DOD Expanded Telehealth for Mental Health Care during the COVID-19 Pandemic (GAO-22-105149)

Summary

A GAO report, GAO-22-105149, dated February 3, 2022, to the leaders of the Senate and House Committees on Armed Services, on defense health care. It states that the COVID-19 pandemic presented stressors for both members of the military services and military mental health providers. For some these were similar to those in the civilian population, such as illness, financial challenges and isolation; others were on the front lines, treating patients with COVID-19 and supporting testing and vaccination efforts. Its title states that the Department of Defense expanded telehealth for mental health care during the pandemic.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Full text

441 G St. N.W.
Washington, DC 20548




February 3, 2022

The Honorable Jack Reed
Chairman
The Honorable James M. Inhofe
Ranking Member
Committee on Armed Services
United States Senate

The Honorable Adam Smith
Chairman
The Honorable Mike Rogers
Ranking Member
Committee on Armed Services
House of Representatives

Defense Health Care: DOD Expanded Telehealth for Mental Health Care during the
COVID-19 Pandemic

The COVID-19 pandemic presented stressors for both members of the military services and
military mental health providers. For some, these challenges were likely similar to those
experienced in the civilian population—illness, financial challenges, and isolation. For others,
the COVID-19 pandemic meant they were on the front lines of fighting the virus, such as treating
patients diagnosed with COVID-19 in both civilian and military settings and supporting COVID-
19 testing and vaccination efforts. These stressors may have affected servicemembers’ mental
health care needs during the COVID-19 pandemic.

As part of its mission, the Department of Defense’s (DOD) Military Health System (MHS)
provides a full range of medical care and services, including mental health care, to
servicemembers and other eligible individuals. Within DOD, the Defense Health Agency (DHA)
supports the delivery of military health care across MHS, which includes direct care provided at
military treatment facilities (MTFs) and through the military’s network of civilian healthcare
providers.1 Mental health care can include the treatment and management of conditions like
anxiety and depression, among others, and a range of therapies such as medication and talk
therapy.




1During the period of this audit, DHA was in the process of completing its legislatively mandated transition to begin

management and administration of MTFs in the United States and around the world, which were traditionally
administered by the individual military services.


Page 1                                  GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
The William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021
includes a provision for GAO to review mental health care for servicemembers during the
COVID-19 pandemic.2 In this report, we describe

    1) what DOD did to provide mental health care during the COVID-19 pandemic, and

    2) the information DOD shared with mental health providers and servicemembers to help
       cope with the potential mental health impacts of the COVID-19 pandemic.

To describe what DOD did to provide mental health care during the COVID-19 pandemic, we
reviewed DOD reports and briefing materials that addressed mental health care during the
pandemic, from March 2020 through November 2021.3 We also obtained and analyzed data
from the DHA on the utilization of telehealth for mental health care services from January 2019
through April 2021, the most recent data available at the time of our review.4 To assess the
reliability of these data, we reviewed DOD documentation regarding the data source,
interviewed knowledgeable agency officials about the quality of the data, and checked for
obvious errors; we determined the data were sufficiently reliable for purposes of reporting
telehealth utilization rates. We also examined DOD policies and guidance on the provision of
telehealth, including documents that address the provision of mental health care via telehealth
and DOD policies on mental health screening.

To describe the information DOD provided to mental health providers and servicemembers to
help cope with the potential mental health impacts of the COVID-19 pandemic, we reviewed
DOD’s COVID-19 clinic guidance, materials from DOD research entities, and other related
resources compiled by military service officials. For both objectives we interviewed officials from
DHA, and from each of the military services—Army, Navy, Air Force, and the Marine Corps—as
well as officials from the military reserves and the National Guard.5 This report focuses on active
duty servicemembers. In addition, we provide information on mental health care for reserve
component servicemembers during the pandemic in enclosure I.

We conducted this performance audit from April 2021 through February 2022 in accordance
with generally accepted government auditing standards. Those standards require that we plan
and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for
our findings and conclusions based on our audit objectives. We believe that the evidence
obtained provides a reasonable basis for our findings and conclusions based on our audit
objectives.




2Pub. L. No. 116-283, § 736, 134 Stat. 3388, 3704-3705 (2021).


3For the purposes of this review, the start of the COVID-19 pandemic is based on the January 31, 2020, declaration

of a public health emergency for the United States, retroactive to January 27, 2020.
4We analyzed data on total outpatient mental health encounters, or visits, provided in person or via telehealth by

DOD providers at military treatment facilities and through the military’s network of civilian health care providers.
5The military services also include Coast Guard and the newly created Space Force. Our scope for this report

excludes Coast Guard, which is part of the Department of Homeland Security, and Space Force.


Page 2                                   GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
Background

Mental health care is provided by several types of health care workers, including therapists,
clinical social workers, and psychologists. DOD makes a variety of mental health care services
available to active duty servicemembers, ranging from outpatient services such as
psychotherapy and medication management, to inpatient services such as acute psychiatric
care. Mental health care can also be provided remotely through synchronous video or telephone
communications, which DOD refers to as telehealth.6 In addition to treating servicemembers
who seek care, DOD and the military services are required to screen for mental health
conditions to ensure military readiness. These screenings occur during servicemembers’ annual
health assessment and before, during, and after certain deployments.

Servicemember utilization of mental health care services has remained relatively stable in
recent years. According to DOD, from fiscal years 2016 through 2020, active duty
servicemembers’ use of mental health care remained about the same, with around 3.1 million
outpatient visits annually. Although utilization of mental health care services has remained
stable, we and others have reported that perceived stigma continues to be a barrier to
servicemembers seeking mental health care.7 For example, in 2021 we reported that perceived
stigma may discourage servicemembers from seeking help for themselves or for their
colleagues.8

The mental health impacts of the COVID-19 pandemic on servicemembers (and the general
population) may take time to fully understand. A survey fielded by Army Public Health between
May and June of 2020 found that the rates of positive screens for generalized anxiety among
Army servicemembers were similar to pre-COVID-19 rates.9 However, a December 2020
internal DOD presentation noted that DOD’s research on this topic continues, as there is not yet
sufficient information to determine the potential mental health impacts of the COVID-19
pandemic on servicemembers.10

DOD Significantly Increased Its Use of Telehealth to Provide Mental Health Care
during the COVID-19 Pandemic

DOD significantly increased its use of telehealth to provide mental health care to
servicemembers during the COVID-19 pandemic, beginning in March 2020. According to DOD

6Asynchronous care—the transmission of information in one direction at a time via electronic communication—is

rarely used by DOD to provide mental health care, according to DHA. An example of asynchronous mental health
care is the exchange of emails about a condition between a patient and a provider.
7See GAO, Defense Health Care: DOD Needs to Fully Assess Its Non-clinical Suicide Prevention Efforts and Address

Any Impediments to Effectiveness, GAO-21-300, (Washington, D.C.: Apr. 26, 2021); GAO, Human Capital: Additional
Actions Needed to Enhance DOD’s Efforts to Address Mental Health Care Stigma, GAO-16-404 (Washington, D.C.:
Apr. 18, 2016); and Joie D. Acosta et al., Mental Health Stigma in the Military (Santa Monica, Calif.: RAND
Corporation, 2014).

8GAO-21-300.

9Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience and U.S. Army Public

Health Center Behavioral and Social Health Outcomes Program & Public Health Assessment Division, Behavioral
Health Advisory Team – COVID-19 Survey Phase I Findings, Technical Report No. S.0079120-20 (November 2020).
10Army Public Health fielded a second phase of this survey in the spring of 2021. Army officials told us that a report

covering the spring 2021 survey and additional efforts is expected to be completed during late spring 2022.


Page 3                                  GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
documents, DOD made changes to its telehealth guidance to provide enhanced access to
mental health care services during the early months of the COVID-19 pandemic when MTFs
limited in-person appointments to slow the spread of COVID-19. Military service officials also
told us that telehealth has been valuable, and that despite some of the challenges providing
care through telehealth presented, they would likely continue its use once the pandemic
recedes.

Prior to the pandemic, telehealth visits represented about 15 percent of total outpatient mental
health care visits from January 2019 through February 2020, DHA data show. These data also
show that the number of telehealth visits for outpatient mental health care increased 275
percent from February 2020 to its peak in April 2020, rising from 31,504 visits in February to
118,246 visits in April (see fig. 1).11 This increase in telehealth visits came as DOD shifted its
delivery of outpatient mental health care from in-person visits to telehealth; DHA data show in-
person outpatient mental health care simultaneously decreased from 163,039 visits in February
2020 to 57,593 visits in April 2020.12 While the utilization of outpatient mental health care DOD
provided through telehealth decreased following its peak in April 2020, it remained above pre-
pandemic levels, accounting for 33 percent of all outpatient mental health care visits provided in
April 2021.




11We analyzed data on total outpatient mental health encounters, or visits, provided in person or via telehealth by

DOD providers at military treatment facilities and through the military’s network of civilian health care providers.
12This trend was not unique to the military. For example, a January 2021 study found that of the general population,

between mid-March and early May 2020, telehealth was used by over 50 percent of those with a mental health
condition. See: S.H. Fischer, L. Uscher-Pines, E. Roth, and J. Breslau, “The Transition to Telehealth during the First
Months of the COVID-19 Pandemic: Evidence from a National Sample of Patients,” Journal of General Internal
Medicine, vol. 36, no.3 (2021): 849-51.


Page 4                                   GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
Figure 1: In-Person and Telehealth Outpatient Mental Health Visits for Active Duty Servicemembers, 2019-
April 2021




Notes: We analyzed data on total outpatient mental health encounters, or visits, provided in person or via telehealth
by Department of Defense providers at military treatment facilities and through the military’s network of civilian health
care providers. Telehealth is care provided remotely through synchronous video and telephone communication.
Telehealth can also be provided asynchronously—the transmission of information in one direction at a time via
electronic communication—but asynchronous telehealth is infrequently utilized to provide mental health care,
according to Defense Health Agency officials. This figure shows active duty servicemembers’ utilization of outpatient
mental health visits where one of the primary diagnoses was related to mental health care, including, for example, the
treatment and management of conditions such as anxiety and mood disorders. This figure excludes substance use
disorders such as those related to alcohol.

To support increased use of telehealth in response to the pandemic, DHA released guidance to
the military services on March 27, 2020, which allowed providers to use commonly available
programs such as Apple FaceTime and Microsoft Skype to provide telehealth services.13 This

13Specifically, DHA’s March 27, 2021 guidance allowed the optional use of three non-public facing everyday

communication applications—Apple FaceTime, Google Duo, and Microsoft Skype—across the MHS to supplement
DHA’s existing telehealth capabilities, which included voice communication and network video applications.

DHA’s guidance was based on a Department of Health and Human Services (HHS) announcement that went into
effect on March 17, 2020. The announcement provided that HHS would not impose penalties for noncompliance with
certain Health Insurance Portability and Accountability Act (HIPAA) regulatory requirements in connection with the
good faith provision of telehealth during the COVID-19 public health emergency. 85 Fed. Reg. 22,024 (Apr. 21,
2020). Subsequent guidance from DHA also allowed the use of Microsoft Teams.


Page 5                                  GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
guidance also allowed providers to use their personal devices to provide telehealth services to
their clients. Officials we spoke to from the Navy and Air Force told us that this guidance was
instrumental in allowing for care to be conducted virtually via telehealth.

DOD officials described the following benefits associated with expanded telehealth services for
mental health care.

Bolstering access and continuity of care. DOD officials told us that telehealth was a valuable
tool in providing mental health care during the COVID-19 pandemic, with some officials noting
its use will likely continue after the pandemic recedes. For example, a Navy official noted that
the quick rollout of telehealth for mental health care ensured that people could still be evaluated
and treated during the pandemic. In addition, an Air Force official described how the ability to
provide telehealth by remote providers helped offset staffing shortages the Air Force faced in its
smaller, more rural MTFs. An official from the Marine Corps also noted that the Marine Corps is
looking for ways to maximize telehealth across health services and MTFs, and that telehealth is
now a routine way for the Marine Corps to deliver mental health care.

Reducing perceived stigma. Officials also described the value of telehealth in mitigating the
stigma of seeking mental health care. For example, a Marine Corps official told us that by
logging on to a telehealth appointment from their barracks, servicemembers could reduce the
fear they may have about running into somebody they know in a clinic waiting room. As a result,
telehealth may greatly reduce servicemember concerns about confidentiality. Similarly, a DHA
official told us that in the past, servicemembers waiting for mental health care appointments in
the clinic waiting room of a MTF were required to be in uniform—uniforms may include
information that is identifiable such as a servicemember’s name, rank, and service branch. This
official noted that receiving care through telehealth gave servicemembers confidentiality and
eliminated the concern of being seen waiting for mental health care services.

Military service officials also explained that the use of telehealth for mental health care
presented challenges. For instance, telehealth may not be the appropriate modality to deliver
certain types of mental health care services. Navy and DHA officials described the difficulty of
conducting group therapy sessions via telehealth. For example, while a provider could ensure
privacy for participants in an in-person group therapy session by locking the door and limiting
entry, an official noted that a group therapy session conducted via telehealth raises concerns
about group confidentiality and may require additional provider training on how to lock down the
virtual room to ensure privacy for participants. In addition, Army and Marine Corps officials
noted that outdated computer systems and web camera equipment made providing care via
telehealth difficult for some mental health providers.

Officials also told us that telehealth may not be appropriate for patients with high-risk diagnoses
or for those experiencing acute symptoms. For example, a Marine Corps official and provider
told us that if they are seeing a patient with suicidal thoughts, they prefer to deliver treatment to
that patient face-to-face. Another provider noted that if the option was to provide care to a high-
risk patient via telehealth or not at all, a telehealth session would be that provider’s preference.
When delivering mental health care via telehealth, one official told us that additional planning is
required for the visit to ensure the safety of the patient. For example, the provider needs to
obtain the patient’s location and contact information during the appointment in the event the
patient disconnects from the telehealth visit. If the provider cannot reach the patient and has
concerns about the patient’s wellbeing, then the provider can arrange for a welfare check by
local authorities.



Page 6                            GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
DOD Shared Information on Coping with the Mental Health Impacts of the COVID-
19 Pandemic with Providers and Servicemembers

Our review of DOD documents and interviews with department officials found that DOD shared
information on coping with the mental health impacts of the COVID-19 pandemic with mental
health providers and servicemembers. This included information on providing care via telehealth
and tip sheets for providers, resources for servicemembers on topics like stress reduction and
wellness promotion, and information provided by DOD research entities.

Information for Mental Health Providers

Starting in the first few months of the pandemic (March through May 2020), DOD shared
information with mental health providers to help cope with the potential mental health impacts of
the COVID-19 pandemic, including resources intended to help prevent provider burnout,
information on providing care via telehealth, and information regarding mental health clinic
management during the COVID-19 pandemic.14 DOD officials told us this information was
disseminated in a variety of ways, including through posting resources online, hosting expert
speakers in meetings, and emailing newsletters.

Military service officials described resources intended to promote wellness among mental health
providers and help prevent burnout. For example, a Navy official described how leadership at
one MTF brought in speakers to talk about how mental health providers could manage stress
during the pandemic. The official said the Navy provided this support because mental health
providers were struggling during the pandemic like the rest of the population. An Army official
noted that the Army created and disseminated newsletters to mental health providers through
regional leadership. Examples of items included in these newsletters include links to an
informational paper on how providers can mitigate family violence, a sleep checklist developed
by the Walter Reed Army Institute of Research for health care providers during the pandemic,
and American Psychological Association tip sheets on how to support employee mental health.

DOD also shared information with providers to help them adapt to providing mental health care
via telehealth during the COVID-19 pandemic. Military service officials we spoke with noted that
many mental health providers had not used telehealth to deliver mental health care prior to the
pandemic, and told us that there were online trainings on how to provide health care via
telehealth. Another military service official noted that providers have also used online resources
from the American Psychological Association and the National Association for Social Workers
on providing mental health care through telehealth. This official noted that the telehealth
trainings included information on technical aspects like lighting and sound, administrative
requirements like obtaining accurate contact information in case of an emergency or technical
issue, and privacy considerations like dissuading a patient from conducting a telehealth visit in
public. DOD also created a guide to help providers adapt to delivering care in the pandemic
environment.15 While this guide is not specific to mental health care, it includes a section on




14GAO did not assess the effectiveness of DOD resources in addressing potential mental health risk factors.


15DOD noted that this document was designed to provide information and did not supersede DOD policy. Department

of Defense, Defense Health Agency, DOD COVID-19 Practice Management Guide: Clinical Management of COVID-
19 (Falls Church, Va.: June 18, 2020).


Page 7                                 GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
mental health; for example, it notes that providers should use telehealth tools as much as
possible when caring for isolated patients.

Information for Servicemembers

DOD officials noted that they shared information with servicemembers to help cope with the
potential mental health impacts of the COVID-19 pandemic, including adapting existing
resilience efforts for the pandemic environment and sharing relevant DOD research.

DOD officials told us that some existing resources for servicemembers had been refocused to
address the potential mental health impacts of the COVID-19 pandemic. For example, an Air
Force official described how a tip sheet for servicemembers was revised to focus on COVID-19
related mental health topics. This resource addressed self-care topics like ensuring
servicemembers get good quality sleep and providing alternatives to stress relief other than
drinking alcohol. DOD officials also described resources intended to help prevent worsening of
existing stressors and mental health conditions, such as information on fitness and wellness
programs tailored to the COVID-19 pandemic and non-medical counseling offered through
Military OneSource.16

DOD research entities also provided a range of information intended for a broader DOD and
military service audience. Examples of these entities and their resources include the following:

   Uniformed Services Center for the Study of Traumatic Stress, which offers a range of public
    resources for healthcare workers, leaders, and families on topics including stress
    management in mortuary affairs operations and how healthcare providers can help patients
    concerned about COVID-19.
   DHA’s Psychological Health Center of Excellence “Clinician’s Corner” blog, which includes
    posts on topics like offering support and compassion for COVID-19 positive colleagues,
    coping with separation from family and friends during the pandemic, and connecting to
    psychological health care resources during the pandemic.
   The Walter Reed Army Institute of Research, which has a public facing website with
    behavioral health resources, including fatigue management and sleep checklists.

Agency Comments

We provided a draft of this report to DOD for review and comment. DOD concurred with the
draft report and had no comments.

                                                       -----


We are sending copies of this report to the appropriate congressional committees and the
Secretary of Defense. In addition, the report will be available at no charge on the GAO website
at http://www.gao.gov.



16Military OneSource is a resource DOD provides to servicemembers and their families and offers a range of services

including non-medical counseling and health coaching. Military OneSource’s non-medical counseling is offered in-
person, on the phone, through online chat, or via video, and can address issues like parenting, marital problems, grief
and loss, and financial concerns, according to the Military OneSource website.


Page 8                                  GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
If you or your staff members have any questions about this report, please contact me at (202)
512-7114 or HundrupA@gao.gov. Contact points for our offices of Congressional Relations and
Public Affairs may be found on the last page of this report. In addition to the contact named
above, Ann Tynan (Assistant Director), Luke Baron (Analyst-in-Charge), and Elaina Stephenson
made key contributions to this report. Also contributing were Jacquelyn Hamilton, Vikki Porter,
and Cathy Hamann Whitmore.




Alyssa M. Hundrup
Director, Health Care




Enclosures – 1




Page 9                          GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
Enclosure I: Reserve Servicemembers and Mental Health during the COVID-19
Pandemic

The military reserve component comprises the Army Reserve, the Navy Reserve, the Air Force
Reserve, the Marine Corps Reserve, the Army National Guard, and the Air National Guard.
Reserve component members typically spend most of their time as civilians, with training
requirements that vary by the Reserve component and type. They can be activated for service
overseas and domestically and may serve in armed conflicts or respond to emergencies like
natural disasters and the COVID-19 pandemic. The Army, Navy, Air Force, and Marine Corps
Reserves are exclusively federal organizations, and are governed by their respective military
services. National Guard units are managed in part by their respective state’s Adjutant General
and governor, and can be activated for both state and federal missions.1

Health Care Coverage and Access for Reserve Component

Generally, when activated for federal duty for more than 30 days, reserve component members
can access the Military Health System (MHS), including receiving care at military treatment
facilities (MTFs) and through the military’s network of civilian healthcare providers.2 Non-
activated reserve members can purchase health care coverage through TRICARE Reserve
Select, a premium-based Department of Defense (DOD) healthcare benefit, if they meet certain
eligibility criteria.3 Some reserve members may also have insurance through their employer.4

While the Reserve components employ mental health providers, the role of these providers is
primarily to conduct mental health assessments of reserve members and provide referrals for
mental health services in the reserve member’s community when needed. Such referral
services are provided to reserve members by the psychological health programs for each of the
military services in the reserve component. A reserve component official told us that the military
services generally do not provide mental health care treatment directly to reserve members
when members are not activated–the focus on referrals rather than treatment was also noted in
reserve component documents.5


1An Adjutant General is appointed by the governor of each state; the duties of the Adjutant General are laid out in

each state’s statutes. The Adjutant General is typically the senior officer of the National Guard unit of the state. For
the District of Columbia, this officer is referred to as the Commanding General.
2Under DOD’s TRICARE program, eligible beneficiaries can obtain health care, including mental health care services,

through the department’s direct care system of MTFs or through its private sector care system of civilian providers.
3National Guard personnel health eligibility is based on their military status as defined in Title 10 of the United States

Code. Members of the National Guard on state activations receive state benefits, which may differ from federal
benefits.
4A 2021 RAND report based on 2018 DOD survey data found that around 8 percent of reserve members did not have

health insurance. Sarah O. Meadows, et al., 2018 Department of Defense Health Related Behaviors Survey (HRBS):
Results for the Reserve Component (Santa Monica, Calif.: RAND Corporation, 2021).
5If a reserve component member incurs or aggravates an injury, illness, or disease, including mental health

conditions, in the line of duty (performing active duty or inactive duty training, at a drill weekend, or in other training
while on orders), they may be eligible for health care, referred to as Line of Duty Care. Assuming a line of duty
determination is made, this would allow a reserve component member to receive care through the MHS while in
reserve status.


Page 10                                   GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
The Reserve Component Role in the COVID-19 Pandemic and Impacts on Mental Health

Reserve component servicemembers played a role in responding to the COVID-19 pandemic
and served in various capacities, with Reserve and National Guard personnel providing medical
care and logistical support related to the COVID-19 pandemic. For example, Army and Air Force
Reserves deployed personnel to COVID-19 hotspots to assist civilian and military medical
personnel providing medical care to patients with COVID-19, and National Guard members
supported COVID-19 testing and vaccination efforts, provided medical care, and conducted
mortuary affairs missions.

Reserve component officials told us that some COVID-19 activations were challenging for their
members and may have resulted in additional stress. For example:

          Officials told us that early on in the pandemic in 2020, National Guard members on a
           mortuary affairs mission in New York retrieved the bodies of people who had died in their
           homes. An official told us this was challenging both because of the nature of the work,
           and because some Guard members assigned to these duties were not trained in
           mortuary affairs. For example, an official described a deployment in which finance
           specialists were assigned to assist in body retrievals; the official noted that the National
           Guard did not train or prepare the finance specialists to carry out these duties prior to
           deployment.

          Additionally, an official noted that some Guard members had their activations extended
           from 30 days to 90 days, which caused additional stress for some members and their
           families.

Reserve officials also described efforts to address reserve component members’ mental health
during the COVID-19 pandemic. For example, National Guard officials told us that around
March of 2020 they started weekly meetings with the National Guard Directors of Psychological
Health at the state level to discuss COVID-19 related messaging and topics, which officials told
us they held regularly for about a year. They also noted that they sent out newsletters with
information on resilience—for example, officials said one newsletter promoted a guide
describing resources on preventing substance abuse, improving social connectedness, and
other topics. Other officials described adaptations to existing reserve mental health resources.
For example, a Navy Reserve official noted that staff from the Navy’s Psychological Health
Outreach Program who previously checked in with Navy Reserve members in person during drill
weekends had transitioned to doing those check-ins remotely by phone.




(105149)


Page 11                             GAO-22-105149 DOD Mental Health Care in the COVID-19 Pandemic
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