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INSIGHTi
FY2024 NDAA: Military Mental Health
Strategy Development and Program
Assessment Provisions
October 11, 2023
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 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 456,293 active duty servicemembers were diagnosed with at least one mental
health disorder from 2016 through 2020. 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, adjustment disorders, anxiety disorders, and depressive disorders composed
the majority (64%) of mental health diagnoses.
DOD has made numerous efforts to address mental health issues. The Government Accountability Office
(GAO), DOD Inspector General (DODIG), and other observers of military health have highlighted
potential opportunities for improvement. During ongoing deliberations on an FY2024 NDAA, Congress
has expressed interest in understanding the current state of DOD’s mental health programs available to
servicemembers and their families through the Military Health System (MHS) and other resources.
Table 1 lists the military mental health strategy development and program assessment-related provisions
included in the House-passed (H.R. 2670) and Senate-passed (S. 2226) versions of an FY2024 NDAA.
Table 1. FY2024 NDAA Selected Legislative Proposals
House-passed H.R. 2670
Senate-passed S. 2226
Mental Health Strategy Development Provisions
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House-passed H.R. 2670
Senate-passed S. 2226
Section 729 would require the Secretary of Defense to
No similar provision.
establish a task force, not later than 90 days after
enactment, to examine the mental health of
servicemembers, provide Congress a report on findings and
recommendations to improve mental health services, and
develop an implementation plan based on the task force’s
recommendations.
Section 742 would require the Secretary of Defense to
No similar provision.
submit a comprehensive strategy on force resilience to the
armed services committees not later than 270 days after
enactment.
Mental Health Program Assessment Provisions
Section 743 would require the Secretary of Defense, in
No similar provision.
coordination with the service secretaries, to conduct a study
and provide a report to Congress, not later than June 1,
2024, on DOD nonclinical mental health programs, including
how they are administered, how they differ from clinical
mental health services, program effectiveness and outcomes,
and recommendations for future programs.
Section 746 would establish a five-year annual congressional
Section 713 would require the Secretary of Defense to
reporting requirement on the number of servicemember
submit an annual report to the armed services committees
overdoses, demographics, comorbidities, naloxone usage,
on the number of annual drug overdoses among
and other details.
servicemembers and other demographic and health care
utilization data. The provision would also require the
Secretary of Defense to establish standards for distributing
and providing training on naloxone, medications for
overdose reversal, and other topics relating to substance
use and misuse.
Section 752 would direct the Comptrol er General to
No similar provision.
conduct a study on TRICARE payments to network
behavioral health professionals. Study results would be
reported to the armed services committees.
Section 754 would require the Secretary of Defense to
No similar provision.
conduct a study and provide a report to the armed services
committees on the accessibility of mental health providers
and services for members of the Armed Forces.
Section 755 would require the Secretary of Defense and
No similar provision.
Secretary of Health and Human Services to col aborate on a
study of barriers to mental health care for military pilots and
aviators. The provision would also require a report to
Congress on the study’s results no later than one year after
enactment.
No similar provision.
Section 723 would require the Comptrol er General to
conduct a study on perinatal mental health conditions among
servicemembers and their dependents. The provision would
require a report to the armed services committees no later
than one year after enactment.
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House-passed H.R. 2670
Senate-passed S. 2226
No similar provision.
Section 724 would require the Defense Health Agency
(DHA) Director to provide a report to the armed services
committees on servicemembers’ wait times to access mental
health care in the TRICARE program, an assessment of
mental health providers needed to meet access standards,
and an explanation of DOD credentialing standards for
mental health providers.
No similar provision.
Section 725 would require the Secretary of Defense to
provide a report to the armed services committees on
activities to address the mental health of pregnant and
postpartum servicemembers and dependents.
No similar provision.
Section 5721 would require the Secretary of Defense to
submit a report to the congressional defense committees on
the mental health care referral process for servicemembers
and the potential impact of removing primary care referral
requirements for outpatient mental health care. The report
would also include recommendations to improve military
readiness, access to and uptake of outpatient mental health
care, and suicide prevention.
No similar provision.
Section 5723 would require the Secretary of Defense to
submit a report, not later than March 31, 2024, to the
armed services committees on applicable federal and state
laws and policies governing DOD’s provision of mental
health services via telehealth to servicemembers and their
families. The report would also provide a description of
challenges and opportunities to improve continuity of
mental health care after changing duty stations.
Source: CRS analysis of legislation on Congress.gov.
Discussion
Mental Health Strategy Development
In 2006, Congress established a task force to assess and develop recommendations to improve mental
health services for servicemembers after reported challenges with “inadequate” mental health assessments
and poor access to care and support. The task force found that DOD lacked “fiscal resources and fully-
trained personnel to fulfill its mission to support psychological health in peacetime or fulfill the
requirements imposed during times of conflict.” To address these findings, the task force published 95
recommendations, many of which DOD implemented through subsequent program changes or integration
into strategy documents (e.g., Integrated Mental Health Strategy, DOD Strategy for Suicide Prevention,
military services’ psychological health strategic plan).
In June 2023, a Defense Health Board (DHB) report asserted that DOD continues to be challenged by the
existing national “mental health crisis” and that the MHS “lacks the resources it needs, in terms of
providers and treatment options” to meet the needs of the military. How DOD intends to enhance
servicemember resiliency and the provision of mental health services remains to be seen.
Section 729 of the House-passed bill would require the Secretary of Defense to establish a task force, not
later than 90 days after enactment, to examine the mental health of servicemembers, provide Congress a
report on findings and recommendations to improve mental health services, and develop an
implementation plan based on the task force’s recommendations. Section 742 of the House-passed bill
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would require the Secretary of Defense to submit a comprehensive strategy on force resilience to the
armed services committees not later than 270 days after enactment.
Mental Health Program Assessments
Since at least 2001, Congress has expressed interest in understanding how DOD implements mental
health programs and the effect of these programs on servicemember wellbeing. Congress has inserted
briefing or reporting requirements in annual defense-related legislation (e.g., NDAA or defense
appropriations acts) or accompanying committee reports or explanatory statements. DOD and GAO often
make these reports to Congress available online. The House- and Senate-passed bills of an FY2024
NDAA include provisions that would require certain reports to Congress on the following military mental
health-related topics:
• access to mental health care,
• substance use and misuse,
• mental health and pregnancy, and
• mental health & aviators.
For more on military mental health topics, see CRS Insight 12242, FY2024 NDAA: Mental Health Care
and Research Provisions; CRS Insight 11801, FY2022 NDAA: Mental Health Care; CRS In Focus 10876,
Military Suicide Prevention and Response; and CRS In Focus 10951, Substance Abuse Prevention,
Treatment, and Research Efforts in the Military.
Author Information
Bryce H. P. Mendez
Specialist in Defense Health Care Policy
Disclaimer
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Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of
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