Appropriations for the Department of Veterans Affairs (Oral Testimony)
Subcommittee on VA-HUD and Independent Agencies
Joel Streim, M.D., President, American Association for Geriatric Psychiatry
4/10/2003
Mr. Chairman and members of the Subcommittee, I’m Dr. Joel Streim, President of the American Association for Geriatric Psychiatry, which is a professional membership organization dedicated to promoting the mental health and well being of older Americans.
Mr. Chairman, I join other witnesses in acknowledging this Subcommittee’s support for health care of our nation’s veterans. Yet I’m here today to convey our concern that the existing gap between mental health needs and resources will widen rapidly unless Congress acts to increase support for mental health care of older veterans.
More than a third of VA patients need psychiatric care, and the most rapid growth in demand has been among the oldest veterans. During the last decade, there was a 4-fold increase in the number of veterans age 75-84 who received VA mental health services. Care of older patients is more complex because of the co-occurrence of mental disorders and physical illnesses such as heart disease, lung disease, and diabetes. Psychiatric disorders complicate medical care; and, conversely, medical conditions complicate psychiatric care. These patients require integration of mental health services with the rest of their medical care, and these healthcare services must be well coordinated.
Despite the increasing need for integrated mental health services and care coordination for older veterans, funding for VA mental health research, training, and services is falling dangerously behind. Given that the VA health care system has sustained deep cuts in its psychiatric and substance abuse programs, the Administration’s Fiscal Year 2004 budget proposal is inadequate. While the proposed budget is purported to increase funding for medical care, it relies heavily on suppressing demand, limiting services, and increasing veterans’ copayments. It provides no plan for restoring lost capacity in VA mental health care and substance abuse programs; rather, it will further impede access to mental health care. We’re especially concerned that, as veterans of the war in Iraq enter the VA health care system, the increase in demand for mental health services will far exceed capacity, and many will have to be turned away unless the system receives a substantial infusion of support.
And to which system do we direct elderly veterans diverted from the VA when Medicare, Medicaid, and state programs are no less constrained by budgetary shortfalls? There is no safety net. Elderly veterans with mental illness are especially vulnerable because private health plans and Medicare HMOs have limited mental health coverage, and they continue to reduce and eliminate drug benefits.
AAGP believes that the VA should have sufficient support to provide a range of integrated services to veterans with mental disorders, and that this should serve as a benchmark for all health care systems in our country. We recommend that the VA expand its offerings of integrated medical and mental health services through Community Based Outpatient Clinics. With this approach, veterans will receive the highest quality care, and further reductions in inpatient services should be feasible. AAGP also applauds the VA leadership for pursuing more efficient models of care coordination for outpatients. AAGP believes that a majority of older veterans can benefit from these models, including peer monitoring and other non-traditional support systems that can help to maintain elderly veterans in the community.
This approach should also be extended to elderly veterans with cognitive impairment. An estimated 30% of veterans residing in VA nursing homes suffer from Alzheimer disease or other types of dementia. As the elderly veteran population increases, the need for dementia care will overwhelm existing VA nursing homes. The VA should encourage innovation in the management of veterans with Alzheimer’s; and should provide family and caregiver support programs, which research has shown to be effective in delaying nursing home admission. AAGP recommends new funding for mental health research to develop, test, and disseminate treatment interventions for the psychiatric and behavioral symptoms of Alzheimer’s and related dementias.
For the purpose of coordinating mental health research with education and clinical care, the VA Mental Illness Research, Education, and Clinical Centers, or MIRECCs, have played a vital role. AAGP commends Congress for funding eight MIRECCs thus far. These Centers have demonstrated that coordinated research and education projects can translate scientific knowledge into clinical service. Given the success of these programs in addressing problems related to aging, medical comorbidity, substance abuse and mental health, AAGP urges that full funding for all existing MIRECCs be continued, and recommends the funding of at least two new MIRECCs in Fiscal Year 2004.
In conclusion, we are under-investing in mental health services, training and research for our nation’s veterans. The future cost of this under-investment will be staggering, especially with the aging veteran population and the anticipated influx of veterans from the war in Iraq. AAGP urges you to commit the resources necessary for coordinated physical and mental health care for veterans across the lifespan.
I would like to thank the Subcommittee again for the opportunity to testify here today, and I would be pleased to answer any questions.
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