Issue Summary
Mental health conditions and substance use disorders, known collectively as behavioral health conditions, affect millions of people in the United States every year. Treatment for mental health conditions, such as anxiety and depression, can help people manage their symptoms and improve their quality of life.
However, there are a number of issues concerning access to mental health treatment. For instance, individuals with insurance may have difficulty finding an in-network provider. Once they do, they may struggle to navigate administrative approval processes and coverage limitations. Additionally, the availability of qualified behavioral health providers in the United States has also been a persistent challenge. Financial, educational, and workplace barriers pose challenges to recruiting and retaining providers. Finally, veterans are 1.5 times more likely to die by suicide than the general population. The Department of Veterans Affairs (VA) has made efforts to meet an increased demand for mental health services and prevent suicide, though challenges remain. For example, veterans living in rural areas have an elevated risk of death by suicide, and rural provider shortages may mean these veterans have less access to mental health treatment.
Multiple federal programs are working to address these and other issues, but additional federal actions could improve care for the individuals who rely on these programs.
For example:
Servicemembers’ mental health needs. Military servicemembers may experience mental health conditions as a result of exposure to dangerous and traumatic situations. The Department of Defense (DOD) has reported that suicide rates among servicemembers increased by one-third between 2016 and 2020. Servicemembers assigned to remote installations outside the U.S. may be especially at risk for suicide because of less access to mental health services and increased social isolation. However, DOD has not fully assessed suicide risk at such installations.
Servicemembers’ access to behavioral health services. DOD provides behavioral health care for servicemembers and their dependents through TRICARE, which includes DOD-run military treatment facilities and private providers. Although DOD generally monitors the timeliness of services provided under TRICARE, it does not separately track how long servicemembers wait for appointments when they receive urgent referrals to private providers. In addition, DOD has not assessed whether TRICARE coverage of behavioral health services aligns with program goals it established in 2016, such as eliminating unnecessary treatment limitations.
State Department employees. State Department employees based overseas often face high levels of stress due to heavy workloads and to instability or conflict in countries where they are based. Although the State Department offers several mental health services to help sustain employees’ well-being, it does not collect ongoing feedback about all of its services to help ensure they are meeting the needs of those who receive them.
Veterans’ access to mental health treatment. The VA has five regional networks of community providers that deliver care to eligible veterans when they have challenges accessing timely care at VA facilities. However, the way VA analyzes data to oversee these networks could result in an incomplete, and potentially misleading, assessment of whether networks have enough mental health care providers in the community to provide care.
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Transitioning to civilian life. Thousands of servicemembers transition from military to civilian life each year. Some may face challenges during the period, such as the loss of a sense of purpose, or symptoms of PTSD. To help those who may need mental health support, DOD automatically enrolls servicemembers who had a mental health appointment in the prior year in its "inTransition" program. However, this program doesn't conduct outreach to servicemembers until 2 to 3 months after their separation. The program was also unable to make phone contact with 70% of servicemembers it tried to reach.
