Improving Mental Health Screening at Military Separation: GAO Finds Gaps in Validation and Implementation
As military personnel transition to civilian life, ensuring their mental well-being is paramount. The June 2025 GAO report (GAO-25-107205), Military to Civilian Transition: Actions Needed to Ensure Effective Mental Health Screening at Separation, offers a detailed examination of the Department of Defense (DOD) and the Department of Veterans Affairs’ (VA) implementation of mental health screening during the critical separation period. The report was requested by Congressional committees in light of research showing elevated suicide risk among recently separated veterans—up to 2.5 times higher than their active-duty peers.
In response to a 2018 executive order, the VA and DOD developed a joint Separation Health Assessment (SHA) that includes mental health screening. This new SHA was intended to replace separate exams conducted by each department and provide a unified approach to identifying and referring at-risk service members. The SHA includes five mental health screening areas: depression, suicide risk, alcohol use, post-traumatic stress disorder (PTSD), and violence risk. While the VA began implementing the joint SHA in April 2023 for service members applying for disability benefits, the DOD has only completed a limited pilot at three sites as of May 2025.
The GAO found that only two of the five mental health screening tools used in the SHA—those for depression and suicide risk—are fully validated and widely accepted as effective. The depression screen uses the Patient Health Questionnaire-2, and the suicide risk screen is based on the Columbia-Suicide Severity Rating Scale, both of which are supported by robust clinical evidence. However, the remaining three tools—those for alcohol use, PTSD, and violence risk—lack validation in their current modified forms. Specifically, the alcohol use screen was changed to include sex-differentiated binge drinking questions without revalidation. The PTSD screen omits a key pre-screening question used in validated versions, potentially inflating false positives. The violence risk screen, meanwhile, is not based on any validated tool and was included for consistency with other DOD forms, despite expert concerns about its utility.
Between May 2023 and April 2024, VA contractors administered approximately 50,500 joint SHAs. Sixty-seven percent of those screened tested positive for at least one mental health condition, most commonly PTSD and depression. The high positive screen rate raised concerns among officials, who acknowledged that modifications to screening tools and the population’s specific risk profile—individuals applying for disability benefits—may have contributed. Notably, 48 percent of individuals offered mental health referrals accepted, while 52 percent declined, with no tracking of reasons provided.
GAO concluded that while mental health screening is essential, its efficacy depends on the validity and reliability of the tools used. Without proper validation, DOD and VA cannot confidently assess the mental health risks of service members transitioning out of the military. The report calls for urgent action, recommending that the VA-DOD Joint Executive Committee: (1) validate the alcohol use screen; (2) validate the PTSD screen; and (3) evaluate the necessity and method of violence risk screening, including the possibility of replacing or removing it. While the VA concurred with all recommendations, DOD only partially agreed, suggesting the need for further discussion and alignment between the two departments.
In short, this GAO report underscores a critical moment for improving the mental health outcomes of transitioning service members. It calls on both the VA and DOD to move beyond administrative coordination and invest in evidence-based screening tools that can reliably identify those at greatest risk. With over 210,000 service members separating annually, this is not just a procedural issue—it is a public health imperative.
Disclaimer:
This blog post is a summary and interpretation of GAO Report GAO-25-107205. It is not guaranteed to be accurate and does not constitute legal, medical, or psychological advice. Readers should consult the official GAO publication and relevant experts for authoritative guidance.
