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INSIGHTi
FY2022 NDAA: Mental Health Care
November 18, 2021
Background
Congress authorizes, through the annual National Defense Authorization Act (NDAA), Department of
Defense (DOD) mental health programs and services that support servicemembers, military retirees, and
their families. DOD administers many mental health programs that offer education; awareness; crisis
prevention resources; clinical treatment; nonclinical support and counseling services; and research and
development.
DOD has estimated that, from 2016 through 2020, 456,293 active duty servicemembers were diagnosed
with at least one mental health disorder. Mental health disorders also accounted for the highest number of
hospital bed days and were the second most common reason for outpatient visits among servicemembers.
During the same time period, the majority (64%) of mental health diagnoses were attributed to adjustment
disorders, anxiety disorders, and depressive disorders.
DOD has made numerous efforts to address the wide range of mental health issues, and potential
opportunities for improvement have been highlighted by the Government Accountability Office (GAO),
DOD Inspector General (DODIG), and other observers of military health. Table 1 lists the mental health-
related provisions included in the proposed House and Senate versions of the FY2022 NDAA.
Table 1. FY2022 NDAA Legislative Proposals
Senate Armed Services Committee-Reported S.
House-Passed H.R. 4350
2792
Section 702 would require the TRICARE program to cover
No related provisions.
certain inpatient and outpatient health care services to treat
eating disorders among servicemembers or their
dependents. The provision would also require DOD to
periodical y screen servicemembers for eating disorders.
Section 714 would amend 10 U.S.C. §1090a to establish an
additional process using a trigger phrase, by which a
commanding officer or supervisor confidential y refers a
servicemember for a mental health evaluation.
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Senate Armed Services Committee-Reported S.
House-Passed H.R. 4350
2792
Section 731 would require DOD, in col aboration with the
Department of State, to award grants to certain entities for
col aborative research with Israeli institutions on post-
traumatic stress disorder.
Section 734 would require DOD to conduct a one-year
pilot program that provides “direct assistance” with
scheduling mental health appointments at certain military
treatment facilities (MTFs).
Section 736 would authorize DOD to conduct a pilot
program, by September 1, 2023, that surveys certain active
duty servicemembers on perceptions of access to mental
health care and related stigma.
Section 739 would require the Secretary of Defense to
establish a committee to conduct an independent review of
DOD’s suicide prevention and response programs.
Section 6480 would require the Military Services to submit a
report to Congress on substance abuse disorder treatment
concerns among servicemembers and their dependents. The
provision would also require a report to Congress on the
use of substance abuse disorder treatment programs on or
near military instal ations.
Discussion
Mental Health Screening and Treatment
In August 2020, GAO found that while DOD does not general y screen servicemembers for eating
disorders during the annual periodic health assessment, “DOD is examining ways to improve its screening
of eating disorders in the military as wel as identify possible ways to prevent such conditions in the
military.” Section 702 of the House-passed bil would require DOD to periodical y screen for, and treat,
eating disorders among servicemembers. The provision would also require the TRICARE program to
cover certain outpatient and inpatient treatment services (e.g., residential services or partial-
hospitalization programs) for eating disorders among servicemembers and their dependents.
DOD policy al ows servicemembers to obtain a mental health evaluation on a voluntary (i.e., self-referral)
or involuntarily (i.e., command-directed) basis. Section 714 of the House-passed bil would require DOD
to establish a new process that triggers a command-directed mental health evaluation. The new process
would al ow a servicemember to disclose a certain phrase that then initiates an automatic, confidential
referral for an evaluation.
A 2020 DOD Inspector General report found that the Department “did not consistently meet outpatient
mental health access to care standards for active duty service members and their families, in accordance
with law and applicable [DOD] policies.” Section 734 of the House-passed bil would require DOD to
conduct a one-year pilot program that provides “direct assistance” to beneficiaries scheduling mental
health appointments at certain military treatment facilities. The provision would also require DOD to
assess the program and provide a report to Congress, within 90 days after the pilot program ends, on the
effectiveness and barriers of accessing mental health appointments.
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Mental Health Research
Section 731 of the House-passed bil would direct the Secretary of Defense, in coordination with the
Secretary of State, to award grants for a period of no more than seven years to academic or nonprofit
entities for collaborative research between the United States and Israel on post-traumatic stress disorder.
The provision would also require DOD to provide a report to Congress, within 180 days after each grant-
funded project is completed, that describes how funds were used and an evaluation on the project’s
success.
Program Assessments
The House-passed bil includes three provisions that would authorize or require DOD to assess certain
aspects of its mental health programs and services. Section 736 of the House-passed bil would provide
DOD an authority, through September 1, 2023, to survey servicemember perceptions of access and stigma
related to mental health care in the Military Health System. Servicemembers’ input would be collected
through the Defense Organizational Climate Survey.
Section 739 of the House-passed bil would require the Secretary of Defense to establish an independent
committee to conduct a review of DOD’s suicide prevention and response programs, factors that
contribute to military suicides, and provide an initial (270 days after the committee is established) and
final report (330 days after the committee is established) to Congress on their findings.
Section 6480 of the House-passed bil would require the Military Service Secretaries to, within 180 days
after enactment, submit two reports to Congress relating to substance abuse in the military: (1) a report on
substance abuse treatment concerns of servicemembers and their families; and (2) a report on substance
abuse treatment programs located on or near military instal ations.
Author Information
Bryce H. P. Mendez
Analyst in Defense Health Care Policy
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