FY 2006 Appropriations for the Department of Veterans Affairs (Oral Statement)
Subcommittee on Military Quality of Life & Veterans Affairs, House Appropriations Committee, U.S. House of Representatives
Dan Blazer, MD, AAGP President
4/7/2005
Written Testimony
Mr. Chairman and members of the Subcommittee, I’m Dan Blazer, President of the American Association for Geriatric Psychiatry (AAGP), which is a professional membership organization dedicated to promoting the mental health and well-being of older Americans and improving the care of those with late-life mental disorders.
I’m here today to specifically 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. Because these patients require integration of mental health services with the rest of their medical care, both physical and mental, these healthcare services must be well coordinated.
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 recent years in its psychiatric and substance abuse programs, the Administration’s Fiscal Year 2006 budget proposal is inadequate because it would unfairly shift the burden of rising health care costs from the Federal Government to veterans, it would eliminate Federal funding for state programs that provide veterans with long-term care, and dramatically increases health care fees for some veterans through enrollment fees and higher 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.
The New England Journal of Medicine has documented the alarming numbers of soldiers returning from Iraq and Afghanistan who suffer from symptoms of post-traumatic stress disorder, major depression, generalized anxiety disorder, and other mental health disorders. I personally am acutely aware of the burden borne by these soldiers through my service on the Armed Forces Epidemiological Board (AFEB), the civilian advisory board to the Department of Defense on the prevention of disease and injury and the promotion of health. I am also a member of the Institute of Medicine (IOM) and there are 10 IOM Committees that address military and VA health care. The study also pointed to the inability of those veterans to obtain the mental health services they desperately need. In its Fiscal Year 2006 budget recommendation, the Administration has recognized this problem and has proposed an increase in funding for mental illness treatment services. This funding is crucial. As large numbers of soldiers return from Iraq and Afghanistan and enter the VA health care system, the increase in demand for mental health services will far exceed capacity.
AAGP is very concerned that the mental health needs of older veterans will continue to be neglected. Simultaneously, Medicare, Medicaid, and state programs are no less constrained by budgetary shortfalls? There is no safety net.
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.
Integrated models of mental health services should also be extended to elderly veterans with cognitive impairment. An estimated 30 percent of veterans residing in VA nursing homes suffer from Alzheimer’s 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. We recommend new funding for mental health research to develop, test, and disseminate treatment interventions for efficient and effective 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, and Geriatric Research, Education and Clinical Centers (GRECCs) have played a vital role. AAGP commends Congress for funding these efforts.
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 influx of veterans from the wars in Afghanistan and Iraq, which has already begun. 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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