 |
 |
|
|
Congress should appropriate more funds than recommended by President Clinton for health research at the Department of Veterans Affairs (V.A.), said Patricia Isbell Ordorica, M.D., on behalf of APA on Capitol Hill last month.
Ordorica spoke before members of the House Appropriations Subcommittee on V.A.-HUD and Independent Agencies. She chairs APA's Minority Fellowship Program and is the immediate past chair of the APA Council on Addiction Psychiatry. The House subcommittee is chaired by Jerry Lewis (R-Calif.).
Ordorica urged appropriators to allocate $325 million for V.A. health research, $25 million more than the President's Fiscal 1999 budget proposal and $53 million more than was appropriated in Fiscal 1998. She urged appropriators to allocate $18.1 billion for V.A. medical care, the same amount provided in Fiscal 1998 and recommended by the President for Fiscal 1999.
She congratulated legislators for having ended discriminatory coverage of mental illness and substance abuse for veterans. She expressed concern, however, that "any expansion of prescribing privileges by non-physicians undertaken by the V.A. would endanger the quality of care for veterans and expose veterans to unnecessary risk."
One quarter of all V.A. patients receive psychiatric treatment, Ordorica told the subcommittee. "The V.A. must be able to provide comprehensive psychiatric services to veterans suffering from disabling illnesses such as post-traumatic stress disorder, alcohol and substance abuse disorders, schizophrenia, depression, Alzheimer's disease, and other dementias," she commented.
The V.A.'s highest priorities should be maintaining capacity for substance abuse treatment, taking care of homeless veterans, improving treatments for seriously mentally ill veterans, and increasing research funding for psychiatric disorders "proportionate to our veterans' utilization of psychiatric services," Ordorica said.
Psychiatric research funding at the V.A. continues to be disproportionate to psychiatric services provided, said Ordorica. Although mentally ill veterans account for a quarter of all veterans getting treatment in V.A. medical centers, only 12 percent of V.A. research funds are directed toward the study of mental illness and substance abuse, she noted.
The trend at the V.A. to eliminate inpatient substance abuse treatment has, in some cases, created "a serious void in services," she noted. This is particularly an issue in the Veterans Integrated Service Networks (VISN's). The V.A. should preserve inpatient treatment in the VISN's not only because of the high prevalence of psychiatric disorders among veterans, but also because there has been an erosion of psychiatric services in the private sector, "making V.A.'s treatment continuum even more critical for our veterans," she added.
Seriously mentally ill veterans are another priority, said Ordorica. Although APA appreciates efforts by the V.A. to improve treatment for this group, it is concerned that some VISN's have been reluctant to improve service delivery. For example, some VISN's "continue to rely on older, less effective psychiatric medications and have been reluctant to invest in the more effective, newer antipsychotic medications," she added.
Homelessness among veterans is often symptomatic of severe psychiatric and substance abuse disorders, she observed. About one-third of all adult homeless people are veterans, which translates into 250,000 veterans sleeping on the streets or in shelters on any given night. About 40 percent suffer from chronic, disabling mental illness, and another 40 percent suffer from substance abuse disorders.
"APA recommends that HUD programs for veterans should be linked to V.A. medical care, particularly mental health services," she told legislators. Further, APA "urges you to improve funding for residential care and clinical care for our nation's veterans."