Specifically, DOD  increased the number of providers across the MHS from 4,608 providers  in fiscal year 2009 to 6,186 providers in fiscal year 2013. This  increase was in response to a requirement in the NDAA for Fiscal Year  2010 that DOD increase its mental health capabilities. Specifically, social workers  and psychologists were the most frequently added types of mental health  providers during this period, while psychiatrists and mental health nurses  were the least frequently added. DOD Created a Model for Developing Mental Health Provider Staffing Needs, but the Military Services Do Not Use It Consistently

DOD created the Psychological Health Risk-Adjusted Model for Staffing  (PHRAMS) to show current and estimate future mental health provider  staffing needs of the MHS. In fiscal year 2014, PHRAMS was used for a  common purpose by the military services for the first time—the  development of the fiscal year 2016 DOD budget request for mental  health programs. Military Services Mental Health Provider Estimates Are Not Based Mainly on PHRAMS

Despite all military services agreeing to use PHRAMS to generate their  estimates of mental health provider staffing needs for the fiscal year 2016  budget request, the military services either did not use PHRAMS as the  main basis for their mental health provider staffing estimates or  supplemented PHRAMS results using other service-specific methods  prior to submitting their fiscal year 2016 budget requests. Standards for  internal control in the federal government state that agencies’ control  activities should ensure that management’s directives are carried out.The military services reported making these adjustments because  PHRAMS does not account for several factors that are crucial to their  assessment of mental health provider staffing needs, specifically the  following:
Army. Each military service and  the NCR Medical Directorate submits quarterly staffing reports to DHA  through the OASD HA human capital office that include information on  three areas of mental health provider staffing: (1) the number of mental  health providers each military service needs to fulfill the needs of their  beneficiaries, referred to as requirements; (2) the number of authorized  positions each military service has for various types of mental health  providers, referred to as authorizations; and (3) the actual number of  mental health providers each military service has working within their  MTFs and subordinate clinics that quarter, referred to as on-board  providers. Recommendations for Executive Action

To ensure DHA can accurately and consistently assess mental health  provider staffing needs across each of the military services, we  recommend that the Secretary of Defense direct the Secretaries of the  Army, Air Force, and Navy to take the following two actions:
Require the medical commands of each military service to report any  additional service-specific methods they use to determine their final  estimates of mental health provider staffing needs; and
Require the medical commands of each military service to include its  estimated mental health provider staffing needs generated through  PHRAMS in the requirements fields of DHA’s quarterly mental health  staffing reports. In its comments, DOD generally concurred with  two of our four recommendations. Bonuses for mental health providers. Appendix III: Mental Health Provider Staffing Increases by Military Service

This appendix provides results from our analysis of Department of  Defense (DOD) quarterly mental health staffing reports for fiscal years  2009 and 2013.
Why GAO Did This Study

Mental health providers are essential to DOD's delivery of health care to servicemembers and other beneficiaries. DOD's need for these providers has grown as increasing numbers of servicemembers experience life-threatening combat situations. This led to congressional attention—such as the NDAA for Fiscal Year 2010, which included provisions to help DOD increase the number of mental health providers it employs.
GAO was asked to review DOD's efforts to increase its mental health provider workforce. Among other objectives, GAO examined (1) how staffing levels changed in response to congressional direction and (2) how DOD and the military services assess current and future needs for mental health providers. GAO reviewed DOD's mental health staffing estimation model and the military services' quarterly mental health provider staffing reports for fiscal years 2009 through 2013, the latest information available. GAO also interviewed DOD and military service officials responsible for assessing mental health staffing needs.

What GAO Found

In response to the enactment of the National Defense Authorization Act (NDAA) for Fiscal Year 2010, the Department of Defense (DOD) military health system (MHS) increased its mental health provider staffing level by 34 percent. Specifically, DOD increased the number of mental health providers across the MHS from 4,608 providers in fiscal year 2009 to 6,186 providers in fiscal year 2013. Social workers and psychologists were the most frequently added types of mental health providers during this period.
In 2007, DOD created the Psychological Health Risk-Adjusted Model for Staffing (PHRAMS) to assess the MHS's current and future mental health provider staffing needs and DOD annually revises this model. Fiscal year 2014 marked the first time the model was used by the three military services responsible for providing health care—the Army, Air Force, and Navy—for a common purpose, which was the development of DOD's fiscal year 2016 budget request for mental health services. However, GAO found that the military services either were not using PHRAMS as the main basis of their mental health provider staffing needs estimates or were supplementing PHRAMS results with other service-specific methods. The services reported making these adjustments because PHRAMS does not account for factors that are crucial to assess mental health provider staffing needs, such as mental health providers needed for deployments. As a result, the military services' estimates of mental health provider staffing needs may not consistently reflect the beneficiary demand for mental health providers across the military services, and the current version of PHRAMS may not fully capture the military services' needs.

What GAO Recommends

GAO recommends that the military services report on service-specific or supplemental processes for generating mental health provider staffing estimates and that DOD continue to refine its staffing estimation model. DOD generally concurred with these recommendations, but did not concur with two others related to the use of PHRAMS that are also included in the report. GAO continues to believe these recommendations are valid as discussed further in the report.