Military housing: strengthened oversight needed to make and sustain improvements to living conditions
Abstract: Junior-enlisted service members without dependents (e.g., a spouse or child) typically live in military-managed barracks. GAO reported in September 2023 that some barracks pose serious health and safety risks. As part of site visits to selected installations, GAO observed a variety of living conditions that service members and unit leaders stated were negatively affecting their quality of life, such as sewage overflow, mold and mildew, and broken windows and locks. GAO found numerous challenges in the Department of Defense's (DOD) approach to managing its barracks, including the following: DOD standards for health and safety in barracks were not well defined. Some barracks do not meet DOD standards for privacy and configuration, such as minimum number of bedrooms, in part because the military services' guidance for privacy and configuration do not reflect DOD standards. DOD does not provide sufficient oversight of housing programs for barracks, such as through appropriate guidance or direction to the military services on tracking, assessing, and remediating deficiencies in barracks conditions. GAO's work similarly shows that DOD needs to continue to improve privatized military housing, which includes about 200,000 homes for service members and their families in the United States. Around 2018, reports of lead-based paint and other hazards, such as pest infestation, raised questions about DOD's management of privatized housing. In March 2020, GAO made several recommendations to improve DOD oversight, and DOD has taken steps to implement them. However, in April 2023, GAO reported that gaps remain in DOD's efforts. For example, GAO found that DOD had not (1) set clear and consistent inspection standards for homes undergoing change of occupancy or (2) provided adequate guidance or training to officials on assisting residents in using a new formal dispute resolution process. Improved oversight and addressing GAO's recommendations would position DOD to improve the quality of living conditions for its service members.
Abstract: There are a number of treatments that have an emerging evidence base and could be considered in the management of common mental health conditions affecting veterans. Emerging and adjunct treatments are typically considered when an individual’s adherence or response to accepted or conventional treatment/s is poor (i.e., chronic, treatment-resistant, or treatment-refractory mental health conditions). The aim of the rapid evidence assessment (REA) was to identify and critically evaluate the current evidence on emerging and adjunct treatments for posttraumatic stress disorder (PTSD) and common mental health conditions affecting veterans. From the four databases that were searched, 25 studies met the inclusion criteria, including 12 secondary sources: four (4) systematic reviews (SRs) and eight (8) SRs with accompanying meta-analyses (MAs). The studies within these secondary sources (i.e., those contained within SRs and MAs) were extracted to a database containing the primary sources (i.e., randomised controlled trials, RCTs). From this collated set of articles (281 in total), all studies that did not meet the inclusion criteria were excluded (e.g., cohort and case-control studies), and all duplicate studies were removed (i.e., often the same RCT would appear in multiple SRs and MAs; as well as being directly retrieved by the search strategy). The final set of articles included 13 RCTs. The findings from these studies were narratively synthesised, and risk of bias assessments were conducted for each RCT. Strengths of the REA include the focus on peer-reviewed Level I and Level II evidence (NHMRC, 2009) from scientific journals in the fields of health, medicine, psychiatry, and psychology (including a specialist database developed by the US Department of Veterans’ Affairs focusing on literature relevant to veterans with PTSD). Limitations of the REA include the exclusion of potentially relevant papers that were published prior to 2017 and the exclusion of non-English language papers. It is difficult to draw conclusions and recommendations regarding DCS interventions from the body of evidence considered by the REA. DCS is proposed to enhance fear extinction or extinction learning via partial agonism of the NMDA receptor (neurobiological mechanism of action). Thus, most of the included studies examined the effects of DCS administration in combination with exposure-based psychotherapy for anxiety disorders. Some studies appear to indicate that DCS improves outcomes from evidence-based psychotherapy. However, due to the mixed findings across studies, it is difficult to recommend the use of DCS interventions in specific clinical situations. Further high-quality research is required.