VA Reported Spending about $4.4 Billion in Fiscal Year 2009 for Mental Health Services in VA Settings Primarily Used for Providing Mental Health Services

In its fiscal year 2011 congressional budget justification, VA reported  spending about $4.4 billion in fiscal year 2009 for mental health services  provided in VA settings primarily used for mental health services. 1.) 2.) However, VA did not report this  spending as mental health spending in its fiscal year 2011 congressional  budget justification or in any other publicly available report. Although VA determines how much it spends for some of its mental health  services, it did not report fiscal year 2009 spending for these mental health  services as mental health spending in its fiscal year 2011 congressional  budget justification or in any other publicly available report. According to VA  officials, VA does not have complete spending information for inpatient  hospital mental health services provided by mental health providers in VA  settings not primarily used to provide mental health services. Additionally,  VA does not have spending information for counseling services to address  mental health issues provided by Vet Centers. VA Provided Mental Health Services to More Than 1 Million Unique Patients in Fiscal Year 2009, but VA Did Not Report Workload for All of Its Mental Health Services

In fiscal year 2009, VA provided mental health services to about   1.22 million unique patients in VA settings primarily used for providing  mental health services. The number of unique patients is not available  until after VA’s budget justification is published. In addition, VA did not report workload for the mental health services that  it provided in other settings—community settings for which VA paid non- VA providers to provide mental health services and VA settings not  primarily used for providing mental health services, such as nursing  homes, in which VA mental health providers provided services. VA also did  not report workload for counseling services to address mental health  issues provided by Vet Centers. Specifically, VA did not report the number of encounters for  outpatient services or the average daily census for each of its inpatient  hospital, residential, and domiciliary services. Additionally, VA did not  report the spending and workload for mental health services provided in  other settings that are key to VA’s efforts to meet the mental health needs  of veterans: VA settings not primarily used for providing mental health  services and community settings where VA pays non-VA providers to  provide mental health services. VA’s reporting of mental health spending and workload does not give  Congress a complete overview of VA’s mental health services and limits  information available for congressional oversight. Recommendations for Executive Action

To enhance information available for congressional oversight and use by  stakeholders on VA’s spending and workload for mental health services,  we recommend that the Secretary of Veterans Affairs take the following  four actions:  include workload information, including number of encounters and  average daily census, by type of service, for mental health services  provided in VA settings primarily used for providing mental health services  with its presentation of mental health spending in its annual congressional  budget justification; include spending and workload information, including number of  encounters and average daily census, for mental health services that VA  pays non-VA providers to deliver in community settings in its annual  congressional budget justification, or in a separate, annual, publicly  available report soon after the information becomes available; include spending and workload information, including number of  encounters and average daily census, for mental health services provided  in VA settings not primarily used for providing mental health services in its  annual congressional budget justification, or in a separate, annual, publicly  available report soon after the information becomes available; and include workload information, including number of visits, for counseling  services to address mental health issues provided by Vet Centers in its  annual congressional budget justification, or in a separate, annual, publicly  available report soon after the information becomes available. Appendix I: Scope and Methodology

To examine the Department of Veterans Affairs’ (VA) spending and  workload for mental health services, we examined, for fiscal year 2009,   (1) VA’s spending for mental health services and (2) VA’s workload for  mental health services.
Why GAO Did This Study

The Department of Veterans Affairs (VA) provides, or pays for, a range of mental health services for veterans. To effectively manage resources and ensure access to eligible veterans, VA needs complete spending and workload information for mental health services. This information is also important for congressional oversight GAO was asked to examine VA's mental health spending and workload. In this report, GAO examined for fiscal year 2009 (1) VA's spending for mental health services and (2) VA's workload for mental health services. GAO examined VA's reporting of mental health spending and workload data for fiscal year 2009 in its fiscal year 2011 congressional budget justification and whether VA reported these data in any other publicly available report. GAO analyzed additional mental health spending and workload data and interviewed VA officials.

What GAO Found

VA reported in its fiscal year 2011 congressional budget justification spending about $4.4 billion on mental health services in fiscal year 2009 in VA settings primarily used for providing mental health services. However, VA had additional spending in fiscal year 2009 for mental health services that VA did not report as mental health spending in its budget justification or in any other publicly available report. Specifically, VA did not report as mental health spending the amounts it spent for those mental health services that it (1) paid non-VA providers to provide in community settings and (2) provided in VA settings not primarily used for providing mental health services, such as nursing homes. VA also did not report as mental health spending the amount it spent for counseling services to address mental health issues provided by VA Vet Centers. Although VA did not report this spending information, VA does determine its spending for mental health services provided by non-VA providers and for outpatient mental health services provided in VA settings not primarily used for providing mental health services. According to VA officials, VA spent an additional $269 million for these services in fiscal year 2009. VA does not have complete spending information for inpatient hospital mental health services provided by mental health providers in VA settings not primarily used to provide mental health services nor does it have spending information for counseling services to address mental health issues provided by Vet Centers. In fiscal year 2009, VA provided mental health services to about 1.22 million unique patients in VA settings primarily used for providing mental health services. However, VA did not report this information in its fiscal year 2011 congressional budget justification or in any other publicly available report. VA officials said that the number of unique patients is not available until after VA's budget justification is published. Additionally, VA did not report other workload information that it has on (1) the number of encounters for outpatient services and the average daily census for each of its inpatient hospital, residential, and domiciliary services provided in VA settings primarily used for providing mental health services and (2) the workload for mental health services provided in other settings--community settings for which VA paid non-VA providers to provide mental health services and VA settings not primarily used for providing mental health services. VA also did not report the workload for counseling services to address mental health issues provided by Vet Centers, but VA is able to estimate its workload for these services. VA's reporting of mental health spending and workload does not give Congress a complete overview of VA's mental health services and limits information available for congressional oversight of VA's mental health services. Reporting additional mental health spending and workload information could enhance information available for congressional oversight.