FY2024 NDAA: Military Mental Health Strategy Development and Program Assessment Provisions

FY2024 NDAA: Military Mental Health Strategy Development and Program Assessment Provisions

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INSIGHTi

FY2024 NDAA: Military Mental Health
Strategy Development and Program
Assessment Provisions
Updated January 23, 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 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 proposed and enacted military mental health strategy development and program
assessment-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.
Table 1. FY2024 NDAA Selected Legislative Proposals
House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Mental Health Strategy Development Provisions
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House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Section 729 proposed to require the
No similar provision.
Not adopted.
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 proposed to require the
No similar provision.
Not adopted.
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 Assessment Provisions
Section 743 proposed to require the
No similar provision.
Not adopted.
Secretary of Defense, in 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 proposed to establish a
Section 713 proposed to require the
Section 724 adopts the Senate
five-year annual congressional
Secretary of Defense to submit an
provision with an amendment that
reporting requirement on the number
annual report to the armed services
requires the annual report to begin no
of servicemember overdoses,
committees on the number of annual
later one year after enactment. The
demographics, comorbidities, naloxone
drug overdoses among
amendment also omitted the standards
usage, and other details.
servicemembers and other
for distributing and providing training
demographic and health care utilization
on naloxone that was included in the
data. The provision also proposed to
Senate provision.
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 proposed to direct the
No similar provision.
Not adopted.
Comptrol er General to conduct a
study on TRICARE payments to
network behavioral health
professionals. Study results would be
reported to the armed services
committees.

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House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Section 754 proposed to require the
No similar provision.
Not adopted.
Secretary of Defense to 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 proposed to require the
No similar provision.
Not adopted.
Secretary of Defense and 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 also
proposed to require a report to
Congress on the study’s results no
later than one year after enactment.
No similar provision.
Section 723 proposed to require the
Not adopted.
Comptrol er General to conduct a
study and provide a report to the
armed services committees, no later
than one year after enactment, on
perinatal mental health conditions
among servicemembers and their
dependents.
No similar provision.
Section 724 proposed to require the
Not adopted.
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 proposed to require the
Not adopted.
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 proposed to require the
Not adopted.
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 have included
recommendations to improve military
readiness, access to and uptake of
outpatient mental health care, and
suicide prevention.

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House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
No similar provision.
Section 5723 proposed to require the
Not adopted.
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 have provided 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.
House Section 729, which was not adopted, would have required 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. In the conference report, the
conferees noted that DOD “already has established at least two bodies in support of [military] mental
health: the Suicide Prevention and Response Independent Review Committee and, in conjunction with the
Departments of Veterans Affairs and Health and Human Services, the Interagency Task Force on Military
and Veterans Mental Health.”
House Section 742, which was not adopted, would have required the Secretary of Defense to submit a
comprehensive strategy on force resilience to the armed services committees not later than 270 days after
enactment. The conferees directed the Secretary of Defense to submit a report to the armed services
committees, not later than one year after enactment, on force resilience. The report is to include a
proposal for a comprehensive strategy on force resilience and assessments of current resilience models,
among other items.

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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.
Section 724 of the enacted bill adopted Senate Section 713, with an amendment that requires the
Secretary of Defense to submit an annual report to the armed services committees on the number of
annual drug overdoses among servicemembers and other demographic and health care utilization data.
The conferees also directed the following briefing or reporting requirements to the armed services
committees:
Secretary of Defense
• A briefing on non-clinical mental health programs and the Military and Family Life
Counseling Program (not later than December 1, 2024).
• A briefing on mental health care referral process for servicemembers and
recommendations for relevant legislative changes (not later than 180 days after
enactment).
• A briefing on DOD’s provision of mental health services via telehealth (not later than
March 31, 2024).
Comptroller General
• A briefing (not later than 180 days after enactment) and a report on a study of TRICARE
payments to TRICARE network behavioral health professionals.
For more on military mental health topics, see
• CRS Insight IN12242, FY2024 NDAA: Military Mental Health Care and Research
Provisions
• CRS Insight IN12268, FY2024 NDAA: Military Mental Health Workforce Provisions
• CRS In Focus IF10876, Military Suicide Prevention and Response
• 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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Disclaimer
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