From the U.S. Government Accountability Office, www.gao.gov Transcript for: Federal Efforts Related to Serious Mental Illness Description: Audio interview by GAO staff with Linda Kohn, Director, Health Care Related GAO Work: GAO-15-113: Mental Health: HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness Released: February 2015 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's February 2015. The U.S. mental health care system has a range of federal programs for the millions of Americans with mental illness. A team led by Linda Kohn, a director in GAO's Health Care team, recently studied federal efforts to support individuals with serious mental illness. GAO's Jacques Arsenault sat down with Linda to talk about what they found. [ Jacques Arsenault: ] How many federal programs are there to support individuals with serious mental illnesses? [ Linda Kohn: ] We identified a lot of federal programs that support this population. Serious mental illness includes conditions such as schizophrenia, bipolar disorder, major depression, and severe post-traumatic stress disorder—PTSD. We identified by asking the agencies—we identified about 100 programs across 8 different departments and agencies that generally supported people with serious mental illness—that was in fiscal year 2013. And what that means is they sponsor programs that address broad, social issues such as homelessness, but they can also serve people that have serious mental illness. Now, within that hundred programs, we also identified a smaller number—about 30—that specifically targeted individuals with serious mental illness, meaning that the specific mission of that program—the focus of that program—is the seriously mentally ill. What was interesting about this work is that the number of programs serving this population seems like pretty basic information, but generally that information was not known. How many of these programs are sponsored by federal agencies to support this very vulnerable population. [ Jacques Arsenault: ] That sounds like a lot of programs. Can you talk about how these programs and agencies are coordinating with each other? [ Linda Kohn: ] We identified some coordination efforts, particularly at a programmatic level. For example, one of the programs that the agencies identified for us is a program that is with the Department of Justice, in an agency within Health and Human Services, the Substance Abuse and Mental Health Services Administration, or SAMSA. Well, SAMSA and Justice have a program that directs people with serious mental illness out of the criminal justice system and into more community-based treatment. There have been some coordination efforts among the agencies within HHS, and there have been some inter-agency efforts. But generally, those inter-agency efforts have been focused on broad, social issues, like as I noted before, homelessness. At the program level, staff told us they are talking to each other and they do take steps to coordinate their activities. So, for example, I mentioned before the program that SAMSA and Justice do together. VA and HUD work together on a program for homeless veterans that may pull in people with mental illness as well. So there is some coordination activities happening at the programmatic level. At a higher level, we did not identify as many activities that were in place. [ Jacques Arsenault: ] So then, what recommendations is GAO making to federal agencies involved in mental healthcare? [ Linda Kohn: ] Given the number of programs we identified, and given that they were spread across 8 different departments and agencies, our main recommendation calls on HHS to establish a mechanism to facilitate more inter-agency coordination. We called on HHS because they had many of the programs that are sponsored for this population. And because the Substance Abuse and Mental Health Services Administration—the agency within HHS—is required, as part of its mission, to promote program coordination in this area throughout the federal government. So we believe that interagency coordination across the federal government could be improved. We came as close as we could to a list of the federal programs for the seriously mentally ill. But what we don't know, for example, is whether we have the right number of programs. Do we have the right mix of programs? Are federal resources being used as effectively as possible? Program level staff may not be in the best position to know that. So we call on HHS to improve interagency coordination, and give greater attention to that over-arching perspective. [ Jacques Arsenault: ] And finally, what do you see as the bottom line of this report? [ Linda Kohn: ] Millions of people's lives and families are affected by serious mental illness. Given the number of federal programs that are in place, given that they cross multiple departments and agencies, we strongly believe that leadership from HHS is needed to foster greater coordination to make sure we're meeting the needs of this very vulnerable population. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.