey numbering over 26,000 observations, several hypotheses were examined.;Several important findings were made. First, in spite of expectations of a more mentally fit active duty force, active duty members and family members have approximately the same mental health needs. Moreover, the aggregate mental health need (based on mental health status) was not statistically different from that of the general population. These findings defy the expectation that military members are more mentally fit due to entry level screening and programs designed to boost force morale. Second, DoD beneficiaries exhibit lower levels of usage of mental health services general population. The active duty force's underutilization of mental health care is more marked than the underutilization attributable to active duty family members. Paradoxically, the Air Force, the Service with the highest mental health status on average, had the highest mental health utilization rates. The lack of consistency between need for and use of mental health services in the DoD requires further exploration.;The underutilization of ambulatory mental health services suggests that programs for expanding access to care should be considered. Expanding access might result in a cost savings if the so-called "offset effect" was detected in the population, whereby users of mental health care with mental health problems generated fewer costs than nopnusers of such care because unnecessary physical health visits were reduced. However, no evidence of an offset effect was found in the aggregate or any subgroups examined. Instead, expansion of mental health access to those in need of such care, while perhaps beneficial from a quality of care and force readiness perspective, is unlikely to be beneficial from a financial perspective. The absence of an offset effect means that remedying the mental health underutilization problem will not be accomplished easily or inexpensively. |
