What GAO Found The Department of Defense (DOD) and its components—relevant DOD offices and the military departments (Army, Navy, and Air Force)—are taking steps to prevent and mitigate the brain health effects of blast exposure. In 2024, DOD established several blast overpressure requirements, including one requiring that brain health be monitored. Specifically, this requires that all high-risk active duty service members complete a baseline cognitive assessment in fiscal year 2025 and all new service members complete one during initial military training. DOD also required tracking service members’ exposures to blast overpressure. As of fiscal year 2025, components have begun to implement tracking requirements, including updating the centralized data system to be able to track exposures. Figure: Number of Cognitive Assessments Completed in Fiscal Year 2025 Note: For more details, see fig. 4 in GAO-26-107829. According to DOD documentation and interviews, DOD components faced resource challenges: Cognitive assessments. DOD component officials reported that implementation was hindered by resource constraints, such as insufficient staff and technology to conduct the assessments, and that these challenges may affect their ability to meet additional requirements going forward. Such requirements expand assessments to all active and reserve service members, along with the goal to repeat assessments every 5 years. Exposure tracking. DOD component officials reported a lack of industrial hygiene personnel to complete exposure tracking requirements. Required tracking includes information about weapons systems used and exposures from those weapons for any service members exposed. Such tracking creates a record of the hazards that a service member is exposed to during their military service. DOD officials said that because of the need to expeditiously begin cognitive assessments and start exposure tracking efforts, there was not an opportunity to fully evaluate and ensure they allocated the resources necessary, as required by DOD policy and guidance. Officials said a 1-year pilot starting summer 2026 of a new cognitive assessment tool may address resource issues, but DOD did not have documented plans to assess this. DOD officials said they also have efforts underway to assess industrial hygiene resources needed for exposure tracking but such efforts have not been finalized. These efforts are important first steps, but comprehensive assessments would provide a sound foundation for ensuring the resources needed to implement DOD’s requirements. Such assessments would ultimately strengthen DOD’s ability to identify and provide treatment to service members who may need medical care and help ensure vital records are maintained about their exposures during military service. Why GAO Did This Study There is growing evidence that using certain weapons that produce high levels of what is called blast overpressure (the sudden onset of a pressure wave) can affect service members’ brain health. Symptoms of blast overpressure exposure can include headaches, memory loss, and, most seriously, traumatic brain injury. DOD is responsible for management of blast overpressure effects and issued a key memo with requirements for DOD components in August 2024. The requirements include prevention efforts such as mandated stand-off distances when firing weapons and monitoring efforts such as conducting periodic cognitive assessments. A report accompanying the National Defense Authorization Act for Fiscal Year 2025 includes a provision for GAO to examine DOD’s efforts related to blast overpressure. Among other things, this report examines the status of implementation of DOD’s requirements and challenges DOD encountered in implementation. GAO reviewed DOD policies and guidance and obtained DOD data on cognitive assessments completed in fiscal year 2025. GAO conducted interviews with DOD components and site visits to four military installations. The installations were selected to include an initial military training site, a site with special operations forces, and military department representation.

What the OIG Found GAO aims to provide Congress, the heads of executive agencies, and the public with timely, fact-based, non-partisan information that can be used to improve government and save taxpayers billions of dollars. To execute its mission, GAO relies on a highly-qualified workforce that includes employees in mission-critical occupations (MCO) such as contracting, human resources management, and information technology management. In FY 2024, GAO’s hiring of MCO employees took about 103 days on average, which is longer than its internal target of 98 or 101 days (depending on the application review process used), OPM’s goal of 80 days for executive branch agencies, and executive branch agencies’ reported time frames depicted on OPM’s public dashboard. GAO competes with the private sector and other federal agencies to hire highly-qualified employees. Hiring employees more quickly could decrease the risk of GAO losing qualified candidates to other opportunities and improve its ability to meet the needs of Congress. In addition, the agency’s internally-reported calculations on the timeliness of hiring excluded about 30 percent of the employees hired in MCOs and were based on inaccurate dates for when hiring actions began. Finally, GAO’s internal reporting and hiring guidance had different targets for how long the hiring process should take. By using reliable data and targets for the length of its hiring process, GAO may be better able to meet its hiring timeliness goals. Why the OIG Did This Evaluation The agency’s ability to provide timely, quality reports to Congress and to ensure the accountability of the federal government to the American people depends on hiring knowledgeable, skilled employees. In fiscal year 2024, GAO highlighted managing a quality workforce—including hiring—as one of its top management challenges. The OIG conducted this evaluation to assess the timeliness of GAO’s hiring process.

What GAO Found The 988 Suicide & Crisis Lifeline provides free, confidential 24/7 support for anyone experiencing mental health distress, suicidal thoughts, or substance use crises. The National Maternal Mental Health Hotline provides free, confidential emotional support, resources, and referrals to pregnant and postpartum women experiencing mental health challenges. Both of these hotlines, within the Department of Health and Human Services (HHS), are operated by nonfederal entities—primarily by local crisis contact centers and a contractor, respectively—while the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) are responsible for oversight. In addition, the Veterans Crisis Line offers specialized, confidential support to veterans, service members, and their families. The Department of Veterans Affairs (VA) operates the Veterans Crisis Line and employs its crisis responders. Contact volume for the three hotlines generally increased throughout fiscal year 2025, based on available monthly agency data GAO reviewed. For example, for the 988 Suicide & Crisis Lifeline, volume increased for each contact method in FY 2025, with an overall increase of 23 percent compared to FY 2024 (see figure). In addition, trends and fluctuations in volume and performance metrics for the 988 Suicide & Crisis Lifeline and Veterans Crisis Line during fiscal year 2025 were generally similar to prior years, based on previous GAO reporting on these hotlines. Agency data also show that the federal agencies responsible for the three hotlines experienced some reductions of staff who oversee or operate the hotlines during fiscal year 2025. At the same time, selected stakeholders representing users of all three hotlines said that they experienced consistent services during the fiscal year. 988 Lifeline Contact Volume by Method, July 2022 Through September 2025 Why GAO Did This Study In early 2025, HHS and VA announced plans to implement the President’s February 2025 executive order to reduce the size of the federal workforce. GAO was asked for information on the operations and workforce of these three national crisis and support hotlines. This report describes what available monthly data covering fiscal year 2025 show for the hotlines, including data on staffing, contact metrics, and quality metrics. GAO obtained and reviewed available fiscal year 2025 data from SAMHSA, HRSA, and VA, and compared these data to similar data from previous GAO reports, when available. GAO also interviewed agency officials and representatives of nine external stakeholders, selected for their experience with the hotlines. For more information, contact Alyssa M. Hundrup at hundrupa@gao.gov.