Policy Topics

Veterans Living With Severe Mental Illness

  • NAMI endorses recommendations contained in the Independent Budget and urges that they be incorporated into the FY 2003 VA-HUD Appropriations Bill.
  • NAMI supports open access to the newest and most effective medications. The VHA should be prevented from using restrictive prescription drug formularies to limit access to the newest and most effective psychiatric medications including atypical psychotropic and selective serotonin reuptake inhibitors (SSRIs).
  • NAMI supports expanding assertive community treatment (ACT) and fidelity to the ACT model within the Veterans Administration. The VA should ensure compliance of the VHA directive for Mental Health Intensive Care Management (MHICM) which was issued in October 2000. Assertive Community Treatment (ACT) is an evidence based, service-delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illnesses. A FY 1998 survey by the Committee on Care of Severely Mentally Ill Veterans 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 Fidelity Measures criteria, for intensive case management.
  • NAMI supports FULL funding of Veterans Health Administration (VHA) Mental Illness Research Education and Clinical Care (MIRECCs) Centers.
  • NAMI urges the VA to significantly expand 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. Severe mental illness and co-occurring substance abuse problems contribute significantly to homelessness among veterans. 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.
  • NAMI urges the VA to expand the availability of mental health services in Community Based Outpatient Clinics (CBOCs). Many of the CBOCs serve as primary care clinics and were instituted in areas where 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 these facilities offer treatment services for veterans with severe mental illness. NAMI is truly concerned that meaningful community-based capacity is not being developed to treat chronically mentally ill veterans in their communities.
  • NAMI supports the implementation of evidence based programs within the VA, including Family to Family education.


Treating veterans with severe mental illness should be the highest priority for the VA:

  • 454,598 veterans are service connected for a mental illness
  • 130,211 veterans are service connected for psychosis, a chronic, severely debilitating disorder that often emerges or is aggravated during time in the service
  • 129,694 veterans are service connected for PTSD, a disorder most often directly related to combat duty.
  • Of the 104,593 veterans treated in the VHA in FY 99 for schizophrenia, one of the most disabling disorders, 99.5% were category A high priority patients due to service connection or low income status.

About 20% of VA patients need mental health treatment and VA mental health spending has decreased by 8% over the past five years. The Independent Budget estimates that simply to achieve parity, the VA should be devoting an additional $478 million to mental health spending. The Independent Budget recommends the Congress should incrementally augment funding for veterans with serious mental illness by $160 million each year from FY 2002 through FY 2004.

NAMI believes that veterans should receive the same full range of integrated services within the hospital and upon discharge to the community that are received by other people with brain disorders. NAMI calls for veterans hospitals and veterans outpatient treatment programs to be held to the same standards of performance as all other hospitals and outpatient treatment programs. An acceptable continuum of care should include the availability and accessibility of physician services, state of the art medications, family education and involvement, inpatient and outpatient care, residential treatment, supported housing, assertive community treatment, psychosocial rehabilitation, peer support, vocational and employment services, and integrated treatment for co-occurring mental illness and substance abuse.

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