FY2024 NDAA: Military Mental Health Workforce Provisions

FY2024 NDAA: Military Mental Health Workforce Provisions

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INSIGHTi

FY2024 NDAA: Military Mental Health
Workforce 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, 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 proposed and enacted military mental health workforce-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)
DOD Mental Health Workforce Provisions
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House-passed H.R. 2670
Senate-passed S. 2226
Enacted Legislation (P.L. 118-31)
Section 741 proposed to amend the
No similar provision.
Not adopted.
requirements for a DOD 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 proposed to require the
No similar provision.
Not adopted.
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
policies on clinical supervision
requirements of certain mental health
providers.
No similar provision.
Section 503 proposed to amend 10
Not adopted.
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.
Mental Health Training Provisions
Section 714 proposed to direct the
No similar provision.
Not adopted.
Secretary of Defense to conduct a
study on TRICARE provider training
gaps in screening and treating maternal
mental health conditions.
Section 753 proposed to require the
No similar provision.
Not adopted.
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 Provisions
Section 704 proposed to amend 10
Section 532 proposed to amend 10
Section 581 adopted the Senate
U.S.C. §1781 to allow licensure
U.S.C. §1781 to allow licensure
provision.
portability for mental health
portability for mental health
professionals providing nonmedical
professionals providing nonmedical
counseling under the Military and
counseling under the MFLC program.
Family Life Counseling program
The authority to allow licensure
(MFLC).
portability would have terminated
three years after the date of
enactment.
Source: CRS analysis of legislation on Congress.gov.

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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.
Congress considered, but did not adopt, the following provisions.
• House Section 741 proposed to 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), to include the number of military behavioral health providers assigned to
certain nonclinical positions (e.g., command, recruitment, training, or staff 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 proposed to require the Secretary of Defense to submit a report to the House
and Senate on the feasibility of revising Defense Health Agency (DHA) policies to align with
Veterans Health Administration (VHA) Directive 1027 on clinical supervision requirements for
certain mental health providers who are not yet licensed to practice independently. In the
conference report, the conferees directed the Secretary of Defense, not later than September 30,
2024, to brief the House and Senate on the “feasibility of revising DHA policies” on the clinical
supervision requirements of certain mental health providers to align with VHA Directive 1027.
• Senate Section 503 proposed to 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 the FY2016 NDAA (P.L. 114-92 §717), Congress 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.”

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Congress considered, but did not adopt, the following provisions.
• House Section 714 proposed to 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 proposed to 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. 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 Title 10, Chapter 55, of the 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 Title 10, Chapter 88, of U.S. Code).
Section 581 adopted Senate Section 532 and amends 10 U.S.C. §1781 to allow licensure portability for
mental health professionals providing nonmedical counseling under the MFLC program. The authority to
allow licensure portability expires three years after enactment. House Section 704, which was not
adopted, was a similar provision that proposed to permanently allow licensure portability for mental
health professionals under the MFLC program.
For more on military mental health care, see the folllwing.
• 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 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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IN12268 · VERSION 2 · UPDATED