Can a Military Service Member Get Confidential Mental Health Care?

Commanders make risk decisions daily about personnel in the military context.

Source: U.S. Army photo by LtCol John Hall, in the public domain

Service members at times wonder whether they can go and see a mental health provider without informing their command. The answer isn’t a simple one. This is because the military has to take into consideration any service member’s medical and mental health status and make decisions about what can be supported in the military environment and what realistically cannot. In order to do that, commanders must be able to take into account all variables that may impact mission and safety. They make these risk-based decisions in a military context, which includes weapons, heavy machinery, dangerous environments, operational risk, and remote locations which may have few or no medical and mental health resources. Because of these variables, the military understandably has medical and mental health standards that must be met and sustained in order to keep everyone safe and fully mission capable.

Service members are aware of and understand this. There is a nonstop focus on medical readiness in order to maintain fitness and be ready to deploy at short notice such that preventative medical care is tracked administratively. Additionally, each year service members provide written acknowledgment that they know they must report medical issues, including mental health concerns, that may affect deployability or fitness for duty.

Medical and mental health problems which increase the risk of decreased functioning or medical emergencies are especially concerning. The symptoms of serious mental health conditions, such as psychotic disorders, Major Depressive Disorder, bipolar disorder, and eating disorders may present great risk to individuals and their fellow service members, and require significant treatment and risk mitigation. Because of this, federal law allows for these disclosures by providers via the Military Command Exception within the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This law applies to all mental health providers, not just military providers.

However, what I’ve just described are very serious conditions. For much of the military, the typical problems that someone might want to see a therapist for do not fall into these categories. To provide clarity on what needs to be disclosed, the military issued written regulations in the form of a Department of Defense Instruction, entitled Command Notification Requirements to Dispel Stigma in Providing Mental Health Care to Service Members. Within this document, the military outlines when it is necessary to inform command about mental health care. These specific circumstances are:

• Harm to self. If a medical/mental health provider determines that a service member is a potential danger to themselves, this must be disclosed to the command so that the individual may be treated and the commander can make risk decisions based on the service member’s duties.
• Harm to others. If a medical/mental health provider determines that a service member presents a danger to others, the command must be notified such that processes may be put into place to protect others and facilitate care.
• Harm to mission. If a medical/mental health provider determines that the symptoms of a mental health condition may negatively affect a mission by increasing/causing impulsivity, or impacting insight, reliability, or judgment, the command must be notified.
• Special personnel. The military has a range of duties and specific jobs. All service members must meet requirements for general duty, but some jobs have higher standards due to their physical, emotional, or other requirements. For individuals designated as special personnel (e.g., those with access to nuclear programs), any contact with mental health must be disclosed to the command. Note that unless there are significant symptoms or a serious mental illness, this generally doesn’t impact their ability to receive services or continue working.
• Inpatient care. If a service member is admitted to a mental health unit or an inpatient substance disorder treatment facility, the command must be informed in order to account for the service member and to allow the command to provide both social/unit and logistical support both during the hospitalization and after.
• Acute medical conditions interfering with duty. When a service member is experiencing acute mental health symptoms and/or is being treated for them, this is to be disclosed.
• Substance abuse treatment program. Attendance at any substance disorder treatment program, whether outpatient, residential, or inpatient, must be disclosed to the command, such that the command may make risk-based decisions and ensure resources for aftercare.
• Command Directed Evaluation (CDE). In the case of a CDE, a commander has requested an evaluation due to observed mental health symptoms. This is a legally-regulated evaluation initiated by the command in order to determine if there is a mental-health condition impairing fitness for duty.

With that said, the vast majority of service members seek counseling, therapy, or consultation with a mental health provider, for help with life’s challenges. Grief, relationship breakups, family or couple’s therapy, gaining better coping strategies, learning to adjust to life in the military, managing significant stressors, mild sleep, depressive, or anxiety problems, and the like can be addressed confidentially, per military instruction. Depending on who sees the service member, there may not even be any documentation in the medical record (e.g., Fleet and Family Services Provider, Military & Family Life Counselor, etc.).

The bottom line is that when symptoms or concerns are relatively minor and are the result of life’s stressors, service members may take advantage of confidential mental health support.