Every year, the National Defense Authorization Act (NDAA) allows Congress to authorize mental health programs and services within the Department of Defense that support service members, military retirees, and their families.
The NDAA is legislation that Congress passes each year to make changes to the policies and organization of U.S. defense agencies and provide guidance on how military funding can be spent. Though funding for the U.S. military must be approved through appropriations bills, Congress uses the NDAA to establish defense priorities, make organizational changes to military agencies, and provide guidance on how funding should be used.
The NDAA of 2022 was signed into law on Dec. 27, 2021 by President Biden You can read more about it here.
Background on Department of Defense (DOD) Mental Health Programs
DOD administers many mental health programs that offer education, awareness, crisis prevention resources, clinical treatment, nonclinical support and counseling services, and research and development.
Mental health disorders also accounted for the highest number of hospital bed days and were the second most common reason for outpatient visits among service members.
During the same period, the majority (64%) of mental health diagnoses were attributed to adjustment disorders, anxiety disorders, and depressive disorders.
DOD has made numerous efforts to address the wide range of mental health issues, and potential opportunities for improvement have been highlighted by the Government Accountability Office (GAO), DOD Inspector General (DODIG), and other experts about military health issues.
Mental Health Provisions in the 2022 NDAA
Eating Disorders
Currently only partial hospitalization and intensive outpatient treatment for eating disorders are covered for TRICARE beneficiaries up to age 20—a limitation that keeps military from receiving care they desperately need. Fortunately, Congress removed that restriction in this year’s NDAA for most military family members, meaning that those struggling with eating disorders will be able to get the care they need regardless of their age. Unfortunately, the barrier remains in place for retirees and their families, but the criteria is expected to be addressed next year.
In a 2020 report, GAO found that DOD does not generally screen service members for eating disorders during the annual periodic health assessment, stating “DOD is examining ways to improve its screening of eating disorders in the military as well as identify possible ways to prevent such conditions in the military.”
Section 701 of the NDAA 2022 legislation bill requires DOD to periodically screen for, and treat, eating disorders among service members. The provision also requires the TRICARE program to cover certain outpatient and inpatient treatment services (e.g., residential services or partial hospitalization programs) for eating disorders among service members and their dependents.
Referral for Mental Health Evaluations
Currently DOD policy allows service members to obtain a mental health evaluation on a voluntary (i.e., self-referral) or involuntary (i.e., command-directed) basis.
A 2020 DOD Inspector General report found that the Department “did not consistently meet outpatient mental health access to care standards for active-duty service members and their families, in accordance with law and applicable [DOD] policies.”
Section 704 of the new NDAA 2022 law requires DOD to establish a new process that triggers a command-directed mental health evaluation. The new process allows a service member to disclose a certain phrase that then initiates an automatic, confidential referral for a mental health evaluation.
Scheduling Appointments
Families have been telling DOD representatives about the challenges of accessing mental health care.
This issue has been amplified during the pandemic, which increased many of the stressors associated with military life and the need for mental health services.
For many military family members, the process of scheduling a mental health appointment can be overwhelming due to navigating confusing, outdated provider directories to find a provider who takes TRICARE and is accepting new patients.
The NDAA provides for a new mental health appointment scheduling pilot program that will ease the burden on families by connecting them directly with mental health care providers.
Section 734 of the bill requires DOD to conduct a 1-year pilot program that provides “direct assistance” to beneficiaries scheduling mental health appointments at certain military treatment facilities. The provision also requires DOD to assess the program and provide a report to Congress, within 90 days after the pilot program ends, on the effectiveness and barriers of accessing mental health appointments.
Suicide Prevention
Suicide rates among active-duty military members are currently at an all-time high since record-keeping began after 9/11 and have been increasing over the past 5 years at an alarmingly steady pace. In 2021, research found that 30,177 active-duty personnel and veterans who served in the military after 9/11 have died by suicide, compared to the 7,057 service members killed in combat during those same 20 years. Military suicide rates are four times higher than deaths that occurred during military operations.
High Suicide Rates among United States Service Members and Veterans of the Post-9/11 Wars PDF.
Section 738 of the House-passed bill requires the Secretary of Defense to establish an independent committee to conduct a review of DOD’s suicide prevention and response programs and factors that contribute to military suicides and provide an initial (270 days after the committee is established) and final report (330 days after the committee is established) to Congress on their findings.
NBCC supports service members, veterans, and their families and promotes ensuring access to qualified mental health counselors, and will provide updates on various federal bills on military and veteran’s mental health legislation and implications for counselors in 2022.
