By Sandra Basu

WASHINGTON — The DoD organization at the forefront of efforts to improve care for psychological health and traumatic brain injury (TBI) is falling short of its mission, a watchdog agency found.

A recent GAO investigation done at the request of Congress found no single entity that coordinates DoD’s psychological health and TBI programs, despite the creation of the Defense Centers of Excellence (DCoE) for Psychological Health and TBI. That DCoE, charged with addressing TBI and psychological health practice standards, training, outreach, research and direct care, does not “reflect a clear mission focusing the organization on its statutory responsibilities,” GAO reported.

“At present, there is no entity tasked with maintaining up-to-date and comprehensive information on DoD’s PH and TBI activities and, more importantly, no entity coordinates DoD’s PH and TBI activities,” the report concluded. “As a result, DoD is hampered in its efforts to ensure that resources are used effectively to meet goals; and Congress and entities with oversight responsibility will be limited in their ability to obtain reliable information to guide their decision-making.”

DCoE’s Role

DCoE brings together five directorates and three centers. Its mission is “assessing, validating, overseeing and facilitating prevention, resilience, identification, treatment, outreach, rehabilitation, and reintegration programs for PH and TBI to ensure the Department of Defense meets the needs of the nation's military communities, warriors and families,” according to the DCoE website.

The organization was created as a result of the FY 2008 National Defense Authorization Act that required DoD to create centers of excellence for TBI, PTSD and other mental-health conditions. DCoE was intended to be the lead entity for DoD’s effort to “to lead efforts in practice standards, training, outreach, research and direct care,” the report noted.

Instead, the GAO auditors said the group’s statutory responsibilities “are dispersed among the TRICARE Management Activity, the Army Medical Research and Materiel Command, and others.”

This is not the first time the organization has been the focus of criticism. Two other GAO reports last year also found DCoE issues that needed to be addressed.

A February 2011 GAO report entitled “Management Weaknesses at Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Require Attention,” stated that “DCoE’s development has been challenged by a mission that lacks clarity and by time-consuming hiring processes.”

In addition, a GAO report in June 2011 found limited budget information was available for the organization. “Because DCOE is only one, relatively small entity receiving funds through the broader DHP [Defense Health Program] appropriation, it is not visible in DoD budget-presentation materials,” the report stated.

At a 2010 hearing, members of Congress also expressed concern about the direction of the DCoE. Then-House Armed Services Committee Military Personnel Subcommittee Chairwoman Rep. Susan Davis (D-CA) stated that DCoE, while having “achieved some notable small-scale successes,” still hasn’t “inspired great confidence or enthusiasm thus far.”

“The great hope that it would serve as an information clearinghouse has not yet materialized,” she said at the time. “The desire that the center become the preeminent catalogue of what research has been done, what is being done and what needs to be done has not been realized.”

GAO Recommendations

GAO recommended that DoD “revisit” DCoE’s role as the coordinating authority for issues concerning psychological health and TBI and determine whether DCoE or another organization should perform this function.

Other findings of the report included that DoD had failed to account to Congress for how it spent $2.7 billion in research and treatment of psychological-health issues and TBI. DoD is required to account to Congress for how it is spending the funding but did not include expenditures, as required by law. In addition, obligations data included was “unreliable,” the report found.

To increase visibility over how DoD is spending appropriated funds to address psychological health and TBI conditions, the GAO recommended that the Secretary of Defense direct the Assistant Secretary of Defense for health affairs to include expenditures for PH and TBI activities in annual reports to Congress as directed by a FY 2008 law.

In response to the GAO’s findings, DoD stated in the report that it agreed with all of GAO’s recommendations.

DoD said that a “revisit” of DCoE’s role is under way. “A CoE Advisory Board, which is part of the Military Health System’s governance structure, is overseeing the development of a revised and detailed Concept of Operations for DCoE” the reported stated.

To increase visibility over how DoD is spending appropriated funds to address PH and TBI conditions, DoD stated that it will include available expenditure data in its next annual report, but noted that “expenditure data often lag behind the end of the fiscal year by several months.”

GAO Report

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