As the military healthcare system adjusts course to align with the Department of Defense’s focus on warfighter readiness, Navy medicine, in concert with the Defense Health Agency, is working to ensure both a ready medical force and a medically ready force. To do so, Navy medicine must find innovative ways to integrate with operational units to provide adequate support and keep sailors mission-ready at sea. One of these innovations is virtual mental health care.
Poor mental health can have disastrous consequences if not addressed urgently and effectively. Previously, however, the primary option to provide sailors at sea with acute mental health care was a costly and potentially hazardous emergency medical evacuation to the nearest ashore facility, an evolution that can result in the ship losing many on-station mission days. Using shipboard technology to treat patients virtually was merely conceptual. A secure video teleconference consultation for a sailor at sea (a “VT-Sea”) with a shore-based medical specialist had been demonstrated only once, in 2018, as a proof-of-concept for non-emergent cases. The success of the VT-Sea consultation on board the Arleigh Burke–class guided-missile destroyer USS Chung-Hoon (DDG-93) was captured in “Treatment on the Waves: Exploring the Potential of Medical VT-Sea,” published by Carrier Strike Group 3 on the Defense Visual Information Distribution Service.
But in 2019, the mental health staff at U.S. Naval Hospital Rota, Spain, used their knowledge of the 2018 Chung-Hoon proof-of-concept to collaborate with Navy destroyers homeported at Naval Station Rota and mental health professionals at Destroyer Squadron 60 in Naples, Italy, to explore expanding VT-Sea care for mental health patients at sea. This pilot focused on acute patients, broadening the virtual health aperture, with the goal of providing sailors adequate care while under way, thereby limiting the need for medical evacuation and enabling the ships to remain on station to accomplish their missions.
Using VT-Sea, mental health specialists also were able to rapidly determine if a sailor needed emergency evacuation. Some evacuations always may be necessary, but the fewer the better. A cost analysis conducted by Naval Hospital Rota estimated a medical evacuation from sea costs as much as $175,000 and incurs on average 60 workdays lost, in addition to the operational impact to the mission of losing key personnel. In 2018, 12 sailors from Destroyer Squadron 60 required medical evacuation from sea for acute mental health concerns, costing an estimated $2.4 million and 720 manpower days lost.
Prior to launching the Naval Hospital Rota VT-Sea pilot program in August 2019, the embedded mental health professional at Destroyer Squadron 60, a licensed clinical social worker, conducted connectivity testing with the four destroyers homeported at Rota to demonstrate a reliable service that meets the current standard of care. During the ensuing pilot, mental health evaluations and treatments were offered to sailors who had expressed acute distress while at sea, with full support from the ships’ independent duty corpsmen, commanding officers, and the commodore of Destroyer Squadron 60.
From August to December 2019, a total of 11 sailors received mental health services through the Naval Hospital Rota VT-Sea pilot program. One patient was properly identified for medical evacuation, while the remaining 10 sailors stayed on board for the duration of the mission. These 10 sailors were provided acute mental health treatment on returning to Rota, as determined during the VT-Sea evaluations. Following deployment of mental health VT-Sea in 2019, there was only one mental health–related medical evacuation over the same five-month period—an 80 percent reduction in medical evacuations compared with 2018, when the average was one per month.
It is difficult to prove a causal relationship from such a limited data pool, but it is likely that all 11 sailors diagnosed with acute mental health crises would have been evacuated had they not had access to mental health VT-Sea. It also is possible that just knowing there was readily accessible specialty care while at sea provided a form of support for mental health patients. Successfully evaluating and treating a sailor using VT-Sea increases warfighter readiness. According to Captain Joseph Gagliano, the Destroyer Squadron 60 commodore, “Building and sustaining resilient sailors is at the core of our combat readiness, and our embedded mental health team is excelling in that task by speaking directly with the sailors when combat readiness matters most . . . at sea.”
The implications of the Naval Hospital Rota mental health VT-Sea pilot are potentially far-reaching. The system could reasonably be used for other medical issues to assist the decision-making process for medical evacuation. Extending virtual care delivery across the medical spectrum could further decrease mission disruption, saving money and preventing days off station, and allow Navy medicine to more fully integrate into operations at sea. As the Navy continues to modernize, it is imperative that Navy medicine make the best use of cutting-edge communications technology, acknowledging that medicine is just one of many competing priorities operational commanders must balance while at sea and in harm’s way.
The author would like to thank Lieutenant Commanders Rebecca Miranda, Christopher Weiss, and Brandon Hadfield; Commanders Andrew McDermott and David A. Paz; and Captain Timothy Quast for their assistance with this article.
