FY 2010 Appropriations for Mental Health Research and Services for Veterans (Oral Testimony)

Published Thursday, April 23, 2009 7:00 am

Subcommittee on Military Construction, Veterans Affairs and Related Agencies Committee on Appropriations U.S. House of Representatives

Joel E. Streim, MD


Oral Testimony of
Joel E. Streim, MD
Before the Subcommittee on Military Construction, Veterans Affairs and Related Agencies
Committee on Appropriations
U.S. House of Representatives

Written Testimony

Mr. Chairman and members of the Subcommittee, I am Joel Streim, a past president of the American Association for Geriatric Psychiatry, and a practicing geriatric psychiatrist. 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 mental disorders.

You have our written statement, which addresses a number of concerns. I’ll focus my testimony today on two issues: first, the return on VA investments in geriatric mental health research and services, with benefits that are now accruing to veterans across the lifespan; and, secondly, the need to safeguard funding to ensure full implementation of the VHA Comprehensive Mental Health Strategic Plan and the Uniform Mental Health Services Handbook that specifies requirements supporting implementation.

The number of veterans 85 years of age or older has grown rapidly in recent years, and the VA predicts that this oldest group will reach 1.2 million next year. Providing health care for these veterans is challenging, as many of them have co-occurring chronic medical conditions, psychiatric illness including cognitive disorders, and/or substance use disorders. For these patients, the interactions between their medical and psychiatric illnesses often complicate their health and result in poorer clinical outcomes. To deal with these common interactions, geriatric specialists have recognized that psychiatric treatment must be integrated and highly coordinated with general medical care.

Over the past decade, the VA made a historic investment in aging research and integrated service models – and now it’s paying dividends not only in better treatments for older veterans, but also in how we approach complex conditions across the lifespan. VA has played a leading role in developing the scientific evidence base for understanding and treating health problems that are common in late-life, such as cognitive impairment, musculoskeletal disorders, and chronic pain. VA expertise in managing these interacting infirmities of aging now informs the approach to younger veterans with similar problems. The cross-fertilization made possible by advances in geriatric mental health care will be especially important in working with returning OEF/OIF veterans who have poly-trauma, which results in functional limitations due to a combination of cognitive impairment and physical disability. A related concern is the previously recognized association between head trauma and an increased risk of developing dementia, which raises the worrisome possibility of accelerated brain aging in these younger veterans. AAGP urges Congress to support the VA in monitoring and managing the downstream effects of traumatic brain injury and its associated cognitive and physical disabilities—beyond the initial recovery period—as these veterans continue to age.

A second successful VA investment in mental health services for veterans across the lifespan must be continued and strengthened. This is the Mental Health Enhancement Initiative, which has grown from $100 million when this special purpose fund was created in 2005, to $557 million in 2009. Through this important initiative, VA has ensured the availability of mental health staff to treat elderly veterans who receive their general health care through Home-Based Primary Care programs and in Community Living Centers, previously known as Nursing Home Care Units. The integration of mental health services into primary care and related settings has made it easier for older veterans to access mental health care, and has improved the coordination of care for the complex problems of this population.

It’s now been five years since the development of the VHA Comprehensive Mental Health Strategic Plan, and five years since the Mental Health Enhancement Initiative was made available to support that plan. We at AAGP look forward to the time when the Strategic Plan is fully implemented according to the requirements specified in the recent Uniform Mental Health Services Handbook. However, it is anticipated that after 2009, the Enhancement Initiative will be rolled over into the Veterans Equitable Resource Allocation (known as VERA). While we believe VA’s intent is to maintain these enhancements of mental health care for older veterans, we have concerns about VA’s ability to achieve full implementation of the Strategic Plan without sustained, dedicated funding. We therefore urge Congress to enact safeguards to prevent diffusion of the ongoing support that is required to reach this goal. AAGP appreciates that there is an important existing safeguard in appropriations language that requires no less than $3.8 billion to be spent for mental health purposes. However, further safeguards are necessary to ensure continuation of funding specifically dedicated to full implementation of the VHA Comprehensive Mental Health Strategic Plan.

I would like to thank the Subcommittee for the opportunity to testify here today, and I would be pleased to answer any questions.