Federal Mental Health Program Assessments Inconclusive, Leaving Questions About Effectiveness

A federal program intended to aid adults with serious mental illnesses has shown unclear results, according to a new report from the U.S. Government Accountability Office. Although nearly $150 million in grants have been distributed since 2016 to support court-ordered outpatient mental health treatment, assessments of the program’s impact remain inconclusive due to data reliability issues and wide variation in how states administer it.

The grants, awarded by the Department of Health and Human Services through its Substance Abuse and Mental Health Services Administration, fund assisted outpatient treatment programs across the country. These programs are designed for individuals who are considered unable to safely manage their condition without supervision and often involve involuntary court orders requiring adherence to treatment plans. While the model aims to improve patient outcomes and reduce hospitalizations or encounters with law enforcement, its involuntary nature and legal implications have sparked controversy.

So far, efforts to evaluate the program’s effectiveness have faced consistent hurdles. Both of HHS’s assessments—one conducted by the Office of the Assistant Secretary for Planning and Evaluation and the other by SAMHSA—relied heavily on self-reported survey data from participants, raising concerns about accuracy, especially for sensitive issues like substance use. Moreover, state laws governing these programs differ significantly, leading to inconsistent implementation across sites.

One federal review compared patients in assisted outpatient treatment to those in voluntary care but was limited to data from a single program site. The small sample size further reduced the ability to draw conclusions. Some programs also enrolled participants voluntarily, contradicting the basic framework of assisted outpatient treatment and complicating the evaluation. These limitations suggest that a reliable measure of the program’s national effectiveness may remain elusive as long as variability and data issues persist.

The GAO report was required by the Consolidated Appropriations Act of 2023 to inform Congress about the results of these mental health interventions. The findings leave open questions about whether taxpayers are getting value from this multimillion-dollar investment, and whether people with serious mental illness are receiving the support they need.

Article by multiple contributors, based upon information from the U.S. Government Accountability Office press release

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