Mental health services are provided for a range of conditions such  as depression, PTSD, and substance abuse disorders. Such strategies include, for  example, the use of RFPs solicited from networks for specific initiatives to  be carried out at their individual medical centers. VA Allocated about $88 Million of the $100 Million Planned for Mental Health Strategic Plan Initiatives in Fiscal Year 2005, but Officials Reported That Not All Allocated Funds Were Used for Plan Initiatives

VA headquarters allocated about $88 million of the $100 million that VA  officials said would be allocated for VA mental health strategic plan  initiatives in fiscal year 2005 by using several approaches. Officials we  interviewed at seven medical centers in four networks reported using  allocated funds to provide new mental health services and to provide more  of existing services. However, some medical center officials reported that  they did not use all allocated funds for plan initiatives by the end of fiscal  year, due in part to the length of time it took to hire new staff. VA Allocated Approximately $53 Million Directly to Medical Centers and Certain Offices

VA headquarters allocated about $53 million directly to medical centers  and certain offices based on proposals submitted for funding and other  approaches targeted to specific initiatives related to the mental health  strategic plan in fiscal year 2005. VA Allocated $35 Million through Its General Resource Allocation System to Its Health Care Networks on a Retrospective Basis

VA allocated $35 million for mental health strategic plan initiatives in fiscal  year 2005 through its general resource allocation system to its health care  networks, according to VA headquarters officials. However, because network and  medical center officials we interviewed did not know that funds had been  allocated for mental health strategic plan initiatives through VA’s general  resource allocation system, nor did VA headquarters notify networks and  medical centers throughout VA of this retrospective allocation, it is likely  that some of these funds were not used for plan initiatives. VA Did Not Allocate about $12 Million Planned for Mental Health Strategic Plan Initiatives

VA did not allocate approximately $12 million remaining of the   $100 million planned for mental health strategic plan initiatives in fiscal  year 2005 because, according to VA headquarters officials, there was not  enough time during the fiscal year to allocate the funds through the RFP  process or other approaches targeted to specific initiatives. Medical Center Officials Reported Using Allocated Funds for Mental Health Strategic Plan Initiatives, but Not Using All Funds Allocated for Plan Initiatives

Officials we interviewed from seven medical centers in four networks  reported using the funds allocated to them for mental health strategic plan  initiatives through RFPs and other targeted approaches, but some officials  said that some of these funds were not used for plan initiatives in fiscal  year 2005. VA Allocated about $158 Million of the $200 Million Planned for Mental Health Strategic Plan Initiatives in Fiscal Year 2006, but Some Officials Were Uncertain If All Funds Would Be Used for Plan Initiatives

VA headquarters allocated about $158 million of the $200 million to be  used for VA mental health strategic plan initiatives in fiscal year 2006  directly to medical centers and certain offices by using several  approaches. About $92 million of these funds was allocated to support  new mental health strategic plan initiatives for fiscal year 2006. VA also  allocated about $66 million to support the recurring costs of the  continuing mental health strategic plan initiatives that were funded in  fiscal year 2005. Officials at two medical centers reported that they did not anticipate  problems using all of the funds they had received in fiscal year 2006. In addition, officials at the Bay Pines and  Phoenix medical centers noted that they had not yet learned whether  proposals they submitted in response to fiscal year 2006 RFPs would be  funded; as a result, officials at those medical centers were uncertain  whether they would be able to use all of their fiscal year 2006 funds for  plan initiatives by the end of the fiscal year. VA Tracking of Funds Spent for Mental Health Strategic Plan Initiatives Was Inadequate, but Available Information Indicates That Spending for These Initiatives Was Substantially Less Than Planned

VA tracking of spending for mental health strategic plan initiatives was  inadequate for fiscal years 2005 and 2006. Moreover, VA did not track  specifically how these funds were spent. As a consequence, VA cannot  determine how much of the approximately $112 million that was allocated  for plan initiatives and not returned to headquarters was spent on plan  initiatives. The extent of spending is unknown because  VA did not track spending of these funds. CBOCs are affiliated with a VA medical  center. Department of Veterans Affairs: Key Management Challenges in Health  and Disability Programs.
Why GAO Did This Study

The Department of Veterans Affairs (VA) provides mental health services to veterans with conditions such as post-traumatic stress disorder (PTSD) and substance abuse disorders. To address gaps in services needed by veterans, VA approved a mental health strategic plan in 2004. VA planned to increase its fiscal year 2005 allocations for plan initiatives by $100 million above fiscal year 2004 levels and its fiscal year 2006 allocations for plan initiatives by $200 million above fiscal year 2004 levels. GAO was asked to provide information on VA's allocation and use of funding for mental health strategic plan initiatives in fiscal years 2005 and 2006, and to examine the adequacy of how VA tracked spending and the extent of spending for plan initiatives. GAO reviewed VA reports and documents on plan initiatives and conducted interviews with VA officials at headquarters, 4 of 21 health care networks, and seven medical centers. VA networks provide oversight of medical center operations and most medical center resources.

What GAO Found

In fiscal year 2005, VA headquarters allocated about $88 million of the $100 million above fiscal year 2004 levels that VA officials intended for mental health strategic plan initiatives. VA allocated about $53 million directly to medical centers and certain offices based on proposals submitted for funding and other approaches targeted to specific initiatives. VA solicited proposals from networks for initiatives to be carried out at medical centers through requests for proposals (RFP). In addition, VA headquarters officials said that VA allocated $35 million for plan initiatives through VA's general resource allocation system to its 21 health care networks on a retrospective basis, several months after resources had been provided to the networks though the general resource allocation system. VA did not notify network and medical center officials that these funds were to be used for plan initiatives. Network and medical center officials interviewed told GAO that they were not aware these allocations had been made. As a result, it is likely that some of these funds were not used for plan initiatives. VA did not allocate the approximately $12 million remaining of the $100 million for fiscal year 2005 because, according to VA officials, there was not enough time during the fiscal year to do so. Medical center officials said they used funds allocated for plan initiatives for new services and for enhancement of existing services. For example, two medical centers increased the number of mental health providers at community-based outpatient clinics. However, some medical center officials reported they did not use all funds allocated by the end of the fiscal year, due in part to the time it took to hire staff. In fiscal year 2006, VA headquarters allocated about $158 million of the $200 million above fiscal year 2004 levels intended for mental health strategic plan initiatives directly to medical centers and certain offices. VA allocated about $92 million of these funds to support new initiatives, using RFPs and other targeted funding approaches. VA also allocated about $66 million to support recurring costs of continuing initiatives from the prior fiscal year. About $42 million of the $200 million for fiscal year 2006 was not allocated. Officials from seven medical centers GAO interviewed reported they had used funds for plan initiatives, such as the creation of a new case management program. Officials at some medical centers reported they did not anticipate problems using all of the funds allocated within the fiscal year; however, officials at other medical centers were less certain they would be able to do so. VA tracking of spending for plan initiatives was inadequate. In fiscal year 2005, VA did not track such spending. In fiscal year 2006, VA tracked aspects of plan initiatives but not dollars spent. However, available information indicates that VA spending for plan initiatives was substantially less than planned. In fiscal year 2006, VA medical centers returned to headquarters about $46 million of about $158 million allocated for plan initiatives because they could not spend the funds that year. However, VA cannot determine to what extent the approximately $112 million remaining was spent on plan initiatives because it did not track specifically how these funds were spent.