Unwanted Sexual Behavior: Improved Guidance, Access to Care, and Training Needed to Better Address Victims' Behavioral Health Needs

Fast Facts

Service members who have experienced unwanted sexual behavior, such as harassment or assault, may suffer from chronic mental health problems.

These service members can get non-medical counseling through the Department of Veterans Affairs. But longer-term and psychiatric care are only available with a referral that would be shared with the Department of Defense as part of their patient record—which may deter some service members from seeking it.

DOD also doesn't always screen service members during routine medical exams to determine if they have experienced sexual trauma.

We recommended addressing these and other issues we found.

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Highlights

What GAO Found

The Department of Defense (DOD) and Department of Veterans Affairs (VA) offer behavioral health care to active-duty service members and veterans who experience unwanted sexual behavior. Unwanted sexual behavior includes sexual harassment, sexual assault, and domestic sexual abuse. However, several issues limit screening for and access to related care. For example:

VA requires clients in VA medical facilities to be screened for military sexual trauma; DOD screens for behavioral health conditions but not specifically for experiences with unwanted sexual behavior. Without developing guidance specifying how and when DOD medical providers should screen for such experiences, DOD cannot ensure consistent patient support or care.
Service members who have experienced unwanted sexual behavior may confidentially access non-medical counseling through VA. However, longer-term medical behavioral health care requires a referral from DOD, which may deter service members from seeking care. Until DOD considers how best to enable service members to access longer-term services through VA, without a referral, some service members may not seek needed care.

Analysis of separation data shows that service members who made unrestricted, formal, or some informal reports of experiences with unwanted sexual behavior left the military—voluntarily and involuntarily—at substantially higher rates than the overall active-duty population from fiscal years 2015 through 2021 (see fig.).

Separation Rates for All Active-Duty Service Members Compared to Those who Reported an Experience with Unwanted Sexual Behavior, Fiscal Years 2015–2021

However, multiple factors impede DOD's ability to determine if an experience with unwanted sexual behavior played a role in separation decisions. For example, certain processes related to medical examinations and higher-level reviews of involuntary separations are available only for victims of sexual assault, for specific time periods, and for certain behavioral health diagnoses. Until DOD considers potential modifications to these processes service members may be unable to benefit from actions that may affect eligibility for VA benefits.

Why GAO Did This Study

Service members who experience unwanted sexual behavior—sexual harassment, sexual assault, and domestic sexual abuse—during military service may suffer from chronic mental health conditions. Service members who have such experiences are also more likely to separate from the military, exacerbating DOD's critical recruitment and retention challenges.

GAO was asked to review service member mental health related to experiences with unwanted sexual behavior. This report examines, among other issues, the extent to which (1) DOD and VA screen for and provide access to behavioral health care services for such experiences, and (2) such experiences play a role in voluntary and involuntary separations of service members from the military. GAO reviewed guidance, analyzed DOD and VA behavioral health care data and DOD separation data, and interviewed DOD and VA officials at the headquarters level and at a nongeneralizable sample of military installations and VA medical facilities.

Recommendations

GAO is making 15 recommendations, 13 to DOD and two to VA, including that DOD develop guidance specifying how and when to screen for experiences with unwanted sexual behavior; consider how best to enable service members' access to care related to such experiences at any VA facility, without a referral; and consider modifying its guidance to help ensure it fully considers potential factors contributing to service member separations. DOD and VA concurred with the recommendations.

Recommendations for Executive Action

See All 15 Recommendations

Full Report

Highlights Page (1 page)

Full Report (174 pages)

Accessible PDF (218 pages)

GAO Contacts

Brenda S. Farrell

Former Director

FarrellB@gao.gov

Media Inquiries

Sarah Kaczmarek

Managing Director

Office of Public Affairs

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Public Inquiries

Topics

Health Care

Confidential communicationsElectronic health recordsEmployee dismissalHealth careHealth care administrationHealth care providersHealth care standardsMedical recordsMental healthMilitary dischargesMilitary health carePost-traumatic stress disordersSexual abuseSexual assaultsSexual harassmentVeteransVeterans affairs

Agency Affected	Recommendation	Status
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency develops guidance that establishes protocols specifying how and when providers should screen patients for experiences with unwanted sexual behavior. (Recommendation 1)	Open DOD concurred with this recommendation. DHA officials said that in January 2025, they added a sexual trauma screen to the web-based behavioral health data portal for all new behavioral health intake assessments. In addition, as of March 2025, DHA officials said that DHA is developing a standardized screening protocol specifying how and when providers screen for sexual trauma and document in the electronic health record. The officials estimated that this protocol should be completed and active by November 2025. To fully implement GAO's recommendation, DOD needs to develop and issue guidance that establishes protocols specifying how and when providers should screen patients for experiences with unwanted sexual behavior.
Department of Defense	The Secretary of Defense should ensure that as the department revises its guidance on health care management for patients who have experiences with unwanted sexual behavior, it considers modifications to clarify (1) when and how medical care should be prioritized for victims of unwanted sexual behavior, and (2) whether to expand the provisions about prioritization of care to include service members who have experienced sexual harassment. Any such revisions to the guidance should specify how providers can prioritize care for victims of unwanted sexual behavior in a manner that is consistent with DOD policy while also allowing them to effectively care for victims of other types of trauma. (Recommendation 2)	Open DOD concurred with this recommendation. As of March 2025, DHA officials said that they have updated the annual required training for behavioral health providers to clarify how to prioritize sexual assault survivors as medical emergencies. The officials said that the updated training is expected to be available in June 2025. In addition, DHA officials said that they plan to update the relevant DOD instruction in September 2026 to provide guidance on when and how to provide care for victims of sexual trauma. To fully implement GAO's recommendation, DOD needs to consider, when revising its health care management guidance, whether to clarify when and how medical care should be prioritized for victims of unwanted sexual behavior, and whether to expand the provisions about prioritization of care to include service members who have experienced sexual harassment.
Department of Defense	The Secretary of Defense should include, as part of the department's planned study to implement the Independent Review Commission's recommendation to authorize service members' access to the full spectrum of VA care related to unwanted sexual behavior, consideration of several factors to balance confidentiality with mission needs to better facilitate implementing the Commission's recommendation to the greatest extent feasible. Specifically, the department's study should consider how best to enable such access by assessing the following: the extent that permitting greater access to VA behavioral health resources would pose risks to DOD that would be different from the risks DOD faces from service members who confidentially obtain care in the private sector; whether access to VA care without a referral could be granted for service members who are not in certain populations or positions that require greater disclosure; potential revisions of or clarifications to service member disclosure requirements related to behavioral health; and mechanisms that could help facilitate confidential access to care, such as distinctions between treatments that do and do not require disclosure. (Recommendation 3)	Open DOD concurred with this recommendation. As of May 2025, DOD had not provided GAO with an update on the status of this recommendation. To fully implement GAO's recommendation, DOD needs to include, as part of its planned study about authorizing service members' access to the full spectrum of VA care related to unwanted sexual behavior, consideration of the several factors identified in our recommendation.
Department of Defense	The Secretary of Defense and the Secretary of Veterans Affairs should collaborate to take steps to ensure that service members who have experienced unwanted sexual behavior and are eligible for VA services related only to military sexual trauma are provided information about and connected to all programs that assist in the transition from DOD to VA care. (Recommendation 4)	Closed – Implemented DOD and VA concurred with this recommendation. DOD and VA have taken several steps to increase information about VA care for military sexual trauma that is shared with all servicemembers. For example, VA and DOD finalized an informational poster describing the free VA care and benefits available to current and former service members who experienced sexual trauma during military service. In August 2024, the Under Secretary of Defense for Personnel and Readiness instructed DOD facilities to immediately disseminate and post this poster in all Sexual Assault and Response Program offices, Military Equal Opportunity Program offices, behavioral health care offices or clinics, Family Advocacy Program offices, and other high traffic areas throughout the facility within 90 days from the date of the memorandum. In addition, VA and DOD have implemented cross-training among staff who are key touch points for providing information about VA services to survivors of military sexual trauma. For example, in June 2024, VA officials provided a briefing to DOD Sexual Assault Prevention and Response Office personnel about VA's free health care related to military sexual trauma, which included information that former service members do not need to enroll or be eligible to enroll in VA health care to receive such care. Further, VA officials said that in September 2024, VA sent an email communication from the VA Solid Start program to all eligible veterans. According to documentation we reviewed, this email contained information about the free military sexual trauma care, benefits, and services that are available from the VA. By taking these steps, DOD and VA have increased the likelihood that service members will be aware of and may potentially receive critical care for which they are eligible. These actions meet the intent of the recommendation.
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency adopts information security best practices for MHS GENESIS to incorporate the principle of least privilege and limit health record access to those with an established provider-patient relationship or a need to know, and therefore better ensure victim confidentiality and privacy. (Recommendation 5)	Open DOD concurred with this recommendation. In February 2025, DOD officials noted that MHS GENESIS was compliant with the Health Insurance Portability and Accountability Act (HIPAA). In our report, in response to DHA officials' comments that health record access in GENESIS was addressed by HIPAA compliance, we noted that HHS guidance for HIPAA implementation establishes a minimum necessary requirement, which "requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to protected health information." To fully implement GAO's recommendation, DOD needs to limit access to its electronic health record to those with an established provider-patient relationship or a need to know, and therefore better ensure victim confidentiality and privacy.
Department of Veterans Affairs	The Secretary of Veterans Affairs, in conjunction with the Secretary of Defense, should develop and evaluate options and make a determination of the best approach for incorporating a mechanism in its new electronic health record whereby VA providers can record unwanted sexual behavior care at medical centers and community-based outpatient clinics while limiting sharing that information to the greatest extent feasible. (Recommendation 6)	Open VA concurred with this recommendation. As of October 2024, VA stated that it had completed the Options Development and Evaluation plan that includes the core strategy required to develop and evaluate new options that includes goals, objectives, interim milestones, metrics, and timelines for each step of the project. This plan includes a policy and law review to guide development of new options for incorporating a mechanism in the new electronic health record to allow VA providers to record unwanted sexual behavior care at medical centers and community-based outpatient clinics while limiting sharing that information to the greatest extent feasible. As of May 2025, the project team expects to complete full implementation of the plan by June 2026. To fully implement GAO's recommendation, VA needs to develop and evaluate options and determine the best approach for incorporating a mechanism in its new electronic health record whereby VA providers can record unwanted sexual behavior care at medical centers and community-based outpatient clinics while limiting sharing that information.
Department of Defense	The Secretary of Defense should ensure that the Director of the Defense Health Agency issues guidance that specifies how information about behavioral health care related to experiences with unwanted sexual behavior should be consistently documented in the electronic health record. (Recommendation 7)	Open DOD concurred with this recommendation. As of March 2025, DHA officials said that they have updated the annual required training for behavioral health providers to provide guidance on standardized documentation, including informed consent, notification requirements, and documentation of restricted reports and content related to sexual assault. The officials said that the updated training is expected to be available in June 2025. All providers will be required to complete this training within 90 days, with full compliance expected by September 30, 2025. To fully implement GAO's recommendation, DOD needs to issue guidance specifying how information about behavioral health care related to experiences with unwanted sexual behavior should be documented in the electronic health record.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Director of the Office for Diversity, Equity, and Inclusion, revises harassment prevention and response training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 8)	Open DOD concurred with this recommendation. As of May 2025, DOD had not provided GAO with an update on the status of this recommendation. To fully implement GAO's recommendation, DOD needs to revise its harassment training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in training that is administered to all service members, and take steps to ensure that the military services implement the revised guidance.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Director of the Sexual Assault Prevention and Response Office, revises sexual assault prevention and response training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 9)	Open DOD concurred with this recommendation. DOD officials said that they plan to update the Sexual Assault Prevention and Response annual refresher training implementation guide and review the services' existing training materials, to assess their training content. As of May 2025, the officials said that they expect to complete this update by October 2026. To fully implement GAO's recommendation, DOD needs to revise its sexual assault training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in training that is administered to all service members, and take steps to ensure that the military services implement the revised guidance.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Deputy Assistant Secretary of Defense for Military Community and Family Policy, revises domestic sexual abuse training guidance to require that information about Department of Veterans Affairs resources for experiences with unwanted sexual behavior be included in annual or periodic training that is administered to all service members, and takes steps to ensure that the military services implement the revised guidance. (Recommendation 10)	Closed – Implemented DOD concurred with this recommendation. In July 2024, DOD updated the domestic abuse victim reporting form to include information about VA military sexual trauma resources. In addition, in January 2025, the Military Community Advocacy Directorate completed a review and analysis of the servicemember training developed and used by each military service to verify that information about VA resources was included in the training. Finally, the Directorate updated pages on the Military OneSource web site that discussed domestic abuse and the family advocacy program to include a link to the VA military sexual trauma, in order to increase awareness of the VA as a resource for servicemembers. By revising the domestic abuse reporting form to include information about available VA resources for experiences with unwanted sexual behavior, service members who report experiences of domestic sexual abuse will be aware that these resources exist. Moreover, by ensuring that the military services included information on VA resources for experiences with unwanted sexual behavior in training that is administered to all service members and on several Military One Source resource pages, all service members who experience unwanted sexual behavior will be aware of these resources, even if they do not report their experience. These actions meet the intent of the recommendation.
Department of Veterans Affairs	The Secretary of Veterans Affairs, in coordination with the Secretary of Defense, should revise the participant guide for the Transition Assistance Program's Department of Veterans Affairs benefits and services course taken by all separating service members to include information about available Department of Veterans Affairs resources for experiences with unwanted sexual behavior, similar to what is included in the Transition Assistance Program's optional course on women's health. (Recommendation 11)	Closed – Implemented VA concurred with this recommendation. In January 2024, VA issued an updated version of the VA Benefits and Services Participant Guide that includes more detailed information on VA resources for experiences with unwanted sexual behavior. Specifically, it includes a section on unwanted sexual behavior (which VA refers to as military sexual trauma) that discusses eligibility, disability compensation, and access to care as well as links to relevant websites for additional information. It also includes a related appendix that discusses information on counseling and treatment options, and the availability of such care, similar to the optional women's health course. According to VA officials, VA and DOD worked collaboratively to publish the updated guide. These actions meet the intent of the recommendation.
Department of Defense	The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness conducts a comprehensive evaluation to consider whether to modify DOD guidance on involuntary officer and enlisted administrative separations concerning medical examinations and higher-level general or flag officer reviews, including proposing changes to relevant statutes, as necessary. This evaluation should assess the following areas: (a) whether the eligible population should be service members who experienced any type of unwanted sexual behavior; (b) the appropriate timeframes between when an incident is reported and when a separation is proposed, and other eligibility restrictions for obtaining a medical examination or higher-level review; (c) which behavioral health conditions or diagnoses should determine eligibility for a behavioral health examination; (d) whether service members who file restricted reports should be eligible to request a general or flag officer review; and (e) whether to permit documentation of the alleged sexual assault in the report of the separation health assessment. (Recommendation 12)	Open DOD concurred with this recommendation. To fully implement GAO's recommendation, DOD needs to conduct a comprehensive evaluation about whether to modify DOD guidance on involuntary officer and enlisted administrative separations concerning medical examinations and higher-level general or flag officer review. This evaluation should consider the several factors identified in our recommendation, and should include proposing changes to relevant statutes, as necessary.
Department of the Army	The Secretary of the Army should ensure that Army guidance on involuntary officer and enlisted administrative separations is modified to require that the Army's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 13)	Open DOD concurred with this recommendation. DOD officials said that they are revising the relevant Army regulations so that the sample formats for notification of separation will include information about the option for a general officer review. As of May 2025, DOD officials said that they expected the revised regulations to be published by June 2025. To fully implement GAO's recommendation, the Army needs to modify its guidance on involuntary officer and enlisted administrative separations to require that the Army's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault.
Department of the Navy	The Secretary of the Navy should ensure that Navy guidance on involuntary officer and enlisted administrative separations is modified to require that the Navy's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 14)	Open DOD concurred with this recommendation. Navy and Marine Corps officials said that they plan to update their separations policy to include relevant language for involuntary separations. As of May 2025, the officials expected the revisions to be complete by November 2025. To fully implement GAO's recommendation, the Navy needs to modify its guidance on involuntary officer and enlisted administrative separations to require that the Navy's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault.
Department of the Navy	The Secretary of the Navy should ensure that the Marine Corps guidance on involuntary officer and enlisted administrative separations is modified to require that the Marine Corps's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault. (Recommendation 15)	Open DOD concurred with this recommendation. Navy and Marine Corps officials said that they plan to update their separations policy to include relevant language for involuntary separations. As of May 2025, the officials expected the revisions to be complete by November 2025. To fully implement GAO's recommendation, the Marine Corps needs to modify its guidance on involuntary officer and enlisted administrative separations to require that the Marine Corps's standardized separation notification correspondence includes information about the general or flag officer review for victims of sexual assault.