United States Government Accountability Office

GAO Report to Congressional Requesters

VA HEALTH CARE

Spending for Mental 

Health Strategic Plan 

Initiatives Was 

Substantially Less 

Than Planned 

November 2006 

 

GAO-07-66 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

November 2006

VA HEALTH CARE

Spending for Mental Health Strategic Plan 

Initiatives Was Substantially Less Than 

Planned 

Highlights of GAO-07-66, a report to 

congressional requesters 

The Department of Veterans 

Affairs (VA) provides mental 

health services to veterans with 

conditions such as post-traumatic 

stress disorder (PTSD) and 

substance abuse disorders. To 

address gaps in services needed 

by veterans, VA approved a 

mental health strategic plan in 

2004. VA planned to increase its 

fiscal year 2005 allocations for 

plan initiatives by $100 million 

above fiscal year 2004 levels and 

its fiscal year 2006 allocations for 

plan initiatives by $200 million 

above fiscal year 2004 levels. 

GAO was asked to provide 

information on VA’s allocation 

and use of funding for mental 

health strategic plan initiatives in 

fiscal years 2005 and 2006, and to 

examine the adequacy of how VA 

tracked spending and the extent 

of spending for plan initiatives. 

GAO reviewed VA reports and 

documents on plan initiatives and 

conducted interviews with VA 

officials at headquarters, 4 of 21

health care networks, and seven 

medical centers. VA networks 

provide oversight of medical

center operations and most 

medical center resources. 

What GAO Recommends

GAO recommends that VA track 

the extent to which the resources 

allocated for strategic plan 

initiatives are spent for these

initiatives. VA did not comment 

on the content of this report. 

In fiscal year 2005, VA headquarters allocated about $88 million of the 

$100 million above fiscal year 2004 levels that VA officials intended for 

mental health strategic plan initiatives. VA allocated about $53 million 

directly to medical centers and certain offices based on proposals submitted 

for funding and other approaches targeted to specific initiatives. VA solicited 

proposals from networks for initiatives to be carried out at medical centers 

through requests for proposals (RFP). In addition, VA headquarters officials 

said that VA allocated $35 million for plan initiatives through VA’s general 

resource allocation system to its 21 health care networks on a retrospective 

basis, several months after resources had been provided to the networks 

though the general resource allocation system. VA did not notify network 

and medical center officials that these funds were to be used for plan 

initiatives. Network and medical center officials interviewed told GAO that 

they were not aware these allocations had been made. As a result, it is likely 

that some of these funds were not used for plan initiatives. VA did not 

allocate the approximately $12 million remaining of the $100 million for 

fiscal year 2005 because, according to VA officials, there was not enough 

time during the fiscal year to do so. Medical center officials said they used 

funds allocated for plan initiatives for new services and for enhancement of 

existing services. For example, two medical centers increased the number of 

mental health providers at community-based outpatient clinics. However, 

some medical center officials reported they did not use all funds allocated by 

the end of the fiscal year, due in part to the time it took to hire staff. 

In fiscal year 2006, VA headquarters allocated about $158 million of the 

$200 million above fiscal year 2004 levels intended for mental health 

strategic plan initiatives directly to medical centers and certain offices. VA 

allocated about $92 million of these funds to support new initiatives, using 

RFPs and other targeted funding approaches. VA also allocated about 

$66 million to support recurring costs of continuing initiatives from the prior 

fiscal year. About $42 million of the $200 million for fiscal year 2006 was not 

allocated. Officials from seven medical centers GAO interviewed reported 

they had used funds for plan initiatives, such as the creation of a new case 

management program. Officials at some medical centers reported they did 

not anticipate problems using all of the funds allocated within the fiscal year;

however, officials at other medical centers were less certain they would be 

able to do so. 

VA tracking of spending for plan initiatives was inadequate. In fiscal year

2005, VA did not track such spending. In fiscal year 2006, VA tracked aspects 

of plan initiatives but not dollars spent. However, available information 

indicates that VA spending for plan initiatives was substantially less than 

planned. In fiscal year 2006, VA medical centers returned to headquarters 

about $46 million of about $158 million allocated for plan initiatives because 

they could not spend the funds that year. However, VA cannot determine to 

what extent the approximately $112 million remaining was spent on plan 

initiatives because it did not track specifically how these funds were spent. 

www.gao.gov/cgi-bin/getrpt?GAO-07-66.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Laurie E. 

Ekstrand at (202) 512-7101 or 

ekstrandl@gao.gov. 
Contents 

Letter 1

Results In Brief 5 

Background 7

VA Allocated about $88 Million of the $100 Million Planned for 

Mental Health Strategic Plan Initiatives in Fiscal Year 2005, but 

Officials Reported That Not All Allocated Funds Were Used for 

Plan Initiatives 10 

VA Allocated about $158 Million of the $200 Million Planned for 

Mental Health Strategic Plan Initiatives in Fiscal Year 2006, but 

Some Officials Were Uncertain If All Funds Would Be Used for 

Plan Initiatives 18 

VA Tracking of Funds Spent for Mental Health Strategic Plan 

Initiatives Was Inadequate, but Available Information Indicates

That Spending for These Initiatives Was Substantially Less Than 

Planned 24

Conclusion 25

Recommendation for Executive Action 26 

Agency Comments 26 

Appendix I Department of Veterans Affairs (VA) Health Care 

Networks, Medical Centers, and Other Facilities 

GAO Selected for Review 28 

Appendix II Description of Selected Department of Veterans 

Affairs (VA) Mental Health Services 29 

Appendix III Comments from the Department of Veterans Affairs 31 

Appendix IV GAO Contact and Staff Acknowledgments 32 

Related GAO Products 33 

Page i GAO-07-66 VA Mental Health Services
Tables 

Table 1: Summary of VA Information on Mental Health Strategic 

Plan Allocations to Medical Centers and Certain Offices by 

Type of Mental Health Service, Fiscal Year 2005 11 

Table 2: Summary of VA Information on Planned Funding for 

Mental Health Strategic Plan Initiatives Not Allocated by 

Type of Mental Health Service, Fiscal Year 2005 16 

Table 3: Summary of VA Information on Mental Health Strategic 

Plan Allocations to Medical Centers and Certain Offices by 

Type of Mental Health Service, Fiscal Year 2006 19 

Table 4: Summary of VA Information on Planned Funding for 

Mental Health Strategic Plan Initiatives Not Allocated by 

Type of Mental Health Service, Fiscal Year 2006 22 

Abbreviations 

CBOC community-based outpatient clinic 

CWT Compensated Work Therapy 

OEF Operation Enduring Freedom 

OIF Operation Iraqi Freedom

OMHS Office of Mental Health Services 

PTSD post-traumatic stress disorder 

RFP request for proposal 

VA Department of Veterans Affairs 

VERA Veterans Equitable Resource Allocation system 

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Page ii GAO-07-66 VA Mental Health Services
United States Government Accountability Office

Washington, DC 20548 

November 21, 2006 

The Honorable Lane Evans 

Ranking Minority Member 

Committee on Veterans’ Affairs 

House of Representatives 

The Honorable Michael Michaud 

Ranking Minority Member 

Subcommittee on Health

Committee on Veterans’ Affairs 

House of Representatives 

The Department of Veterans Affairs (VA) provides a range of inpatient and 

outpatient mental health services to veterans with conditions such as 

depression, post-traumatic stress disorder (PTSD), and substance abuse 

disorders. In November 2004, the Secretary of VA approved a mental 

health strategic plan that identified additional services that VA planned to

add to the baseline of mental health services that it already offered to meet

veterans’ mental health needs.1

 This mental health strategic plan was 

based on previous VA efforts that identified gaps in the availability and 

adequacy of VA mental health services, including services for the 

treatment of substance abuse disorders. VA’s mental health strategic plan

was intended to help VA’s leadership identify the actions and resources 

needed to begin eliminating the gaps between mental health services VA 

provided at the time of the plan’s formulation and those additional 

services VA anticipated that would be required to meet future needs. 

VA indicated at a 2005 congressional hearing2

 that it would provide 

$100 million above fiscal year 2004 levels for mental health strategic plan 

initiatives in fiscal year 2005 from available resources. In addition, in a 

2005 executive decision memo, VA indicated its intent to increase its fiscal 

year 2006 funding levels to $200 million above fiscal year 2004 levels for 

 1

The plan is known formally as A Comprehensive Veterans Health Administration Strategic 

Plan for Mental Health Services. In this report, we will refer to it as the mental health 

strategic plan. 

2

Full Committee Hearing on the Continuum of Care for Post Traumatic Stress Disorder

Before the House Comm. on Veterans’ Affairs, 109th Cong. (July 27, 2005). 

Page 1 GAO-07-66 VA Mental Health Services
mental health strategic plan initiatives. This $200 million in funds for fiscal 

year 2006 was to be composed of $100 million for a continuation of fiscal 

year 2005 initiatives plus an additional $100 million included in the 

President’s budget request for fiscal year 2006, according to the executive

decision memo. These additional funds represented only a portion of the 

overall funds available to support VA mental health services in those 

2 fiscal years. VA’s appropriation for fiscal year 2006, for example, 

included more than $31.5 billion for its medical programs,3

 of which VA 

expected to spend more than $2 billion on mental health services. VA 

headquarters allocates most of these resources to VA’s 21 regional health

care networks4

 through a general resource allocation system and the 

networks in turn allocate resources to their medical centers. 

VA officials have stated that funds for mental health strategic plan 

initiatives are to be used to address priorities such as the expansion of 

PTSD services, postdeployment mental health services for veterans 

returning from combat in Iraq and Afghanistan and other geographic 

areas—Operation Iraqi Freedom (OIF) and Operation Enduring Freedom 

(OEF), respectively, and the expansion of programs for the treatment of 

substance abuse disorders. In recent years, VA’s mental health services 

and budget have come under increased scrutiny due to the potential for 

increased demand for mental health services from veterans returning from 

combat in Iraq and Afghanistan. In particular, concerns have been 

expressed by members of Congress and others regarding the adequacy of

resources that VA is devoting to provide mental health care for these 

veterans while also continuing to provide services for veterans who are 

currently receiving mental health care. 

You requested that we provide information on VA’s allocation and 

spending for mental health strategic plan initiatives in fiscal years 2005

and 2006, and the extent to which VA tracks the use of funding for plan 

initiatives. In this report, we provide information on (1) how much of the 

$100 million for mental health strategic plan initiatives in fiscal year 2005 

was allocated and how those funds were used by selected medical centers, 

 3

Total includes medical care collections, but does not include certain other amounts, such

as appropriations for construction. 

4

VA headquarters delegates decision making regarding financing and service delivery for

health care services to its 21 health care networks, including most budget and management 

responsibilities concerning medical center operations. Medical centers typically include 

one or more hospitals as well as other types of health care facilities such as outpatient

clinics and nursing homes.

Page 2 GAO-07-66 VA Mental Health Services
(2) how much of the $200 million for mental health strategic plan 

initiatives in fiscal year 2006 was allocated and how those funds were used 

by selected medical centers, and (3) the adequacy of how VA tracked 

funds spent for mental health strategic plan initiatives in fiscal years 2005 

and 2006 and the extent to which allocated funds were spent for these 

initiatives. 

To provide information on how much of the $100 million for fiscal year 

2005 and $200 million for fiscal year 2006 for mental health strategic plan

initiatives was allocated to networks, medical centers, and certain offices, 

we reviewed the plan itself as well as reports and other documents related 

to the development, implementation, and funding of the mental health

strategic plan. We also conducted interviews with VA headquarters 

officials with responsibilities related to mental health services, budgeting,

and the allocation of financial resources. We took steps to ensure that the

data VA provided to us on the funding allocated in fiscal years 2005 and 

2006 were sufficiently reliable for our purposes. We reviewed the data for 

internal consistency and compared the data to other VA information as 

well as information we obtained through interviews with VA officials. We 

did not independently verify the accuracy of the data. Nor did we 

independently determine the extent to which legislation regarding VA 

health care expressly requires spending or authorizes various types of 

mental health services but relied on VA’s determination regarding these 

services. To describe how funds were used by selected medical centers, in

May and June 2006, we conducted site visits to 2 of VA’s 21 health care 

networks and three medical centers located in those networks, and we 

also conducted phone interviews with officials in 2 other networks and 

four medical centers located in those networks.5

 We selected these 4 

networks because VA had identified them as having gaps in substance 

abuse and/or mental health services prior to the implementation of the 

mental health strategic plan, and because they received varying levels of 

funding—from relatively high to relatively low—in fiscal year 2005 for 

mental health strategic plan initiatives. We interviewed clinical and 

administrative officials at these networks and medical centers and at three 

 5

Throughout this report, the phrase “how funds were used by medical centers” refers to

information provided by medical center officials regarding the hiring of staff, purchase of 

certain equipment, and other purposes. These activities would be expected to result in

obligations and expenditures of funds either immediately or in the future. 

Page 3 GAO-07-66 VA Mental Health Services
community-based outpatient clinics (CBOC)6

 associated with these 

medical centers and at five Vet Centers.7

 We conducted these interviews in 

May and June 2006. The findings from our site visits and phone interviews 

with network and medical center officials cannot be generalized to other 

medical centers or networks. For a list of VA health care networks and 

medical centers included in our review, see appendix I. For a list of 

selected VA mental health services discussed in this report, see appendix 

II. This work expands upon the preliminary findings that we reported in 

September 2006.8

To discuss how VA tracked funds spent for mental health strategic plan 

initiatives in fiscal years 2005 and 2006 and the extent to which these 

funds were spent for mental health strategic plan initiatives, we reviewed 

documents related to VA’s tracking efforts and interviewed VA 

headquarters officials responsible for those efforts. We also requested 

from VA headquarters information on the amount of funds returned by 

medical centers to headquarters when medical centers were unable to 

spend all the funds in a fiscal year. In addition, we requested information 

from VA headquarters on the amount of funds medical centers spent on 

plan initiatives. To gain further insights and perspectives on veterans’ 

mental health services generally, we reviewed our previous work on VA 

health care, including those related to mental health and strategic planning 

(see Related GAO Products at the end of this report), and interviewed 

officials from selected veterans’ service organizations and professional 

and advocacy organizations. We focused on the allocation and use of 

funds related to mental health strategic plan initiatives, and did not 

evaluate the appropriateness of the mental health strategic plan, VA’s 

efforts to implement the initiatives outlined in the plan, or VA’s allocation 

and use of funding for mental health services generally. We performed our 

work from January 2006 through November 2006 in accordance with 

generally accepted government auditing standards. 

 6

CBOCs provide medical services, which may include mental health services, on an

outpatient basis in local communities. As of December 2005, VA operated over 700 

freestanding CBOCs, in addition to other CBOCs that are located in VA medical centers. 

7

Vet Centers provide mental health services, including readjustment counseling and

outreach services, to all veterans who served in any combat zone. There are 207 such 

centers that operate in all 50 states, the District of Columbia, Guam, Puerto Rico, and the 

U.S. Virgin Islands. 

8

See GAO, VA Health Care: Preliminary Information on Resources Allocated for Mental

Health Strategic Plan Initiatives, GAO-06-1119T (Washington, D.C.: Sept. 28, 2006). 

Page 4 GAO-07-66 VA Mental Health Services
VA headquarters allocated about $88 million of the $100 million VA 

officials said would be used for VA mental health strategic plan initiatives 

in fiscal year 2005 by using several approaches. VA allocated about 

$53 million directly to medical centers and certain offices based on 

proposals submitted for funding and other approaches targeted to specific 

initiatives. VA headquarters solicited submissions from networks through 

requests for proposals (RFP) for specific initiatives to be carried out at 

networks’ medical centers. In addition, VA headquarters officials said that

VA allocated $35 million for mental health strategic plan initiatives 

through VA’s general resource allocation system to its 21 health care 

networks, which, in turn, could allocate these resources to individual 

medical centers. VA’s decision that $35 million of the funds allocated 

through its general resource allocation system was for mental health 

strategic plan initiatives was a retroactive decision, made several months 

after these resources had been provided to networks through the general 

resource allocation system. Moreover, VA did not notify networks and 

medical centers that these funds were to be used for plan initiatives. 

Network and medical center officials we interviewed in 4 networks told us

that they were unaware that any portion of their general allocation was to 

be used specifically for mental health strategic plan initiatives. The 

approximately $12 million remaining of the $100 million was not allocated 

because, according to headquarters officials, there was not enough time 

during the fiscal year to allocate the funds. Officials we interviewed from 

seven medical centers in four networks reported using resources allocated 

directly to their medical centers for plan initiatives for new mental health

services and more of the services they were already providing. For 

example, one medical center used funding to develop a program to help 

veterans with mental health diagnoses develop job skills and find 

employment. Some medical center officials told us they had not been able

to use all of the funds provided for plan initiatives during the fiscal year in

part because of the length of time it took to hire new staff. 

Results In Brief 

VA headquarters allocated about $158 million of the $200 million VA 

planned for its mental health strategic plan initiatives in fiscal year 2006

directly to medical centers and certain offices by using several

approaches. VA allocated about $92 million of these funds to support new 

mental health strategic plan initiatives, using RFPs and other approaches 

targeted to specific initiatives. VA also allocated about $66 million to 

support the recurring costs of continuing mental health strategic plan

initiatives that were funded in fiscal year 2005 through RFPs and other 

targeted approaches. About $42 million of the $200 million for fiscal year 

2006 was not allocated. A portion of the approximately $42 million not 

allocated was a result of partial-year allocations made for projects that 

Page 5 GAO-07-66 VA Mental Health Services
were funded later in fiscal year 2006 and that are expected to receive 

12-month allocations for fiscal year 2007, according to VA officials. 

Officials we interviewed at seven medical centers said they had used funds 

to implement plan initiatives. Such initiatives included a new mental 

health intensive case management program at one medical center. 

However, officials at some medical centers told us they were uncertain 

that they would be able to use all of the funds for plan initiatives by the 

end of the fiscal year. 

VA tracking of spending for plan initiatives in fiscal years 2005 and 2006

was inadequate. In fiscal year 2005, VA headquarters did not track the 

spending of allocated funds for mental health strategic plan initiatives. In

fiscal year 2006, VA began tracking information on mental health strategic 

plan initiatives by developing a quarterly reporting system that focused 

primarily on staffing but did not track dollars spent. In fiscal year 2006, VA

compiled information on allocated funds returned to headquarters by 

medical centers that they could not spend in the fiscal year. However, VA 

does not have information on whether the funds medical centers retained

were spent for plan initiatives. Available information indicates that 

spending of allocations for plan initiatives was substantially less than 

planned in both fiscal years 2005 and 2006. In fiscal year 2005, about 

$12 million of the planned $100 million for plan initiatives was not 

allocated for them and thus was not spent for them. Thirty-five million 

dollars was allocated through VA’s general resource allocation system, but 

because VA headquarters did not specify that these funds were for plan 

initiatives, it is likely that portions of this money were not spent on them 

and VA officials said that they do not have information on these funds 

being spent for plan initiatives. VA officials also told us that they did not

have information on the extent to which the approximately $53 million 

allocated directly to medical centers and certain offices was actually spent 

on plan initiatives. Officials at medical centers we interviewed told us that

they used some of these funds on mental health activities other than the 

planned initiatives or carried over funds until the next fiscal year. In fiscal

year 2006, available information indicates that the maximum amount of 

allocated funds that could have been spent for plan initiatives also fell 

substantially below what was planned. About $42 million of the 

$200 million that was planned for allocation to plan initiatives was never 

allocated for these initiatives, and thus, never spent for them. Also, about 

$46 million of the approximately $158 million that was allocated was 

returned by medical centers to headquarters because it had not been spent 

on plan initiatives by the end of the fiscal year. However, all of the 

approximately $112 million in allocations that medical centers and offices

retained was not necessarily spent on plan initiatives as originally planned. 

Page 6 GAO-07-66 VA Mental Health Services
VA instructed medical centers in August 2006 to spend funds for other 

mental health activities if they could not spend the funds for the plan 

initiatives for which they were allocated by the end of the fiscal year. 

Moreover, VA did not track specifically how these funds were spent. 

To help provide information on how funds are spent for VA’s mental 

health strategic plan initiatives, we are recommending that VA track the 

extent to which the resources allocated for plan initiatives are spent for 

those initiatives. 

VA did not provide agency comments on the contents of this report. We 

offered VA the opportunity to review but not retain copies of this report as 

part of a process to help safeguard the draft contents from unauthorized 

disclosure. However, VA chose not to review the draft report in this 

manner. VA had previously seen portions of this report that had been

included in a statement for the record prepared for a hearing of the House 

Veterans’ Affairs Committee, Subcommittee on Health, on September 28, 

2006. We discussed the information in that statement with VA officials who 

have responsibilities related to mental health services, budgeting, and the 

allocation of financial resources, and they agreed that the data in the 

statement were accurate. Further, we briefed VA staff on the new material 

in this report on November 14, 2006.

VA operates a national health care system that provides health care 

services to over 5 million patients annually. As part of that system, VA 

provides mental health services to veterans in inpatient and outpatient 

settings in a variety of VA health care facilities, including medical centers, 

CBOCs, and Vet Centers. Veterans receiving these services include 

homeless veterans, veterans with serious mental illness, and veterans 

returning from combat who are dealing with postdeployment readjustment 

issues. Mental health services are provided for a range of conditions such 

as depression, PTSD, and substance abuse disorders. 

VA’s Under Secretary for Health heads VA health care programs and is 

responsible for oversight of operations in VA’s 21 health care networks, 

which are structured to manage and allocate resources to more than 150

VA medical centers. Mental health services are provided on an inpatient 

and outpatient basis in medical centers and may also be provided on an

outpatient basis in CBOCs, which are associated with medical centers. 

Within VA, the lead mental health expert is the Deputy Chief Patient Care

Services Officer for Mental Health. This position does not have direct 

Background 

Organizational Structure 

and Funding of VA’s Mental 

Health Services 

Page 7 GAO-07-66 VA Mental Health Services
authority for operations, but instead serves as an advisor to VA networks 

and medical centers on mental health services. In addition, the official in

this position is responsible for oversight of the Office of Mental Health 

Services (OMHS) located at VA headquarters. OMHS includes various 

clinical experts who provide consultation on mental health services, 

including PTSD and substance abuse, to VA program officials in the 

networks and medical centers. 

VA headquarters allocates most of its medical program services budget 

each year through a general resource allocation system to its 21 health 

care networks. This system, the Veterans Equitable Resource Allocation 

(VERA) system, uses a case-mix9

 formula to allocate funding to the 

networks, which in turn allocate funding to their medical centers. 

Although the VERA system is used to allocate funds, it does not designate 

funds for specific purposes or prescribe how those funds are to be used.10

Medical centers also receive funding for specific purposes, such as 

prosthetics, from VA headquarters that is not allocated through the VERA 

system. In addition, VA medical center resources include collections from 

insurance reimbursements, copayments, and deductibles for the care of 

some veterans.11

VA’s Mental Health 

Strategic Plan 

In April 2002, President Bush established the President’s New Freedom 

Commission on Mental Health and directed the Commission to identify 

policies that could be implemented by federal, state, and local 

governments to improve the delivery of mental health care across the 

country.12 In July 2003, the Commission released its final report and 

recommendations for improving the American mental health care system. 

After release of the report, VA’s Under Secretary for Health formed a work 

group of mental health and health care professionals charged with 

 9

Case mix is a classification of patients into categories based on their health care needs and 

related costs. 

10For a discussion of how VERA allocates resources to networks, see GAO, VA Health

Care: Allocation Changes Would Better Align Resources with Workload, GAO-02-338 

(Washington, D.C.: Feb. 28, 2002). 

11For a discussion of resource allocations to medical centers, see GAO, VA Health Care: 

Resource Allocations to Medical Centers in the Mid South Healthcare Network, 

GAO-04-444 (Washington, D.C.: Apr. 21, 2004). 

12For more information about the President’s New Freedom Commission on Mental Health, 

see, for example, http://www.mentalhealthcommission.gov. 

Page 8 GAO-07-66 VA Mental Health Services
reviewing the Commission’s recommendations to determine if those 

recommendations were relevant to VA’s mental health program. 

Following that effort, in July 2004, VA completed its mental health 

strategic plan for improving the delivery of mental health services within 

its health care system. This plan was formally approved by the Secretary 

of VA in November 2004. The mental health strategic plan contained 

recommended initiatives for improving VA mental health services by 

addressing a range of issues, including, for example, improving awareness 

about mental illness and improving access to mental health services. 

According to VA officials, the mental health strategic plan was designed to

address gaps in mental health services provided to veterans across the 

country. Some of the service gaps identified by the VA were in treating 

veterans with serious mental illness,13 female veterans, and veterans 

returning from combat in Iraq and Afghanistan. The implementation of the 

mental health strategic plan sought to ensure, for example, that mental 

health services are provided in community-based outpatient settings; that

veterans have consistent access to mental health services across the 

country; and that acute inpatient mental health services are coordinated 

with other inpatient services provided to veterans. 

Within VA, OMHS is responsible for coordinating with the networks and 

medical centers on the overall implementation of the mental health 

strategic plan. This includes formulating strategies for allocating funds 

committed for the plan’s implementation. Such strategies include, for 

example, the use of RFPs solicited from networks for specific initiatives to 

be carried out at their individual medical centers. In addition to making 

these funding decisions, OMHS is also responsible for tracking the use of 

funds allocated for implementing the mental health strategic plan. 

While VA initially attempted to develop an estimate of the cost to fully 

implement the mental health strategic plan, VA has since decided that a

comprehensive cost estimate is inappropriate. According to VA, a fullimplementation cost estimate is inappropriate because the plan is a “living 

 13For the purposes of the mental health strategic plan, VA defined veterans with serious

mental illness to be “those who currently or at any time during the past year: 1) have a

diagnosed mental, behavioral or emotional disorder of sufficient duration to meet the

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria, that 2)

results in a disability (i.e. functional impairment that substantially interferes with or limits 

one or more major life activities).” This definition included adults who would meet these 

criteria during the year without the benefit of treatment or support services. 

Page 9 GAO-07-66 VA Mental Health Services
document” that will continue to change over time as it is implemented, and 

thus, the costs will change as well. VA, working with an actuarial firm that 

used certain assumptions provided by VA, developed both a long-term and 

a shorter-term “unofficial” estimate of implementation costs for the 

initiatives included in the plan because VA wished to have a “rough 

estimate” of what might be entailed in providing all services that might be

needed if capacity were not a constraint, according to VA officials. VA and 

the actuary it used concluded, however, that the methodology used to 

develop these estimates was problematic. For example, the estimates used 

incorrect projections for utilization of mental health services, in part, 

because VA’s population and mental health services are different from 

those in the private sector. VA officials said that more current and 

accurate data are becoming available for use in projecting the number of 

OIF and OEF veterans who would be entering the system and need such 

services, and that such data and improvements in projecting demand were 

used in development of the President’s budget request for fiscal years 2006 

and 2007. 

VA headquarters allocated about $88 million of the $100 million that VA 

officials said would be allocated for VA mental health strategic plan 

initiatives in fiscal year 2005 by using several approaches. About 

$53 million was allocated directly to medical centers and certain offices 

and $35 million was allocated through VA’s general resource allocation 

system to its health care networks, according to VA officials. The 

approximately $12 million remaining of the $100 million was not allocated 

by any approach, headquarters officials said, because there was not 

enough time during the fiscal year to allocate the funds. Officials we 

interviewed at seven medical centers in four networks reported using 

allocated funds to provide new mental health services and to provide more 

of existing services. However, some medical center officials reported that

they did not use all allocated funds for plan initiatives by the end of fiscal

year, due in part to the length of time it took to hire new staff. 

VA headquarters allocated about $53 million directly to medical centers 

and certain offices based on proposals submitted for funding and other 

approaches targeted to specific initiatives related to the mental health

strategic plan in fiscal year 2005. (See table 1.) VA headquarters developed 

RFPs and solicited submissions from networks for specific initiatives to be 

carried out at their individual medical centers through these RFPs. VA 

VA Allocated about 

$88 Million of the 

$100 Million Planned 

for Mental Health 

Strategic Plan 

Initiatives in Fiscal 

Year 2005, but 

Officials Reported 

That Not All Allocated 

Funds Were Used for 

Plan Initiatives

VA Allocated 

Approximately $53 Million 

Directly to Medical

Centers and Certain 

Offices 

Page 10 GAO-07-66 VA Mental Health Services
allocated resources through this and other targeted approaches to support 

a range of mental health services, based, in part, on the priorities of VA 

leadership and legislation for programs related to PTSD, substance abuse, 

and other mental health areas,14 according to VA headquarters officials. VA 

headquarters officials told us that the Secretary of VA had identified 

several areas of the mental health strategic plan that were to be priorities 

for implementation, including those related to substance abuse, PTSD, 

services for veterans of OIF/OEF, mental health in CBOCs, and 

homelessness. Nearly $20 million of the approximately $53 million 

allocated by using RFPs and other targeted approaches was for mental 

health services related to legislation that expressly required spending or 

authorized such services, according to VA officials. In addition, nearly 

$33 million was allocated for mental health services not directly related to

such legislation. 

Table 1: Summary of VA Information on Mental Health Strategic Plan Allocations to

Medical Centers and Certain Offices by Type of Mental Health Service, Fiscal Year 

2005 

Type of mental health service 

Amount allocated

(dollars)

Allocations related to legislation that expressly 

required spending or authorized services 

Domiciliary expansiona$5,999,971

Compensated work therapy/supported employment 

mentoring sitesb

4,535,738

PTSDb2,726,840

Operation Iraqi Freedom (OIF) and Operation 

Enduring Freedom (OEF)

b

2,445,554

Substance abuseb 2,175,367

Psychosocial rehabilitation for veterans with serious 

mental illnessb

1,786,414

 14The Veterans Health Care, Capital Asset, and Business Improvement Act of 2003, Pub. L. 

No. 108-170, § 108, 117 Stat. 2042, 2046-47, required VA to allocate a minimum of $25 million 

in each of fiscal years 2004, 2005, and 2006 to carry out a program to expand and improve 

the provision of specialty mental health services for veterans, including PTSD and 

substance abuse services. Congress also required VA to ensure that after these allocations, 

total expenditures related to treatment of substance abuse and PTSD were not less than 

$25 million above the total expenditures on such programs in fiscal year 2003, adjusted for 

increases in the costs of delivering those services. The Homeless Veterans Comprehensive 

Assistance Act of 2001, Pub. L. No. 107-95, § 2043, 115 Stat. 903, 913, authorized VA to

establish up to 10 new domiciliary programs for homeless veterans. 

Page 11 GAO-07-66 VA Mental Health Services
Type of mental health service 

Amount allocated

(dollars)

Subtotal $19,669,884

Allocations not directly related to legislation that 

expressly required spending or authorized servicesc

PTSD and OEF/OIF 12,899,611

Compensated work therapy enhancement and expansion 4,972,784

Grant and per diem liaisons 4,500,000

Mental health services in nursing homes 4,000,000d

Community-based outpatient clinic mental health 1,997,653

Substance abuse 2,998,911

Mental health intensive case management teams 999,824

Development of educational programs 600,000e

Subtotal $32,968,783

Total $52,638,667

Source: GAO summary of VA information. 

Notes: A total of $48 million was allocated to medical centers to use for their mental health services. 

In addition, $4 million was allocated to VA’s Office of Geriatrics and Extended Care and $600,000 

was allocated to the Employee Education System. GAO did not independently determine the extent to

which legislation regarding VA health care expressly requires spending or authorizes these services

but relied on VA’s determination regarding these services. 

a

Related to the Homeless Veterans Comprehensive Assistance Act of 2001, which authorized VA to

establish up to 10 new domiciliary programs for homeless veterans, and authorized appropriations of

$5 million in fiscal years 2003 and 2004 for any such domiciliaries. See Pub. L. No. 107-95, § 2043, 

115 Stat. 903, 913. 

b

Related to the Veterans Health Care, Capital Asset, and Business Improvement Act of 2003, in 

which Congress required VA to allocate a minimum of $25 million in each of fiscal years 2004, 2005,

and 2006 to carry out a program to expand and improve the provision of specialized mental health 

services for veterans, including PTSD and substance abuse services. Congress also required VA to 

ensure that after these allocations, total expenditures related to treatment of substance abuse and

PTSD were not less than $25 million above the total expenditures on such programs in fiscal year 

2003, adjusted for increases in the costs of delivering those services. See Pub. L. No 108-170 § 108,

117 Stat. 2042, 2046-47. 

c

For some mental health services, such as substance abuse, VA planned to allocate some funds that 

were related to legislation expressly requiring spending or authorizing those services as well as other

funds that were not. 

d

This amount was allocated to VA’s Office of Geriatrics and Extended Care. 

e

This amount was allocated to VA’s Employee Education System. 

Most of the approximately $53 million allocated—about $48 million—went 

to VA medical centers. PTSD services and OEF/OIF veterans’ mental 

health care received combined allocations of about $18 million. In 

addition, combined allocations for Compensated Work Therapy (CWT) 

totaled nearly $10 million. Other initiatives receiving funding included 

substance abuse services, domiciliary expansion, and psychosocial 

Page 12 GAO-07-66 VA Mental Health Services
rehabilitation for veterans with serious mental illness. In addition, VA 

allocated $4 million that was initially planned for CWT programs to VA’s 

Office of Geriatrics and Extended Care to support development of a new 

nursing home care model. This shift occurred toward the end of the fiscal 

year, when it appeared that not all mental health strategic plan funding 

would be allocated that year. VA officials noted that the nursing home 

model was aligned with initiatives in the mental health strategic plan 

related to the needs of veterans in long-term care settings. The remaining 

funds—$600,000—were allocated to VA’s Employee Education System to 

develop educational programs. 

VA headquarters officials issued five RFPs from October 2004 to January

2005 that described the specific types of services for which mental health

strategic plan funding was available. The RFPs related to PTSD, veterans

of OIF and OEF, substance abuse, and psychosocial rehabilitation services 

were issued in October 2004; the domiciliary RFP was issued in January 

2005. All of the RFPs noted that funding would be provided to address 

unmet needs or gaps in services. Review panels headed by mental health 

experts within VA reviewed the proposals submitted by networks, ranked 

them, and provided their rankings to VA’s leadership who made the 

allocation decisions.15 VA then allocated funding directly to medical 

centers for the mental health strategic plan initiatives beginning in 

February 2005 and continuing throughout fiscal year 2005. 

In addition to RFPs, VA also used other approaches targeted to specific 

initiatives based on identified needs. For example, VA headquarters 

officials used a targeted approach to allocate funding to medical centers to 

expand mental health services at CBOCs that had fewer mental health 

visits than a standard that VA identified for this purpose.16 In addition, VA 

headquarters allocated funds to support the creation of CWT-supported 

employment mentor sites in each network. The medical centers selected at

those sites were expected to provide training and support for existing and 

future CWT programs aimed at helping veterans with serious mental 

illness find and maintain employment. VA headquarters also used targeted 

 15According to the network and medical center staff we spoke with, even though the

proposals were formally submitted by the networks, medical center staff had a significant 

amount of input into the proposals. 

16VA’s performance measure was that for each network, in at least 85 percent of all CBOCs 

with 1,500 or more patients, mental health visits would account for at least 10 percent of all 

visits. VA targeted funds to CBOCs that had no mental health providers or that needed

additional providers to meet the performance measure of 10 percent. 

Page 13 GAO-07-66 VA Mental Health Services
funding approaches to allocate funds to medical centers to enhance 

existing CWT programs through the addition of new staff and to establish 

CWT programs at medical centers without such programs. VA 

headquarters used targeted approaches to allocate funding for new and 

expanded mental health intensive case management teams; grant and per

diem liaisons for homeless veterans; and PTSD, OIF and OEF veterans’, 

and substance abuse services. 

VA headquarters officials said that allocations made for initiatives in fiscal

year 2005 through RFPs and other approaches targeted to specific 

initiatives would be made for a total of 2 to 3 fiscal years. These officials 

said they anticipated that medical centers would hire permanent staff 

whose positions would need to be funded for more than 1 year. The 

expectation of VA leadership was that after funds allocated through these 

approaches were no longer available, medical centers would continue to 

support these programs using their general operating funds received

through VA’s general resource allocation system. 

VA Allocated $35 Million 

through Its General 

Resource Allocation 

System to Its Health Care 

Networks on a 

Retrospective Basis 

VA allocated $35 million for mental health strategic plan initiatives in fiscal 

year 2005 through its general resource allocation system17 to its health care 

networks, according to VA headquarters officials. The decision to allocate

these resources to VA’s networks for mental health strategic plan 

initiatives was retrospective and VA did not notify networks and medical 

centers of this decision. Although VA headquarters made fiscal year 2005 

general resource allocations to the networks in December 2004,18 the 

decision that $35 million in funds allocated at that time was for mental 

health strategic plan initiatives was not finalized until April 2005, several 

months after the general allocation had been made. VA headquarters 

officials said that they made the decision to allocate $35 million from the 

general resource allocation system because these resources would be 

more rapidly allocated than if they had been allocated through RFPs. 

However, other VA headquarters officials told us that the decision was 

 17This allocation system is known as the Veterans Equitable Resource Allocation (VERA)

system. In fiscal year 2005, VA headquarters used VERA to allocate about 85 percent of its 

medical care appropriations to its 21 health care networks, which in turn allocated 

resources to their medical centers. VERA allocates resources primarily on the basis of 

patient workload and case mix where workload is the number of veterans treated and case 

mix is a classification of patients into categories based on their health care needs and 

related costs. See GAO-02-338 and GAO-04-444. 

18Fiscal year 2005 covered the period of October 1, 2004, through September 30, 2005.

Page 14 GAO-07-66 VA Mental Health Services
also made, in part, because VA did not have sufficient unallocated funds 

remaining after the December 2004 general allocation to fund $100 million 

for the mental health strategic plan through RFPs and other targeted 

approaches.

VA headquarters officials, as well as network and medical center officials, 

indicated that there was no guidance to the networks and medical centers 

instructing them to use specific amounts from their general fiscal year 

allocation for mental health strategic plan initiatives. Network and medical 

center officials we spoke with in four networks were unaware that any 

specific portion of their general allocation was intended by headquarters 

officials to be used for mental health strategic plan initiatives. Several VA 

medical center officials noted, however, that some of the funds in their 

general allocation were used to support mental health programs generally, 

as part of their routine operations. However, because network and 

medical center officials we interviewed did not know that funds had been 

allocated for mental health strategic plan initiatives through VA’s general 

resource allocation system, nor did VA headquarters notify networks and 

medical centers throughout VA of this retrospective allocation, it is likely 

that some of these funds were not used for plan initiatives. 

VA Did Not Allocate about 

$12 Million Planned for 

Mental Health Strategic 

Plan Initiatives 

VA did not allocate approximately $12 million remaining of the 

$100 million planned for mental health strategic plan initiatives in fiscal 

year 2005 because, according to VA headquarters officials, there was not 

enough time during the fiscal year to allocate the funds through the RFP 

process or other approaches targeted to specific initiatives. In addition, 

officials said that when resources were allocated later in the fiscal year 

through an RFP, rather than at the beginning of the year, the amount 

allocated was only a portion of the annualized cost. For example, if funds 

for a project with an annual cost of $4 million were allocated midway 

through the fiscal year, only half the annual cost was allocated at that 

time—$2 million. The expectation was that the full $4 million would be 

made available for the project over the 12 months in the next fiscal year. 

The approximately $12 million in unallocated funds in fiscal year 2005 was 

intended for mental health strategic plan initiatives based on an allocation 

plan developed by VA. (See table 2.) About $11 million of the resources not 

allocated was for services related to legislation that expressly required 

spending or authorized such services, according to VA officials. VA 

headquarters officials said that the funds not allocated for mental health 

strategic plan initiatives were allocated for other health care services. 

Page 15 GAO-07-66 VA Mental Health Services
Table 2: Summary of VA Information on Planned Funding for Mental Health

Strategic Plan Initiatives Not Allocated by Type of Mental Health Service, Fiscal 

Year 2005 

Type of mental health service 

Planned amount 

not allocated

(dollars) 

Related to legislation that expressly required spending 

or authorized services 

Substance abusea$2,824,633

Operation Iraqi Freedom (OIF) and Operation 

Enduring Freedom (OEF)

a

2,554,446

PTSDa2,273,160

Psychosocial rehabilitation for veterans with serious 

mental illnessa

2,213,586

Compensated work therapy/supported employment 

mentoring sitesa

1,464,262

Subtotal $11,330,116b

Not directly related to legislation that expressly required 

spending or authorized servicesc

Compensated work therapy enhancement and expansion 1,027,216

Subtotal $1,031,217d

Total $12,361,333

Source: GAO summary of VA information. 

Notes: GAO did not independently determine the extent to which legislation regarding VA health care 

expressly requires spending or authorizes these services but relied on VA’s determination regarding 

these services. 

a

Related to the Veterans Health Care, Capital Asset, and Business Improvement Act of 2003, in 

which Congress required VA to allocate a minimum of $25 million in each of fiscal years 2004, 2005,

and 2006 to carry out a program to expand and improve the provision of specialized mental health 

services for veterans, including PTSD and substance abuse services. Congress also required VA to 

ensure that after these allocations, total expenditures related to treatment of substance abuse and

PTSD were not less than $25 million above the total expenditures on such programs in fiscal year 

2003, adjusted for increases in the costs of delivering those services. See Pub. L. No 108-170 § 108,

117 Stat. 2042, 2046-47. 

b

Included in this subtotal is less than $100 that was not allocated for domiciliary expansion. The 

Homeless Veterans Comprehensive Assistance Act of 2001 authorized VA to establish up to 10 new 

domiciliary programs for homeless veterans. See Pub. L. No.107-95, § 2043, 115 Stat. 903, 913. 

c

For some mental health services, such as substance abuse, VA planned to allocate some funds that 

related to legislation expressly requiring spending or authorizing those services as well as other funds 

that were not. 

d

Included in this subtotal is approximately $4,000 that was not allocated for community-based 

outpatient clinic mental health, substance abuse, PTSD, and OIF/OEF services, as well as for mental 

health intensive case management teams. 

Page 16 GAO-07-66 VA Mental Health Services
Officials we interviewed from seven medical centers in four networks 

reported using the funds allocated to them for mental health strategic plan

initiatives through RFPs and other targeted approaches, but some officials 

said that some of these funds were not used for plan initiatives in fiscal 

year 2005. Officials said they used funds allocated to provide new mental 

health services and to provide more of existing mental health services 

included in plan initiatives. For example, officials at medical centers in 

Bay Pines and the Tennessee Valley Healthcare System reported using 

funds to increase the number of mental health providers at CBOCs, some 

of which previously had no mental health providers available to see 

veterans. The Albuquerque medical center used funds to develop a CWTsupported employment program to help veterans with mental health

diagnoses develop job skills and find employment. The Tennessee Valley 

Healthcare System also implemented a new 6-week PTSD day treatment

program in which veterans live in the community but come to the medical 

center during the day for counseling, group therapy, and other services. 

The Tampa medical center funded new mental health staff to work with 

veterans being treated in its Polytrauma Rehabilitation Center. The 

Tuscaloosa medical center opened a new domiciliary for homeless 

veterans and the Phoenix medical center hired a new grant and per diem 

liaison for its homeless program. The medical centers in our review used 

the mental health strategic plan funds for recurring uses, such as hiring 

staff, and for nonrecurring uses. Nonrecurring uses included acquisition of

furniture and equipment as well as building renovation. 

Medical Center Officials 

Reported Using Allocated 

Funds for Mental Health 

Strategic Plan Initiatives, 

but Not Using All Funds 

Allocated for Plan 

Initiatives 

Officials at four medical centers reported that they were not able to use all

of their fiscal year 2005 funding by the end of the fiscal year as planned 

and cited several factors that contributed to this situation. The length of 

time it takes to recruit new staff in general and the special problems of 

hiring specialized staff such as psychiatrists were cited. Officials at two 

medical centers noted that they received funding for multiple new 

positions, but that it was difficult for the medical center to recruit and hire 

for so many positions in a relatively short period of time. In addition, in 

some cases the need to locate or renovate space for mental health 

programs contributed to delays in using funds. For example, officials at 

the Albuquerque medical center reported that although it received funding

for staff for a new residential program, it took some time to renovate the 

space needed for that program, which limited the amount of funding for 

staff they were actually able to spend in fiscal year 2005. 

Medical centers varied in how they treated fiscal year 2005 funds that were 

allocated by VA for mental health strategic plan initiatives but not used for 

those initiatives. Officials at three medical centers reported that they 

Page 17 GAO-07-66 VA Mental Health Services
carried over the funds for use in the next fiscal year.19 For example, 

officials at the Phoenix medical center reported carrying over unused 

funding for a substance abuse residential rehabilitation program. Officials 

at two medical centers reported that they used these funds for other health 

care purposes. For example, officials at the Albuquerque medical center 

said that funding that was not used for staffing due to difficulties with 

hiring was made available to meet other needs in the medical center for 

that fiscal year. Officials at another medical center, the Tennessee Valley 

Health Care System, reported having unused fiscal year 2005 funding due 

to difficulties with hiring, and using this funding to support other mental 

health programs, in particular to hire mental health staff for its CBOCs. VA 

headquarters officials advised participants from networks and medical 

centers in a weekly conference call in August 2005 that if they were unable 

to hire staff for initiatives in fiscal year 2005, they should use the funds 

allocated only for mental health services. 

VA headquarters allocated about $158 million of the $200 million to be 

used for VA mental health strategic plan initiatives in fiscal year 2006 

directly to medical centers and certain offices by using several

approaches. About $92 million of these funds was allocated to support 

new mental health strategic plan initiatives for fiscal year 2006. VA also 

allocated about $66 million to support the recurring costs of the 

continuing mental health strategic plan initiatives that were funded in 

fiscal year 2005. The remaining approximately $42 million was not 

allocated. Officials at some medical centers expected to use all the 

allocations they received during fiscal year 2006. However, officials at 

other medical centers were uncertain that they would use all their 

allocated funds for plan initiatives during the fiscal year. 

VA Allocated about 

$158 Million of the 

$200 Million Planned 

for Mental Health 

Strategic Plan 

Initiatives in Fiscal 

Year 2006, but Some 

Officials Were 

Uncertain If All Funds 

Would Be Used for 

Plan Initiatives

 19VA may carry over from one fiscal year to the next unobligated balances of funds made 

available without fiscal year limitation and other funds appropriated for multiple fiscal 

years. 

Page 18 GAO-07-66 VA Mental Health Services
VA headquarters allocated about $158 million directly to medical centers 

and certain offices through RFPs and other approaches targeted to 

specific initiatives related to the mental health strategic plan in fiscal year 

2006. (See table 3.) About $92 million was for new mental health strategic 

plan activities, and about $66 million was to support the recurring costs of 

continuing mental health strategic plan initiatives that were first funded in 

fiscal year 2005. As in fiscal year 2005, the new resources went to support 

a range of mental health services in line with priorities of VA’s leadership 

and legislation, according to VA officials. Funding for services for PTSD, 

OIF and OEF veterans, substance abuse, and CBOC mental health services

accounted for nearly three-fifths of the funds allocated for new initiatives. 

VA did not allocate resources in fiscal year 2006 for mental health strategic 

plan initiatives through its general resource allocation system, according 

to VA officials. 

VA Allocated about 

$158 Million Directly to 

Medical Centers and 

Certain Offices 

Table 3: Summary of VA Information on Mental Health Strategic Plan Allocations

to Medical Centers and Certain Offices by Type of Mental Health Service, Fiscal 

Year 2006 

Type of mental health service 

Amount allocated

(dollars)

New fiscal year 2006 initiatives 

Allocations related to legislation that expressly required spending 

or authorized services 

Domiciliary expansiona$7,437,593

Allocations not directly related to legislation that expressly 

required spending or authorized services 

PTSD and OEF/OIF 18,772,089 

Substance abuse 16,887,550

Community-based outpatient clinic mental health 16,782,344

Psychosocial and recovery-oriented services 6,249,025

Telemental health programs to provide mental health services 

through videoconferencing 5,063,987

Web-based support tools for veterans with mental health 

concerns 5,000,000

Grant and per diem liaisons 4,700,000

Mental health intensive case management teams 3,749,029

Suicide prevention and residential rehabilitation treatment 

program infrastructure improvements 1,803,853

Inpatient mental health services at two VA facilities in

Tennessee 1,629,657

Support for Gulf Coast mental health programs affected by 

Hurricane Katrina 1,610,643

Page 19 GAO-07-66 VA Mental Health Services
Type of mental health service 

Amount allocated

(dollars)

Educational programs 1,391,208

Stand Down events for homeless veterans 467,665

Pilot program for incarcerated veterans with mental illness 233,334

Peer housing assistance pilot program for homeless veterans 168,980

Initiative for mentally ill chemically-addicted veterans 69,517

Subtotal—new fiscal year 2006 initiatives $92,016,474 

Initiatives initially funded in fiscal year 2005 65,675,513

Total $157,691,987 

Source: GAO summary of VA information. 

Notes: GAO did not independently determine the extent to which legislation regarding VA health care 

expressly requires spending or authorizes these services but relied on VA’s determination regarding 

these services. 

a

Related to the Homeless Veterans Comprehensive Assistance Act of 2001, which authorized VA to

establish up to 10 new domiciliary programs for homeless veterans. See Pub. L. No. 107-95, § 2043, 

115 Stat. 903, 913. 

VA headquarters officials used RFPs and other approaches targeted to 

specific initiatives to determine which medical centers would receive

funding for new mental health strategic plan initiatives in fiscal year 2006.

In November 2005, for example, VA issued an RFP that covered six mental 

health areas: PTSD services, including residential services; health 

promotion and preventive care services for veterans returning from OEF 

and OIF; specialized substance abuse treatment programs; new mental 

health residential rehabilitation and treatment programs;20 enhanced or 

new CBOC mental health services; and new telemental health programs to 

provide mental health services through videoconferencing. VA also used 

other approaches to target funds to medical centers for grant and per diem 

program liaisons, new or expanded mental health intensive case 

management teams, and expanded inpatient services at the Tennessee 

Valley Healthcare System medical center. Further, VA allocated funding 

for medical supplies, equipment, and office furniture for Gulf Coast mental 

health programs affected by Hurricane Katrina. As in fiscal year 2005, VA 

allocated funding to the Employee Education System to support 

educational programs. VA also allocated funding to support additional 

mental health initiatives such as the development of web-based support 

tools for veterans with mental health concerns, infrastructure 

 20These could include homeless domiciliary programs, psychosocial programs, substance 

abuse programs, PTSD programs, or other general programs. 

Page 20 GAO-07-66 VA Mental Health Services
improvements at residential rehabilitation treatment facilities, suicide 

prevention efforts, and Stand Down events to provide services such as 

counseling and health screenings for homeless veterans. 

VA Did Not Allocate about 

$42 Million for Mental 

Health Strategic Plan 

Initiatives 

VA did not allocate about $42 million of the $200 million planned for 

mental health strategic plan initiatives in fiscal year 2006 by any approach. 

The approximately $42 million in unallocated funds were intended for 

certain mental health strategic plan initiatives based on an allocation plan

developed by VA. According to VA officials, VA was unable to allocate all

the $200 million, in part, because of the delayed implementation of three 

new Centers of Excellence, focusing on veterans’ mental health issues, 

including PTSD, for which VA planned allocations totaling $4.5 million.21

VA officials also cited the unanticipated length of time required to refine 

the processes for implementation of initiatives related to the provision of 

mental health services in primary care settings. VA had solicited proposals 

related to primary care mental health services through a May 2006 RFP22

and had anticipated allocating about $11 million for such services from 

funds reserved for emerging needs related to the mental health strategic 

plan. In addition, VA officials reported that a portion of the funds were 

unallocated for reasons related to the timing of allocations that were made 

for plan initiatives through RFPs and other funds targeted to medical 

centers. Specifically, some of these allocations were made well into the

fiscal year. VA allocated only the amount of funds through these 

approaches for fiscal year 2006 that would fund the projects through the 

end of the fiscal year, and not the full 12-month costs, which VA expects to

fund in fiscal year 2007. VA officials said they anticipated that the full 

12-month allocation would be available for these projects in fiscal year 

2007. Most of the unallocated funds had been planned for initiatives to 

provide services that VA identified as not directly in response to legislation 

 21In the Conference Report accompanying the Military Quality of Life and Veterans Affairs 

Appropriations Act of 2006, Pub. L. No. 109-114, the Conference Committee stated that VA 

should consider designating specialized medical treatment facilities for mental health and 

PTSD as Centers of Excellence, and directed VA to establish three specific centers. These 

centers are to be located at VA facilities in Canandaigua, New York; Waco, Texas; and San 

Diego, California. See H.R. Conf. Rep. No. 109-305, at 39 (2005). 

22Through the RFP, funds were available for programs that promote effective treatment of 

common mental health conditions in primary care settings, in order to integrate care for

veterans’ physical and mental health and allow mental health specialists to focus on 

veterans with more severe illnesses. Funds were also available for related education and 

training. 

Page 21 GAO-07-66 VA Mental Health Services
that expressly required spending or authorized such services. (See 

table 4.) 

Table 4: Summary of VA Information on Planned Funding for Mental Health

Strategic Plan Initiatives Not Allocated by Type of Mental Health Service, Fiscal 

Year 2006 

Type of Mental Health Service 

Planned Amount 

Not Allocated

(dollars)

Related to legislation that expressly required spending or 

authorized services 

Centers of Excellencea$4,500,000

Domiciliary expansionb8,804

Not directly related to legislation that expressly required 

spending or authorized services 

PTSD and OEF/OIF 10,690,920

Psychosocial and recovery-oriented services 5,652,638

Telemental health programs to provide mental health 

services through videoconferencing 3,936,013

Substance abuse 3,112,450

Mental health program review 1,000,000

Inpatient mental health services at two VA facilities in

Tennessee 773,503

Mental health intensive case management teams 539,419

Community-based outpatient clinic mental health 194,266

Reserved for emerging needs 11,900,000

Total $42,308,013

Source: GAO summary of VA information. 

Notes: GAO did not independently determine the extent to which legislation regarding VA health care 

expressly requires spending or authorizes these services but relied on VA’s determination regarding 

these services. 

a

In the Conference Report accompanying the Military Quality of Life and Veterans Affairs

Appropriations Act of 2006, the Conference Committee stated that VA should consider designating 

specialized medical treatment facilities for mental health and PTSD as Centers of Excellence, and 

directed VA to establish three specific centers. See H.R. Conf. Rep. No. 109-305, at 39 (2005). 

b

Related to the Homeless Veterans Comprehensive Assistance Act of 2001, which authorized VA to

establish up to 10 new domiciliary programs for homeless veterans. See Pub. L. No. 107-95, § 2043, 

115 Stat. 903, 913. 

Page 22 GAO-07-66 VA Mental Health Services
Officials at seven medical centers we interviewed in May and June of 2006 

reported using funds allocated to them through RFPs and other 

approaches to support new 2006 initiatives and to continue to support 

initiatives funded in fiscal year 2005. Officials at four of these medical 

centers told us that they were using these funds to support expanded 

mental health services. For example, officials at several medical centers, 

including Bay Pines, Decatur, and the Tennessee Valley Healthcare 

System, reported using fiscal year 2006 funding to expand mental health 

services in their CBOCs by adding clinical staff. As part of this expansion 

of services, the Tampa medical center used funding for a new mental 

health intensive case management program. Five medical centers had 

received funding for expanded mental health services, but had not yet 

used all of the allocated funds. The Albuquerque medical center, for 

example, had received funding for a new substance abuse program for 

geriatric patients and a new case management program for veterans with 

PTSD. As of May 2006, both programs were still being developed and 

positions had been advertised but had not yet been filled. 

Medical Center Officials 

Reported Using Allocated 

Funds for Mental Health 

Strategic Plan Initiatives, 

but Were Uncertain 

Whether All Funds 

Allocated Would Be Used 

for Plan Initiatives

Officials at two medical centers reported that they did not anticipate 

problems using all of the funds they had received in fiscal year 2006. 

However, officials at four other medical centers were less certain they 

would be able to use all of the funds. Officials at two of these medical 

centers were not sure whether they would be able to hire all of their new 

staff by the end of the fiscal year. In addition, officials at the Bay Pines and 

Phoenix medical centers noted that they had not yet learned whether 

proposals they submitted in response to fiscal year 2006 RFPs would be 

funded; as a result, officials at those medical centers were uncertain 

whether they would be able to use all of their fiscal year 2006 funds for 

plan initiatives by the end of the fiscal year. 

Page 23 GAO-07-66 VA Mental Health Services
VA tracking of spending for mental health strategic plan initiatives was 

inadequate for fiscal years 2005 and 2006. In fiscal year 2005, VA 

headquarters did not track spending on mental health strategic plan 

initiatives. In fiscal year 2006, VA began to track some information on 

medical centers’ mental health strategic plan initiatives, but did not track 

the amount of allocated funds that was spent for them.23 VA headquarters 

officials used this newly instituted tracking system to gather 

implementation information reported by networks and medical centers on 

a quarterly basis. The tracked information was primarily related to 

positions to be filled, the schedule for filling them, and when they were 

filled. Headquarters officials said that this tracking was intended, in part, 

to measure medical centers’ progress in implementing plan initiatives. 

Officials told us that they believe that tracking of hiring provides 

information on how funds were spent because most costs of initiatives are 

personnel costs. However, the data on hiring did not include information 

on the individual salaries of staff, associated benefits, the portion of the 

fiscal year for which staff are employed, equipment, supplies, rent, or 

renovation of facilities. As a result the quarterly reports do not allow VA to 

determine how much was spent on plan initiatives. In fiscal year 2006, VA

headquarters officials compiled information on the amount of funds 

returned to headquarters that medical centers could not spend during the 

fiscal year. However, VA does not have information on whether the funds 

medical centers retained were spent for plan initiatives. 

VA Tracking of Funds 

Spent for Mental 

Health Strategic Plan 

Initiatives Was 

Inadequate, but 

Available Information 

Indicates That 

Spending for These 

Initiatives Was 

Substantially Less 

Than Planned 

Available information indicates that spending of allocations for mental 

health strategic plan initiatives was substantially less than planned in both

fiscal years 2005 and 2006. In fiscal year 2005, approximately $12 million of 

the planned $100 million for plan initiatives was not allocated for plan 

initiatives and thus was not spent on them. Thirty-five million dollars was 

allocated through VA’s general resource allocation system, but because VA

headquarters did not specify that these funds were for mental health 

strategic plan initiatives, it is likely that portions of this money were not 

spent on them, and VA officials said they do not have information on these

funds being spent for plan initiatives. In addition, VA officials told us that 

they did not have information on the extent to which the approximately 

 23Although VA headquarters’ tracking system did not track spending for plan initiatives in 

fiscal year 2005, some network and medical center staff we spoke with reported on 

separate efforts to track medical centers’ use of funds for mental health strategic plan 

initiatives. Some network staff told us that they developed their own tracking processes

because they anticipated that they would eventually have to account for the use of funds 

allocated for mental health strategic plan initiatives. 

Page 24 GAO-07-66 VA Mental Health Services
$53 million in funds that were allocated directly to medical centers and 

certain offices was actually spent on plan initiatives. Officials at medical 

centers we interviewed told us that they used some of these funds on 

mental health activities other than the planned initiatives or carried over 

funds until the next fiscal year. 

In fiscal year 2006, available information indicates that the maximum 

amount of allocated funds that could have been spent for plan initiatives in 

fiscal year 2006 also fell substantially below what was planned. About 

$42 million of the $200 million that was planned for allocation to mental 

health strategic plan initiatives was never allocated for them, and thus, 

never spent for plan initiatives. Additionally, about $46 million of the 

approximately $158 million that was allocated was returned by medical 

centers to headquarters because it had not been spent for plan initiatives 

before the end of the fiscal year.24 However, all of the remaining 

approximately $112 million of funds allocated to and retained by medical 

centers and offices was not necessarily spent on plan initiatives as 

originally planned. VA officials provided written guidance to medical 

centers in August 2006 instructing them to spend funds for other mental 

health activities if they could not spend them for the planned initiatives 

before the end of the fiscal year. VA officials told us that because they had

provided instructions to spend the funds on mental health activities that 

such activities would constitute spending on mental health strategic plan

activities. VA’s guidance, however, did not specify that funds be used for 

the plan initiatives or alternative initiatives. Moreover, VA did not track 

specifically how these funds were spent. As a consequence, VA cannot 

determine how much of the approximately $112 million that was allocated 

for plan initiatives and not returned to headquarters was spent on plan 

initiatives. 

VA allocated additional resources for mental health strategic plan 

initiatives in fiscal years 2005 and 2006 to help address identified gaps in 

VA’s mental health services for veterans. The allocations that were made 

resulted in some new and expanded mental health services for plan 

initiatives according to officials at selected medical centers. However, in 

fiscal year 2005, lack of adequate time for headquarters to allocate funds 

Conclusion 

 24Officials told us that unspent fiscal year 2006 funds returned to headquarters were placed

in a reserve fund for use in fiscal year 2007 and would be used for plan initiatives in that 

fiscal year. These officials said that the reserve fund is composed of appropriations that do 

not have to be obligated within a single fiscal year. 

Page 25 GAO-07-66 VA Mental Health Services
for plan initiatives to medical centers, late-in-the-year allocations that 

hampered medical center efforts to bring staff on board during the fiscal

year, and a lack of guidance concerning allocations for plan initiatives 

made through VA’s general resource allocation system resulted in 

spending on initiatives falling short of what was planned. In fiscal year 

2006, a larger amount, approximately $158 million of the planned 

$200 million for plan initiatives, was allocated to medical centers and 

other offices than in fiscal year 2005. However, at the end of the fiscal year

about $46 million was returned to VA headquarters that had not been 

spent on mental health strategic plan initiatives, and some funds that 

remained with medical centers and other offices may have been directed

towards mental health activities other than plan initiatives. 

Although available information shows that a substantial portion of the 

resources intended for plan initiatives in fiscal years 2005 and 2006 was 

not spent on these initiatives, VA does not know the amount of allocated 

funds actually spent on them. The extent of spending is unknown because 

VA did not track spending of these funds. Although some tracking of 

mental health strategic plan initiatives was started in fiscal year 2006, data

were not collected that would allow an assessment of spending. Tracking 

the extent to which allocations for plan initiatives are spent for these 

initiatives is important as VA continues to allocate resources for future 

plan initiatives. This would help to ensure that the money is being spent as 

planned, and that VA is in fact addressing gaps that it has identified in 

mental health services for veterans. 

To provide information for improved management and oversight of how 

funds VA allocates are spent to fill identified gaps in mental health services 

for veterans, we recommend that the Secretary of Veterans Affairs direct 

the Under Secretary for Health to take the following action:

Track the extent to which the resources allocated for mental health 

strategic plan initiatives are spent for plan initiatives. 

VA did not provide agency comments on the contents of this report. We 

offered VA the opportunity to review and comment on the report, but not 

retain copies of the draft as part of a process to help safeguard the 

contents from unauthorized disclosure. VA in a written response 

(reproduced in app. III) said that it was unable to provide comments on 

the draft report because VA was not provided a copy of the report for 

appropriate staffing to include review and analysis. VA further stated that

Recommendation for 

Executive Action 

Agency Comments 

Page 26 GAO-07-66 VA Mental Health Services
while it respected our desire to maintain the integrity of GAO draft reports 

by preventing improper disclosure of draft contents, that this did not 

outweigh the need for VA staff to have a copy of the draft report for review

and analysis. We have provided similar report review opportunities to 

other agencies for other reports, and have received agency comments in 

those circumstances. 

We met with VA officials on November 14, 2006, and provided them with 

an oral briefing covering the contents of the draft report. Further, a 

portion of the contents of this report had previously been released as a 

statement for the record at a hearing held by the House Veterans’ Affairs 

Committee, Subcommittee on Health, on September 28, 2006. We 

discussed the information in that statement with VA officials who have 

responsibilities related to mental health services, budgeting, and the 

allocation of financial resources, and they agreed that the data in the 

statement were accurate. As a result, VA is aware of the report’s contents.

As agreed with your office, unless you publicly announce the contents of

this report earlier, we plan no further distribution of it until 30 days from 

the date of this report. At that time, we will send copies to the Secretary of 

Veterans Affairs, appropriate congressional committees, and other 

interested parties. We will also make copies available to others upon 

request. In addition, the report will also be available at no charge on the 

GAO Web site at http://www.gao.gov. If you or your staff have any 

questions about this report, please contact me at (202) 512-7101 or 

ekstrandl@gao.gov. Contact points for our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. 

GAO staff who made major contributions to this report are listed in 

appendix IV.

Laurie E. Ekstrand 

Director, Health Care 

Page 27 GAO-07-66 VA Mental Health Services
Appendix I: Department of Veterans Affairs 

(VA) Health Care Networks, Medical Centers, Appendix I: Department of V and Other Facilities GAO Selected for Revie eterans Affairs w

(VA) Health Care Networks, Medical Centers, 

and Other Facilities GAO Selected for Review

VA health care network Site visits or phone interviews Medical centers and other facilities 

Network 7 (Atlanta, Ga.)—Southeast 

Network 

Phone interviews • Decatur, Ga., medical center

• Tuscaloosa, Ala., medical center 

• Birmingham, Ala., Vet Center 

Network 8 (Bay Pines, Fla.)—Sunshine 

Healthcare Network 

Site visits • Bay Pines, Fla., medical center

• Tampa, Fla., medical center 

• Dunedin, Fla., community-based outpatient 

clinic (CBOC) 

• Lakeland, Fla., CBOC

• St. Petersburg, Fla., Vet Center 

• Tampa, Fla., Vet Center 

Network 9 (Nashville, Tenn.)—Mid South 

Healthcare Network 

Site visits • Tennessee Valley Healthcare Systema

(Nashville, Tenn., and Murfreesboro, Tenn., 

campuses) medical center 

• Clarksville, Tenn., CBOC

• Chattanooga, Tenn., Vet Center 

Network 18 (Phoenix, Ariz.)—Southwest 

Health Care Network 

Phone interviews • Albuquerque, N.M., medical center 

• Phoenix, Ariz., medical center

• Albuquerque, N.M., Vet Center 

Source: GAO.

a

The Tennessee Valley Healthcare System is a medical center that has two locations. 

Page 28 GAO-07-66 VA Mental Health Services
Appendix II: Description of Selected 

Department of Veterans Affairs (VA) Mental

Health Services

VA Mental Health Service Description

Community-based outpatient clinics (CBOC) CBOCs provide medical services, which can include mental health, on an 

outpatient basis in a community setting. CBOCs are affiliated with a VA medical 

center. 

Compensated Work Therapy (CWT) CWT is a therapeutic work-for-pay program that (1) uses remunerative work to 

maximize a veteran’s level of functioning, (2) prepares veterans for successful 

reentry into the community, and (3) provides a structured daily activity to those 

veterans with severe and chronic disabling physical and/or mental conditions. 

Domiciliary program Domiciliary residential rehabilitation and treatment programs for homeless 

veterans, providing coordinated, integrated rehabilitative and restorative clinical 

care in a bed-based program, with the goal of helping eligible veterans achieve 

and maintain the highest level of functioning and independence possible. 

Grant and Per Diem program VA offers grants to non-VA organizations in the community to provide 

supportive housing programs and supportive service centers for homeless 

veterans. Once programs are established, VA provides per diem payments to 

help offset operational expenses of the program. Grant and per diem liaisons 

oversee services provided by these organizations. 

Mental health intensive case management Mental health intensive case management teams are designed to deliver highquality services that: (1) provide intensive, flexible community support; 

(2) improve health status (reduce psychiatric symptoms and substance abuse); 

(3) reduce psychiatric inpatient hospital use and dependency; (4) improve

community adjustment, functioning, and quality of life; (5) enhance satisfaction 

with services; and (6) reduce treatment costs. 

Mentally ill chemically-addicted veterans initiative The Mentally Ill Chemically Addicted program, intended to assist underserved 

veterans with serious and persistent mental illnesses, involves recovery- and 

rehabilitation-oriented services in Network 17 as well as training on the recovery 

model and psychosocial rehabilitation concepts and skills. 

Operation Iraqi Freedom (OIF) and Operation

Enduring Freedom (OEF) 

Assessment, preventative, and early intervention mental health services for 

veterans returning from combat in Iraq, Afghanistan, and other areas. These 

services involve outreach and education efforts, as well as a range of 

psychosocial support services.

Peer housing assistance pilot program for homeless 

veterans 

The Peer Housing Location Assistance Group pilot program is a recoveryoriented program that encourages and enables each veteran to take 

responsibility and initiative to choose and apply for as many housing 

opportunities as his or her eligibility characteristics, preferences, and motivation 

permit. The program aims to help participants manage the process and 

frustrations of finding and maintaining safe and secure housing through a 

combination of information, problem-solving, encouragement, professional 

assistance, and peer support. 

Pilot program for incarcerated veterans with 

mental illness 

A collaborative venture between the North Texas Health Care System and the 

Texas Correctional Office on Offenders with Medical and Mental Impairments 

that provides active outreach and case management services to veterans with 

diagnosed mental illness being released from the Texas prisons and involves 

work with the Texas diversion courts for mentally ill offenders to provide 

outreach and case management services for veterans convicted of minor 

offences who have been diagnosed with mental illness. 

Appendix II: Description of Selected 

Department of Veterans Affairs (VA) Mental 

Health Services 

Page 29 GAO-07-66 VA Mental Health Services
Appendix II: Description of Selected 

Department of Veterans Affairs (VA) Mental

Health Services

VA Mental Health Service Description

Polytrauma Rehabilitation Centers Polytrauma Rehabilitation Centers provide comprehensive interdisciplinary

rehabilitation and coordinated complex medical, surgical, and mental health 

care, as well as long-term follow-up, to veterans of OIF and OEF who have 

sustained severe injuries and have complex rehabilitation needs. 

Post-traumatic stress disorder (PTSD) Specialized services for veterans returning from Iraq and Afghanistan, as well 

as veterans from past service eras, including the Vietnam War. As part of VA’s 

overall coordination of postdeployment programs, PTSD services are focused 

on veterans who are survivors of traumatic events and require comprehensive 

treatment. 

Psychosocial rehabilitation for veterans with serious 

mental illness 

A comprehensive approach to restoring a veteran’s full potential following the 

onset of serious mental illness. This approach involves assisting the veteran in 

all aspects of normal life to attain the highest level of functioning in the 

community; it includes such components as patient and family education; 

enhancement of residential, social, and work skills; cognitive behavioral 

therapy; motivational interviewing, integrated dual diagnosis treatment, and 

provision of intensive case management when needed. 

Residential rehabilitation treatment program 

infrastructure improvements 

Safety, security, privacy, access, and infrastructure improvements to domiciliary 

and residential rehabilitation treatment programs, including repairs, renovations, 

furnishings, appliances, equipments, household goods, and program supplies 

and materials. A special emphasis for a component of these funds was 

improving access to these mental health residential programs for women 

veterans. 

Stand Downs Stand Downs are typically 1 to 3 day events that provide services to homeless 

veterans such as food, clothing, health screenings, VA and Social Security

benefits counseling, and referrals to a variety of other supportive services such 

as housing, employment, and substance abuse treatment. Stand Downs are 

collaborative events that are coordinated between local VA facilities, other

government agencies, and community agencies that serve the homeless. 

Substance abuse Specialized services for veterans with substance abuse disorders such as 

alcoholism and drug addictions. These services, for example, are provided in 

residential rehabilitation treatment programs.

Suicide prevention initiative Initiative designed to obtain causes of death for veterans who have died in

recent years, to identify those who have died from suicide and related causes, 

to identify risk factors, and to evaluate regional and local variability in rates and 

risk factors. The goal is to obtain information that can guide evidence-based 

efforts at suicide prevention, nationally and at other levels. 

Support for Gulf Coast mental health programs 

affected by Hurricane Katrina 

Special needs funding for medical supplies, equipment, office furniture, and 

modular buildings for Gulf Coast VA mental health programs that sustained 

damage due to Hurricane Katrina. 

Telemental health Telemental health uses electronic communications and information technology 

to provide and support mental health care where geographic distance separates 

the clinicians and patients. These services are often used in rural areas where 

the availability of mental health providers is limited. 

Web-based support tools for veterans with 

mental health concerns 

Initiative to develop an interactive set of web-based tools to allow veterans who 

have behavioral or mental health concerns to track important aspects of their 

self-care and professional care. 

Source: GAO summary of VA information. 

Page 30 GAO-07-66 VA Mental Health Services
Appendix III: Comments from the Department Appendix III: Comments from the of Veterans Affairs 

Department of Veterans Affairs 

Page 31 GAO-07-66 VA Mental Health Services
Appendix IV: 

A

GAO Contact and Staff 

cknowledgments 

Page 32 GAO-07-66 

Appendix IV: GAO Contact and Staff 

Acknowledgments 

GAO Contact Laurie E. Ekstrand, (202) 512-7101 or ekstrandl@gao.gov

In addition to the contact named above, Debra Draper, Assistant Director; 

James Musselwhite, Assistant Director; Jennie Apter; Robin Burke; and 

Steven Gregory made key contributions to this report. 

Acknowledgments 

VA Mental Health Services
Related GAO Products Related GAO Products 

VA Health Care: Preliminary Information on Resources Allocated for 

Mental Health Strategic Plan Initiatives. GAO-06-1119T. Washington, 

D.C.: September 28, 2006. 

VA Health Care: Budget Formulation and Reporting on Budget 

Execution Need Improvement. GAO-06-958. Washington, D.C.: 

September 20, 2006. 

VA Long-Term Care: Data Gaps Impede Strategic Planning for and 

Oversight of State Veterans’ Nursing Homes. GAO-06-264. Washington,

D.C.: March 31, 2006. 

VA Long-Term Care: Trends and Planning Challenges in Providing 

Nursing Home Care to Veterans. GAO-06-333T. Washington, D.C.: 

January 9, 2006. 

VA Health Care: VA Should Expedite the Implementation of 

Recommendations Needed to Improve Post-Traumatic Stress Disorder

Services. GAO-05-287. Washington, D.C.: February 14, 2005. 

VA Long-Term Care: Oversight of Nursing Home Program Impeded by 

Data Gaps. GAO-05-65. Washington, D.C.: November 10, 2004. 

VA and Defense Health Care: More Information Needed to Determine If 

VA Can Meet an Increase in Demand for Post-Traumatic Stress Disorder

Services. GAO-04-1069. Washington, D.C.: September 20, 2004. 

VA Health Care: Resource Allocations to Medical Centers in the Mid 

South Healthcare Network. GAO-04-444. Washington, D.C.: April 21, 2004.

Department of Veterans Affairs: Key Management Challenges in Health 

and Disability Programs. GAO-03-756T. Washington, D.C.: May 8, 2003.

VA Health Care: Allocation Changes Would Better Align Resources with 

Workload. GAO-02-338. February 28, 2002. 

Agencies’ Annual Performance Plans Under the Results Act: An 

Assessment Guide to Facilitate Congressional Decisionmaking, 

Version 1. GAO/GGD/AIMD-10.1.18. Washington, D.C.: February 1998.

Managing for Results: Critical Issues for Improving Federal Agencies’ 

Strategic Plans. GAO/GGD-97-180. Washington, D.C.: September 16, 1997. 

Page 33 GAO-07-66 VA Mental Health Services
Related GAO Products 

Business Process Reengineering Assessment Guide, Version 3. 

GAO/AIMD-10.1.15. Washington, D.C.: May 1997.

Agencies’ Strategic Plans Under GPRA: Key Questions to Facilitate 

Congressional Review, Version 1. GAO/GGD-10.1.16. Washington, D.C.: 

May 1997. 

(290522) Page 34 GAO-07-66 VA Mental Health Services
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