ACA Blog

Natosha Monroe
Nov 18, 2010

Telebehavioral Health in Afghanistan: Increasing Access to Behavioral Health Services

I have currently been working on the 101st Airborne Division’s implementation of what is currently called Telebehavioral Health in this region of Afghanistan. TBH is also currently starting up in Iraq as well. This is just one way the 101st Airborne Division and the Army are addressing behavioral health needs of Troops—of all branches, not just Army—who are deployed to this theater of operation. This past week marked a historical milestone for behavioral health care, in my opinion, as I connected with a psychiatrist miles away so he could offer services to a client sitting in my office.

As you’ve all probably heard, there is seemingly a “shortage” of behavioral health care providers in uniform. While there is currently no initiative to include Licensed Professional Counselors or Therapist to the ranks, this remains a problem. Without giving out exact numbers, let’s just say there are not that many Social Workers, Psychologists, and Psychiatrists in this area of Afghanistan to meet the various BH needs of Troops. The Telebehavioral Health (TBH) initiative is a way to connect to those Troops in smaller operating bases and more remote locations where there are no behavioral health professionals present.

Every single behavioral health professional/asset (to include myself and my Officer-in-Charge, MAJ Sebastian Schnellbacher) I know personally travels to other locations to offer services and support. However, travel restrictions due to volume, weather, and mostly just limitation of available flights to certain areas always create the risk of a traveling professional being stuck extra days at the location. Meanwhile, work is piling up and clients are going without care in their primary location. TBH will help to address these issues by allowing the professional to remain in the primary office location.

Virtual therapy (and the many other names it’s been given) is a hot topic in the field of counseling today. While skeptical at first, I am now a huge supporter of this idea of professional services being made available to individuals. I still don’t think a virtual session can facilitate the same quality as one in person due to aspects of therapy such as non-verbal cues that might be missed due to technology. I also don’t think it should be a primary source of therapy—that’s just my opinion. However, I especially see this as a valuable option in situations such as this where the individual seeking service is in a remote location or is far away from behavioral health care facilities. I could also see this being helpful in other scenarios such as a client who is has physical challenges that make it difficult to travel to an office or clinic.

Clearly there are confidentiality, privacy, and HIPAA-related concerns. I’m not quite sure how this is or should be addressed elsewhere or on the “normal” internet. While I cannot give out specific information, I can tell you these concerns have been given great attention and addressed properly here and there is a secure system in place to protect client rights. In addition, clients are educated about TBH prior to beginning the session, and we also are receiving and utilizing feedback from the first clients to use the system via anonymous surveys.

Not all areas in this region are up and running just yet—we haven’t even gotten the equipment out to one area yet, this is all so new. I’m really excited to be a key coordinator in getting this service out and available to the Troops. We are facing some challenges due to the technological aspects of being in Afghanistan, but we are making great strides and I’ve now seen TBH in action. The Soldiers I worked with liked their experiences (rated 4 and a 5 on a Likert scale with 5 being the highest score) and received the care they needed—so it’s definitely worth the tons of emails, phone calls and policy headaches!



Natosha Monroe is an Army Reserve Mental Health Specialist stationed in Afghanistan. She is a counselor and PhD candidate passionate about increasing Troop access to counseling services. Her blog contents are not representative of the Army or Department of Defense in any way.

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