Title: Active-Duty Military Can Face Long Wait Times for Even Urgent
Mental Health Care 

Description: Serving in the military, especially combat, may carry a
psychological cost for active-duty service members. If left untreated,
behavioral health conditions--such as mental health and substance use
disorders-- can worsen with consequences for the service member, as well
as for the military. In a new report, we found that service members may
face delays in receiving this critical health care. GAO's Alyssa Hundrup
joins us to tell us more.

Related work: GAO-24-106267, Defense Health Care: DOD Should Monitor
Urgent Referrals to Civilian Behavioral Health Providers to Ensure
Timely Care

Issuance: February 2024

{Music}

[Alyssa Hundrup:] Increase in demand and then couple that with provider
shortages is just taking a long time to get an appointment.

[Holly Hobbs:] Hi and welcome to GAO's Watchdog report. Your source for
fact-based, nonpartisan news and information from the U.S. Government
Accountability Office. I'm your host, Holly Hobbs. Serving in the
military, especially in combat, may carry psychological costs for
active-duty service members. And if left untreated, behavioral health
conditions--such as mental health and substance use disorders--can worsen
with consequences for the service member, as well as for the military.
The Department of Defense's Defense Health Agency oversees the TRICARE
program, which provides a full range of health services for active-duty
personnel. But in a new report, we found that service members may face
delays in receiving this critical health care. Joining us to tell us
more is GAO's Alyssa Hundrup, an expert on military health care. Thanks
for joining us.

[Alyssa Hundrup:] Thanks for having me Holly.

[Holly Hobbs:] So, Alyssa, if I'm active-duty military and I need to
make a behavioral health, let's say, mental health appointment--would I
receive that care through the military or through a private provider?

[Alyssa Hundrup:] Well, you would start by seeking care at a military
treatment facility. DOD aims to provide all of its care to active-duty
service members through its facilities. So a member would first need to
seek care there. That said, if a military treatment facility can't
accommodate a timely appointment or doesn't offer those services, then a
service member would need to obtain a referral and it could see a
provider in the TRICARE network of private providers.

[Holly Hobbs:] So whether I go through a military facility or a private
provider, how long would it take for me to get that appointment? 

[Alyssa Hundrup:] Well, it really depends on a number of factors, such
as whether it's for a new appointment or for a follow-up appointment for
an existing condition, and whether you can get the appointment at that
military treatment facility or if you would need to go to that TRICARE
network of private providers. In our review, we really looked at initial
or new appointments and looked at fiscal year 2022 data. There we found
that, when they could get care at a military treatment facilities,
members were on average able to get an appointment within about 16 days
from when they booked it. On the other hand, if a military treatment
facility can't accommodate an appointment, then they will refer that
member to the TRICARE network. And for those initial appointments in the
network, we found the overall average was 31 days after receiving a
referral in the East and 32 days in the West. And, I would just note,
that these are averages I'm talking about, so the individual times could
really vary from there. Lastly and importantly, I just want to mention
for urgent referrals where a provider has determined the need for
expedited care--that initial appointment averaged 17 days in the East and
23 days in the West. So we're looking at over two and three weeks
respectively in waiting for an appointment.

[Holly Hobbs:] For an urgent appointment.

[Alyssa Hundrup:] Correct yes, for urgent care. 

[Holly Hobbs:] Given how important these appointments can be. Are there
deadlines or even like requirements for the maximum amount of time a
service member would have to wait to receive care?

[Alyssa Hundrup:] So yes and no. So for initial appointments, DOD
requires that appointments occur within 28 days. And they're generally
meeting this requirement for the treatment facilities, as well as in the
TRICARE network, where they're just over. In contrast, there is not a
requirement for urgent referrals made to the network. So that means
there's not a set standard for how quickly care should be received. DOD
has explained to us that they don't have this because it can really
depend vary based on clinical need and what the provider indicates.
However, when we looked at guidance related to the TRICARE network for
one region, they said that referrals should be marked urgent when a
provider determines the patient needs to be seen within 72 hours. So we
certainly appreciate that clinical needs vary, but with timeframes of
over two and three weeks, it's hard to see how under any circumstance
that would be considered expedited or urgent.

[Holly Hobbs:] Do we know why military service members are having to
wait so long?

[Alyssa Hundrup:] So unfortunately, DOD is experiencing the same
shortage of behavioral health providers that we're seeing nationwide,
and that could be a big part of it. For example, DOD data that we saw as
of January 2023 showed that about 43% of authorized positions for
behavioral health care providers were vacant across the military
treatment facilities. We also heard that facilities are facing hiring
challenges, such as slow hiring processes or they're not able to offer
competitive pay when compared to the private sector or other agencies.
And then specific to the TRICARE network, we heard that some service
members had a hard time finding people that would accept TRICARE or that
had availability. And that, again, may go back to those shortages of the
providers in this area. 

[Holly Hobbs:] So the DOD and the DHA, the Defense Health Agency,
they're the ones overseeing this care. Are they doing anything to help
improve wait times?

[Alyssa Hundrup:] Well they're certainly aware of the issue and are
taking a number of actions. For example, we found that the Defense
Health Agency has instituted a physician recruitment team, and that's
helping to expand the types of that types of providers eligible to
provide care. Another effort it has underway is a pilot at a few
treatment facilities that's testing triage approaches. So really looking
at kind of the different levels and types of care and maybe using
non-medical services, such as chaplains or increased use of group
therapy rather than individual therapy to get folks the care that they
need. And then lastly, I would just mention they're also looking to
really expand telehealth. And when an onsite provider is not available,
then a service member could access care remotely, and has a big effort
underway to bring on new capabilities through telehealth in this coming
year.

{MUSIC}

[Holly Hobbs:] So, Alyssa just told us that active-duty service members
may experience long waits for behavioral health appointment, even those
that are deemed urgent. And that DOD and DHA are aware of this and are
taking steps to help improve timely access to care. So, Alyssa, what
more do we think the DOD or the Defense Health Agency should be doing to
address this issue?

[Alyssa Hundrup:] Well, in addition to all of its efforts to bolster
staffing at its medical treatment facilities, we really believe the
Defense Health Agency should be more closely monitoring what's happening
with the timeliness of those appointments in the TRICARE network. This
is especially important as we're seeing DOD rely more on referrals given
the demand and then the staffing shortages at its own facilities. In
particular, given that service members are waitingtwo or three weeks to
receive urgent care in the network we recommended that Defense Health
Agency develop a timeframe to more closely monitor this. By doing this,
it's going to have better information to understand what is happening,
why there are these delays, and then help the contractors running the
network take corrective actions.

[Holly Hobbs:] And last question, what's the bottom line of this report?

[Alyssa Hundrup:] So with increasing demand and then couple that with
provider shortages, it is just taking a long time to get an appointment.
And I think the good news is that the Defense Health Agency is aware of
this and taking a number of steps to help service members get care more
quickly. But we also believe that it needs to take action specific to
appointments for urgent referrals so that it really can better ensure
service members get the expedited care that they need.

[Holly Hobbs:] That was Alyssa Hundrup talking about our new report on
military behavioral health care. Thanks for your time, Alyssa.

[Alyssa Hundrup:] Thanks so much for having me. Holly.

[Holly Hobbs:] And thank you for listening to the Watchdog Report. To
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