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    Subject Term: "Mental health"

    17 publications with a total of 56 open recommendations including 2 priority recommendations
    Director: Gretta L. Goodwin
    Phone: (202) 512-8777

    5 open recommendations
    Recommendation: To better understand the available opportunities for collecting inmate health care utilization data, BOP should conduct a cost-effectiveness analysis of potential solutions, and take steps toward implementation of the most effective solution.

    Agency: Department of Justice: Bureau of Prisons
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To better understand the available opportunities for controlling health care costs, BOP should implement its guidance to conduct "spend analyses" of BOP's health care spending, using data sources already available

    Agency: Department of Justice: Bureau of Prisons
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To determine the actual or likely effectiveness of its ongoing or planned health care cost control initiatives, BOP should evaluate the extent to which its initiatives achieve their cost control aim.

    Agency: Department of Justice: Bureau of Prisons
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To enhance its strategic planning for and implementation of health care cost control efforts, BOP should incorporate elements of a sound planning approach and (1) establish a means of measuring progress toward and effectiveness of its activities for its current strategic objectives and goals related to controlling health care costs; and (2) identify the resources and investments necessary for implementation of its planned health care cost control initiatives.

    Agency: Department of Justice: Bureau of Prisons
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To improve the reliability and utility of its Federal Medical Center mission analyses, BOP should document the analyses and findings that underlie its recommendations.

    Agency: Department of Justice: Bureau of Prisons
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    5 open recommendations
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to screening certain servicemembers, including servicemembers separating in lieu of trial by court-martial, for PTSD and TBI and reviewing the results prior to separation for misconduct.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should direct the Air Force and Navy to address inconsistencies with DOD policy in their policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to screening certain servicemembers for PTSD and TBI prior to separation for misconduct.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to training servicemembers, including officers, on how to identify mild TBI symptoms in the deployed setting.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To increase its assurance that PTSD and TBI are appropriately considered prior to separating certain servicemembers from the military for misconduct, the Secretary of Defense should ensure that the military services routinely monitor adherence to policies related to counseling about VA benefits and services during the process of separating certain servicemembers for misconduct.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    6 open recommendations
    Recommendation: To help ensure that program staff are being used in an effective and efficient manner, and to facilitate the consideration and identification of total force solutions for staffing sexual assault prevention and response and Sexual Harassment/Assault Response and Prevention (SHARP) programs throughout the Department of the Army, the Secretary of Defense should direct the Secretary of the Army, in coordination with the Chiefs of the National Guard Bureau and the Army Reserve, to conduct an evaluation of staffing approaches used to administer the sexual assault prevention and response program, and consider opportunities to leverage resources across all Army components. This evaluation should include an assessment of the number and allocation of full-time and collateral-duty personnel, the fill rates for program positions, and the types of positions used.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that Army National Guard and Army Reserve program staff have the necessary information to develop their budgets and to help ensure the efficient and effective use of program funds, the Secretary of Defense should direct the Secretary of the Army to direct the Army National Guard SHARP Program Office to communicate and disseminate its guidance on budget development and execution for the SHARP program to all full-time SHARP program personnel.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that Army National Guard and Army Reserve program staff have the necessary information to develop their budgets and to help ensure the efficient and effective use of program funds, the Secretary of Defense should direct the Secretary of the Army to direct the Army Reserve SHARP Program Office to develop clear guidance on budget development and execution for the SHARP program and disseminate this guidance to its full-time SHARP program personnel.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that Army National Guard and Army Reserve program staff have the necessary information to develop their budgets and to help ensure the efficient and effective use of program funds, the Secretary of Defense should direct the Secretary of the Army to direct the Director of the Army SHARP Program Office to expand the scope of the midyear review to include monitoring and providing oversight of SHARP program expenditures at the Army National Guard state and Army Reserve command level.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that sexual assault crimes involving Army National Guard members are investigated in a timely manner, with a full investigation of the offense regardless of the reserve component or duty status of the victim, the Secretary of Defense should direct the Chief of the National Guard Bureau, in collaboration with the secretaries of the military departments as appropriate, to reassess the Office of Complex Administrative Investigation's (OCI) timeliness and resources to determine how to improve the timeliness of processing sexual assault investigations involving members of the Army National Guard, and identify the resources needed to improve the timeliness of these investigations.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: To help ensure that victims of sexual assault in the Army Reserve have timely access to medical and mental health-care services without having to pay for their care upfront, if they are eligible for care paid for or provided by DOD, the Secretary of Defense should direct the Secretary of the Army to direct the Chief of the Army Reserve to develop and implement an expedited line-of-duty determination process for Army Reserve sexual assault victims, along with a method for tracking the length of time to make the determinations. When developing this process, the Chief should ensure that it allows soldiers who wish to file a confidential or restricted report to go through the determination process without disclosing their circumstances to the chain of command.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    8 open recommendations
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to incorporate medical screening questions specific to gambling disorder as part of a systematic screening process across DOD, such as DOD's annual Periodic Health Assessment, for behavioral and mental-health issues.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to update DOD Instruction 1010.04, Problematic Substance Use by DOD Personnel, to explicitly include gambling disorder as defined in the 2013 Diagnostic and Statistical Manual of Mental Disorders.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Secretary of the Army to update Army Regulation 600-85, The Army Substance Abuse Program, to explicitly include gambling disorder.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Secretary of the Navy to update Naval Operations Instruction 5350.4D, Navy Alcohol and Drug Abuse Prevention and Control, to explicitly include gambling disorder.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Secretary of the Air Force to update Air Force Instruction 44-121, Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program, to explicitly include gambling disorder.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Commandant of the Marine Corps to update Marine Corps Order 5300.17, Marine Corps Substance Abuse Program, to explicitly include gambling disorder.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commandant of the Coast Guard should update Commandant Instruction M6000.1F, Coast Guard Medical Manual, to classify gambling disorder as an addiction and not as an impulse control issue.

    Agency: Department of Homeland Security: United States Coast Guard
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commandant of the Coast Guard should update Commandant Instruction M1000.10, Coast Guard Drug and Alcohol Abuse Program, to explicitly include gambling disorder.

    Agency: Department of Homeland Security: United States Coast Guard
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Kay E. Brown
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: To help states effectively address ongoing challenges related to ensuring the appropriate use of psychotropic medications for children in foster care, the Secretary of HHS should consider cost-effective ways to convene state child welfare, Medicaid, and other stakeholders to promote collaboration and information sharing within and across states on psychotropic medication oversight.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS agreed with this recommendation and provided examples of the virtual convening of contingency groups they employed to provide technical assistance and peer to peer networking in child welfare. The agency plans to offer additional technical assistance that is specifically related to the topic of mental health and psychotropic medication. GAO will consider closing the recommendation when the agency completes these efforts.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: To enhance oversight of access to mental health care and help ensure that servicemembers have timely access to mental health care, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to establish an access standard for mental health follow-up appointments and regularly monitor data on these appointments.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    7 open recommendations
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to collect and monitor deployed civilians' perceptions related to mental health care.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to leverage recommendations made by the RAND Corporation in its 2014 report on mental health stigma in the military to update and clarify policies as needed to remove stigmatizing provisions, such as career restrictions that may be too limiting for individuals who have received mental health care.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to establish a clear, consistent definition of those barriers to care generally understood by DOD as "mental health care stigma," to include explanations of its causes or contributing risk factors and ways that stigma is apparent in behaviors and policies.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to establish goals for efforts to address barriers to care generally understood by DOD as "stigma reduction efforts," and performance measures that link to these goals.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to develop a method to collect and analyze information on barriers to seeking mental health care, including stigma, so that reliable data may be gathered and used to measure the effectiveness of stigma reduction efforts over time.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to designate an entity to coordinate efforts to reduce mental health care stigma, among other barriers to care.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Secretary of Defense should direct the Under Secretary of Defense for Intelligence to reissue consolidated guidance, incorporating subsequent updates for the denial or suspension of access to classified information and for assignment to sensitive duties based solely on information about mental health care.

    Agency: Department of Defense
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Debra Draper
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Secretary of Defense should direct the Secretary of the Army to implement processes to review and monitor the Army military treatment facility prescribing practices for medications discouraged under the PTSD guideline and address identified deviations.

    Agency: Department of Defense
    Status: Open

    Comments: We requested an update on the status of this recommendation. As of June 21, 2016, we are waiting for a response from DOD.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    5 open recommendations
    Recommendation: To improve the effectiveness of DOD's strategy for preventing sexual assault in the military, as part of the department's next biennial update to the 2014-16 sexual-assault prevention strategy, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Secretaries of the military departments, to link sexual-assault prevention activities with desired outcomes.

    Agency: Department of Defense
    Status: Open

    Comments: DOD action in progress. DOD is conducting assessments at large installations that reflect a cross-section of each of the service's cultures and result in the development of the 2017-2021 DOD Sexual Assault Prevention Plan of Action. According to department officials, the plan will link risks and protective factors.
    Recommendation: To improve the effectiveness of DOD's strategy for preventing sexual assault in the military, as part of the department's next biennial update to the 2014-16 sexual-assault prevention strategy, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Secretaries of the military departments, to identify risk and protective factors for all of its domains, including the military community and its leaders.

    Agency: Department of Defense
    Status: Open

    Comments: DOD action in progress. DOD is conducting assessments at large installations that reflect a cross-section of each of the service's cultures and will inform the development of the 2017-2021 DOD Sexual Assault Prevention Plan of Action. According to department officials, the plan will identify risk and protective factors for all domains, including military community and leaders.
    Recommendation: To help ensure widespread adoption and implementation of DOD's sexual-assault prevention strategy and to fulfill its role as a framework that can assist leaders and planners in the development of appropriate tasks, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Secretaries of the military departments, to communicate and disseminate DOD's prevention strategy and its purpose to the appropriate levels of program personnel as well as their roles and responsibilities for its implementation.

    Agency: Department of Defense
    Status: Open

    Comments: DOD action in progress. According to DOD officials, DOD's 2017-2021 Sexual Assault Prevention Plan of Action will include a comprehensive communications roll-out plan to ensure every level of DOD understands its role in prevention.
    Recommendation: To help improve DOD's ability to measure the effectiveness of the department's efforts in preventing sexual assault in the military, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military departments, to fully develop the department's performance measures for the prevention of sexual assault so that the measures include all key attributes of successful performance measures.

    Agency: Department of Defense
    Status: Open

    Comments: DOD action in progress. DOD is conducting a feasibility assessment to identify metrics that will detect impacts of prevention efforts and show progress on reducing risk and prevalence of sexual assault. The results will be included in the 2017-2021 DOD Sexual Assault Prevention Plan of Action.
    Recommendation: To help ensure widespread adoption and implementation of DOD's sexual-assault prevention strategy and to fulfill its role as a framework that can assist leaders and planners in the development of appropriate tasks, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in conjunction with the Secretaries of the military departments, to ensure the military services' Sexual Assault Prevention and Response policies are aligned with the department's prevention strategy.

    Agency: Department of Defense
    Status: Open

    Comments: DOD action in progress. As part of its development of the department's 2017-2021 Sexual Assault Prevention Plan of Action, DOD is working to align military service sexual assault prevention policies with the department's overarching sexual assault prevention strategy.
    Director: Brenda S. Farrell
    Phone: (202) 512-3604

    6 open recommendations
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help DOD's sexual assault prevention and response program realize the full benefit of the data it collects on sexual assault incidents, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop a plan for data-driven decision making to prioritize program efforts.

    Agency: Department of Defense
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to develop clear goals with associated metrics to drive the changes needed to address sexual assaults of males and articulate these goals, for example in the department's next sexual assault prevention strategy.

    Agency: Department of Defense
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to include information about the sexual victimization of males in communications to servicemembers that are used to raise awareness of sexual assault and the department's efforts to prevent and respond to it.

    Agency: Department of Defense
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to address challenges faced by male servicemembers as DOD continues to seek to transform its culture to address sexual assault, the Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Secretaries of the military services, to revise sexual assault prevention and response training to more comprehensively and directly address the incidence of male servicemembers being sexually assaulted and how certain behavior and activities--like hazing--can constitute a sexual assault.

    Agency: Department of Defense
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help ensure that all of DOD's medical and mental health providers are generally aware of any gender-specific needs of sexual assault victims, and that victims are provided the care that most effectively meets those needs, the Assistant Secretary of Defense for Health Affairs should, in collaboration with the services' Surgeons General, systematically evaluate the extent to which differences exist in the medical and mental health-care needs of male and female sexual assault victims, and the care regimen, if any, that will best meet those needs.

    Agency: Department of Defense: Office of the Assistant Secretary of Defense (Health Affairs)
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Recommendation: To improve DOD's ability to prevent sexual assaults of male servicemembers, to increase its responsiveness to male servicemembers who are sexually assaulted, and to help ensure that all of DOD's medical and mental health providers are generally aware of any gender-specific needs of sexual assault victims, and that victims are provided the care that most effectively meets those needs, the Assistant Secretary of Defense for Health Affairs should, in collaboration with the services' Surgeons General, develop and issue guidance for the department's medical and mental health providers--and other personnel, as appropriate--based on the results of this evaluation that delineates these gender-specific distinctions and the care regimen that is recommended to most effectively meet those needs.

    Agency: Department of Defense: Office of the Assistant Secretary of Defense (Health Affairs)
    Status: Open

    Comments: DOD was contacted on July 26, 2016 for an update on efforts to address this recommendation and responded that they are working on the report required by the NDAA on male victims of sexual assault and they believe that the report will, at a minimum, take some steps to address this recommendation. DOD also noted that the report required by the NDAA is due in the first quarter of FY 17 and that they will provide us with a copy once it has been approved. We will provide updated information when we confirm any actions the agency has taken in response to this recommendation.
    Director: Randall B. Williamson
    Phone: (202) 512-7114

    4 open recommendations
    Recommendation: To ensure DHA can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to ensure DHA, through the PHRAMS contractor, continue to refine PHRAMS to incorporate the needs of the military services to reduce the need for additional service-specific methods of determining mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: To ensure the Defense Health Agency (DHA) can accurately and consistently assess mental health provider staffing needs across each of the military services, the Secretary of Defense should direct the Secretaries of the Army, Air Force, and Navy to require the medical commands of each military service to report any additional service-specific methods they use to determine their final estimates of mental health provider staffing needs.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Recommendation: The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to require the National Capital Region Medical Directorate to include its estimated mental health provider staffing needs generated through PHRAMS in the requirements fields of DHA's quarterly mental health staffing reports.

    Agency: Department of Defense
    Status: Open

    Comments: As of July 2017, DOD officials have not implemented this recommendation. GAO considers it to be open. We will update the status of this recommendation when we receive additional information.
    Director: Linda Kohn
    Phone: (202) 512-7114

    2 open recommendations
    Recommendation: To help determine if programs are effective at supporting those individuals with serious mental illness, the Secretaries of Defense, Health and Human Services, Veterans Affairs, and the Attorney General--which oversee programs targeting individuals with serious mental illness--should document which of their programs targeted for individuals with serious mental illness should be evaluated and how often such evaluations should be completed.

    Agency: Department of Defense
    Status: Open

    Comments: The Department of Defense's position is that it already engages in periodic program evaluation of its psychological health programs as required. It noted that on November 24, 2014, the Under Secretary of Defense for Personnel and Readiness directed the Military Departments and other Department of Defense components to assist in an initiative to evaluate Psychological Health and Traumatic Brain Injury programs across the Department of Defense. As of September 2017, we have not received a further update on the Department of Defense's actions. We will continue to monitor these efforts and seek to determine whether they result in documentation of which programs should be evaluated and how such evaluations should be completed.
    Recommendation: To help determine if programs are effective at supporting those individuals with serious mental illness, the Secretaries of Defense, Health and Human Services, Veterans Affairs, and the Attorney General--which oversee programs targeting individuals with serious mental illness--should document which of their programs targeted for individuals with serious mental illness should be evaluated and how often such evaluations should be completed.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: HHS did not concur with this recommendation. The Helping Families in Mental Health Crisis Reform Act of 2016 enacted in December 2016 included a requirement for HHS to develop a strategy for conducting ongoing evaluations of programs related to mental illness--including serious mental illness--and substance use disorders. As of August 2017, HHS is in the process of preparing a report that identifies key programs and activities across the department, as well as summarizes data on those programs and develops criteria for use in prioritizing programs for evaluation. However, this report is not yet complete. We will continue to monitor HHS's efforts in this regard and look for documentation of HHS plans for future evaluations of programs for individuals with serious mental illness.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    including 1 priority recommendation
    Recommendation: The Secretary of Veterans Affairs should take steps to better understand both the difficulties faced by readjusting veterans and the characteristics of those who may be more likely to face such difficulties, and use the results to determine how best to enhance its benefits and services to these veterans.

    Agency: Department of Veterans Affairs
    Status: Open
    Priority recommendation

    Comments: VA has begun taking steps to better understand the difficulties faced by readjusting veterans but has not yet completed them. Since November 2014, VA reported that it has been working with DOD to develop the joint process for conducting Care Coordination Process Reviews (formerly known as Qualitative Case Reviews), which will focus on reviewing care coordination processes and effectiveness. VA's Interagency Care Coordination Committee (IC3) Policy and Oversight Work Group is revising the policies and procedures for these reviews and has begun a national roll out of the Lead Coordinator initiative, which, according to VA, will improve the level of complex care coordination within and between DOD and VA. After completing a tabletop exercise of case review presentations on October 3, 2016, VA identified areas which needed fine tuning, so it developed open forums for lead coordinators to discuss process and resources. In an effort to enhance its briefings under the Transition Assistance Program, now known as the Transition Goals, Plans, Success program, VA used participant satisfaction data and is developing a long-term survey instrument that will assist VA in identifying and tracking recommended process improvements. In January 2015, VA produced a report on veteran economic competitiveness that recommended that VA develop targeted strategies for vulnerable populations, such as veterans who separate from the military without a GED or high school diploma and veterans who are separating after their rehabilitation. The report also recommended that VA continue to research the educational and economic status of veterans and coordinate with other federal agencies to identify and address gaps in current programs and policies that may result in barriers to economic success among vulnerable segments of the veteran population. GAO will consider this recommendation closed when VA has completed the joint Care Coordination Process Reviews, developed the long-term survey instrument for the Transition Goals, Plans, and Success program, and used the results from these reviews and survey to determine how best to enhance its benefits and services to veterans.
    Director: Stephen M. Lord
    Phone: (202) 512-6722

    1 open recommendations
    Recommendation: To assist states that rely on or are planning to contract with an MCO to administer Medicaid prescription benefits, and to help provide effective oversight of psychotropic medications prescribed to children in foster care, the Secretary of Health and Human Services should issue guidance to state Medicaid, child-welfare, and mental-health officials regarding prescription-drug monitoring and oversight for children in foster care receiving psychotropic medications through MCOs.

    Agency: Department of Health and Human Services
    Status: Open

    Comments: In a July 2016 written response, Health and Human Services (HHS) stated that the Centers for Medicare & Medicaid Services (CMS) in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued an informational bulletin in August 2012 and in July 2013, that addressed this recommendation. However, in the report, we acknowledged that CMS issued this bulletin along with other guidance. Further, as we stated in our report, the HHS guidance did not address third-party MCOs administering medications. We continue to believe that additional HHS guidance that helps states implement oversight strategies within the context of a managed-care environment is needed to help ensure appropriate monitoring of psychotropic medications prescribed to children in foster care.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to develop new measures of long-term employment that go beyond the minimum 60 days of post-placement monitoring that is currently required. In developing measures, the Secretary of Veterans Affairs should direct the Under Secretary for Benefits to consider the feasibility of using results from planned post-closure surveys of veterans as a data source.

    Agency: Department of Veterans Affairs
    Status: Open

    Comments: As of March 2017, VA continues to develop its new Vocational Rehabilitation and Employment Case Management System (VRE-CMS). The expected date of implementation for this system is September 2018, and it will enable VA to track participants' status post-case closure. VA indicated that after this system has been operational for six months and initial data have been collected on participants' post-case closure outcomes, the agency will develop new performance metrics tied to these outcomes. VA also indicated that it is exploring the possibility of tracking VR&E participants post-closure earnings data through a data sharing agreement with the Social Security Administration. To close this recommendation as implemented, VA will need to demonstrate that it has developed and implemented performance metrics related to long-term employment outcomes.
    Director: Cosgrove, James C
    Phone: (202)512-7029

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To increase D-SNPs' accountability and ensure that CMS has the information it needs to determine whether D-SNPs are providing the services needed by dual-eligible beneficiaries, especially those who are most vulnerable, the Administrator of CMS should conduct an evaluation of the extent to which D-SNPs have provided sufficient and appropriate care to the population they serve, and report the results in a timely manner.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of October 2016, HHS has not implemented this recommendation. CMS noted that, in 2012, they conducted two independent reviews to evaluate how well SNPs, including D-SNPs, developed and implemented a quality improvement tool used to ensure that the unique needs of SNP enrollees are identified and addressed through the plan's care management practices. However, CMS has not conducted an evaluation of the extent to which D-SNPs have provided sufficient and appropriate care to the population they serve. In prior updates, CMS officials said that they were uncertain whether an evaluation of D-SNPs would be conducted in the future, since the likelihood of an evaluation would be dependent on availability of funding for an independent contract. However, they noted that, to the extent that CMS is able to develop solid care coordination outcome measures (which would be incorporated into the HEDIS requirements), that they expect these measures will serve as key indicators of D-SNP performance. For this recommendation to be closed as implemented, CMS will need to conduct an evaluation of the extent to which D-SNPs have provided sufficient and appropriate care to the population they serve.
    Director: Williamson, Randall B
    Phone: (206)287-4860

    1 open recommendations
    Recommendation: To help DOD obtain reasonable assurance that all active and Reserve component servicemembers to whom the PDHRA requirement applies are provided the opportunity to have their health concerns identified, the Assistant Secretary of Defense for Health Affairs and the military services should take steps to ensure that PDHRA questionnaires are included in DOD's central repository for each of these servicemembers.

    Agency: Department of Defense
    Status: Open

    Comments: In its comments to this report, the Department of Defense (DOD) concurred with this recommendation. On October 2009, DOD's Force Health Protection and Response Office sent a memo to each of the military service Surgeons General emphasizing the need for the post-deployment health reassessment (PDHRA) to be offered to all service members who are eligible to complete the assessment. In 2010, DOD's noted that the services would work with the Armed Forces Health Surveillance Center (AFHSC) repository to ensure PDHRAs are submitted correctly, without transmission errors. DOD's 2011 case records showed that the Air Force and Army had developed data verification processes to ensure that AFHSC received PDHRAs. Further, the Defense Medical Data Center (DMDC) had planed to create a file consisting of the date of deployment for deployed personnel, and that the file would be available to the services in order to match DMDC with data from each of the service-specific systems, in accordance to requirements. In September 2011, although DMDC and the services had agreed to match rosters of deployed service members, there were still inconsistencies in deployment dates. In March 2012, DOD was still verifying data inconsistencies which, until resolved, leads to inaccurate reporting based on errors in the deployment dates.