VA Mental Health Care: Improvements Needed in Tracking and Overseeing Partnerships with Nongovernmental Entities
Fast Facts
The Department of Veterans Affairs partners with nongovernmental groups, like non-profits or universities, through formal agreements aimed at making veterans aware of available suicide prevention programs and mental health services.
Within VA, 7 different offices make these agreements, but information about them isn't tracked centrally. As a result, VA can't readily search or identify all of its suicide prevention and mental health agreements.
VA has designed a system that could track all agreements, but doesn't require its use, and hasn't adequately trained staff on it. We recommended that VA require its use, among other things.
Highlights
What GAO Found
In an effort to reduce veteran suicides, the Department of Veterans Affairs (VA) tries to reach veterans through partnerships with nongovernmental entities using memorandums of agreement (agreements) focused on mental health and suicide prevention efforts. However, VA cannot readily track—that is, search for and identify—the full universe of its suicide prevention and mental health agreements. For example, it took officials from VA and its Veterans Health Administration (VHA) more than 4 months to identify for GAO 43 relevant agreements entered into across seven offices over a 5-year period.
Number of Suicide Prevention and Mental Health Agreements with Nongovernmental Entities across Seven VA and VHA Offices (Oct. 2015 to Oct. 2020)
GAO found that VA cannot readily track its agreements because VA policy does not require use of any single database to store agreement information. VA's Strategic Relationships Application, which VA designed to document agreement information, could be used for tracking, but only four of the seven offices with such agreements used it. Requiring its use would facilitate VA's ability to track all of its agreements and identify areas for improvement to better reach veterans not using its services.
Individual VA and VHA offices conduct ongoing oversight of their own suicide prevention and mental health agreements, as required by VA policy. For example, officials monitor performance metrics such as the number of veterans served. VA policy also requires annual reviews that are used to determine if a partnership is still needed. However, GAO found that officials did not always document the completion of these annual reviews. VA's policy requires that “significant activity” be documented, but it does not specify that annual reviews fall under that category, though officials managing the policy confirmed they do. Providing specificity on what VA wants documented as significant activity—e.g., by adding examples to the policy or providing specific guidance—would help ensure that annual reviews are being documented and maintained for future use.
Why GAO Did This Study
Many veterans struggle with mental health conditions, several of which are risk factors for suicide. VA reported that almost two-thirds of veterans that died by suicide in 2019 did not receive VHA services in 2018 or 2019. VA partners with a variety of entities, such as non-profits or academic institutions, through formal agreements aimed at expanding awareness of and access to suicide prevention activities and mental health services, in part to reach veterans not receiving VHA services.
The Veterans' Care Quality Transparency Act contained a provision for GAO to review VA's agreements with non-VA entities that are related to suicide prevention activities and mental health services. This report examines (1) how VA tracks such agreements with nongovernmental entities across the department, and (2) how VA oversees individual agreements.
GAO reviewed VA and VHA policies, the agreements VA and VHA identified, and related documentation for tracking and oversight. GAO also received demonstrations of two VA databases and interviewed VA and VHA officials and representatives from 14 selected entities that have agreements with VA or VHA with variation in type of entity and services provided.
Recommendations
GAO is making three recommendations, including that VA require use of the Strategic Relationships Application and that VA ensure staff know to document annual reviews as significant activity. VA concurred with these recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require offices department-wide to use the Strategic Relationships Application to document agreement information. (Recommendation 1) |
VA concurred with this recommendation. In November 2024, VA implemented this recommendation by updating its policy related to managing agreements, VA Directive 0008 Developing Non-Monetary Public-Private Partnerships with and Accepting Gifts to VA from Non-Governmental Organizations. The updated directive includes a requirement that VA administration and staff offices ensure information on agreements is documented in the Strategic Relationships Application. The directive includes a list of the minimum level of information to be recorded, such as the name of the entity with which VA has established an agreement, a description of the agreement's purpose or goals and recorded performance measures, and whether the agreement is active or inactive. Requiring the use of the Strategic Relationships Application will facilitate VA's ability to track all of its agreements and identify areas for improvement to better reach veterans not using its services.
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| Department of Veterans Affairs | The Secretary of Veterans Affairs should require training and provide a more comprehensive user guide to officials using the Strategic Relationships Application. (Recommendation 2) |
VA concurred with this recommendation. In March 2025, VA officials told GAO that the agency was updating the user guide for the Strategic Relationships Application. Officials also said that training will be required for users of the application within 45 days of requesting access. To close this recommendation, VA needs to provide documentation of an updated, more comprehensive user guide, as well as documentation of the training requirement.
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| Department of Veterans Affairs | The Secretary of Veterans Affairs should take steps to ensure staff understand that requirements for documenting significant activity for agreements include documenting annual reviews, such as by updating VA's partnership policy with examples or by providing additional guidance. (Recommendation 3) |
VA concurred with this recommendation. In November 2024, VA implemented this recommendation by updating its policy related to managing agreements, VA Directive 0008 Developing Non-Monetary Public-Private Partnerships with and Accepting Gifts to VA from Non-Governmental Organizations. The revised directive does not require annual reviews. However, the directive requires staff to document significant activity, which the updated directive explicitly defines as "any engagement with a [nongovernmental organization] that quantitatively or qualitatively improves or impacts, as demonstrated anecdotally or empirically, the lives of veterans, family members, caregivers, survivors, or other VA beneficiaries." Providing specificity on what VA wants documented as significant activity will help ensure that the information VA deems relevant is being documented and maintained for future use.
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