APA Calls for Major Increase In VA MH Care Budget

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 Psychiatric News.

“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,” English testified.

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,” English testified.

“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 employment.”

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 disorder.

“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 services.”

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.”

The full text of APA's submitted testimony is posted online at<www.psych.org/advocacy_policy/leg_res/apa_testimony/20050407VA_Approp_written_fy06_%20testimony_DrEnglish.pdf>.▪