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INSIGHTi
FY2024 NDAA: Military Mental Health
Workforce Provisions
October 25, 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, 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 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
workforce and resources available to servicemembers and their families through the Military Health
System (MHS), the military departments, and Military OneSource.
Table 1 lists the military mental health workforce-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
Section 704 would amend 10 U.S.C. §1781 to allow
Section 532 would amend 10 U.S.C. §1781 to allow
licensure portability for mental health professionals
licensure portability for mental health professionals
providing nonmedical counseling under the Military and
providing nonmedical counseling under the MFLC program.
Family Life Counseling program (MFLC).
The authority to allow licensure portability would terminate
three years after the date of enactment.
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House-passed H.R. 2670
Senate-passed S. 2226
Section 714 would direct the Secretary of Defense to
No similar provision.
conduct a study on TRICARE provider training gaps in
screening and treating maternal mental health conditions.
Section 741 would amend the requirements for a DOD
No similar provision.
behavioral health workforce report, directed by Section
737(c) of the James M. Inhofe National Defense
Authorization Act for Fiscal Year 2023 (P.L. 117-263), to
include additional data points and analysis of the workforce.
Section 747 would require the Secretary of Defense to
No similar provision.
submit a report to the House and Senate, not later than
September 30, 2024, on the feasibility of revising Defense
Health Agency (DHA) policies to align with Veterans Health
Administration policies on clinical supervision requirements
of certain mental health providers.
Section 753 would require the Secretary of Defense to
No similar provision.
update the mental health provider readiness designation
registry required by Section 717 of the FY2016 NDAA (P.L.
114-92) and provide a report to Congress on the number of
TRICARE providers with this designation.
No similar provision.
Section 503 would amend 10 U.S.C. §523(b) to exclude
military commissioned officers who are licensed behavioral
health providers (e.g., clinical psychologists, social workers,
and mental health nurse practitioners) from counting toward
the authorized strength of certain officers on active duty.
Source: CRS analysis of legislation on Congress.gov.
Discussion
DOD Mental Health Workforce
According to the Department of Health and Human Services, by 2025, the demand for mental health
services across the United States is expected to exceed the supply of “behavioral health providers,
including psychiatrists, mental health and substance abuse social workers, mental health and substance
use disorder counselors, and marriage and family therapists.” In a 2020 report to Congress, DOD stated
that mental health provider shortages “may affect the ability to adequately meet the [mental health] care
needs of [active duty servicemembers]; specifically affecting access to care, quality of care, and/or
timeliness of care.” DOD also reported that certain compensation and non-compensation factors can be
“barriers to recruitment, retention, promotion, and attrition” of mental health providers, including
• budgetary and statutory limitations that hinder DOD’s ability to adjust special and
incentive pays,
• a nationwide shortage of mental health providers,
• public and private sector competition for talent, and
• limited awareness of DOD health professions programs and scholarships.
House Section 741 would amend the requirements for a DOD behavioral health workforce report,
directed by Section 737(c) of the James M. Inhofe National Defense Authorization Act for FY2023 (P.L.
117-263). The provision would add data points in the report, including the number of military behavioral
health providers assigned to certain nonclinical positions (e.g., command, recruitment, training, or staff
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assignments), the effect of collateral duties and other factors on the ability of military and civilian
behavioral health providers to provide care, and information on how DOD calculates full-time equivalent
providers.
House Section 747 would require the Secretary of Defense to submit a report to the House and Senate, not
later than September 30, 2024, on the feasibility of revising Defense Health Agency (DHA) policies to
align with Veterans Health Administration Directive 1027 on clinical supervision requirements for certain
mental health providers who are not yet licensed to practice independently.
Senate Section 503 would amend 10 U.S.C. §523(b) to exclude commissioned officers who are licensed
behavioral health providers (e.g., clinical psychologists, social workers, and mental health nurse
practitioners) from counting toward the authorized strength of certain officers on active duty.
Mental Health Training for TRICARE Providers
Some researchers have found that “military cultural competence is a critical part of providing care to
military patients.” In 2015, Congress enacted Section 717 of the FY2016 NDAA (P.L. 114-92), which
established requirements for DOD to develop a civilian mental health provider readiness designation
system that enhances knowledge on military culture and care for the military population. The Uniformed
Services University of the Health Sciences’ Center for Deployment Psychology also administers an
online-based training and registry to “enhance behavioral health providers’ scope of knowledge and
skills” for treating servicemembers, veterans, and their families with “reintegration- and deployment-
related concerns.”
House Section 714 would direct the Secretary of Defense to conduct a study on TRICARE provider
training gaps in screening and treating maternal mental health conditions. House Section 753 would
require the Secretary of Defense to update the mental health provider readiness designation registry
required by Section 717 of the FY2016 NDAA (P.L. 114-92) and provide a report to Congress on the
number of TRICARE providers with this designation.
Military and Family Life Counseling
Military OneSource offers support services, including confidential, nonmedical counseling through its
Military and Family Life Counseling (MFLC) program. DOD policy requires certain MFLC mental
health professionals to maintain a “valid unrestricted counseling license or certification” from a U.S. state
or territory in order to provide counseling services. In certain instances, MFLC staff who move to another
state that does not offer licensure reciprocity may be required to obtain a new counseling license from the
new state of residence. Currently, 10 U.S.C. §1094 (under Chapter 55 of Title 10, U.S. Code) provides
licensure portability for DOD health care providers who operate under the MHS or a military department
only. This statute does not apply to MFLC mental health professionals, who operate under distinct
military family program statutes (under Chapter 88 of Title 10, U.S. Code).
House Section 704 would amend 10 U.S.C. §1781 to codify the MFLC program and allow licensure
portability for MFLC mental health professionals providing nonmedical counseling. Senate Section 532 is
a similar provision; however, the licensure portability authority for MFLC mental health professionals
providing nonmedical counseling would terminate three years after the date of enactment.
For more on military mental health care, see CRS Insight IN12242, FY2024 NDAA: Military Mental
Health Care and Research Provisions; CRS Insight IN12263, FY2024 NDAA: Military Mental Health
Strategy Development and Program Assessment Provisions; CRS Insight IN11801, FY2022 NDAA:
Mental Health Care; CRS In Focus IF10876, Military Suicide Prevention and Response; and CRS In
Focus IF10951, Substance Abuse Prevention, Treatment, and Research Efforts in the Military.
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Author Information
Bryce H. P. Mendez
Specialist in Defense Health Care Policy
Disclaimer
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