What the GAO found
The Veterans Health Administration (VHA) requires that its medical facilities serve at least 5,000 veterans annually to integrate mental health services into the primary care services they provide. Specifically, facilities are required to have mental health providers, such as psychologists, psychiatrists, and social workers, available within primary care settings to work collaboratively and share responsibility with primary care providers to (1) assess and treat Veterans with mental health symptoms and conditions, such as anxiety or depression; and (2) follow up with those veterans to monitor symptoms and medication compliance, and provide education and referral services.
VHA data shows that, as of February 2022, about 79 percent of VHA’s 455 facilities reported meeting both requirements, with the remainder meeting one or neither requirement. VHA officials said the regional networks are responsible for monitoring their facilities’ compliance with the requirements and developing corrective action plans. However, VHA does not oversee the implementation of corrective action plans. Doing so would ensure that facilities are taking the appropriate steps to comply. Veterans at those facilities would then have better access to mental health care services in primary care settings, as the VHA intends.
VHA centers reported that persistent staffing challenges have negatively impacted their efforts to integrate mental health services into primary care settings from 2016 through February 2022 (see figure).
Percentage of VHA facilities that reported staffing as their most important challenge, from 2016 to 2022
Note: Data was reported in the annual VHA surveys. According to VHA officials, they did not administer a 2020 annual survey due to the COVID-19 pandemic.
To address staffing challenges, officials at facilities selected in the GAO review reported taking steps such as offering more flexible work hours and providing additional technology to reduce workload. Regional network officials identified several additional strategies that the VHA could consider, such as providing additional guidance on recruiting and retaining staff and increasing funding for certain positions. Evaluating and implementing these strategies, and any others as appropriate, can help facilities mitigate staffing challenges. Doing so would help ensure that veterans receive the most appropriate and timely mental health care services available.
Why GAO did this study
VHA has seen a significant increase in the demand for mental health services and expects that demand to continue to grow. One way VHA meets that demand is by integrating certain mental health services within primary care settings.
The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 included a provision for the GAO to review the integration of VHA mental health and primary services. Among other goals, this report examines the extent to which facilities have met VHA requirements for integrating mental health care into primary care. It also discusses the challenges that have affected such integration and the steps VHA has taken to mitigate them.
GAO reviewed VHA documentation and policies on integration efforts and annual survey data from 2011 to 2022. GAO also interviewed VHA officials and providers from nine VHA facilities. These facilities were selected based on geographic location and other factors, such as the percentage of veterans who received integrated mental health services in fiscal year 2020.