Congress boosts VA mental health care

Congress approved a Veterans' Affairs appropriations bill last year that is designed to ensure that money intended for veteran's mental health care is actually spent for that purpose.

The legislation, which President Bush signed Nov. 30, 2005, fences off $2.2 billion of the VA's appropriation for fiscal 2006 to be spent on specialty mental health care.

The earmark "is pretty unprecedented," said David Tucker, a Democratic staffer on the House Committee on Veterans' Affairs. Congress does not typically wall off spending for certain purposes within the VA's medical services budget, he said.

Overall, the law allocates $29.9 billion for VA medical care in fiscal 2006 -- an 8% increase over the $27.7 billion appropriated the previous year.

Congress also provided an additional $1.5 billion last summer to cover a shortfall in the VA's health care budget.

It's unclear whether the earmark actually will increase spending on VA mental health services. The current amount of VA spending on mental health care "is kind of hazy," Tucker said. "But I think there is an acknowledgment that VA has not put the money into mental health care that is needed."

Lawmakers say they want to make sure veterans have access to adequate mental health services, particularly as more soldiers return from Iraq and Afghanistan with posttraumatic stress disorder and other mental health conditions.

About 26% of veterans who returned from Iraq and Afghanistan and were treated at VA medical centers between October 2003 and February 2005 were diagnosed with mental health disorders, according to a study published in the March 31, 2005, New England Journal of Medicine.

The study, conducted by the VA, found that the 26% were diagnosed with at least one mental health disorder, including 10% who were diagnosed with posttraumatic stress disorder, 9% with alcohol or drug abuse, 7% with depression and 6% with anxiety disorders.

At a July House Committee on Veterans' Affairs hearing that focused on improving care for veterans with posttraumatic stress disorder, the American Psychiatric Assn. testified that the VA's funding for mental health outreach, diagnosis and treatment has not kept pace with increased demand for services.

"For too long, mental health care has not been a priority for the VA," said APA Medical Director James H. Scully Jr., MD. He noted, for example, that the number of VA patients with severe posttraumatic stress disorder increased 42% from 1998 to 2003, while expenditures increased only 22% during that same time.

The VA appropriations bill that Congress passed last year showed that lawmakers are responding to concerns about veterans' access to mental health care, said Lizbet Boroughs, the APA deputy director for governmental relations.

The legislation not only fences off funding for mental health care, it also increases VA's accountability by requiring the department to report to Congress on a quarterly basis on how its money is spent, she said.

The law also instructs the VA to establish clinical teams specializing in posttraumatic stress disorder at every VA medical center. Currently, only about half of all VA medical centers have such clinical teams in place.

The legislation also directs the agency to establish three "Centers of Excellence" for posttraumatic stress disorder at VA hospitals in San Diego; Waco, Texas; and Canandaigua, N.Y. The new centers are expected to consolidate expertise on the disorder to advance research and improve patient care.

Mental health organizations have applauded the increased emphasis on mental health care.

"This is the right way to go," said Andrew Sperling, legislative advocacy director for the National Alliance for the Mentally Ill.

Overall research budget disappoints

But a coalition of groups called Friends of VA Medical Care and Health Research says it is disappointed by the bill's allocation for medical research. The legislation provides $412 million for the VA's Medical and Prosthetics Research program -- a 2.4% increase over the $402.3 million appropriated in fiscal 2005 and more than the $393 million requested by the Bush administration.

But FOVA, which represents about 75 academic, medical and veterans' organizations, had requested an appropriation of $460 million.

"While better than what the president proposed, the funding level for fiscal 2006 is disappointing," said Gary Ewart, government relations director for the American Thoracic Society and a member of FOVA's executive committee. "The 2.4% increase is less than research inflation and will mean reduced funding opportunity in the VA research program," he said.

The coalition also opposes the earmarking of research funds. The appropriation designates $15 million within the medical research program for research on Gulf War illness and its long-term health effects.

The House Committee on Veterans' Affairs also announced that the law doubles funding for mental health research.

The concern is that targeting money to specific types of research moves the agency away from the peer review process, said David Moore, who also serves on FOVA's executive committee and is senior associate vice president for government affairs at the Assn. of American Medical Colleges. "We're concerned that everything be done to ensure the best projects are the ones to get the money."