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Key points
- Embedded psychology models are being implemented in earnest across all military services.
- Embedded mental health assets facilitate resources for optimal functioning in healthy service members.
- Strengths of the embedded model are access to care, prevention and early identification of problems, cultural competence, and stigma reduction.
Clinical military psychologists essentially practice in two contexts, in a traditional clinical setting (i.e., clinic or hospital) or as a part of an operational unit (e.g., as the psychologist assigned to a Marine infantry command). The latter is considered embedded psychology, which may be defined as:
The practice of clinical psychology from within a military unit with the goals of enhancing coping strategies, preventing behavioral and mental health problems, early problem identification and intervention, and provision of a focused amount of traditional mental health assessment and treatment.
The movement of military mental health from traditional medical settings to the unit has been spurred by the need to more effectively address the increasing demand for mental health services and concerns over the military suicide rate. Embedded psychology models are being implemented in earnest across all of the services, though it’s not a new concept.
The first formally-recognized embedded military psychologists were those assigned as a part of the Psychology-At-Sea program. In the late 1990s, the Navy began assigning psychologists as the ship’s company to every aircraft carrier.
Since then, there has been a psychologist aboard every carrier, whether the ship is in the yards, in port, or deployed. This program has expanded over the years such that most surface ships have either a mental health provider on board or access to embedded mental health professionals pierside (e.g., psychologist, social worker, psychiatrist, and/or counselors, and behavioral health technicians), with smaller ships sharing assets (e.g., the nine ships based in Pearl Harbor, Hawaii share a team). Additionally, the program has expanded to most other military populations over the years (e.g., ground forces, submarine squadrons, etc.).
One erroneous assumption is that embedded mental health professionals function as a sort of displaced clinic, fulfilling all the roles of a traditional mental health clinic or hospital setting, just at the command. The embedded model is not a re-creation of a traditional clinic. Embedded mental health assets facilitate resources for optimal functioning in healthy service members, serve as consultants to the chain of command, are integrated into the unit such that the range of potential issues may be identified before significant problems arise, and provide clinical assessment and treatment for those who will benefit from short-term, goal-oriented therapy.
Individuals who have been diagnosed with a serious mental illness or who have significant medical co-morbidities (as examples) are better treated within a traditional clinical setting, which has a range of resources and specialty care.
The benefits of embedded psychology are innumerable. The most significant strengths of the embedded model are access to care, prevention and early identification of potential problems, cultural competence of providers, and stigma reduction.
Access to care. When the psychologist’s office is at the unit, seeing the psychologist becomes both logistically and psychologically easier. All unit members know who the psychologist and other mental health providers are and where their offices are. A well-resourced and efficiently run embedded program accepts walk-ins, encourages appropriate curbside consults, and has short wait times for formal appointments.
Prevention and early identification of problems. One of the embedded missions is to provide resources to the unit members so that when individuals are faced with problems, they have well-developed coping skills and understand what resources they have at their disposal to assist. Because the psychologist is always around, and part of the embedded job responsibilities is to spend time in the workspaces of the command, the psychologist is able to liaise with various members of the command, learn about potential problems in workspaces or face individuals in real-time, and work to address them before they become larger problems. This requires a close working relationship with all levels of the chain of command. When mental health services are combined with the support and resources of leadership, service members benefit substantially.
Cultural competence of providers. Cultural competence, or the ability of the mental health provider to make informed decisions in the military context, is significantly enhanced when the provider is specially trained to work with the population in question and is located in that working environment. The provider understands exactly what any given service member does, what the stakes are, and how each individual fits into the overall mission and is better able to make risk assessments and effective recommendations.
Stigma reduction. Because the psychologist is a part of the command, they share experiences with the rest of the unit. Normal everyday activities, such as eating in the galley/chow hall, participating in command PT (physical training), going to the shooting range, and/or sitting through safety briefs, provide service members trust and a familiarity with the embedded mental health assets which normalizes interactions with them. This makes it more likely that a given service member or a member of the chain of command will feel comfortable consulting with the psychologist.
As more providers are embedded, it will become important to remember that an effectively run embedded mental health program refers those with high resource needs to the traditional clinical settings outside of the unit. This ensures the embedded providers have time for rapid touchpoints, assessments, timely short-term treatment, and goal-focused planning in order to maintain sustained performance across the unit.
The increase in embedded resources is promising, and embedded mental health teams may prove to be the most powerful systemic change in our efforts to make a more resilient force and our fight against suicide.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.
