Veterans’ Growing Demand for Mental Health Services

The number of veterans receiving mental health care from the Department of Veterans Affairs increased 90% from FY 2006-2019. During this time, VA’s mental health budget increased from $2.4 to $8.9 billion.

  • VA projects a 32% increase in outpatient mental health care over 10 years
  • Preventing suicide is VA’s highest priority; veterans are 1.5 times more likely to die by suicide
  • VA conducts outreach to raise awareness of mental health services, yet some veterans may remain unaware
  • Telehealth visits for mental health increased by over 200% in the first 8 months of the pandemic

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    A recent program honoring the 25th anniversary of a landmark case allowing women to enroll in the Virginia Military Institute (VMI) also celebrated a broader theme: Justice Ruth Bader Ginsburg’s decades-long effort to remove gender bias from state and federal laws.
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  • Domestic Abuse: DOD Needs to Enhance Its Prevention, Response, and Oversight
    In U.S GAO News
    What GAO Found In its May 2021 report, GAO found that the Department of Defense (DOD) met a statutory requirement to collect and report data for incidents that it determined met its criteria for domestic abuse. In fiscal years 2015-2019, DOD determined that over 40,000 domestic abuse incidents met its criteria, of which 74 percent were physical abuse. However, DOD has not collected and reported accurate data for all domestic abuse allegations received, including those that did not meet DOD's criteria, as statutorily required. Thus, DOD is unable to assess the scope of alleged abuse and its rate of substantiation. In addition, despite a statutory requirement since 1999, DOD has not collected comprehensive data on the number of allegations of domestic violence—a subcategory of different types of domestic abuse that constitute offenses under the Uniform Code of Military Justice—and related actions taken by commanders. Improving collection of these data could enhance DOD's visibility over actions taken by commanders to address domestic violence. DOD and the military services have taken steps to implement and oversee domestic abuse prevention and response activities, but gaps exist in key areas, including creating awareness of domestic abuse reporting options and resources, allegation screening, and victim risk assessment. For example, while DOD and the military services have taken steps to promote awareness of reporting options and resources, DOD has not fully addressed challenges in doing so, and may miss opportunities to provide available resources to victims. In addition, the military services perform limited monitoring of installation incident-screening decisions and therefore lack reasonable assurance that all domestic abuse allegations are screened in accordance with DOD policy. DOD and the military services have developed risk assessment tools in accordance with DOD policy, but the Army, the Navy, and the Marine Corps have not ensured their consistent implementation across installations, and may therefore be limited in their ability to identify and convey the need for any critical safety measures for victims of domestic abuse. Finally, GAO found that the military services perform limited oversight of commanders' disposition of domestic violence incidents, referred to as command actions. These command actions can have significant implications, including for victims' eligibility for transitional compensation and Lautenberg Amendment restrictions to firearm possession for alleged abusers. DOD has not assessed the potential risks associated with its current disposition model for domestic violence incidents and the feasibility of potential alternatives that may respond to such risks. Performing such an assessment could provide the department and military services with a better understanding of such risks and their resulting potential impacts. Why GAO Did This Study This testimony summarizes the information contained in GAO's May 2021 report, entitled Domestic Abuse: Actions Needed to Enhance DOD's Prevention, Response, and Oversight (GAO-21-289). Specifically, this testimony discusses the extent to which 1) DOD has met statutory requirements to collect and report complete data on reports of domestic abuse and 2) DOD and the military services have implemented and overseen domestic abuse prevention and response activities, including commanders' disposition of incidents, in accordance with DOD policy.
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  • MS-13 Member Pleads Guilty to Racketeering Conspiracy Involving Murder and Attempted Murder
    In Crime News
    A Maryland man pleaded guilty today to conspiracy to participate in a racketeering enterprise by murdering a suspected rival gang member and attempting to murder two other victims, in connection with his MS-13 gang activities. 
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    In Travel
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  • COVID-19: Brief Update on Initial Federal Response to the Pandemic
    In U.S GAO News
    As of August 20, 2020, the U.S. had over 5.5 million cumulative reported cases of COVID-19, and 158,000 reported deaths, according to federal agencies. The country also continues to experience serious economic repercussions and turmoil. Four relief laws, including the CARES Act, were enacted between March and July 2020 to provide appropriations for the response to COVID-19. The CARES Act includes a provision for GAO to report bimonthly on its ongoing monitoring and oversight efforts related to COVID-19. This second report examines federal spending on the COVID-19 response; indicators for monitoring public health and the economy; and the status of matters for congressional consideration and recommendations from GAO’s June 2020 report (GAO-20-625). GAO reviewed data through June 30, 2020 (the latest available) from USAspending.gov, a government website with data from government agencies. GAO also obtained, directly from the agencies, spending data, as of July 31, 2020, for the six largest spending areas, to the extent available. To develop the public health indicators, GAO reviewed research and federal guidance. To understand economic developments, GAO reviewed data from federal statistical agencies, the Federal Reserve, and Bloomberg Terminal, as well as economic research. To update the status of matters for congressional consideration and recommendations, GAO reviewed agency and congressional actions. In response to the national public health and economic threats caused by COVID-19, four relief laws making appropriations of about $2.6 trillion had been enacted as of July 31, 2020. Overall, federal obligations and expenditures government-wide of these COVID-19 relief funds totaled $1.5 trillion and $1.3 trillion, respectively, as of June 30, 2020. GAO also obtained preliminary data for six major spending areas as of July 31, 2020 (see table). COVID-19 Relief Appropriations, Obligations, and Expenditures for Six Major Spending Areas, as of July 2020 Spending area Appropriationsa ($ billions) Preliminary obligationsb ($ billions) Preliminary expendituresb ($ billions) Business Loan Programs 687.3 538.1 522.2c Economic Stabilization and Assistance to Distressed Sectors 500.0 30.4 19.2c Unemployment Insurance 376.4 301.1 296.8 Economic Impact Payments 282.0 273.5 273.5 Public Health and Social Services Emergency Fund 231.7 129.6 95.9 Coronavirus Relief Fund 150.0 149.5 149.5 Total for six spending areas 2,227.4 1,422.2 1,357.0 Source: GAO analysis of data from the Department of the Treasury, USAspending.gov, and applicable agencies. | GAO-20-708 aCOVID-19 relief appropriations reflect amounts appropriated under the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, Pub. L. No. 116-123, 134 Stat. 146; Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 Stat. 178 (2020); CARES Act, Pub. L. No. 116-136, 134 Stat. 281 (2020); and Paycheck Protection Program and Health Care Enhancement Act, Pub. L. No. 116-139, 134 Stat. 620 (2020). These data are based on appropriations warrant information provided by the Department of the Treasury as of July 31, 2020. These amounts could increase in the future for programs with indefinite appropriations, which are appropriations that, at the time of enactment, are for an unspecified amount. In addition, this table does not represent transfers of funds that federal agencies may make between appropriation accounts or transfers of funds they may make to other agencies. bObligations and expenditures data for July 2020 are based on preliminary data reported by applicable agencies. cThese expenditures relate to the loan subsidy costs (the loan’s estimated long-term costs to the United States government). The CARES Act included a provision for GAO to assess the impact of the federal response on public health and the economy. The following are examples of health care and economic indicators that GAO is monitoring. Health care. GAO’s indicators are intended to assess the nation’s immediate response to COVID-19 as it first took hold, gauge its recovery from the effects of the pandemic over the longer term, and determine the nation’s level of preparedness for future pandemics, involving subsequent waves of either COVID-19 or other infectious diseases. For example, to assess the sufficiency of testing—a potential indicator of the system’s response and recovery—GAO suggests monitoring the proportion of tests in a given population that are positive for infection. A higher positivity rate can indicate that testing is not sufficiently widespread to find all cases. That is higher positivity rates can indicate that testing has focused on those most likely to be infected and seeking testing because they have symptoms, and may not be detecting COVID-19 cases among individuals with no symptoms. Although there is no agreed-upon threshold for the test positivity rate, governments should target low positivity rates. The World Health Organization recommends a test positivity rate threshold of less than 5 percent over a 14-day period. As of August 12, 2020, 12 states and the District of Columbia had met this threshold (38 states had not). Resolve to Save Lives, another organization, recommends a threshold of less than 3 percent over a 7-day period, and 11 states and the District of Columbia had met this threshold (39 states had not) as of August 12, 2020. GAO also suggests monitoring mortality from all causes compared to historical norms as an indicator of the pandemic’s broad effect on health care outcomes. Mortality rates have tended to be consistent from year to year. This allows an estimation of how much mortality rose with the onset of the pandemic, and provides a baseline by which to judge a return to pre-COVID levels. According to Centers for Disease Control and Prevention data, about 125,000 more people died from all causes January 1–June 13 than would normally be expected (see figure). CDC Data on Higher-Than-Expected Weekly Mortality, January 1 through June 13, 2020 Note: The figure shows the number of deaths from all causes in a given week that exceeded the upper bound threshold of expected deaths calculated by CDC on the basis of variation in mortality experienced in prior years. Changes in the observed numbers of deaths in recent weeks should be interpreted cautiously as this figure relies on provisional data that are generally less complete in recent weeks. Data were accessed on July 16, 2020. Economy. GAO updated information on a number of indicators to facilitate ongoing and consistent monitoring of areas of the economy supported by the federal pandemic response, in particular the COVID-19 relief laws. These indicators suggest that economic conditions—including for workers, small businesses, and corporations—have improved modestly in recent months but remain much weaker than prior to the pandemic. In June and July initial regular unemployment insurance (UI) claims filed weekly averaged roughly 1.4 million (see figure), which was six and a half times higher than average weekly claims in 2019, but claims have decreased substantially since mid-March, falling to 971,000 in the week ending August 8, 2020. Increasing infections in some states and orders to once again close or limit certain businesses are likely to pose additional challenges for potentially fragile economic improvements, especially in affected sectors, such as the leisure and hospitality sector. National Weekly Initial Unemployment Insurance Claims, January 2019–July 2020 Note: See figure 5 in the report. As GAO reported in June, consistent with the urgency of responding to serious and widespread health issues and economic disruptions, federal agencies gave priority to moving swiftly where possible to distribute funds and implement new programs designed to help small businesses and the newly unemployed, for example. However, such urgency required certain tradeoffs in achieving transparency and accountability goals. To make mid-course corrections, GAO made three recommendations to federal agencies: To reduce the potential for duplicate payments from the Paycheck Protection Program (PPP)—a program that provides guaranteed loans through lenders to small businesses—and unemployment insurance, GAO recommended that the Department of Labor (DOL), in consultation with the Small Business Administration (SBA) and the Department of the Treasury (Treasury), immediately provide information to state unemployment agencies that specifically addresses PPP loans, and the risk of improper unemployment insurance payments. DOL issued guidance on August 12, 2020, that, among other things, clarified that individuals working full-time and being paid through PPP are not eligible for UI. To recoup economic impact payments totaling more than $1.6 billion sent to decedents, GAO recommended that the Internal Revenue Service (IRS) consider cost-effective options for notifying ineligible recipients of economic impact payments how to return payments. IRS has taken steps to address this recommendation. According to a Treasury official, nearly 70 percent of the payments sent to decedents have been recovered. However, GAO was unable to verify that amount before finalizing work on this report. GAO is working with Treasury to determine the number of payments sent to decedents that have been recovered. Treasury was considering sending letters to request the return of remaining outstanding payments but has not moved forward with this effort because, according to Treasury, Congress is considering legislation that would clarify or change payment eligibility requirements. To reduce the potential for fraud and ensure program integrity, GAO recommended that SBA develop and implement plans to identify and respond to risks in PPP to ensure program integrity, achieve program effectiveness, and address potential fraud. SBA has begun developing oversight plans for PPP but has not yet finalized or implemented them. In addition, to improve the government’s response efforts, GAO suggested three matters for congressional consideration: GAO urged Congress to take legislative action to require the Department of Transportation (DOT) to work with relevant agencies and stakeholders, such as HHS, the Department of Homeland Security (DHS), and international organizations, to develop a national aviation-preparedness plan to ensure safeguards are in place to limit the spread of communicable disease threats from abroad, while also minimizing any unnecessary interference with travel and trade. In early July 2020, DOT collaborated with HHS and DHS to issue guidance to airports and airlines for implementing measures to mitigate the public health risks associated with COVID-19, but it has not developed a preparedness plan for future communicable disease threats. DOT has maintained that HHS and DHS should lead such planning efforts as they are responsible for communicable disease response and preparedness planning, respectively. In June 2020, HHS stated that it is not in a position to develop a national aviation-preparedness plan as it does not have primary jurisdiction over the entire aviation sector or the relevant transportation expertise. In May 2020, DHS stated that it had reviewed its existing plans for pandemic preparedness and response activities and determined it is not best situated to develop a national aviation-preparedness plan. Without such a plan, the U.S. will not be as prepared to minimize and quickly respond to future communicable disease events. GAO also urged Congress to amend the Social Security Act to explicitly allow the Social Security Administration (SSA) to share its full death data with Treasury for data matching to help prevent payments to ineligible individuals. In June 2020, the Senate passed S.4104, referred to as the Stopping Improper Payments to Deceased People Act. If enacted, the bill would allow SSA to share these data with Treasury's Bureau of the Fiscal Service to avoid paying deceased individuals. Finally, GAO urged Congress to use GAO's Federal Medical Assistance Percentage (FMAP) formula for any future changes to the FMAP—the statutory formula according to which the federal government matches states' spending for Medicaid services—during the current or any future economic downturn. Congress has taken no action thus far on this issue. GAO incorporated technical comments received the Departments of Labor, Commerce, Health and Human Services, Transportation, and the Treasury; the Federal Reserve; Office of Management and Budget; and Internal Revenue Service. The Small Business Administration commented that GAO did not include information on actions taken and controls related to its loan forgiveness program or its plans for loan reviews. GAO plans to provide more information on these topics in its next CARES Act report. For more information, contact A. Nicole Clowers at (202) 512-7114 or clowersa@gao.gov.
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  • Former Venezuelan Official Charged in Connection with International Bribery and Money Laundering Scheme
    In Crime News
    Charges were unsealed today against a former official at Citgo Petroleum Corporation, a Houston-based subsidiary of Venezuela’s state-owned and state-controlled energy company Petróleos de Venezuela S.A. (PDVSA).
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  • Statement of Acting Attorney General Jeffrey A. Rosen
    In Crime News
    “Yesterday, our Nation watched in disbelief as a mob breached the Capitol Building and required federal and local law enforcement to help restore order. The Department of Justice is committed to ensuring that those responsible for this attack on our Government and the rule of law face the full consequences of their actions under the law. Our criminal prosecutors have been working throughout the night with special agents and investigators from the U.S. Capitol Police, FBI, ATF, Metropolitan Police Department and the public to gather the evidence, identify perpetrators, and charge federal crimes where warranted. Some participants in yesterday’s violence will be charged today, and we will continue to methodically assess evidence, charge crimes and make arrests in the coming days and weeks to ensure that those responsible are held accountable under the law.”
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  • North Carolina Tax Preparer Charged with Conspiracy to Defraud the IRS and Aggravated Identity Theft
    In Crime News
    A federal grand jury in Durham, North Carolina, returned an indictment yesterday charging a tax preparer with conspiring to defraud the United States, preparing false tax returns, filing a false personal tax return, and committing aggravated identity theft, announced Acting Deputy Assistant Attorney General Stuart M. Goldberg of the Justice Department’s Tax Division and U.S. Attorney Matthew G.T. Martin for the Middle District of North Carolina.
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  • Justice Department Settles Citizenship-Status Discrimination Against South Carolina Security Guard Firm Involving Former Interpreter for the U.S. Military in Iraq
    In Crime News
    The Justice Department announced today that it reached a settlement with Security Management of South Carolina LLC (Security Management), a private security company that provides armed and unarmed security services throughout South Carolina and Georgia.
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  • Las Vegas Woman Arrested and Charged with Illegally Exporting Goods to Iran
    In Crime News
    A Las Vegas woman has been indicted by a federal grand jury for conspiracy to export goods from the United States to Iran, in violation of the International Emergency Economic Powers Act (IEEPA) and the Iranian Transactions and Sanctions Regulations.
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  • Department of Justice’s COPS Office Invests More Than $536.7 Million in Grants to Improve Public Safety, Reduce Crime and Advance Community Policing
    In Crime News
    The Department of Justice’s Office of Community Oriented Policing Services (COPS Office) awarded more than $536.7 million in Fiscal Year 2020 to increase law enforcement hiring and to improve school safety, combat opioids and methamphetamine, advance community policing efforts, provide training to the law enforcement field, and protect the health of our nation’s officers and deputies.
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  • Special Presidential Envoy for Arms Control Billingslea to Address the Conference on Disarmament 
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  • Nine Charged with $24 Million COVID-Relief Fraud Scheme
    In Crime News
    The owner of a Florida talent management company and four others were charged in complaints unsealed yesterday for their alleged participation in a scheme to file fraudulent loan applications seeking more than $24 million in forgivable Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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