The New Mexico National Guard's behavioral health team is made up of civilian contractors, and state and military behavioral health officers. (Andrew Theen/Medill)

ALBUQUERQUE – The federal government provides each state with a baseline of mental health resources, according to National Guard leaders, but each state’s guard is responsible for building up additional services.

“It’s a patchwork nation,” said Capt. Joan Hunter, director of psychological health for the National Guard Bureau in Washington. “There’s geography, there’s cultural, there’s regional differences within the National Guard, which can be strengths and challenges.”

Capt. Brian Pilgrim, a former Marine and current behavioral health officer for the state of New Mexico, said large rural states present particular challenges. “When you get into tiny little towns in northern New Mexico with populations of 250, you’re not going to have a psychologist and a psychiatrist with a private practice there.”

The New Mexico National Guard has six family assistance centers, two behavioral health officers in military uniform who work alongside family services and the state psychological health officer. Therese Sanchez, the state family program director, said community-based assistance centers and providers are an especially helpful resource for the guard and their families because “we are the community, we don’t leave.”

Grappling with budget shortfalls and provider shortages, California’s National Guard partnered with TriWest, a major military health care contractor, to pioneer the Embedded Provider Program, which assigns a behavioral health professional to individual guard units. Using trained civilian professionals part-time for drill weekends helps the program keep costs down and meet demand, according to Col. Darc Keller of the California National Guard.

With the third largest military population in the United States, North Carolina recognized National Guard health care networks could not handle the swell of returning service members alone and coordinated with state and community resources. “We all work together collaboratively to close the gaps that exist because service members have been falling through the cracks of no fault of their own for 10 years,” said Stephanie Nissen, North Carolina’s behavioral health programs director.

The North Carolina National Guard Integrated Behavioral Health System includes a toll-free number through which service members and their families can initiate a cascade of behavioral health care services with a single call. The line went live on Nov. 1, 2010, at 8 a.m. The first call came through 18 minutes later – more than 800 followed in the first year.

“I’m comfortable in thinking that we’ve stopped some significant suicides,” Nissen said.