National Alliance on Mental Illness
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Veterans Living with Severe Mental Illness

NAMI places the highest priority on meeting the treatment and community support needs of individuals with severe mental illness that have protected our freedom through military service. The Department of Veterans’ Affairs is the largest single provider of psychiatric services in the U.S., according the Veterans’ Health Administration (VHA):

  • 454,598 veterans are service connected for a mental illness.
  • 130,221 veterans are service connected for a psychosis - a chronic, severely debilitating disorder that often emerges or is aggravated during time in the service.
  • 129,694 veterans are service connected for post-traumatic stress disorder (PTSD), a disorder most often directly related to combat duty.
  • In 2002, more than 700,000 veterans received mental health services from VA.

NAMI believes that veterans should receive at least the same full range of integrated services within the hospital and upon discharge to the community that are received by people with mental illnesses served by other public systems such as: the availability and accessibility of physicians services, state of the art medications, family education and involvement, inpatient and outpatient care, residential treatment, supported housing, assertive community treatment (ACT), psychosocial rehabilitation, peer support, vocational and employment services, and integrated treatment for co-occurring mental illness and substance abuse.

NAMI Congratulates Congress for Increases in VA Spending for FY 2004

The FY 2004 omnibus spending bill (HR 2673) now pending before the Senate contains important increases for veterans’ medical care. This includes a record $28.5 billion in funding for the VHA - $1.6 billion above the Bush Administration’s request and $2.8 billion above FY 2003 spending. NAMI urges the Senate to expeditiously pass this legislation and send this important increase to VA medical care to President Bush.

HR 2673 allows the VA to move forward in transferring up to $400 million in FY 2004 toward implementation of the Capital Asset Realignment for Enhanced Services (CARES) initiative. NAMI urges Congress to remain vigilant in requiring the VA and individual Veterans Integrated Service Networks (VISNs) to validate an effective planning model for inpatient and outpatient mental health care. At the same time, NAMI remains concerned that a flawed planning model currently being rushed toward implementation profoundly underestimates veterans’ future needs for mental health services because it is based on long constrained VA mental health utilization rates. NAMI also continues to express strong concerns regarding the loss of and potential elimination of more inpatient beds to treat veterans with mental illness.

NAMI strongly supports provisions in the recently enacted Veterans Health Care, Capital Asset and Business Improvement Act of 2003 (PL 108-170) designed to expand access to specialized care for veterans with mental illness. In particular, NAMI is grateful for increases in the authorized amounts for FY 2004, 2005 and 2006 for specialized services for high priorities identified by the VA’s Committee on the Care of Severely Chronically Mentally Ill Veterans (SMI). These include specialized services targeted to veterans experiencing PTSD and those with co-occurring mental illness and substance abuse disorders. NAMI strongly encourages Congress to remain vigilant to ensure that the VHA uses increased funding provided by Congress in FY 2004 to reach these authorized levels as quickly as possible.

HR 2673 also contains a requirement for the VHA to establish two new Mental Illness Research Education and Clinical Care (MIRECCs) Centers in FY 2004. This requirement was recommended by the House and is a major step forward in meeting a longstanding Congressional requirement for the VA to fully fund a national system MIRECCs to serve veterans with severe mental illnesses.

New Law Promotes Supported Employment for Veterans With Mental Illness

PL 108-170 also includes authorization for expansion of rehabilitative services for veterans with mental illness in the area of supported employment. Specifically these include work skills training and development services, employment support services, and job development and placement services. These new services will help veterans with mental illness achieve greater independence and community integration through employment. NAMI urges Congress to hold the VA accountable in meeting the goals of this expanded authority for employment services.

The VA’s FY 2005 Budget – Opportunities for Improvement

NAMI urges Congress to continue bipartisan efforts to provide the VA with the necessary resources to meet the medical and community support needs of all veterans, including those living with severe mental illness. NAMI urges Congress to follow the forthcoming recommendations in the Independent Budget for FY 2005. NAMI also recommends continued vigilance on the part of Congress to ensure that the VA continues efforts to expand access to the most effective evidence-based models for mental illness treatment and community support programs including:

  • Open access to the newest and most effective medications – The VHA should be prevented from using restrictive prescription drugs formularies to limit access to the newest and most effective psychiatric medications including typical psychotropic and selective serotonin reuptake inhibitors (SSRIs).
  • Expanding ACT – The VA should ensure compliance of the VHA directive for Mental Health Intensive Care Management (MHICM), which was issued in October 2000. A recent survey by the SMI revealed that just over 8,000 veterans currently received some form of mental health team case management from the VHA, and of those, only 2,000 met ACT criteria, for intensive case management.
  • Screening for Homeless Veterans – The VA needs to continue expanding its capacity to conduct outreach and screening efforts to homeless veterans with severe mental illnesses, particularly in settings such as local jails and prisons, homeless shelters and the streets. Studies have shown that nearly one-third (approximately 250,000) of homeless individuals have served in our country’s armed services. Moreover, approximately 43% of homeless veterans have a diagnosis of severe and persistent mental illness, and 69% have a substance abuse disorder.

Community Based Outpatient Clinics (CBOCs) – Many of the VA’s CBOCs serve as primary care clinics and were instituted in areas in which the VA health services were not easily accessible, allowing many more veterans access to needed health care. However, the SMI committee reports that out of the 350 CBOCs operated, only 40% of the facilities offer treatment services for veterans with severe mental illness.

January 2004