DOD and VA Health Care: Actions Needed to Better Facilitate Access to Mental Health Services During Military to Civilian Transitions
Fast Facts
Thousands of service members transition from military to civilian life each year. To help those who may need mental health support, DOD automatically enrolls service members who had a mental health appointment in the year prior to separation in its "inTransition" program. In 2022, inTransition identified 85% of its enrollees this way.
But inTransition doesn't conduct outreach to these enrollees until 2-3 months after their separation—a vulnerable time during transition. And the program wasn't able to successfully connect with 70% of enrollees by phone.
Our recommendations address this and other issues.
Highlights
What GAO Found
The Department of Defense's (DOD) inTransition program assists service members who may need support with mental health services during transitions. It automatically enrolls members transitioning from the military who received mental health or traumatic brain injury care in the year prior to separation. In 2022, inTransition identified 85 percent of its enrollees through its automatic enrollment process. (See figure.) However, GAO found that inTransition does not conduct outreach to these enrollees until 2 to 3 months after their separation. This delayed timing may leave a gap in assistance to mental health services during a vulnerable period.
inTransition Enrollees, Calendar Year 2022
GAO found that the inTransition program was unable to successfully connect with over 70 percent of its automatically enrolled service members in 2022. This was due, in part, to its outreach strategy, which relies on telephone calls. Expanding its outreach methods—such as through email, text, or the use of location services—could improve the program's ability to successfully connect with its enrollees and potentially increase participation in the program. GAO also found that the inTransition program tracks some performance data but has not defined the level of performance it aims to achieve. By establishing performance goals with measurable targets, the program could better assess its performance and use the information to make changes, as appropriate, such as to its outreach strategy.
The DOD and Department of Veterans Affairs (VA) Joint Executive Committee oversees military transition activities. GAO found that it identified an inventory of departmental efforts that may facilitate access to mental health services for transitioning members in 2022. However, it has not assessed the effectiveness of these efforts overall in facilitating access to mental health services during the transition period. As a result, the Committee does not know the extent to which there may be gaps, overlap, or other issues across these efforts. By conducting such an assessment and recommending appropriate changes, the Committee could help to better ensure that transitioning service members and veterans have access to the mental health services they may need.
Why GAO Did This Study
Thousands of service members transitioned from military service to civilian life in 2022. During this transition period, research has shown that service members are especially vulnerable. Some may face challenges, such as the loss of a sense of purpose, post-traumatic stress disorder, or other mental health symptoms.
GAO was asked to review access to mental health services for transitioning members. Among other objectives, this report examines inTransition's enrollment process and efforts to assess performance. It also examines the extent to which the DOD-VA Joint Executive Committee has assessed the effectiveness of efforts to facilitate access to mental health services.
GAO analyzed inTransition program data for calendar year 2022, the most recent available. GAO also reviewed DOD and VA information on efforts that may facilitate access to mental health services and interviewed DOD and VA officials.
Recommendations
GAO is making five total recommendations, including that DOD revise inTransition's enrollment criteria and outreach policy and establish performance goals, and that the DOD-VA Joint Executive Committee assess the departments' efforts to facilitate access to mental health services.VA concurred with the DOD-VA Joint Executive Committee recommendation; DOD did not provide formal comments.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Defense Health Agency | The Defense Health Agency should revise the inTransition program's criteria for auto-enrollment as outlined in its policy to identify and enroll eligible service members prior to their separation from the military. (Recommendation 1) |
In November 2024, DOD responded that it concurred with this recommendation. Its response stated that the inTransition Program is currently working to obtain lists of transitioning service members before they separate based on their enrollment in the Transition Assistance Program (TAP). Specifically, the department plans to revise the inTransition Program's policy for auto-enrollment to allow eligible service members to be identified and enrolled prior to their separation and to use TAP data for this process. DOD estimates completion of planned actions in response to this recommendation by September 2025.
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| Defense Health Agency | The Defense Health Agency should revise the inTransition program's policy to expand the outreach methods used by the program to contact automatically enrolled service members, such as by adding requirements for outreach through email, text, or the use of location services. (Recommendation 2) |
In November 2024, DOD responded that it concurred with this recommendation. Its response stated that the inTransition Program is exploring additional outreach methods to contact automatically enrolled service members, to include email and text messaging. Specifically, by the end of November 2024, DOD reported that the inTransition Program will implement email outreach to its automatically enrolled service members. Additionally, by July 2025, if determined feasible, the inTransition Program will implement text messaging as an additional form of outreach. DOD estimates completion of planned actions in response to this recommendation by September 2025.
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| Defense Health Agency | The Defense Health Agency should establish measurable performance goals for the inTransition program that have quantitative targets and time frames. (Recommendation 3) |
In November 2024, DOD responded that it concurred with this recommendation. Its response stated that officials are reviewing the current inTransition Program performance metrics and will establish measurable performance goals with quantitative targets and time frames for the program. The inTransition Program will work with DHA and DOD leadership to determine appropriate targets with respect to service member needs and program aims for inclusion in the next inTransition Program contract. DOD estimates completion of planned actions in response to this recommendation by July 2025.
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| Defense Health Agency | The Defense Health Agency should implement a process for the inTransition program to use performance information to assess its effectiveness and make any needed improvements, as appropriate. (Recommendation 4) |
In November 2024, DOD responded that it concurred with this recommendation. Its response stated that once the performance goals and targets have been established to address Recommendation #3, the inTransition Program will regularly review this information as one facet of assessing program effectiveness. This performance information will help to inform any needed changes or future improvements to the program. DOD stated that this recommendation will require an extended timeline for completion given its dependency on the completion of several actions within Recommendation #3, to include establishment of measurable performance goals and quantitative targets, prior to its implementation. DOD estimates completion of planned actions in response to this recommendation by September 2026.
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| VA-DoD Joint Executive Committee | The DOD-VA Joint Executive Committee should assess the effectiveness of DOD and VA programs and processes overall in facilitating access to mental health services across the transition continuum, and recommend any needed changes to DOD and VA, including changes to address any identified gaps or unnecessary duplication or overlap. (Recommendation 5) |
In November 2024, DOD responded that it concurred with this recommendation. Its response stated that the JEC will ensure that appropriate executive subcommittees are aligned and that plans of action, milestones, and metrics are established to identify gaps or redundancies in services. DOD estimates completion of planned actions in response to this recommendation by December 2025.
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