Mental health services are  provided for a range of conditions such as depression, PTSD, and  substance abuse disorders. However, some medical center officials reported that  they did not use all allocated funds for plan initiatives by the end of the  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 headquarters developed and solicited  submissions from networks for specific initiatives to be carried out at their  individual medical centers through requests for proposals (RFPs). 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 resources 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  retroactive 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 the 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 Allocations 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 funds allocated to them for mental health strategic plan  initiatives through RFPs and other targeted approaches, but they said that  some of these funds were not used for plan initiatives in fiscal year 2005. Officials said they used funds allocated to provide new mental health  services and to provide more of existing services included in plan  initiatives. For example, two medical centers used funds to increase the  number of mental health providers available at CBOCs. One of those  medical centers also implemented a new 6-week PTSD day treatment  program in which veterans live in the community but come to the medical  center daily for counseling, group therapy, and other services. As of September 20, 2006, VA Had Allocated $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

As of September 20, 2006, VA headquarters had allocated $158 million of  the $200 million to be used for VA mental health strategic plan initiatives  in fiscal year 2006 by using several approaches. About $92 million of these  funds was allocated directly to medical centers and certain offices 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 initiatives that were funded in fiscal year 2005. The remaining $42 million had not been allocated as of September 20. Medical Center Officials Reported Using Allocations for Mental Health Strategic Plan Initiatives, but Were Uncertain Whether All Funds Allocated Would Be Used for Plan Initiatives

Officials from seven medical centers we interviewed in May and June of  2006 reported using funds allocated to them through RFPs and other  approaches to support new 2006 mental health initiatives and to continue  to support the initiatives first funded in fiscal year 2005. Officials at some medical centers reported that they  did not anticipate problems using all of the funds they had received in  fiscal year 2006. In May 2006, officials at two  medical centers that we interviewed said that they did not know whether  they would receive additional funds through RFPs to spend in fiscal year  2006, and as a result they 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  intended to allocate $100 million for plan initiatives in fiscal year 2005.
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. VA also planned to increase its fiscal year 2006 allocations for plan initiatives by $200 million above fiscal year 2004 levels--composed of $100 million for continuation of fiscal year 2005 initiatives and an additional $100 million identified in the President's fiscal year 2006 budget request. GAO was asked to provide preliminary information on VA's allocation and use of funding for mental health strategic plan initiatives in fiscal years 2005 and 2006. A report on this work will be issued later in the fall of 2006. GAO reviewed VA reports and documents on mental health strategic plan initiatives and conducted interviews with VA officials from headquarters, 4 of 21 health care networks, and 7 medical centers. VA delegates decision making to its health care networks for most budget and management responsibilities regarding medical center operations, and medical centers receive most of their resources from the networks.

What GAO Found

In fiscal year 2005, VA headquarters allocated $88 million of the $100 million 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 submissions from networks for specific initiatives to be carried out at their individual medical centers through requests for proposals (RFPs). In addition, VA headquarters officials said that VA allocated $35 million for this purpose through VA's general resource allocation system to its 21 health care networks on a retrospective basis. VA made this decision several months after resources had been provided to the networks through the general allocation system. Moreover, VA did not notify network and medical center officials that these funds were to be used for plan initiatives. Health care 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. Moreover, 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 the funds allocated directly to their medical centers for plan initiatives that included new mental health services and more of the services they already provided. For example, two medical centers used funds allocated to them through RFPs or other targeted approaches to increase the number of mental health providers at community based outpatient clinics. One of those medical centers also started a new 6-week PTSD day treatment program. However, some medical center officials reported that they did not use all funds allocated for plan initiatives by the end of fiscal year 2005, due in part to the length of time it took to hire new staff. In fiscal year 2006, as of September 20, 2006, VA headquarters had allocated $158 million of the $200 million planned for mental health strategic plan initiatives. VA allocated about $92 million of these funds directly to medical centers and certain offices to support new initiatives, using RFPs and other targeted funding approaches. VA also allocated about $66 million to support recurring costs of the continuing initiatives from the prior fiscal year. As of September 20, 2006, about $42 million of the $200 million for fiscal year 2006 had not been allocated. Officials from seven medical centers we interviewed reported that they had used funds for plan initiatives, such as the creation of a new intensive mental health case management program. Officials at some medical centers reported that they did not anticipate problems using all of the funds allocated to them through RFPs and other targeted approaches in fiscal year 2006. However, officials at other medical centers were less certain that they would use all of these funds for plan initiatives by the end of fiscal year 2006. GAO discussed the information in this statement with VA officials who agreed that the data are accurate, and provided updated data which are incorporated as appropriate.