VA Health Care: Preliminary Information on Resources Allocated for Mental Health Strategic Plan Initiatives
Published: 2006-09-28T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: 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. VA also planned to increase its fiscal year 2006 allocations for plan initiatives by $200 million above fiscal year 2004 levels--composed of $100 million for continuation of fiscal year 2005 initiatives and an additional $100 million identified in the President's fiscal year 2006 budget request. GAO was asked to provide preliminary information on VA's allocation and use of funding for mental health strategic plan initiatives in fiscal years 2005 and 2006. A report on this work will be issued later in the fall of 2006. GAO reviewed VA reports and documents on mental health strategic plan initiatives and conducted interviews with VA officials from headquarters, 4 of 21 health care networks, and 7 medical centers. VA delegates decision making to its health care networks for most budget and management responsibilities regarding medical center operations, and medical centers receive most of their resources from the networks.
section_title: What GAO Found
paragraphs: In fiscal year 2005, VA headquarters allocated $88 million of the $100 million 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 submissions from networks for specific initiatives to be carried out at their individual medical centers through requests for proposals (RFPs). In addition, VA headquarters officials said that VA allocated $35 million for this purpose through VA's general resource allocation system to its 21 health care networks on a retrospective basis. VA made this decision several months after resources had been provided to the networks through the general allocation system. Moreover, VA did not notify network and medical center officials that these funds were to be used for plan initiatives. Health care 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. Moreover, 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 the funds allocated directly to their medical centers for plan initiatives that included new mental health services and more of the services they already provided. For example, two medical centers used funds allocated to them through RFPs or other targeted approaches to increase the number of mental health providers at community based outpatient clinics. One of those medical centers also started a new 6-week PTSD day treatment program. However, some medical center officials reported that they did not use all funds allocated for plan initiatives by the end of fiscal year 2005, due in part to the length of time it took to hire new staff. In fiscal year 2006, as of September 20, 2006, VA headquarters had allocated $158 million of the $200 million planned for mental health strategic plan initiatives. VA allocated about $92 million of these funds directly to medical centers and certain offices to support new initiatives, using RFPs and other targeted funding approaches. VA also allocated about $66 million to support recurring costs of the continuing initiatives from the prior fiscal year. As of September 20, 2006, about $42 million of the $200 million for fiscal year 2006 had not been allocated. Officials from seven medical centers we interviewed reported that they had used funds for plan initiatives, such as the creation of a new intensive mental health case management program. Officials at some medical centers reported that they did not anticipate problems using all of the funds allocated to them through RFPs and other targeted approaches in fiscal year 2006. However, officials at other medical centers were less certain that they would use all of these funds for plan initiatives by the end of fiscal year 2006. GAO discussed the information in this statement with VA officials who agreed that the data are accurate, and provided updated data which are incorporated as appropriate.

section_title: Letter
paragraphs: We are pleased to have the opportunity to provide preliminary information  from our work on the Department of Veterans Affairs (VA) resource  allocation for mental health strategic plan initiatives for fiscal years 2005  and 2006 and how those funds were used by selected medical centers in  those 2 fiscal years. 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. This 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  it would need in the future.
VA indicated at a 2005 congressional hearing 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  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. However, 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, 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 networks 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 areas— Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF),  respectively, and expansion of programs for the treatment of substance  abuse disorders. 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 OIF and OEF veterans while also  continuing to provide services for veterans who are currently receiving  mental health care.
In this statement we are providing preliminary information on VA’s  spending for mental health strategic plan initiatives in fiscal years 2005  and 2006. We are currently examining the allocation and use of these  additional funds targeted to mental health strategic plan initiatives.  Therefore, we focus on the increase from fiscal year 2004 targeted on  these initiatives—-$100 million in fiscal year 2005 and $200 million in fiscal  year 2006. In this statement we provide (1) information on 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, and (2) information on 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. A more detailed report  concerning these issues and how VA tracked the use of the funds allocated  will be issued later in the fall of 2006.
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 used a September 20, 2006,  cut off date for reviewing VA’s allocation of the $200 million for  implementing the mental health strategic plan in fiscal year 2006. 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.  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 3 medical centers located in those networks, and we also conducted  phone interviews with officials in 2 other networks and 4 medical centers  located in those networks. 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 3 community based outpatient  clinics (CBOC) associated with these medical centers and 5 Vet Centers.  The findings from our site visits and phone interviews with network and  medical center officials cannot be generalized to other medical centers or  networks. We discussed the information in this statement with VA officials  who have responsibilities related to mental health services, budgeting, and  the allocation of financial resources. These officials agreed that the data  are accurate and they also provided updated data which we incorporated  as appropriate. We performed our work from January 2006 through  September 2006 in accordance with generally accepted government  auditing standards.
In summary, VA headquarters allocated $88 million of the $100 million VA  officials said would be used for 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 solicited submissions from networks for specific initiatives  to be carried out at their individual medical centers through requests for  proposals (RFPs). In addition, VA headquarters officials said that they  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 plan initiatives was a  retroactive decision. VA made this decision several months after resources  had been provided to the networks through the general 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 specifically used for  mental health strategic plan initiatives. The approximately $12 million  remaining of the $100 million was not allocated by any approach because,  according to headquarters officials, there was not enough time during the  fiscal year to allocate the funds. Officials we interviewed at 7 medical  centers in 4 networks reported using resources allocated directly to their  medical centers for plan initiatives that included new mental health  services and more of the services they were already providing. Some  medical center officials told us that they had not been able to spend all of  the funds provided for mental health strategic plan initiatives during the  fiscal year in part because of the length of time it takes to hire new staff.
As of September 20, 2006, VA headquarters had allocated $158 million of  the $200 million VA planned for mental health strategic plan initiatives in  fiscal year 2006 by using several approaches. VA allocated about   $92 million of these funds directly to medical centers and certain offices 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 had not been allocated as of September 20. According to  VA officials, a portion of the $42 million not allocated is a result of partial- year allocations made for projects that were funded later in the fiscal year  and that are expected to receive 12-month allocations for fiscal year 2007.
Officials we interviewed at 7 medical centers said they had used funds to  implement plan initiatives such as a new mental health intensive case  management program. However, officials at some medical centers told us  that they were uncertain that they would be able to use all the funds for  plan initiatives by the end of the fiscal year.
subsections: section_title: Background
paragraphs: VA provides health care services to more than 5 million patients annually.  This care includes 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. Mental health services are  provided for a range of conditions such as depression, PTSD, and  substance abuse disorders. Resources for these and other health care  services are allocated by VA headquarters through a general resource  allocation system—the Veterans Equitable Resource Allocation (VERA)  system—to its 21 health care networks. 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.
In November 2004, the Secretary of VA approved the mental health  strategic plan. This 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 filling gaps in access to mental health services. Some of the  service gaps identified were in treating veterans with serious mental  illness, female veterans, and veterans returning from combat in Iraq and  Afghanistan. Within VA, the Office of Mental Health Services (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 to medical centers and certain  offices for plan initiatives. Such strategies include, for example, the use of  RFPs to decide how the mental health strategic plan funds are to be  allocated to medical centers.
section_title: VA Allocated $88 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
paragraphs: VA headquarters allocated $88 million of the $100 million that VA officials  said would be used for 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 its general resource allocation system to its health care networks,  according to VA officials. The remaining $12 million 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 7 medical centers in 4 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 the  fiscal year, due in part to the length of time it took to hire new staff.
subsections: section_title: VA Allocated Approximately $53 Million Directly to Medical Centers and Certain Offices
paragraphs: 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. VA headquarters developed and solicited  submissions from networks for specific initiatives to be carried out at their  individual medical centers through requests for proposals (RFPs). VA  made resources available through these RFPs and other targeted  approaches to medical centers for plan initiatives to support a range of  specific 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, according to VA headquarters officials.  Nearly $20 million of the $53 million allocated by using RFPs and other  targeted approaches was for mental health services related to legislation,  according to VA officials.
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 an allocation of about $18 million, with Compensated  Work Therapy (CWT) receiving the second highest total—nearly   $10 million. Other initiatives receiving funding included substance abuse  services, mental health services in nursing homes, domiciliary expansion,  and psychosocial rehabilitation for veterans with serious mental illness.
VA headquarters 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. Review panels headed by mental health  experts within VA reviewed the proposals, ranked them, and provided  their rankings to VA’s leadership. Once funding decisions were made, VA  allocated funding directly to the medical centers for the mental health  strategic plan initiatives. VA also used other funding approaches targeted  to specific initiatives. For example, headquarters officials allocated  funding to medical centers to expand mental health services at CBOCs  that had fewer mental health visits than a standard VA identified for this  purpose. VA also used other targeted funding approaches to determine  which medical centers would receive some of the funds for PTSD, OIF and  OEF veterans’, and substance abuse services. In addition, VA targeted  funds to mental health initiatives in Polytrauma Centers—centers within  certain VA medical centers that provide specialized treatment for veterans  of OIF and OEF who have complex rehabilitation needs.
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.
section_title: VA Allocated $35 Million through Its General Resource Allocation System to Its Health Care Networks on a Retrospective Basis
paragraphs: VA allocated $35 million for mental health strategic plan initiatives in fiscal  year 2005 through its general resources allocation system 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, the  decision that $35 million of the funds allocated at that time were 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 also made, in part, because VA did not have sufficient  unallocated funds remaining after the December 2004 general allocation to  fund $100 million for mental health strategic plan initiatives 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 were unaware that any specific portion of  their general allocation was 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 their 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  retroactive allocation, it is likely that some of these funds were not used  for plan initiatives.
section_title: VA Did Not Allocate About $12 Million Planned for Mental Health Strategic Plan Initiatives
paragraphs: VA did not allocate the 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. Officials said  that when resources were allocated later in the fiscal year through an RFP  rather than at the beginning, the amount allocated was only a portion of  the annualized cost. The full annualized cost could be supported in the  next fiscal year. For example, if a project with an annual cost of $4 million  was allocated mid way 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 available for the project over 12 months in the next  fiscal year. The $12 million that VA did not allocate for fiscal year 2005 was  intended for certain mental health strategic plan initiatives based on an  allocation plan developed by VA for the $65 million it planned to allocate  through RFPs and other approaches. VA headquarters officials said that  funds not allocated for mental health strategic plan initiatives were  allocated for other health care purposes.
section_title: Medical Center Officials Reported Using Allocations for Mental Health Strategic Plan Initiatives, but Not Using All Funds Allocated for Plan Initiatives
paragraphs: Officials we interviewed from seven medical centers in four networks  reported using funds allocated to them for mental health strategic plan  initiatives through RFPs and other targeted approaches, but they 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 services included in plan  initiatives. For example, two medical centers used funds to increase the  number of mental health providers available at CBOCs. One of those  medical centers also implemented a new 6-week PTSD day treatment  program in which veterans live in the community but come to the medical  center daily for counseling, group therapy, and other services.
Officials at some medical centers reported that they were not able to use  all of their fiscal year 2005 funding for plan initiatives by the end of the  year as planned and cited several reasons 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. In some cases the need to locate or renovate space for programs  contributed to delays in using mental health strategic plan funds,  according to medical center officials.
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. Some reported that they carried over the funds for use in  the next fiscal year. Officials at some medical centers reported that they  used these funds for other health care purposes. For example, officials at  one medical center said they used funds that they did not spend on mental  health strategic plan initiatives to support other mental health programs.  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.
section_title: As of September 20, 2006, VA Had Allocated $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
paragraphs: As of September 20, 2006, VA headquarters had allocated $158 million of  the $200 million to be used for VA mental health strategic plan initiatives  in fiscal year 2006 by using several approaches. About $92 million of these  funds was allocated directly to medical centers and certain offices 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 initiatives that were funded in fiscal year 2005.  The remaining $42 million had not been allocated as of September 20.  Officials at some medical centers expected to spend all of the allocations  they received during fiscal year 2006. However, officials at some medical  centers were uncertain that they would spend all their allocations for plan  initiatives during the fiscal year.
subsections: section_title: VA Allocated about $158 Million Directly to Medical Centers and Certain Offices
paragraphs: VA headquarters had allocated about $158 million directly to medical  centers and certain offices by September 20, 2006, through RFPs and other  approaches targeted to specific initiatives related to the mental health  strategic plan in fiscal year 2006. 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. As of September 18, 2006, VA had not  allocated resources for mental health strategic plan initiatives through its  general resource allocation system and VA headquarters officials said VA  was not planning to do so.
section_title: VA Did Not Allocate about $42 Million for Mental Health Strategic Plan Initiatives
paragraphs: As of September 20, 2006, 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. VA officials said that a portion of these  unallocated funds are related to the timing of allocations that were made  for plan initiatives through RFPs and other funds targeted to medical  centers. Specifically, some of the allocations through RFPs 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 cost which VA expects  to fund in fiscal year 2007. Because some of these allocations were made  in the later part of fiscal year 2006, these allocations were smaller than  they would be on a 12-month basis and accounted for part of the   $42 million not allocated. VA officials said they anticipated that these  funds would be available in fiscal year 2007.
section_title: Medical Center Officials Reported Using Allocations for Mental Health Strategic Plan Initiatives, but Were Uncertain Whether All Funds Allocated Would Be Used for Plan Initiatives
paragraphs: Officials from 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 mental health initiatives and to continue  to support the initiatives first funded in fiscal year 2005. For example, one  medical center used funding for a new mental health intensive case  management program. Officials at some medical centers reported that they  did not anticipate problems using all of the funds they had received in  fiscal year 2006. However, others were less certain they would be able to  use all of the funds. Officials at several medical centers were not sure they  would be able to hire all of the new staff related to mental health strategic  plan initiatives by the end of the fiscal year. In May 2006, officials at two  medical centers that we interviewed said that they did not know whether  they would receive additional funds through RFPs to spend in fiscal year  2006, and as a result they 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.
section_title: Concluding Observations
paragraphs: Our preliminary findings show that 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. VA  intended to allocate $100 million for plan initiatives in fiscal year 2005. The  allocations that were made resulted in some new and expanded mental  health services to address gaps, according to officials at selected medical  centers. However, approximately $12 million of the $100 million was not  allocated by any method and $35 million was allocated through VA’s  general resource allocation system on a retrospective basis and without  notifying networks and medical centers that resources for plan initiatives  had been allocated in the general allocation that networks received several  months earlier. Finally, some portion of the approximately $53 million that  was allocated directly to medical centers was not used for plan initiatives  in part because the timing of the allocation of the funds did not leave time  to hire needed staff by the end of the fiscal year. As a result, it is likely that  a substantial portion of the   $100 million intended for mental health strategic plan funds in fiscal year  2005 was not used for plan initiatives. A larger amount of the planned  mental health strategic plan funds was allocated in fiscal year 2006,  although as of September 20, 2006, about a fifth of the $200 million  planned for these initiatives was not allocated. However, it is unclear  whether medical centers will be able to spend all of the fiscal year 2006  mental health strategic plan funds for plan initiatives by the end of the  year, in part because of how late in the year the funds were allocated.
section_title: GAO Contact and Staff Acknowledgments
paragraphs: For further information about this statement, please contact Laurie E.  Ekstrand 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 statement. James Musselwhite, Assistant Director, and  Robin Burke made key contributions to this statement.
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