Defense Health Care: Additional Information Needed about Mental Health Provider Staffing Needs
Highlights
What GAO Found
In response to the enactment of the National Defense Authorization Act (NDAA) for Fiscal Year 2010, the Department of Defense (DOD) military health system (MHS) increased its mental health provider staffing level by 34 percent. Specifically, DOD increased the number of mental health providers across the MHS from 4,608 providers in fiscal year 2009 to 6,186 providers in fiscal year 2013. Social workers and psychologists were the most frequently added types of mental health providers during this period.
Total Department of Defense (DOD) Mental Health Providers by Provider Type, September 2009 Compared to September 2013
In 2007, DOD created the Psychological Health Risk-Adjusted Model for Staffing (PHRAMS) to assess the MHS's current and future mental health provider staffing needs and DOD annually revises this model. Fiscal year 2014 marked the first time the model was used by the three military services responsible for providing health care—the Army, Air Force, and Navy—for a common purpose, which was the development of DOD's fiscal year 2016 budget request for mental health services. However, GAO found that the military services either were not using PHRAMS as the main basis of their mental health provider staffing needs estimates or were supplementing PHRAMS results with other service-specific methods. The services reported making these adjustments because PHRAMS does not account for factors that are crucial to assess mental health provider staffing needs, such as mental health providers needed for deployments. As a result, the military services' estimates of mental health provider staffing needs may not consistently reflect the beneficiary demand for mental health providers across the military services, and the current version of PHRAMS may not fully capture the military services' needs.
Why GAO Did This Study
Mental health providers are essential to DOD's delivery of health care to servicemembers and other beneficiaries. DOD's need for these providers has grown as increasing numbers of servicemembers experience life-threatening combat situations. This led to congressional attention—such as the NDAA for Fiscal Year 2010, which included provisions to help DOD increase the number of mental health providers it employs.
GAO was asked to review DOD's efforts to increase its mental health provider workforce. Among other objectives, GAO examined (1) how staffing levels changed in response to congressional direction and (2) how DOD and the military services assess current and future needs for mental health providers. GAO reviewed DOD's mental health staffing estimation model and the military services' quarterly mental health provider staffing reports for fiscal years 2009 through 2013, the latest information available. GAO also interviewed DOD and military service officials responsible for assessing mental health staffing needs.
Recommendations
GAO recommends that the military services report on service-specific or supplemental processes for generating mental health provider staffing estimates and that DOD continue to refine its staffing estimation model. DOD generally concurred with these recommendations, but did not concur with two others related to the use of PHRAMS that are also included in the report. GAO continues to believe these recommendations are valid as discussed further in the report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | 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. |
DOD concurred with our recommendation. DOD considers the recommendation closed because in May 2017 DOD concluded that the PHRAMS staffing model should be discontinued because the model does not sufficiently account for total military health system mental health provider needs. DOD stated that service models have improved over time and similarities between the models have evolved to where a stand-alone mental health requirements model like PHRAMS provides no value over the existing service models. As a result GAO considers the recommendation closed-not implemented.
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| Department of Defense | 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. |
DOD non-concurred with our recommendation. DOD stated in its comments that using PHRAMS in the requirements fields of these reports would not add value to the quarterly mental health staffing reports and noted that the military services do not use PHRAMS as the sole source of mental health requirements. DOD considers the recommendation closed because in May 2017 DOD concluded that PHRAMS should be discontinued because the model does not sufficiently account for total military health system mental health provider needs. DOD stated that service models have improved over time and similarities between the models have evolved to where a stand-alone mental health requirements model like PHRAMS provides no value over the existing service models. As a result GAO considers the recommendation closed-not implemented.
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| Department of Defense | 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. |
DOD concurred with our recommendation. DOD considers the recommendation closed because in May 2017 DOD concluded that PHRAMS should be discontinued because the model does not sufficiently account for total military health system mental health provider needs. DOD stated that service models have improved over time and similarities between the models have evolved to where a stand-alone mental health requirements model, like PHRAMS, provides no value over the existing service models. As a result GAO considers the recommendation closed-not implemented.
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| Department of Defense | 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. |
DOD non-concurred with our recommendation and stated in its comments that using PHRAMS in the requirements fields of these reports would not add value to the quarterly mental health staffing reports and noted that the military services do not use PHRAMS as the sole source of mental health requirements. DOD considers the recommendation closed because in May 2017 DOD concluded that PHRAMS should be discontinued because the model does not sufficiently account for total military health system mental health provider needs. DOD stated that service models have improved over time and similarities between the models have evolved to where a stand-alone mental health requirements model like PHRAMS provides no value over the existing service models. As a result GAO considers the recommendation closed-not implemented.
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