As the nation celebrates its 250th birthday, we ought to follow the lead of an institution that is even older: the U.S. Army. Coloradans might be surprised to know that the Army does significantly more than simply defend our country. They also bring comprehensive healthcare, including behavioral health that I wish the majority of my civilian patients had.
The U.S. healthcare system is broken. It is unaffordable and out of reach for millions of Americans — up to 15 million of whom are expected to become uninsured due to sweeping cuts to Medicaid and the Affordable Care Act as part of the H.R.1 bill.
Here in Colorado, some 130,000 people are expected to lose coverage. Medicaid is the single largest payer of mental healthcare in the U.S., and these cuts will disproportionately affect people with behavioral health needs.
The juxtaposition of caring for patients at Denver Health, the safety net healthcare system where I serve as chair of behavioral health, and in my role as an Army psychiatrist in the U.S. Army Reserve is striking.
Providing care at Denver Health is typically the easiest part of my job. So often I worry about safe housing, whether my patients will eat, if they will take their medications, how they will get to and from appointments, and more. I spend hours navigating multiple electronic records, securing authorizations for treatment and trying to get siloed medical systems to talk to each other. Nowhere is siloing more apparent than in behavioral health where it was decided a half century ago that the brain would be treated separately from the rest of the body.
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These days I’m fighting hard for one of my young patients named Mijo. I seldom know when Mijo will show up for appointments or where he sleeps at night, but I always make time to see him. Access to care is essential, and it’s important to me that Mijo knows that ours is a system that will not reject him.
According to a 2022 Department of Health and Human Services Report, the best outcomes for patients happen when medical care is combined with positive social factors like education, employment, housing and community. Many of these supportive elements are imbued into Army life but elude my patients. Only when these social aspects are met can people live healthier lives, which is why I went to medical school in the first place.
I think a lot about Top, a patient from my first deployment to the Middle East in 2014. Top is a career soldier who shares his name with only a few first sergeants chosen to lead their troops. It was a big deal for someone in Top’s position and generation to seek behavioral healthcare, but his wife gave him an ultimatum.
“She said that I have to talk to someone before I come home.” His voice, otherwise gruff, softened on the word home.
Shortly before I met Top, his armored Humvee vehicle was blown up by an improvised explosive device, and he and the other three soldiers inside experienced traumatic brain injury. Top startled easily and shunned daily, public-facing activities like going to the supermarket. Research shows 20% of service members returning from combat should receive mental health treatment for trauma — the sooner the better.
Treating Top was a dream come true for me as an Army psychiatrist. We saw each other 10 times over the course of a few months. Top knew how to follow orders, in this case, doctor’s orders, and everything else was baked into Army life from the clothes he wore to the chow he ate to the freedom from worry knowing that mental health services were easy to access and fully covered.
The psychiatry I practice with soldiers in the Army works because patients have their most basic needs met in a communal environment, and the system is both simple and efficient for providers and patients.
After every deployment, all service members have mandatory mental health screenings and are referred for appropriate follow-up care. Army Reserve soldiers are also required to get mental health assessments and receive direct support at programs coordinated by the Army Reserve Psychological Health Program.
Isn’t it time that two-and-a-half centuries after America was founded we take care of people in civilian life the way we take care of our soldiers? The reality is that we have all the tools we need to create a more streamlined, inclusive healthcare system that merges medical care, behavioral health and health-related social needs. What we lack is the will.
Dr. Christian Thurstone, of Highlands Ranch, is chair of behavioral health at Denver Health and has served three deployments with the U.S. Army. During his most recent tour in 2024, he supervised behavioral health clinicians across 21 nations in the Middle East.
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