By Sarah Cunningham, Ph.D.
May 6, 2021

U.S. Air Force photo by Airman 1st Class Abbey Rieves

Research findings indicate that mental health technicians may be underutilized in Military Health System mental health clinics, often occupying primarily administrative roles. However, MHTs are uniquely positioned to serve as mental health care extenders and operational support by virtue of their specialized training and status as peers to fellow enlisted service members. Some MHTs may not be integrated into the key clinic functions for which they are qualified because of a lack of understanding among clinic leaders of their skills and training. The optimization of MHTs in outpatient mental health clinics has the potential to greatly improve service members' access to quality care and reduce burden on providers.

The Psychological Health Center of Excellence Mental Health Technician Work Group suggests there are four primary barriers to optimizing utilization of MHTs:

• Time – MHTs have limited time to engage in training, and providers have limited time to provide supervision.
• Trust – Providers may lack sufficient knowledge of MHT training background to fully trust MHT clinical skills.
• Training – Training and proficiency standards for MHTs vary across services, and subsequent on-the-job training varies across clinics.
• Policy – DOD lacks enterprise-wide policies for the integration of MHTs into clinical care.

Scientific literature indicates that providers, MHTs, and the overall clinic/system can benefit from the integration and utilization of MHTs into clinical care. Potential benefits include:

Providers	MHTs	Clinic/System
Reduced burn-out Increased job satisfaction Increased time	Improved readiness for deployment Meeting on-the-job training requirements Increased job satisfaction Improved sense of value	Improved clinic workflow Improved access to care Greater clinic morale Higher patient satisfaction

Improved integration and optimization can be accomplished by the formal training of MHTs, providers, and clinic leaders in how best to optimize the role of MHTs in clinical practice.

The Defense Health Agency Practice-Based Implementation Network helps to facilitate the rapid translation of research into clinical practice in the MHS. It pilots evidence-based practices, policies, and programs at MHS locations throughout the U.S. and overseas. To promote and support the optimization of MHTs in MHS mental health clinics, the PBI Network is launching the MHT Optimization Pilot.

Participants in this pilot will receive live interactive virtual trainings in how to optimize the contributions of MHTs in core clinical functions, and in strategies for best integrating MHTs into care delivery. Participants also will receive a suite of electronic tools which will guide the clinical supervision of MHTs and will provide regular consultations with an implementation expert. To participate in the pilot, sites are required to: 1) be outpatient mental health clinics; 2) have leadership support; and 3) provide the following:

• One internal facilitator who meets the following requirements:
  • Have authority to make clinic-level changes to facilitate the integration of MHTs into clinical care delivery
  • Be responsible for working with the PBI Network and local pilot participants to develop, implement, and monitor clinic action plans and problem solve any implementation challenges
  • Participate in regular facilitation calls with PBI Network facilitators and coordinate with pilot participants to support pilot implementation
• At least two MHTs (exceptions may be made on a case-to-case basis)
• One licensed provider who will provide supervision to pilot MHTs

Results from this pilot will be shared with the Mental Health Clinical Community and other relevant stakeholders to support further training and utilization of MHTs in the MHS.

If you're interested in participating in the MHT Optimization Pilot or have questions, please email the PBI Network.

Sarah Cunningham, Ph.D. is a licensed clinical psychologist and evidence-based practice subject matter expert who provides contract support to the Psychological Health Center of Excellence. Her specialties include evidenced-based treatment delivery for comorbid substance use disorders and PTSD as well as women and minority mental health.