APA urged a congressional subcommittee that oversees the Department of Veterans Affairs to allocate more funds than President George W. Bush proposed in his Fiscal 2002 budget for mental health research and services.
APA recommended that an additional $50 million of the president’s proposed $51 billion VA budget be spent on establishing two new Mental Illness Research, Education, and Clinical Centers (MIRECCs). APA also advocated that $100 million be designated annually in Fiscal 2002 to 2004 for veterans with serious mental illness.
The House Veterans’ Affairs Health Subcommittee heard testimony in June from mental health and veterans advocacy groups on the VA’s mental health, substance abuse, and homelessness programs. APA submitted a written statement.
The goal of the hearing was to ensure that the VA is complying with several mandates contained in a sweeping VA reform law enacted in 1996 (PL 106-262).
The law authorized the VA to create up to five MIRECCS by 2001. The Veterans Health Administration (VHA) has expanded on the Congressional mandate and created eight MIRECCs so far, according to Larry Lehmann, M.D., chief consultant of the VA Mental Health Strategic Health Care Group.
"The MIRECCs conduct basic science research on mental illness and research on the delivery of clinical services. All eight MIRECCs disseminate their findings to health care professionals in the VA system. We are delighted that there is interest in creating two more centers," Lehmann told Psychiatric News.
The 1996 law also mandated that the VA create regional health care networks as a less expensive alternative to inpatient care. There are now 22 regional health care networks, called Veterans Integrated Service Networks (VISNs), scattered throughout the country.
However, the law also required the VA to emphasize special populations in its treatment programs, defined as veterans with blindness, mental illness, amputations, or spinal cord dysfunction.
Congress has since required the VA to submit annual reports on its "capacity" to treat these special populations. Lehmann said the VA defines capacity as the number of patients treated and the dollars spent on those patients.
VA Undersecretary of Health Thomas Garthwaite, M.D., testified at the hearing that the number of veterans seen in the VA’s general psychiatric or substance abuse programs rose 8 percent from 581,625 in 1996 to 678,932 in 2000. Meanwhile, during that time, expenditures on mental health and substance abuse services fell 8 percent from $2.1 billion to $1.9 billion, said Lehmann.
Garthwaite attributed the decline in expenditures primarily to decreased hospital stays in his testimony.
Since 1996 the average length of stay for general inpatient psychiatric patients has decreased from 30 to 17 days nationally. However, there has been a 10 percent increase between 1996 and 2000 in the number of patients receiving outpatient care within 30 days of discharge, said Garthwaite.
Although 33 percent fewer general psychiatric patients were hospitalized since 1996, 22 percent more general psychiatric patients received specialized mental health outpatient care, added Garthwaite.
He concluded at the hearing that the data "suggest an effective move from inpatient to community-based mental health treatment nationwide."
APA, the National Mental Health Association, the National Alliance for the Mentally Ill, and Errera disagreed with Garthwaite’s assertion.
Their main complaint was that the VA has failed to redirect the money it saved on reducing inpatient psychiatric stays into developing a broad array of outpatient mental health services.
Albert Gaw, M.D., chair of the APA Caucus of VA Psychiatrists and speaker-elect of the APA Assembly, told Psychiatric News, "The VA should reinvest the savings into a continuum of outpatient mental health services rather than siphoning off the funds for other purposes."
A continuum of mental health care must include intensive case management, psychosocial rehabilitation, housing alternatives, state-of-the art medications, residential treatment, and integrated treatment for co-occurring mental illness and substance abuse, said Gaw.
Lehmann agreed with the need to provide a continuum of care and mentioned that the VA has always supported psychosocial rehabilitation and pharmacotherapy for veterans with mental illness and substance abuse.
"Rehabilitation includes helping veterans gain job skills and providing housing options," said Lehmann.
He added the VA’s 1999 mental health program guidelines emphasize providing a continuum of care.
But, "I care more about the regional networks’ ability to meet the needs of veterans through adequate outpatient programs and reallocation of inpatient staff than making sure every dollar is transferred from inpatient to outpatient services," said Lehmann.
Meanwhile, the VA is striving to expand mental health services in new or existing community-based outpatient clinics, testified Garthwaite. The VA also operates a large network of Mental Health Intensive Case Management (MHICM) programs. "We now have 54 active MHICM programs, with another 10 to 12 in various stages of development," said Garthwaite.
He also expressed concern about an 8 percent decline in the number of veterans with substance abuse served in VA specialized programs since 1996. Garthwaite promised to conduct a review of VA programs to determine the cause of the drop. ▪