APA is urging Congress to increase the amount of money it makes available for medical research in next year’s budget for the Department of Veterans Affairs.

Testifying on behalf of APA before a House Appropriations subcommittee on April 13, psychiatrist Albert Gaw, M.D., applauded the Clinton administration’s request to increase the VA’s health care budget by $1.4 billion for Fiscal 2001, but expressed disappointment with its decision to "flat line" the medical research portion of the budget.

Gaw said that APA agrees with several veterans’ groups that are calling for Congress to add $500 million to the administration’s VA budget request. While the original request "is a step in the right direction," the additional amount, he testified, would ensure adequate funding for the department’s treatment and research needs.

Gaw is medical director of Medfield State Hospital in Massachusetts and is cochair of APA’s Caucus of VA Psychiatrists.

Highlighting APA’s concern about the welfare of veterans who are mentally ill, he pointed out that 25 percent of veterans who receive medical care through the VA’s system suffer from some type of psychiatric disorder. At the current funding levels, however, "less than 12 percent of research dollars is being applied to the veterans population with psychiatric disorders." He added that "VA resources devoted to mental illness research have lagged far behind those dedicated to other medical disorders."

He also focused the subcommittee’s attention on "the dearth of research funding in the area of geriatric psychiatry," which is particularly troubling, he said, in light of the rapidly growing proportion of veterans who are elderly.

Gaw also informed the subcommittee members about APA’s concerns regarding the VA’s 22 Veterans Integrated Service Networks (VISNs). These geographically based service organizations are facing shrinking budgets, and some are making up the shortfall by shifting dollars away from Congressionally mandated mental health programs, he noted. Many VISNs, he added, "have made little progress in establishing community-based programs for mentally ill veterans" and suffer from staffing shortages and turnover that interfere with care for mentally ill veterans.

Another area of concern for APA is a trend for the VA to impose cost-cutting devices common to private sector managed care organizations. These tactics have been "inappropriately applied to veterans programs" and have harmed veterans "through premature discharges from acute care services," Gaw said.

The problems that the VA network is having in balancing treatment and financial concerns are particularly disruptive for the 20,000 to 30,000 seriously mentally ill veterans who require a continuum of care, "including state-of-the-art intensive community case management programs," Gaw said in written testimony also submitted to the subcommittee. The critical need for case management is further heightened by the VA’s shift of much PTSD treatment from inpatient to outpatient and residential facilities.

Shifting to the area of alcohol abuse, Gaw said in his written testimony that the VA has "appropriately" been moving this care away from inpatient centers, but is lagging in the development of "alternative residential resources, expanded ambulatory care, and the provision of acute inpatient care when necessary." APA is concerned, he said, that some VISNs are downsizing by shifting resources away from alcohol and drug abuse programs at a time when private-sector programs are also cutting back on substance abuse treatment.

Gaw also said that "APA applauds the VA for initiating the program for Psychiatric Primary Care Education, which allows psychiatric residents to assume the duties of primary care physicians for mentally ill patients in mental health and primary care settings."

This valuable program allows psychiatric trainees "to reach a sector of veterans with psychiatric illness who normally would not have come to the attention of psychiatrists or mental health professionals," Gaw pointed out. For this reason, he urged the subcommittee to maintain funding for its psychiatry residency and fellowship programs.

After Gaw completed his testimony, Rep. Anne Northrup (R-Ky.), who chaired the appropriations hearing, emphasized that the subcommittee is commited to ensuring that funding for VA health programs is sufficient to provide services for all disabled veterans who need them, said Lizbet Boroughs, the associate director in APA’s Division of Government Relations who specializes in veterans issues.