VA funding for psychiatric research has been disproportionately low compared with other areas of medical research. Despite mental illness rates of 25 percent to 30 percent among veterans, less than 9 percent of all VA medical research dollars are allocated to research in mental illness and substance abuse disorders, said Mirin.
"The dearth of research funding in geriatric psychiatry is of special concern, given the growing percentage of older veterans with lifetime mental illnesses and the growing number of veterans with Alzheimer’s disease and other dementias," he testified.
Mirin urged the House VA appropriations subcommittee to increase President Bush’s proposed medical research budget for Fiscal 2003 by $16 million, for a total of $425 million. This is $54 million more than what Congress authorized for the VA in Fiscal 2002 ($371 million).
APA advocated that $63 million of the total recommended budget for Fiscal 2003 be spent on psychiatric research, according to Lizbet Boroughs, an associate director of APA’s Division of Government Relations.
APA believes that the growth in VA medical research programs must be kept on a par with the growth of the budget of the National Institutes of Health (NIH), said Mirin. Otherwise, the VA’s research infrastructure will be eroded, along with the ability to translate research findings into clinical practice.
Bush proposed increasing the overall NIH budget by 15 percent for Fiscal 2003 (Psychiatric News, April 19).
"This is especially important as America faces the return of veterans from Afghanistan or other parts of the world," he pointed out.
Mirin’s suggested increases for the Fiscal 2003 VA medical research budget were developed and endorsed by the APA Academic Consortium, which met in March at APA headquarters in Washington, D.C. (Psychiatric News, April 19). Several consortium participants urged increasing the VA and NIH budgets when they met with members of the House and Senate appropriations committees, according to Boroughs.
Mirin recommended that $750 million be added to the VA’s total health care budget for Fiscal 2003. APA called the president’s proposed increase of 11 percent for Fiscal 2003 "a step in the right direction" but said that a 15 percent increase is needed to "help meet the growing health care needs of the nation’s veterans." This would bring the total discretionary budget for medical care to $26 billion.
Mirin also urged the subcommittee to increase funding for the care of veterans with serious mental illnesses by appropriating $160 million annually for the next three years beginning in Fiscal 2003. "This is essential to adequately meet the needs of the aging population of mentally ill veterans," he said.
The VA should also take the savings from closing inpatient mental health programs and put them into establishing a continuum of outpatient health care for veterans, recommended Mirin. The services should include case management, psychosocial rehabilitation, housing alternatives, and other support services for veterans with severe and chronic mental illness.
APA has been concerned about the VA practice of gradually replacing psychiatrists with mental health professionals who lack the training or experience to coordinate the complex medical care of veterans with mental illness. Many mentally ill veterans suffer from heart disease, high blood pressure, diabetes, and other illnesses that require well-coordinated medical care, testified Mirin.
"Because of the shortage of psychiatrists in some areas, veterans have to wait up to four months to get an appointment. Replacing psychiatrists with less trained and experienced professionals is not the solution for these severely ill patients. This is not good medical care and is contrary to congressional mandate," Mirin emphasized.
Congress passed the 2001 VA Health Care Programs Enhancement Act to strengthen the VA’s capacity to serve veterans with mental illness by requiring improvements to the current system to ensure that veterans have access to necessary treatment and services (Psychiatric News, August 3, 2001).
Mirin also testified that care of veterans with schizophrenia continues to be jeopardized by a requirement that they receive a 10-week trial on a specified antipsychotic before they can have access to the full range of psychiatric medications.
"This fail-first policy interferes with clinicians’ ability to use their best judgment and the most advanced pharmacological treatment to help patients," Mirin emphasized.
According to Boroughs, the reports of the "fail-first" policy originated with members of the National Alliance for the Mentally Ill and the National Mental Health Association. Two APA members have also reported fail-first policies in local Veterans Integrated Service Networks (VISNs). A spokesperson for the VA in Washington, D.C., denied that the department had a fail-first policy. He indicated that it was possible that a few local VISNs could be acting independently and implementing such a policy.
Mirin applauded the president’s Fiscal 2003 budget proposal of $52 million to fund an aggressive case management program designed to help homeless veterans move into federally designated, affordable housing. About 40 percent of homeless veterans suffer from severe and often persistent mental illnesses, and nearly 70 percent have substance abuse problems, according to Mirin.
Mirin’s written testimony is posted on APA’s Web site at www.psych.org/pub_pol_adv/vahudsub41602.cfm. ▪