Effectiveness of Mental Health Clinical Training Programs Cannot Be Evaluated

HRD-84-37: Published: Jun 12, 1984. Publicly Released: Jun 14, 1984.

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In response to a congressional request, GAO reviewed the extent to which the National Institute of Mental Health (NIMH) has allocated clinical training funds among mental health disciplines during fiscal years 1980 through 1983 and targeted such funds to priority mental health needs.

Accurate nationwide data on the supply and distribution of various mental health providers would help NIMH focus its clinical training grants in areas with identified shortages. GAO found that inherent problems exist in developing such data because of lack of staff and funding resources and lack of universal definitions of the various mental health professions. In addition, licensing and certification requirements vary among the States which do not collect data on mental health providers. GAO noted that, during fiscal years 1980 through 1983, Congress identified 18 funding priorities for the NIMH clinical training program, which generally paralleled the recommendations of the President's Commission on Mental Health. NIMH estimated the number of grants and funding amounts that addressed the various priorities but did not develop data on the extent to which project funds were actually used for priorities. Although NIMH policies encourage participants of clinical training projects to work in underserved locations, NIMH does not routinely follow up to determine where grantees or trainees work after graduation. GAO found that, because of inadequate reporting and monitoring systems, NIMH finds it difficult to enforce the payback obligations of students receiving stipends. Finally, GAO noted that uncertainty about the continuation of the clinical training program and decreases in funding and staffing have affected NIMH evaluation efforts.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Due to the continued shortages of funds and staff needed to develop more precise data on program effectiveness, and the continued uncertainty of receiving funds each fiscal year, NIMH stated that it will have to continue to use estimates.

    Recommendation: The Secretary of Health and Human Services should discuss with cognizant congressional committees the acceptability of continuing to use estimates as the bases for measuring program effectiveness.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: Despite NIMH awareness of the need for more precise program effectiveness measurements, the continued shortages of funds and staff have made it impossible for NIMH to initiate any actions concerning this recommendation and it is unlikely that any actions will occur in the near future.

    Recommendation: The Secretary of Health and Human Services should instruct the Director, NIMH, to estimate the funds and staff needed to develop reliable data to measure program effectiveness for Congress to consider.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should direct the Director, NIMH, to develop a system requiring recipients of stipends with payback obligations to report to NIMH, in a timely fashion, as to how they are satisfying that obligation and a system for monitoring this process and enforcing the payback obligation.

    Agency Affected: Department of Health and Human Services


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