Embedded Mental Health: Promotion of Psychological Hygiene Within a Submarine Squadron.

INTRODUCTION: Psychological fitness is an important component to operational unit readiness and success. Embedding behavioral health providers can reduce unplanned personnel losses (UPL) as a result of psychological stress. The U.S. Submarine Forces implemented the Submarine Squadron 6 (CSS-6) Embedded Mental Health Pilot (EMHP) Program to address this type of UPL, which is classified as a Code 2 loss. The aim of the study is to evaluate the effectiveness of the EMHP Program at reducing UPL by improving psychological readiness through expedited access to care.

MATERIALS AND METHODS: Using data from the CSS-6 EMHP Program, we identified the cohort of patients who were evaluated and received a full course of treatment from August 1, 2013, to April 30, 2015, and examined their final dispositions. A comparative review of Code 2 losses between 2012 and 2014 was performed to assess for any reduction in the annual incidence of Code 2 losses with EMHP. The Outcome Questionnaire (OQ-45) survey was used to determine the quantitative impact of EMHP on patient psychological readiness. We performed multiple regression analysis to identify any significant correlation between all independent variables and improvement in final OQ-45 scores. We performed logistic regression analysis to assess the logistic score as a function of predicting patient probability of returning vice not returning to duty. The logistic score is a by-product of the end results data and was not an original metric when the program was started. The Clinical Investigations Department at Naval Medical Center, Portsmouth waived this study from institutional review board review. Authorization was obtained from the U.S. Submarine Forces Command Public Affairs Office to publish the contents of this study.

RESULTS: EMHP providers conducted a total of 878 patient sessions for 183 sailors over a 21-month period. There were eight fewer Code 2 losses after 2014, the first full calendar year with EMHP. This decrease in the number of Code 2 losses was in fact statistically significant, given p < 0.001. EMHP providers saw a 200% increase in patient volume and contributed to a 12% decrease in the annual incidence of Code 2 losses in 2014. Seventy patients returning to duty demonstrated clinically and statistically significant improvements in OQ-45 scores at the end of treatment. Only the initial symptomatic distress score on the OQ-45 survey demonstrated any statistical significance of predicting an improvement in OQ-45 composite scores by the end of treatment, given p < 0.01. A negative logistic score was significantly associated with not returning to duty (odds ratio, 16.0; 95% confidence interval, 5.22-49.02; χ2 = 30.63; p < 0.001).

CONCLUSION: The EMHP Program reduced Code 2 losses and positively promoted psychological hygiene for submariners. With the establishment of embedded programs at other squadrons, we can develop a longitudinal study that provides a more inclusive assessment of this model. A future study may be warranted to evaluate the validity of the logistic score as a metric to determine further fitness for submarine duty.