Mental illness is generally defined as a health condition that changes a person’s thinking, feelings, or behavior and causes the person distress and difficulty in functioning. The symptoms associated with a given type of mental illness can vary in frequency and severity across individuals and for each individual over time. Mental illnesses with particularly severe symptoms can have a dramatic impact on an individual’s ability to function in everyday life. The fatigue experienced by an individual with major depressive disorder can be so severe that it is difficult to summon the energy to work every day. The delusions associated with paranoid schizophrenia can make it impossible to maintain stable personal relationships with spouses, co-workers, or friends. Certain other mental illnesses are known for the unpredictable and episodic nature of their symptoms and the harmful effect this has on the ability to function consistently over time. For example, individuals with bipolar disorder can alternate between periods of mania, relative normalcy, and profound depression. The services provided by the public mental health care system to individuals with serious mental illness have changed over time. Historically, state-run public mental health hospitals were the principal treatment option available to them. By the 1960s, the reliance on inpatient care was viewed as ineffective and inadequate because of patient overcrowding, staff shortages, and other factors. At the same time, improved medications and other interventions were reducing some of the symptoms of mental illness and increasing the potential for more of these individuals to live successfully in the community. A recovery-oriented, community-based approach to mental health treatment has since emerged. Under this approach, individuals are to receive services and supports uniquely designed to help them manage their mental illness and to maximize their potential to live independently in the community. These services and supports are multidimensional—intended to address not only mental illness but also employment, housing, and other issues. When feasible, these multidimensional services are provided in what is referred to as a “wrap-around” manner—that is, they are uniquely targeted to the nature and extent of each individual’s needs. When services are provided by multiple agencies, those agencies are to coordinate their activities and funding so that the individual experiences the services and supports seamlessly—as if from one system, not many. The federal government provides a range of programs to support the needs of individuals with serious mental illness, such as funding block grants to community mental health organizations and providing supportive housing programs for individuals with mental illness. The responsibility for the administration and evaluation of these programs falls upon multiple agencies, including Department of Defense (DOD), Department of Education (Education), HHS, Department of Housing and Urban Development (HUD), Department of Justice (DOJ), Department of Labor (DOL), Department of Veterans Affairs (VA), and Social Security Administration (SSA). Programs supporting individuals with serious mental illness may or may not be specifically targeting that population. For example, a program providing housing for homeless veterans may provide support to individuals with serious mental illness because these individuals make up a portion of the population of homeless veterans, but the program is targeting homeless veterans rather than individuals with serious mental illness. SAMHSA, an agency within HHS, leads the federal government’s public health efforts related to behavioral health, which includes mental health. Specifically, SAMHSA administers behavioral health programs, disseminates policies, information and data, and awards contracts and grants to states, tribes, local governments, and other organizations, including those that support individuals with serious mental illness. Our prior work has noted the importance of coordinating and evaluating programs. This is particularly important in the case of federal efforts to support serious mental illness, given the size of the population affected and the complexity of treatment. We have also reported on the importance of coordination between federal agencies on issues of national significance as a way to avoid fragmentation. Many of the meaningful results that the federal government seeks to achieve require the coordinated efforts of more than one federal agency and often more than one sector and level of government. Our past work has identified a range of mechanisms that the federal government uses to lead and implement interagency coordination, including interagency groups sometimes referred to as task forces, working groups, councils, or committees. In addition, for many years, we have reported that more frequent evaluations of performance and results were needed for multiple federal programs and activities. systematic study to assess how well a program or programs are working. GAO, Government Efficiency and Effectiveness: Opportunities to Reduce Fragmentation, Overlap, and Duplication through Enhanced Performance Management and Oversight, GAO-13-590T (Washington, D.C.: May 22, 2013). Evaluations answer specific questions about program performance and may focus on assessing program operations or results. Evaluation can play a key role in agency strategic planning and in program management, providing important feedback on both program design and execution. Program evaluation is closely related to performance measurement and reporting. Performance measurement is the systematic ongoing monitoring and reporting of program accomplishments, particularly progress toward established goals or standards. The Government Performance and Results Act of 1993 (GPRA), as expanded by the GPRA Modernization Act of 2010, encourages federal agencies to conduct evaluations by requiring them to include a schedule of future program evaluations in their strategic plans and summarize their evaluation findings when reporting on their performance goals, among other things. Agencies identified 112 federal programs in fiscal year 2013—across eight federal agencies—that can support individuals with serious mental illness. These 112 programs conducted activities that can generally support individuals with serious mental illness. For example, HUD’s Continuum of Care program provided funding to nonprofit providers and state and local governments to quickly find housing for homeless individuals and families, among other services. See appendix II for a list of the 112 federal programs identified as supporting individuals with serious mental illness in fiscal year 2013. The number and purpose of programs identified by agencies through our questionnaire varied widely. DOD reported the largest number, a total of 34 programs, and HHS identified 33. Together, the agencies accounted for more than half of the 112 programs. DOJ and VA also each reported over 10 programs. Overall, many of the programs focused on the provision of support services and a few programs focused on research or surveillance. Programs that provided support services included those that provided case management services such as SAMHSA’s Criminal and Juvenile Justice Programs. These programs sought to divert individuals with serious mental illness from the criminal justice system by providing support services that connect the individual to behavioral health, housing, and job placement services. DOD was the only agency that reported prevention programs (13 programs) through the questionnaire, and three agencies—DOD, HHS, and VA—reported treatment programs (16 programs). About a quarter of the programs—27 programs—were identified as serving other purposes. For example, the Department of Education included its Personnel Development program that awarded grants to assist in ensuring adequate numbers of highly qualified special education teachers and fully certified personnel to serve children with disabilities, including children with serious emotional disturbance who may have a serious mental illness. Table 1 provides the number of these programs, by primary program purpose, within the eight federal agencies. In addition to serving a variety of purposes the 112 programs that support individuals with serious mental illness, served a variety of subpopulations, ranging from children to homeless veterans. For example, DOJ administered a program—the Second Chance Act Reentry Program—that focused on adults and youth with co-occurring substance abuse and mental health disorders during their confinement or court supervision. In addition, DOL administered the Homeless Veterans Reintegration program, which worked to meet the needs of homeless veterans by reintegrating them into the workforce. A subset of the 112 programs—30 programs, or 27 percent—were identified by agencies as specifically targeting individuals with serious mental illness. These targeted programs were administered by five agencies: DOD, DOJ, HHS, SSA, and VA. The primary purpose of the 30 targeted programs varied. Half of the targeted programs (15 programs) provided support services, such as case management, to individuals with serious mental illness. Ten of those programs were within HHS. Seven of the targeted programs provided treatment services, with 6 of those programs—administered by VA—providing treatment services to veterans with serious mental illness. All targeted programs reported by HHS were within SAMHSA, and focused on providing support services and technical Table 2 provides the number of these programs, by primary assistance.program purpose, within the five federal agencies that identified programs specifically targeted towards individuals with serious mental illness. In addition to serving a variety of purposes, the 30 programs that specifically target individuals with serious mental illness, served a variety of subpopulations, ranging from children and families to homeless veterans. Over half of the targeted programs (16 programs) were administered by three agencies—DOD, DOJ, and VA—and served specific subpopulations; servicemembers, incarcerated or previously incarcerated individuals, and veterans, respectively. Three of the targeted programs (all within HHS) served children and/or families. The remaining programs served adults. Based on agency-reported information from the questionnaire, about $5.7 billion was obligated for the 30 targeted programs in fiscal year 2013.and VA for treatment and support services (among other things) for The majority of these funds—84 percent—was obligated by DOD servicemembers, veterans and their families. HHS’s SAMHSA obligations represented about 13 percent of total obligations for the 30 targeted programs. HHS officials noted that Medicaid is the largest payer for services for individuals with serious mental illness and that Medicare is also a significant payer for services for that population. The See appendix remaining funds were obligated for programs within DOJ.III for more information on the 30 targeted programs. Agencies had difficulty identifying all programs supporting individuals with serious mental illness because they did not always track whether or not such individuals were among the population served by the program.