K–12 Education: DOD Needs to Assess Its Capacity to Provide Mental Health Services to Students

Fast Facts

Schools across the country are concerned about student mental health, especially since the pandemic. DOD schools employ school psychologists and counselors to help meet students' mental health needs.

But these staff said they rarely had time to work with students to prevent crises due to competing responsibilities and other challenges.

Several DOD programs embed additional mental health services in many DOD schools. But these programs often don't coordinate and aren't always available to students with the greatest needs. Evaluating its programs would help DOD better understand what's working and what isn't.

We recommended addressing such issues.

A student siting in a counseling session

Highlights

What GAO Found

The Department of Defense Education Activity (DODEA) educated more than 65,000 military-connected pre-K-12 students in 160 schools worldwide in school year 2023–24. GAO found that, like U.S. public school students, DODEA students have experienced increasing mental health concerns in recent years. Per GAO analysis, DODEA schools assessed one in 50 students for suicide risk in each of school years 2022–23 and 2023–24 in response to an identified mental health concern. In all 27 DODEA schools GAO visited worldwide, school leaders described more frequent and acute concerns (see figure).

Student Mental Health Concerns Shared by Leaders in Select DOD Schools

School psychologists and school counselors told GAO they rarely had time to work with students to prevent crises due to competing responsibilities and heavy administrative workloads, such as testing coordination duties. Such staff are key to successfully implementing DODEA's Multi-Tiered System of Supports (MTSS) framework—an evidence-based approach to help schools identify and proactively address student needs and build resilience. However, DODEA has not assessed its workforce capacity to implement MTSS with fidelity. Federal workforce planning principles include identifying and addressing human capital needs. Without a workforce plan, DODEA may be unaware of resource gaps that could hinder its success—particularly in light of DOD's recent directives to optimize its civilian workforce.

DOD has not assured that the three mental health programs it operates in DODEA schools meet student needs. First, none of the programs have been evaluated, contrary to DOD policy. The largest—Military and Family Life Counseling (MFLC)—places nonclinical counselors in nearly every DODEA school. However, school leaders raised concerns about the program, including poor collaboration with school staff and high turnover among counselors. Second, DOD has not assured that these programs provide the right mix of services to meet student needs. School leaders, parents, and military treatment facility staff all told GAO that DODEA students need additional clinical mental health care. Two programs provide clinical services in some DODEA schools. However, these programs are small—embedding one clinician in DODEA schools for every four non-clinical MFLC counselors. Further, DOD has not facilitated collaboration among these programs to assure that they provide the right mix of services to meet DODEA student needs. GAO has reported that collaboration can help agency components address cross-cutting challenges—such as responding to student mental health needs. Collaboration could help DOD better assure that these programs provide the right mix of services to meet DODEA student needs, in line with leading practices and its own goals.

Why GAO Did This Study

DOD research has found that military families and children face severe barriers to accessing mental health care, harming family well-being and military readiness. Without proper treatment, children with mental health concerns are at risk of school failure, substance misuse, and suicide.

Senate Report 118-58 includes a provision for GAO to examine mental health services in DODEA schools. This review examines (1) mental health concerns of DODEA students, (2) DODEA's capacity to implement its new MTSS framework, and (3) the extent to which DOD has assessed how well mental health programs in DODEA schools meet student needs and their collaboration in doing so.

GAO analyzed suicide-related incident data collected by DODEA for school years 2022–23 and 2023–24, the most recent data available. GAO also conducted site visits to 27 schools and eight military treatment facilities on 11 military installations across DODEA's three regions. GAO interviewed DOD and DODEA officials, reviewed relevant federal laws, policies, and procedures, and assessed DOD actions against policy and relevant federal standards.

Recommendations

GAO is making seven recommendations to DOD, including to assess capacity to implement MTSS, to evaluate its programs that provide mental health services in DODEA schools, and assure that these programs collaborate to align their services with student needs. DOD agreed or partially agreed with six recommendations, and disagreed with one, which GAO maintains is valid.

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Defense	The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to develop and disseminate guidance to schools for assigning standardized testing coordination responsibilities to school leaders. This guidance should discourage schools from relying on school counselors as standardized testing coordinators. (Recommendation 1)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to assess the capacity of its workforce to provide the continuum of behavioral supports indicated in its MTSS framework. This assessment should consider the capacity of school psychologists and school counselors. (Recommendation 2)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Deputy Under Secretary of Defense for Personnel and Readiness should direct the DODEA Director to develop a plan based on the results of its workforce assessment to address any identified gaps in workforce capacity that could hinder the success of its MTSS initiative. (Recommendation 3)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Deputy Under Secretary of Defense for Personnel and Readiness should direct the Director of Military Community Support Programs to evaluate the MFLC program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 4)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of the Army should direct the Director of the Directorate of Prevention, Resilience, and Readiness to evaluate the ASACS program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 5)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Deputy Under Secretary of Defense for Personnel and Readiness should direct the Director of the Defense Health Agency to evaluate the School Behavioral Health program's use in DODEA schools, seeking feedback from DODEA headquarters staff and school leaders, and develop a plan to address any areas of concern identified through its evaluation. (Recommendation 6)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to assure that the ASACS, MFLC, and School Behavioral Health programs collaborate to align their services to meet DODEA student mental health needs. In doing so, and in line with leading practices on federal collaborative efforts, the programs should define common outcomes, identify and sustain leadership for the effort, and involve relevant stakeholders, including DODEA. (Recommendation 7)	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.