Veterans of the wars in Iraq and Afghanistan may not get the mental health
care they need unless Congress approves more resources for the Department of
Veterans Affairs (VA) for Fiscal 2006, warns APA.
APA wants Congress to increase the Fiscal 2006 budget for the VA's health
care and medical research programs by a minimum of $1 billion, for a total of
$23.4 billion in Fiscal 2006.
APA's request is in addition to President Bush's proposed increase of $659
million for the same programs, according to testimony submitted last month to
the House appropriations subcommittee on Military Quality of Life and Veterans
Affairs, and Related Agencies.
"We are concerned about the increasing need for mental health
services based on the number of service members returning from combat and the
severity of mental health diagnoses," testified APA past President
Joseph English, M.D., before the subcommittee last month. English is the chair
of the psychiatry department at St. Vincent's Hospital in New York City, which
is affiliated with two VA clinics, Montrose and Castle Point.
English told the subcommittee that he has a son who is a Marine and served
in Afghanistan and Iraq.
"When Marines finish their tour of duty overseas, the Marine Corps'
tradition is to invite their parents to join their sons and daughters aboard
ship for the last part of the journey home. I boarded the ship with my son's
unit in Hawaii for the trip to California in 2002 when he returned home from
Afghanistan and again in 2004 when he returned from Iraq," English told
"Aboard ship, I initiated conversations with small groups of Marines
similar to the debriefings I initiated as the Peace Corps' chief psychiatrist
for volunteers about 50 years ago who completed their overseas service,"
He would prepare volunteers for their return home by asking them to
anticipate their response to people who disagreed with them about U.S. foreign
policy or what they did. "I used the same strategy with the Marines,
asking them how they would respond to a person who opposes Operation Iraqi or
Enduring Freedom or who trivialized their sacrifice or risks they took,"
"The Marines mentioned hearing from their wounded buddies in the
United States about long delays in obtaining medical care at local VA
facilities. The Marines talked about PTSD openly and realized the value of
treatment, but most were concerned about stigma if they seek help and the
effect that would have on their military career or eventual civilian
English mentioned a study published in the July 1, 2004, New England
Journal of Medicine that found that an estimated 15 percent to 17 percent
of soldiers returning from combat in Iraq met the diagnostic criteria for
posttraumatic stress disorder (PTSD), major depression, or generalized anxiety
"There are not enough specialized PTSD treatment programs in the
VA," APA stated in submitted testimony. "Veterans wait on average
more than 46 days for specialized intensive treatment, and at some facilities,
veterans can wait almost a year for the initial diagnostic evaluation in a
PTSD outpatient program."
English drew the subcommittee's attention to a General Accountability
Office report dated February 14, which stated, "The VA has not presented
evidence of its capacity to absorb increasing numbers of veterans needing
treatment for PTSD in the future. Given that we reported in September 2004
that officials at six of seven medical centers told us that they may not be
able to meet an increase in demand for PTSD services and that the inspector
general found that the VA's PTSD capacity data are error prone and
inadequately supported, we believe our report appropriately raises questions
about VA's capacity to meet veterans' needs for PTSD
Joseph T. English, M.D., urges a House appropriations subcommittee to
increase Fiscal 2006 spending for the Department of Veterans Affairs.
Photo: David Hathcox
English testified that APA is extremely concerned that the lack of accurate
data on PTSD among veterans will limit the VA's ability to expand, improve,
and coordinate PTSD services in a responsive and efficient manner (see story below).
To enable the "VA to catch up with the backlog of patients waiting
for care and keep pace with the expected increased demand for care," APA
recommended that Congress allocate $500 million of the $1 billion proposed
increase in Fiscal 2006 for the specialized treatment of veterans with mental
illnesses, including PTSD and substance abuse.
APA also recommended that Congress appropriate the same amount annually
through Fiscal 2010 for the same purpose.
In addition, APA urged Congress to allocate $460 million of the $1 billion
increase it is requesting for Fiscal 2006 to the medical and prosthetic
research budget, which is where psychiatric research funding originates.
The Friends of VA Medical Care and Health Research, a diverse coalition of
more than 70 organizations including APA, made a similar recommendation.
"APA has seen some progress in VA mental health and substance abuse
programs in clinical care, research, and education," English told the
committee. "But we continue to be concerned about the great disparity in
physician staffing and resources among the Veterans Integrated Service
Networks, the stigma VA administrators associate with mental illness, and the
quality of psychiatric care and patient safety."