SAMHSA, an agency within HHS, leads the federal government’s public  health efforts related to behavioral health, which includes mental health. Eight Agencies Reported over 100 Programs That Can Support Individuals with Serious Mental Illness, but It Is Unlikely All Programs Were Identified

		Agencies Identified 112 Programs That Can Support Individuals with Serious Mental Illness, 30 of Which Specifically Target This Population

Agencies identified 112 federal programs in fiscal year 2013—across  eight federal agencies—that can support individuals with serious mental  illness. It Is Unlikely That Agencies Identified All Programs for Individuals with Serious Mental Illness

Agencies had difficulty identifying all programs supporting individuals with  serious mental illness because they did not always track whether or not  such individuals were among the population served by the program. Agencies also varied in how they defined their programs and in which  programs they chose to include. However, program staff for the majority  of the programs targeting serious mental illness reported taking steps to  coordinate with other program-level staff. However, the steering committee has  not met since 2009. HHS officials told us that the Behavioral Health  Coordinating Council (BHCC) performs some functions previously carried  out by the steering committee. Without such coordination and support,  agencies do not have the necessary information to assess the reach and  effectiveness of their programs or to determine whether or where there  may be gaps or overlap in services for individuals with serious mental  illness. While coordination at the program level is important to ensure  that program staff are aware of the efforts of staff for other programs, it  does not take the place of, or achieve the level of leadership, that we  have noted in past work is key to successful coordination. Agencies Have Evaluated Less than One-Third of the 30 Programs Targeted for People with Serious Mental Illness

Agencies completed few evaluations of the 30 programs that specifically  targeted individuals with serious mental illness. Specifically, as of  September 2014, 9 programs had a completed program evaluation,   4 programs had an evaluation underway, and 17 programs had no  evaluation. 1.) Although SAMHSA—the agency  within HHS that is required to promote coordination of programs relating  to mental illness throughout the federal government—has made some  effort to coordinate on mental health broadly, it has shown little leadership  in coordinating federal efforts on behalf of those with serious mental  illness. We have also reported many times on the importance of conducting  formal program evaluations to inform program managers on the overall  design and operation of the program and ensure that the program’s  objectives are being met. Although about $5.7 billion was obligated by 4  agencies—DOD, HHS, DOJ, and VA—to support federal programs  specifically targeting individuals with serious mental illnesses, less than  one-third had a completed program evaluation. Recommendations

To understand the full breadth of federal programs and the scope of  federal resources expended on programs supporting those with serious  mental illness, we recommend that the Secretary of HHS establish a  mechanism to facilitate intra- and interagency coordination, including  actions that would assist with identifying the programs, resources, and  potential gaps in federal efforts to support individuals with serious mental  illness. To help determine if programs are effective at supporting those  individuals with serious mental illness, we recommend that the  Secretaries of Defense, Health and Human Services, Veterans Affairs,  and the Attorney General—which oversee programs targeting individuals  with serious mental illness—document which of their programs targeted  for individuals with serious mental illness should be evaluated and how  often such evaluations should be completed. Our second recommendation on conducting program evaluations was  directed to DOD, DOJ, HHS, and VA. HHS did not concur with this  recommendation, while DOD, DOJ, and VA agreed. Identification of Federal Agencies

To identify federal agencies that may have programs supporting  individuals with serious mental illness or serious emotional disturbance,  we reviewed the programs and agencies highlighted in the President’s  New Freedom Commission on Mental Health “Major Federal Programs  Supporting and Financing Mental Health Care,” reviewed our prior  reports, other documents, such as reports from the Bazelon Center for  Mental Health Law, and interviewed advocacy groups and agency   Based on this review and our interviews, there were eight  officials.agencies that were cited frequently as having programs supporting  individuals with serious mental illness, and we included those agencies in  our review:
Department of Defense (DOD)
Department of Education (Education)
Department of Health and Human Services (HHS)
Department of Housing and Urban Development (HUD)
Department of Justice (DOJ)
Department of Labor (DOL)
Department of Veterans Affairs (VA), and
Social Security Administration (SSA). Developing and Administering the Web- Based Questionnaire

We developed a web-based questionnaire to collect detailed information  on federal programs that support individuals with serious mental illness or  serious emotional disturbance for fiscal year 2013. 2.) 3).
Why GAO Did This Study

In 2013, about 10 million adults in the United States had a serious mental illness. The U.S. mental health care system includes a range of federal programs—across multiple agencies—for those with mental illness. Past efforts to develop a list of federal programs supporting individuals with serious mental illness have highlighted the difficulty of identifying such programs.
GAO was asked to provide information on federal programs that support individuals with serious mental illness. This report identifies (1) the federal programs that support individuals with serious mental illness; (2) the extent to which federal agencies coordinate these programs; and (3) the extent to which federal agencies evaluate such programs. GAO developed and administered a web-based questionnaire to eight federal agencies regarding program goals, target populations, services offered, evaluations, and coordination. GAO also interviewed agency officials.

What GAO Found

Agencies identified 112 federal programs that generally supported individuals with serious mental illness in fiscal year 2013. The majority of these programs addressed broad issues, such as homelessness, that can include individuals with serious mental illness. The programs were spread across eight federal agencies: Department of Defense (DOD), Department of Education, Department of Health and Human Services (HHS), Department of Housing and Urban Development, Department of Justice (DOJ), Department of Labor, Department of Veterans Affairs (VA), and the Social Security Administration. Thirty of the 112 programs were identified by the agencies as specifically targeting individuals with serious mental illness. Four agencies—DOD, HHS, DOJ, and VA—reported that they obligated about $5.7 billion for programs that specifically targeted individuals with serious mental illness in fiscal year 2013. Agencies had difficulty identifying all programs supporting individuals with serious mental illness because they did not always track whether or not such individuals were among those served by the program. Agencies also varied in which programs they identified because they had different definitions of what such a program might be. Such inconsistency limits the potential comparability across programs.
Interagency coordination for programs supporting individuals with serious mental illness is lacking. HHS is charged with leading the federal government's public health efforts related to mental health, and the Substance Abuse and Mental Health Services Administration is required to promote coordination of programs relating to mental illness throughout the federal government. In the past, HHS led the Federal Executive Steering Committee for Mental Health, with members from across the federal government. However, the steering committee has not met since 2009. HHS officials told us that the Behavioral Health Coordinating Council (BHCC) performs some functions previously carried out by the steering committee. The BHCC, however, is limited to HHS and is not an interagency committee. Other interagency committees were broad in scope and did not target individuals with serious mental illness. Staff for the majority of the programs targeting serious mental illness reported taking steps to coordinate with staff in other agencies. While coordination at the program level is important, it does not take the place of, or achieve the level of, leadership that GAO has previously found to be key to successful coordination and that is essential to identifying whether there are gaps in services and if agencies have the necessary information to assess the reach and effectiveness of their programs.
Agencies completed few evaluations of the programs specifically targeting individuals with serious mental illness. Of the 30 programs specifically targeting individuals with serious mental illness, 9 programs had a completed program evaluation, 4 programs had an evaluation underway, and 17 programs had no evaluation completed and none planned. However, agency officials said they engaged in other efforts—such as drawing on evidence in published literature—to ensure their programs were effective. GAO's prior work has shown the significance of both performance monitoring activities and program evaluations and noted the importance of formal program evaluations to inform program managers about the overall design and operation of the program.

What GAO Recommends

GAO recommends that HHS establish a mechanism to facilitate interagency coordination across programs that support individuals with serious mental illness. GAO also recommends that DOD, HHS, DOJ, and VA document which programs targeting individuals with serious mental illness should be evaluated and how often such evaluations should be completed. HHS disagreed with both recommendations. DOD, DOJ, and VA agreed with the second recommendation. GAO continues to believe the recommendations are valid as discussed in the report.