Spending on mental health services has declined by 25 percent in inflation-adjusted dollars since 1996, he said. In that year, Congress passed PL 104-262, which mandated that the Department of Veterans Affairs "maintain capacity" to provide treatment for mental illness and other categories of disability.
Moreover, Scully said, "APA is concerned that VA mental health service delivery has not kept pace with advances in the field."
Those advances include intensive case management, access to substance abuse treatment, peer support and psychosocial rehabilitation, pharmacologic treatment, housing, employment services, and other supports to independent living.
Scully expressed particular concern about access to treatment for posttraumatic stress disorder (PTSD).
He said that the number of patients diagnosed with severe PTSD had increased 42 percent from 1996 to 2001, but expenditures to treat the disorder had increased by only 22 percent in the VA system.
Fifteen years ago, the VA Special Committee on PTSD urged that there be a PTSD clinical team at every VA medical center. Now, however, only about half of all VA medical centers have such teams.
"Many of the staff originally dedicated to PTSD services at those sites have long since been drawn off to other duties or lost to attrition," he said.
Scully commended members of the subcommittee for adding $25 million for PTSD treatment in Fiscal 2004.
But, he warned, "To catch up with the backlog of patients waiting for care and to keep pace with need, Congress should dedicate funding incrementally by $500 million from Fiscal 2005 to Fiscal 2009 for specialized treatment for veterans" who have mental illnesses, including PTSD and substance use disorders.
Scully commended the VA for initiating eight Mental Illness Research, Education, and Clinical Centers (MIRECCs). The MIRECCs provide support for psychiatric research into severe mental illness.
He pointed out, however, that less than 9 percent of the VA health research budget is dedicated to mental illness and substance use, even though 35 percent to 40 percent of VA patients need mental health care.
Scully also reminded committee members that the VA has considerable "ability to translate progress in medical science to improvements in clinical care" because more than 60 percent of VA researchers treat veterans.
Scully is a Navy veteran with 12 years of experience in the Denver VA department of psychiatry.
Prakash Desai, M.D., chief of staff at the West Side Division of VA Chicago Health Care System and speaker of APA’s Assembly, praised Scully’s testimony for its succinct identification of the resources needed. He also pointed out that many pressures compound that need.
Returning veterans from Iraq and the effect of state budget crises on the public mental health system tax the ability of the VA to provide quality care, as does the fact that many veterans are aging.
More specifically, Desai said, "When a steel mill recently shut down on the south side of Chicago, workers lost their jobs and insurance. Many came to the VA for health services."
The increasing number of people without insurance throughout the country is straining all components of the VA’s health budget.
Scully’s testimony is posted online at www.psych.org/advocacy_policy/leg_res/apa_testimony/vaappropriations03252004.pdf. ▪
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