Psychiatr News March 21, 2008
Volume 43, Number 6, page 1
© 2008 American Psychiatric Association
Care for Vets, Active Military Focus of APA Advocacy Effort
Rich Daly
The VA and the Pentagon have made notable progress in improving mental
health treatment for veterans and active-duty troops in recent years, but they
still have many challenges to confront.
How can veterans' families gain access to the mental health services
offered to former soldiers? When will the government agree on the need for a
bigger boost in the number of Department of Veterans Affairs (VA) and
Department of Defense (DOD) psychiatrists? What will it take for the federal
government to increase treatment reimbursement to private psychiatrists who
participate in the military's health care
network?
Those were among the most-discussed questions and most-lobbied issues
during APA's 2008 Advocacy Day.
The annual event, held last month, drew about 100 psychiatrists to
Washington, D.C., to learn about the biggest federal health policy challenges
facing psychiatry and to urge their members of Congress to support APA-backed
solutions. Attendees participated in several days of training and heard
multiple issue updates before visiting the offices of members of Congress from
44 states, which is an increase from the 40 states whose representatives were
reached in last year's Capitol Hill visits.
This year's advocacy issue updates focused on the mental health needs of
active-duty members of the military and veterans. Health care services for
members of the military and veterans have had large funding increases in
recent years to help remedy inadequate services that have long existed.
Especially damning was the revelation of poor medical conditions at Walter
Reed Army Medical Center in Washington, D.C. But the federal agencies have
placed less emphasis on improving mental health care, and the Advocacy Day
participants hoped to change that.
Veterans health issues are among the few issues in Washington on which
there is bipartisan agreement, "so feel comfortable raising them during
your visits to Capitol Hill and with the knowledge that you bring great
expertise to the issue," said Ralph Ibson, J.D., vice president of
Government affairs at Mental Health America, to the psychiatrists
participating in Advocacy Day.
The participants raised numerous concerns about the shortcomings of the DoD
and VA mental health system—such as an inadequate medical
workforce—that they were encouraged to share with their congressional
representatives during their legislative
visits.
Dan Blazer, M.D., Ph.D., said the heavy caseloads, poor compensation, and
frequent overseas duty had decimated the ranks of mental health professionals
in the military. The military needs to focus resources on recruitment of
active-duty personnel to fill those positions instead of increasing its use of
contract workers, he said.
Kelly Hruska, deputy director of the Department of Government Relations at
the National Military Family Association, agreed that more effort is needed to
increase access to mental health professionals in both the military and VA
systems.
"The biggest concern is access to providers," Hruska said.
"Families know that services are out there; they just don't know how to
find providers that accept TRICARE."
TRICARE is the health care program that serves primarily active-duty
service members, National Guard and Reserve members, retirees, and their
families worldwide. TRICARE brings together the health care resources of the
military and supplements them with networks of civilian health care
professionals and institutions.
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William Callahan, M.D., chair of the Committee on Public Affairs and a
member of APAPAC, talks to fellow psychiatrists during the annual
event.
Credit: Ellen Dallager
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Psychiatrists in private practice repeatedly pointed out that more of them
would participate in TRICARE if it reimbursed at a higher rate or entailed
less-onerous paperwork. The program reimburses clinicians at rates
significantly below those of Medicare, and remuneration frequently takes more
than one year to receive, they said.
Although such changes are needed to encourage more psychiatrists to care
for this population, veterans groups and government officials praised
psychiatrists for already contributing significant assistance through programs
such as Give an Hour (Psychiatric News, March 7). The program,
supported by APA, is a growing network of mental health professionals and
psychiatrists who commit to giving one hour a week for at least a year to
soldiers, veterans, and their family members seeking help through the
program.
Another area of mental health care that psychiatrists attending Advocacy
Day frequently mentioned as needing congressional action is the lack of access
veterans' families have to most VA health care services.
"Right now the focus is on family care to the extent that it helps
the veteran, but it doesn't address the separate care that the families need
who don't have a direct service connection," said Ira Katz, M.D., deputy
chief of patient care services officer for mental health in the VA.
Katz noted that it would take an act of Congress to allow the VA to provide
the same level of health care to veterans' families that it now provides to
veterans.
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Meeting attendees include Elizabeth LeQuesne, M.D., a member of the
Committee on gay, Lesbian, and Bisexual Issues (left) and Sherry Katz-Bearnot,
M.D., president of the American Academy of Psychoanalysis and Dynamic
Psychiatry.
Credit: Ellen Dallager
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Attendees and speakers during the Advocacy Day program also urged steps to
smooth the mental health care transition for soldiers as they leave the
military and its health system and become eligible for VA care.
Blazer and others urged better coordination of electronic medical records
to make them accessible to both the military and VA health systems. A staff
aide said that the member of Congress for whom he works plans to introduce
such legislation.
Legislation that addresses another concern—how to get veterans to
seek and continue needed mental health treatment—was introduced in the
Senate in January and was hailed by several APA members. The Veterans Mental
Health Treatment First Act (S 2573) would pay veterans who are diagnosed with
posttraumatic stress disorder (PTSD) and other serious mental health
conditions and who follow the prescribed treatment.
"There is the fear that if you are less than perfect, then it ends
your career," said APA President Carolyn Robinowitz, M.D., about the
stigma many members of the military fear will follow treatment for an
emotional problem or psychiatric illness.
Transitioning Smoothly From DoD to VA
James Peake, M.D., secretary of the VA, agreed with Advocacy Day
participants that there are many areas in which his department can improve the
mental health care it provides, including reducing the stigma some fear from
mental health treatment and the provision of a smoother transition from the
DoD to the VA health care system.
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James Peake, M.D., secretary of the Department of Veterans Affairs,
tells Advocacy Day attendees about federal efforts to improve the mental
health care provided to veterans and members of the military.
Credit: Ellen Dallager
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"There is no reason that the transition between DoD and the VA can't
be seamless, and that has to be more than a buzzword," he said, in
comments to attendees.
Peake said the development of an electronic medical record that both
systems can use is critical to that seamlessness. Further, advancing health
information technology and conducting more research on traumatic brain injury
(TBI) are other leading priorities of his department, he said.
Recent advances at the VA include an extension from two years to five years
the period in which combat veterans can access VA care, which would provide
more time to identify and treat individuals for TBI and PTSD. Another advance
is that all returning service members are screened for suicidal tendencies and
TBI, with detailed evaluations made when the screening results are positive.
Ongoing research at the VA also seeks to better tailor the PTSD care to the
needs of recent combat veterans, compared with the type of treatment needed by
older Vietnam combat veterans.
Peake noted that the VA has stepped up its suicide prevention efforts after
its leaders were "shocked" by the high number of suicides among
recent veterans under their care. These efforts included a national suicide
prevention hotline for veterans, which has been credited with preventing more
than 400 suicides to date, and placement of suicide prevention coordinators in
all VA medical centers (Psychiatric News, September 7, 2007).
Better care is needed for veterans' families as well, Peake said. He noted,
however, that his department is largely limited by federal law in the care it
can provide.
"The 1945 reality has changed, and many more members of the military
and veterans are now married," Peake said.
Members' Efforts Recognized
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R. Dale Walker, M.D., chair of the Council on Advocacy and Public
Policy, (left) presented the President's Special Recognition Award to Jeffrey
Akaka, M.D., for his legislative efforts on scope-of-practice issues in
Hawaii. Also pictured is Lori Murayama, M.D., secretary-treasurer of the
Hawaii Psychiatric Medical Association.
Credit: Ellen Dallager
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Also at the Advocacy Day event, participants recognized the special
advocacy accomplishments of several individuals, including Jeffrey Akaka,
M.D., speaker of the APA assembly. He was presented the President's Special
Recognition Award for his leadership in the successful lobbying effort to stop
state legislation in Hawaii that would have granted prescribing privileges to
psychologists.
"A Crash-course prescribing practice passed both the House and
Senate, and it looked dark [for us]," Akaka said. "We did not give
up."
The governor eventually vetoed the bill, and Akaka and other psychiatrists
encouraged the legislature not to override it.
"They are tall shoulders on which I have stood to get to this
place," Akaka said. "The shoulders of all you here are what our
members will stand on."
The Advocacy Day event was also a success in reaching APA's goal of
increased lobbying participation by members-in-training. Twenty-five residents
attended the 2008 event, up from 20 last year and 10 in 2006. (For more on
Advocacy Day see Advocacy has Maximum Impact When we all Speak up and First
Advocacy Day Whets Appetite for More.)
Information about the Veterans Mental Health Treatment First Act can be accessed at
<http://thomas.loc.gov:> by searching on the bill number, S 2753.
Related Articles:
-
First Advocacy Day Whets Appetite for More
- Steven Resnick
Psychiatr News 2008 43: 13.
[Full Text]
-
Advocacy Has Maximum Impact When We All Speak Up
- Carolyn Robinowitz
Psychiatr News 2008 43: 3.
[Full Text]
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