A mental health survey given to over 50,000 troops on their way out of the military in 2023 found that two-thirds indicated they might have a mental health condition worthy of medical follow-up. But of those identified in the program, more than half refused referrals to a transition program for counseling or other treatment, a government watchdog found.
The high rate of potential mental health conditions was reported in a report released Thursday by the Government Accountability Office, or GAO, which examined the Department of Veterans Affairs’ mental health screening for troops on their way out of the service in 2023 and early 2024. The GAO found issues with the way that troops were screened for post-traumatic stress disorder, violence risk and alcohol use.
“Given concerns about the risk of suicide and other mental health challenges following service members’ separation from military service, it is essential that they receive effective mental health screening prior to separation. Such screening can lead to the early identification of individuals potentially at high risk and help direct them to further assessment, treatment, and intervention,” the Government Accountability Office wrote in a report released Thursday.
About half of the troops who displayed mental health risk, the report found, declined referrals to the Department of Defense-run inTransition program, a mental health counseling program aimed at members leaving the service.
Studies have found that suicide risk is higher for service members after leaving the military and that the risk increases during their first year of separation.
The Department of Defense requires a health exam for service members leaving the military and the Department of Veterans Affairs does assessments for those filing for disability benefits. To improve coordination between the two agencies, they developed a joint assessment that screens for service members exhibiting signs of depression, suicide risk, alcohol use, post-traumatic stress disorder and violence risk.
The VA had contractors administer 50,500 joint separation health assessments between May 2023 and April 2024 to service members who were evaluated for disability benefits. They found that nearly 67% of troops showered an “elevated risk for the specific mental health condition” with a need for additional evaluation or intervention, GAO found.
The majority of positive screenings included signs of PTSD and depression. In fiscal year 2023, 7% of veterans received disability compensation for mental health, according to data provided by the VA that was included in the report. Of those, 57% received compensation for PTSD, while 13% had major depressive disorders.
VA and DoD officials told the GAO that the mental health rates were higher than expected in a clinical setting or based on prevalence among the military population. However, previous studies and reports have found that generally troops do not seek mental health care during their military careers because of cultural stigmas and privacy concerns around the impact to their careers.
Despite research showing the increasing risk of suicide among recently separated troops and the fact that troops often don’t get help for existing mental health conditions, DoD officials told GAO that “it is reasonable to assume” that the high numbers could be influenced by service members knowing the results would be used to assess their eligibility for benefits like disability compensation.
However, because this mental health exam has not been distributed across the DoD, the GAO said it was not possible to compare rates between troops who were separating and applying for disability from those who were not.
DoD officials also said that the high number of mental health indications could be due to the timing of the exams and “stress associated with leaving the military.”
Questions asked about mental health were not ‘validated’
The purpose of the GAO report was to review the quality of the mental health screenings and whether they were “validated” tools — in other words, were the surveys themselves and results based on widely accepted scientific and clinical research.
The office found that the questions for depression and suicide risk were based on validated tools, but those that asked about alcohol use, PTSD and violence risk were not. Because of those discrepancies, the GAO determined that the “VA and DOD cannot be sure about the effectiveness or reliability of the screening.”
For alcohol use, the GAO found that the exam had different questions around troops’ drinking habits for men and women. While women were asked how often they had consumed “four or more drinks on one occasion” in the previous year, men were asked about six or more drinks.
For PTSD, the GAO found that the survey relied on scientific research that had primarily looked at older, male veterans. The narrow focus of that research, the GAO found, “may limit the generalizability of their findings to a younger and more diverse population separating from military service.”
For questions about risk factors of violence, the GAO consulted experts who disagreed on the effectiveness of the survey. One expert said the violence-related questions were “subjective and vague” while a second said responses would be “insufficient to determine whether the service member is at risk for hurting others.” A third expert, though, thought the questions were reasonable and could be useful.
Transition program
After a service member’s evaluation shows a positive result for mental health conditions, doctors are supposed to provide information on the DoD’s inTransition program. The GAO found that 52% declined to participate in the program. The program is designed to be free and confidential for troops and veterans going through changes like relocating, returning from deployment, or leaving service.
VA officials told GAO “they did not have concerns” about the number who declined the referrals because they may be seeking mental health treatment elsewhere. They also said it’s “more important that all service members who screen positive be informed about the inTransition program and provided its phone number.”
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