FY2024 NDAA: Military Mental Health Care and Research Provisions

FY2024 NDAA: Military Mental Health Care and Research Provisions

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INSIGHTi

FY2024 NDAA: Military Mental Health Care
and Research Provisions
Updated January 19, 2024
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 a range of 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 proposed and
enacted military mental health care and research-related provisions included in the House-passed (H.R.
2670), Senate-passed (S. 2226), and enacted (P.L. 118-31) versions of the FY2024 NDAA.

Congressional Research Service
https://crsreports.congress.gov
IN12242
CRS INSIGHT
Prepared for Members and
Committees of Congress

Congressional Research Service
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Table 1. FY2024 NDAA Legislative Proposals
House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Section 703 would have amended 10
No similar provision.
Section 705 adopts the House
U.S.C. §1090b to exclude members of
provision with an amendment clarifying
the Individual Ready Reserve from the
the applicability of the self-initiated
process requirements for a self-
mental health referral process to
initiated referral to mental health care.
Selected Reserve members in a duty
status.
Section 710 would have required the
No similar provision
Not adopted.
Secretary of Defense, in consultation
with the Secretary of Veterans Affairs,
to conduct a pilot program to study
the health effects of marijuana use by
certain servicemembers or veterans
diagnosed with post-traumatic stress
disorder, depression, anxiety, or for
pain management.
Section 712 would have required the
No similar provision.
Not adopted.
Secretary of Defense to conduct initial
and subsequent psychological
evaluations to servicemembers who
conducted military operations at
Hamid Karzai International Airport in
Kabul, Afghanistan, between August
15-29, 2021.
Section 734 would have required the
No similar provision.
Not adopted.
Defense Health Agency (DHA)
Director to waive, in certain instances,
any requirements for a servicemember
to receive a mental health intake
screening at a military treatment facility
(MTF) prior to receiving mental health
care from a participating TRICARE
provider.
Section 744 would have directed the
No similar provision.
Section 723 adopts the House
Secretary of Defense to carry out a
provision with an amendment that
clinical study in military treatment
clarifies the timeline, process, and
facilities, not later than 90 days after
research entities that the Secretary of
enactment, on the effects of certain
Defense may fund to carry out the
psychedelic substances on
clinical studies for post-traumatic
servicemembers who are diagnosed
stress disorder or traumatic brain
with post-traumatic stress disorder,
injury.
traumatic brain injury, or chronic
traumatic encephalopathy.
Section 749 would have required
No similar provision.
Not adopted.
DOD, in col aboration with the
Department of State and Department
of Veterans Affairs, to award grants to
certain entities for col aborative
research with Israeli institutions on
post-traumatic stress disorder.

Congressional Research Service
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House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
No similar provision.
Section 704 would have codified in
Not adopted.
Title 10, Chapter 55, of the U.S. Code, a
requirement to offer an intensive
outpatient program to treat
servicemembers suffering from post-
traumatic stress disorder, traumatic
brain injuries, and co-occurring
disorders related to military sexual
trauma.
Source: CRS analysis of legislation on Congress.gov.
Discussion
Mental Health Screening and Care
Since at least September 11, 2001, Congress has created requirements (see 10 U.S.C. §1074m, §1074n,
§1090, and §1090a) for DOD to periodically screen and evaluate servicemembers for mental health issues
and to provide necessary treatment. Congress has also established procedures for commanding officers
and supervisors to refer servicemembers for mental health evaluation (see 10 U.S.C. §1090b). In 2021,
Congress enacted “the Brandon Act” as part of Section 704 of the FY2022 NDAA (P.L. 117-81). The
Brandon Act established a self-initiated referral process for servicemembers to confidentially seek mental
health care and reduce associated mental health stigma. In May 2023, DOD issued a policy that
implements the self-initiated referral process, which is available to all servicemembers of the active and
reserve components. Servicemembers may obtain clinical or nonclinical mental health services from a
military treatment facility, TRICARE network providers, embedded mental health providers in their unit,
military family life counselors, or other resources that may be available.
Section 705 of the enacted bill adopts House Section 703, which amends 10 U.S.C. §1090b to exclude
members of the Individual Ready Reserve and Selected Reserve (when not in a duty status) from the
process requirements for a self-initiated referral to mental health.
The enacted bill did not adopt House Section 712, which would have required the Secretary of Defense to
conduct initial and subsequent psychological evaluations of servicemembers who conducted military
operations at Hamid Karzai International Airport in Kabul, Afghanistan, between August 15-29, 2021. In
the conference report, the conferees encouraged these servicemembers to voluntarily “seek mental health
care, without reservation, at the earliest possible time.”
The enacted bill did not adopt House Section 734, which would have required the DHA Director to waive
requirements, if any, for a servicemember to receive a mental health intake screening at an MTF prior to
receiving mental health care from a TRICARE-authorized provider. The waiver of requirements would
have applied when a servicemember requires “rapid provision” of a mental health service and that service
is unavailable at an MTF within 48 hours.
The enacted bill did not adopt Senate Section 704, which would have codified in Title 10, Chapter 55, of
the U.S. Code, a requirement to offer an intensive outpatient program (IOP) to treat servicemembers
suffering from post-traumatic stress disorder, traumatic brain injuries, and co-occurring disorders related
to military sexual trauma. The conferees directed the Secretary of Defense to provide a briefing to the
armed services committees, no later than April 1, 2024, on the “feasibility and advisability” of
establishing an IOP as proposed in the provision.

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Mental Health Research
Under 10 U.S.C. §4001, DOD administers a wide-range of research and development (R&D) programs,
including biomedical research on psychological health, resilience, and emerging mental health treatments.
Numerous DOD components (e.g., Defense Health Agency, Uniformed Services University of the Health
Sciences, military services) perform or sponsor medical research funded through the Defense Health
Program, including the Congressionally Directed Medical Research Programs. According to DOD’s 2019
Strategic Medical Research Plan, the goal of medical R&D programs is to “advance the state of medical
science in those areas of most pressing need and relevance to today’s battlefield experience and emerging
threats.”
Section 723 of the enacted bill adopts House Section 744 language and directs the Secretary of Defense,
not later than 180 days after enactment, to designate a lead administrator and to establish a process to
fund “eligible entities” to conduct research on the effects of certain psychedelic substances (i.e., 3,4-
methylenedioxy-methamphetamine or MDMA, psilocybin, ibogaine, 5–Methoxy-N,N-
dimethyltryptamine or DMT, and “qualified plant-based alternative therapies”) on servicemembers who
are diagnosed with post-traumatic stress disorder or traumatic brain injury.
The enacted bill did not adopt House Section 710, which would have required the Secretary of Defense,
in consultation with the Secretary of Veterans Affairs, to conduct a pilot program to study the health
effects of marijuana use by certain servicemembers or veterans diagnosed with post-traumatic stress
disorder, depression, anxiety, or for pain management.
The enacted bill did not adopt House Section 749, which would have directed the Secretary of Defense, in
coordination with the Secretary of State and Secretary of Veterans Affairs, 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 also would have required DOD to
provide a report to Congress that describes how funds were used and an evaluation on the project’s
success. The conferees noted that “the United States and Israel have cooperated in the field of medical
research since 1978, to include post-traumatic stress disorder.”
For more on military mental health care, see
• CRS Insight IN12263, FY2024 NDAA: Military Mental Health Strategy Development
and Program Assessment Provisions;
• CRS Insight IN12268, FY2024 NDAA: Military Mental Health Workforce Provisions;
• CRS In Focus IF10876, Military Suicide Prevention and Response; and
• CRS In Focus IF10951, Substance Abuse Prevention, Treatment, and Research Efforts in
the Military.

Author Information

Bryce H. P. Mendez

Specialist in Defense Health Care Policy

Congressional Research Service
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IN12242 · VERSION 2 · UPDATED