Servicemembers are also exposed to events such as blasts that increase  their risk of experiencing a TBI. Specifically, DOD  requires three health assessments during the deployment cycle: the pre- deployment health assessment, the PDHA, and the PDHRA. 1). AHLTA does not have this capability. DOD Has Taken Steps to Implement Pre- Deployment Mental Health Screening, but Policies for Medical Record Reviews Are Inconsistent

DOD has taken steps to meet the 2007 NDAA requirements for pre- deployment mental health standards and screening. As required by the  2007 NDAA, which was enacted in October 2006, DOD issued minimum  mental health standards that servicemembers must meet in order to be  deployed. Finally, the policy identified the pre-deployment  health assessment as a mechanism for screening servicemembers for  mental health conditions and for ensuring that the standards are utilized in  making deployment determinations. Because of DOD’s  inconsistent policies, providers determining if OEF and OIF  servicemembers meet DOD’s minimum mental health deployment  standards may not have complete medical information. Health Care Providers at Installations Visited Manually Track Mental Health Referrals from the PDHA

Health care providers at Fort Campbell and Camp Lejeune manually  track whether servicemembers who receive mental heath referrals from  the PDHA make or keep appointments for evaluations with mental health  providers. As a result, PDHA mental health referral tracking is challenging for  Guard and Reserve units due to their reliance on servicemembers to  disclose mental health encounters with civilian providers, which Guard  and Reserve officials told us they may be reluctant to do because of stigma  concerns. To help health  care providers screen servicemembers for mild TBI and issue referrals,  DOD has issued guidance and provided various forms of training. DOD Is Implementing Mild TBI Screening in Its PDHA and Prior to Deployment; Several Installation- Specific Mild TBI Screening Initiatives Are in Place

In response to the 2007 NDAA requirement for pre-and post-deployment  screening for TBI, DOD has added TBI screening questions to the PDHA,  and plans to require screening of all servicemembers beginning in July  2008 for mild TBI prior to deployment. These screening questions are  similar to the screening questions on the PDHA. Prior to DOD’s plans to screen all servicemembers on the PDHA and prior  to deployment, several installations had implemented, as early as 2000,  initiatives for mild TBI screening to be used before or after units from  those locations deployed. A DVBIC official told us that these initiatives would  probably be replaced by the DOD-wide screening. Furthermore, the installations we visited had  developed manual systems for tracking those servicemembers who were  referred from the PDHA to ensure that they made or completed their  appointments. Referral tracking is difficult for the Guard and Reserves  because their servicemembers generally receive civilian care. A health care provider following  DOD’s Instruction on Deployment Health, which is silent on whether  medical record review is required during the pre-deployment health  assessment, may not conduct the medical record review required by  DOD’s policy on minimum mental health standards for deployment. Recommendation for Executive Action

In order to address the inconsistency in DOD’s policies related to the  review of medical record information and to assure that health care  providers have reviewed the medical record when screening  servicemembers prior to deployment, we recommend that the Secretary of  Defense direct the Under Secretary of Defense for Personnel and  Readiness to revise DOD’s Instruction on Deployment Health to require a  review of medical records as part of the pre-deployment health  assessment.
Why GAO Did This Study

The John Warner National Defense Authorization Act for Fiscal Year 2007 included provisions regarding mental health concerns and traumatic brain injury (TBI). GAO addressed these issues as required by the Act. In this report GAO discusses (1) DOD efforts to implement pre-deployment mental health screening; (2) how post-deployment mental health referrals are tracked; and (3) screening requirements for mild TBI. GAO selected the Army, Marine Corps, and Army National Guard for the review. GAO reviewed documents and interviewed DOD officials and conducted site visits to three military installations where the pre-deployment health assessment was being conducted.

What GAO Found

DOD has taken positive steps to implement mental health standards for deployment and pre-deployment mental health screening. However, DOD's policies for providers to review medical records are inconsistent. DOD issued minimum mental health standards that servicemembers must meet in order to be deployed to a combat theater and identified the pre-deployment health assessment as a mechanism for ensuring their use in making deployment decisions. DOD's November 2006 policy implementing these deployment standards requires a review of servicemember medical records during the pre-deployment health assessment. However, DOD's August 2006 Instruction on Deployment Health, which implements policy and prescribes procedures for conducting pre-deployment health assessments, is silent on whether such a review is required. Because of this inconsistency, providers determining if Operation Enduring Freedom and Operation Iraqi Freedom servicemembers meet DOD's mental health deployment standards may not have complete medical information. Health care providers at the installations GAO visited where the post-deployment health assessment (PDHA) is conducted manually track whether servicemembers who receive mental health referrals from the PDHA make or complete appointments with mental heath providers. Because health care providers conducting the PDHA and making referrals from the PDHA may not have an ongoing relationship with referred servicemembers, health care providers responsible for tracking referrals at these installations have developed manual systems to track servicemembers to ensure that they made or kept their appointments for evaluations. Tracking is more challenging for Guard and Reserve units because their servicemembers generally receive civilian care. Guard and Reserve units do not know if servicemembers used civilian care to complete their PDHA referrals unless disclosed by the servicemembers, which they may be reluctant to do because of stigma concerns. DOD is addressing the TBI requirement through implementing screening for mild TBI in its PDHA and prior to deployment. DOD has also provided guidance and training for health care providers. DOD in January 2008 added TBI screening to the PDHA, and plans to require screening of all servicemembers for mild TBI prior to deployment beginning in July 2008. The TBI screening questions on the PDHA assess the servicemember's exposure to events that may have increased the risk of a TBI and the servicemember's symptoms. The TBI screening questions to be used prior to deployment are similar to those on the PDHA. Prior to DOD's screening efforts, several installations had been screening servicemembers for mild TBI before or after deployment. An official from the Defense and Veterans Brain Injury Center told GAO that these initiatives would probably be replaced by the DOD-wide screening.