VA Must Increase MH Funds, To Meet Needs, APA Tells Congress

Veterans with mental health and substance abuse problems are not receiving the high-quality services to which they are entitled, and APA is demanding change.

Former APA president Joseph T. English, M.D., testified last month before the House Appropriations Subcommittee on Veterans Affairs and Housing and Urban Development.

“The number of veterans needing mental health services has increased 26 percent between 1995 and 2001, but during that time relevant programs have been cut 4 percent, the per-patient expenditure has been cut 24 percent, and the average inpatient length of stay has decreased almost 24 percent,” said English, chair of the department of psychiatry and behavioral sciences at St. Vincent’s Catholic Medical Centers of New York.

Parity for mental health and substance abuse services does not exist in the VA (see article on Original article: page 4), said English, who is also professor and chair of the department of psychiatry at New York Medical College. English noted that the college is affiliated with two New York VA medical centers.

“Despite the increase in the numbers of patients with substance use disorders, the number of substance-use programs dropped by 37 percent—from 386 to 243—between 1994 and 2000,” said English.

Because veterans often have comorbid conditions, that is, mental and other medical problems, English recommended that the VA invest in programs that use a continuum of care that includes intensive case management, psychosocial rehabilitation, peer support, and integrated treatment of mental and substance use disorders. “This continuum should also include housing alternatives, compensated work therapy, and other support services for veterans with serious mental illnesses,” he said.

Although valuable programs such as the Mental Health Intensive Case Management and Compensated Work Therapy exist, “they reach only a small number of patients who need their services,” said English.

“The VA estimates that out of 561 such programs, 265 have failed to provide any mental health services. There are also rigid restrictions on medication use and on new and sometimes more expensive drugs that the patient’s condition requires but can be denied in the patient’s treatment,” said English.

APA applauded the VA’s inclusion of $52 million in its budget to enhance and expand services for homeless veterans, English testified. “APA also applauded the VA for initiating the program for Psychiatric Primary Care Education [PsyPCE], which allows psychiatry residents to assume the duties of primary care physicians for mentally ill patients in mental health and primary care settings,” said English. “However, it is important that the VA continue its core psychiatric residency and fellowship training capabilities.”

APA also recommended that the VA increase funding for the Mental Illness Research, Education, and Clinical Care Centers (MERECCs) and fund two new centers in Fiscal 2004.

Written testimony submitted by English on behalf of APA to the VA subcommittee is posted on the APA Web site at www.psych.org/pub_pol_adv/increasefund4vet.cfm. ▪