Homeless people and veterans with severe mental illness should benefit from provisions of an $85 billion package that President Bush signed into law in late November.

The VA-HUD Independent Agencies Appropriations Bill (HR 2620) contains the budgets for both the U.S. Department of Housing and Urban Development (HUD) and the Department of Veterans Affairs (VA) for Fiscal 2002.

The final version of HR 2620 authorized spending to improve programs that serve homeless people with disabilities and made important recommendations to VA physicians who treat veterans with serious mental illnesses.

For instance, new directives specified in the VA-HUD Independent Agencies Appropriations Act are aimed at ensuring that veterans with schizophrenia get the best treatment possible based on individual need.

National guidelines for atypical-antipsychotic use developed earlier this year by the Department of Veterans Affairs Pharmacy Benefits Management, Medical Advisory Panel, and Mental Health Strategic Healthcare Group suggested a treatment protocol for veterans that mandated two failed trials on risperidone and quetiapine before a different, and possibly more expensive, atypical antipsychotic medication could be prescribed. The new directives liberate physicians from having to consider cost before prescribing medication to patients with schizophrenia.

These are among other provisions in the act that should improve the care that veterans receive:

• Price, market share, and corporate interest should not factor into choosing the most appropriate drug to treat mental illness.

• Medication-prescribing practices should not be used as performance indicators when evaluating a physician’s work or job performance.

• The VA must maintain an open policy in formulating any new schizophrenia treatment protocols to ensure that new medications can be added as they become available.

• Any new treatment protocols should be based on scientific and clinical studies showing improvement in treatment efficacy or decreased side effects, with cost savings as a subordinate goal to selecting the best treatment.

Albert Gaw, M.D., cochair of APA’s VA Psychiatrists’ Caucus, told Psychiatric News that the new directives are a victory for veterans.

“The position of APA and that of the VA caucus is that veterans should have access to the best psychotropic medications available, regardless of cost,” said Gaw, who is also speaker-elect of APA’s Assembly.

Gaw said that he was aware of the cost concerns, but patients, “particularly veterans, who have done so much for their country, should have access to the best medications.”

He added that psychiatrists should determine which medication to prescribe in consultation with each patient and his or her family.

Veterans with mental illness are not the only group to benefit from new spending. The law also increased subsidies for homeless people with mental illness.

For instance, the HUD Section 811 program, which funds the development of community housing for adults with severe disabilities, including mental illnesses, will increase by up to $240 million for Fiscal 2002.

In addition, $100 million will be allotted to renew all subsidies under the Shelter Plus Care Program, a HUD program that provides rental assistance for homeless people with disabilities—primarily those with serious mental illness, substance abuse disorders, or HIV/AIDS.

Shelter Plus Care offers homeless people in the program a wide variety of housing options and supportive services that provide health care, including mental health and substance abuse treatment, assistance with entitlement programs, family reunification, and case management—any service that will help participants maintain their stability and independence.

The program provides assistance through four components: tenant-based rental assistance, project-based rental assistance, sponsor-based rental assistance, and single-room-occupancy facilities for homeless individuals.

Sens. Barbara Mikulski (D-Md.) and Kit Bond (R-Mo.) and Reps. James Walsh (R-N.Y.) and Alan Mollohan (D-W.V.) helped to include sufficient funds for the Shelter Plus Care renewals. ▪