Veterans Health Care: Efforts to Hire Licensed Professional Mental Health Counselors and Marriage and Family Therapists

What GAO Found

The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) sets overall hiring goals for mental health professions but leaves decisions on the types of professions to hire to individual VA medical facilities based on their workforce needs. Psychologists and social workers—two professions that provide psychotherapy services—have been employed by VHA for decades. VHA began hiring two additional types of mental health professions—licensed professional mental health counselors (LPMHC) and marriage and family therapists (MFT)—in 2010.

GAO found that VHA's efforts to promote the hiring of LPMHCs and MFTs included disseminating guidance and establishing funded trainee positions. VHA's guidance identifies benefits to hiring LPMHCs and MFTs, including that they may be easier to recruit and retain in rural settings. VHA has been funding LPMHC and MFT trainee positions since academic year 2015-2016. Having funded trainees is an important mechanism for creating a pipeline of qualified potential mental health staff, according to VHA. As of academic year 2020-2021, there were 42 funded LPMHC trainees and 13 funded MFT trainees.

GAO's analysis of VHA staffing information shows that the total number of LPMHCs and MFTs employed in VA medical facilities had increased to nearly 500 since 2010 (see figure below) and that these professions were present in more than two-thirds (69 percent) of facilities as of fiscal year 2021. The number of LPMHCs and MFTs has grown since hiring began in 2010; however, other types of professions employed by VHA for decades make up the majority of the mental health professions providing psychotherapy services. Specifically, LPMHCs and MFTs comprised about 4 percent of mental health professions at VA medical facilities in fiscal year 2021, with psychologists at 45 percent and social workers at about 51 percent.

Number of Employed LPMHCs and MFTs in VA Medical Facilities, Fiscal Year 2010 through 2021

Why GAO Did This Study

Demand for VA mental health care is growing. The number of veterans provided mental health care services by VHA increased by 85 percent from 2006 through 2020. This growth poses challenges for VHA in maintaining an adequate mental health workforce that provides timely, high-quality services. It is compounded by the nationwide shortage of mental health professionals.

VHA typically relies on four types of mental health professions to provide psychotherapy services: psychologists, social workers, and, since 2010, LPMHCs and MFTs. The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 included a provision for GAO to review staffing levels for mental health professionals in VA, in particular for LPMHCs and MFTs.

This report describes (1) VHA efforts to promote the hiring of LPMHCs and MFTs in VA medical facilities; and (2) the extent to which VA medical facilities are employing LPMHCs and MFTs and how their recent employment compares with other mental health professions.

GAO reviewed VHA documents related to LPMHC and MFT hiring, analyzed VHA staffing information on employed LPMHCs and MFTs for fiscal years 2010 through 2021, and compared LPMHCs and MFTs to other mental health professions for fiscal year 2021. GAO interviewed mental health and human resources officials from VHA and from five of its regional networks selected for variation in LPMHC and MFT employment and rurality. GAO also interviewed four associations that represent LPMHCs or MFTs.

For more information, contact Sharon M. Silas at (202) 512-7114 or silass@gao.gov.