Appropriations for the Department of Veterans Affairs for Fiscal Year 2007 (Oral Testimony)
Subcommittee on Military Quality of Life & Veterans Affairs, House Appropriations Committee, U.S. House of Representatives
AAGP President Christopher C. Colenda, MD, MPH
3/1/2006
Mr. Chairman and members of the Subcommittee, I’m Christopher Colenda, President-elect of the American Association for Geriatric Psychiatry (AAGP). I am a physician who specializes in Geriatric Psychiatry. The AAGP 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 psychiatric disorders.
I’m here today to expressly convey AAGP’s position on three serious and inter-related issues: the existing gap between mental health needs and resources for elderly veterans; the need for similar services for the returning OIF/OEF soldiers, sailors, airmen, and marines, and support for mental health research and education in the VA Health Care System.
Why are these issues important? Well, more than a third of VA patients need psychiatric care.
Let’s look at the older veteran group first. The most rapid growth in service 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. These types of patients are among the most complex patients seeking health care services because they often have both psychiatric and medical disorders that contribute to significant morbidity and reduced quality of life as well as to premature mortality. The evidence shows that in order to achieve the highest quality of care, integration of mental health and physical health services at the point of service is the best model. My own research demonstrates that this is the preferred method by which older adults want to receive mental health services.
We applaud the VA’s approach to integrated care, and strongly recommend that the VA expand its offerings of integrated medical and mental health services through Community Based Outpatient Clinics.
We also advise that integrated models of care should 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 challenge existing VA nursing homes’ resources. The VA should encourage innovation in the management of veterans with dementia and should provide family and caregiver support programs.
The aging of Vietnam era veterans – more than 8 million strong – will bring new issues to the VA mental health system. In the late 70’s and early 80’s, as a young physician and psychiatrist in training who cared for and learned from Vietnam Veterans, I struggled with how best to provide effective and compassionate care for veterans with post traumatic stress disorder (PTSD), many of whom had co-morbid substance abuse and other major psychiatric illnesses.
It is important for this committee to understand that because of impact of the current conflict in Iraq and Afghanistan, clinicians are reporting re-emergence of PTSD symptoms among their elderly patients who served in WW2, Korean and Vietnam.
This leads to our second point that relates to the mental health needs of returning OIF/OEF veterans, and our position that to prevent significant psychiatric morbidity in late-life, you must intervene quickly and effectively in mid-life, especially with conditions such as PTSD.
The New England Journal of Medicine has documented that between 11-17% of soldiers returning from Iraq and Afghanistan suffer from significant symptoms of mental health disorders. Today’s Washington Post reported prevalence rates of 33 percent. The New England Journal of Medicine study also pointed out that these veterans had difficulty obtaining mental health services. The irony is that unlike my experiences of nearly 30 years ago, we have made tremendous advances in how to treat returning veterans who experience stress related illnesses, depression and substance abuse.
Our last point focuses on funding for VA mental health services, research and training.
We acknowledge and appreciate this Committee’s efforts to increase funding for mental health services. But, the need is still great because of historic neglect. AAGP is very concerned that the mental health needs of older veterans will continue to be neglected, or worse will have to compete for services desperately needed for OIF/OEF veterans.
Second, as a nation, we owe our veterans the very best research that will lead us to better treatments and better cures. For example, in order to better treat and prevent re-emergence of PTSD, we need to better understand the interactions of environmental exposure (combat), brain biology and plasticity, genetic vulnerability and timing. At my own institution, the Texas A&M Health Science Center, we are working with the Central Texas Veterans Health Care System and Food Hood to establish the center on the Root Cause of Post-traumatic and Developmental Stress Disorders. This committee had the foresight to support our efforts.
One center is not enough. We advocate that VA establish regionalized centers of excellence, that bring together multi-disciplinary research teams who will help us develop effective interventions to address other major psychiatric disorders prevalent in younger and older veterans.
And third, VA has been a model of support for integration of mental health research, education and clinical care. Through programs such as the Mental Illness Research, Education, and Clinical Centers, or MIRECCs, and Geriatric Research, Education and Clinical Centers (GRECCs) great strides have been made. However, we note that current budgets recommendations for MIRECCS and GRECCs have not kept pace with both need and future demand, especially for MIRECCS that are focused on late-life mental disorders. Couple this with the fact that Title 7 of the Public Health Services Act did not renew funding for HRSAs Geriatric Education Centers, geriatric mental health research funding at NIMH has languished, we do not have mental health parity in Medicare, and reduced numbers of psychiatrists and other health care professionals are entering the geriatric workforce. AAGP believes that a looming crisis exists for the 78 million baby-boomers entering their “golden” years, 8 million of whom are veterans. We believe Congress needs to be proactive and incentivize innovative research and training programs and Medicare mental health parity.
In conclusion, psychiatric illnesses are real. They cause significant morbidity, co-morbidity and mortality among those who have served their country. We owe our veterans the best that this country can offer.
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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