APA Testimony on Fiscal Year 2006 Appropriations for the Department of Veterans Affairs

Written Testimony of Steven Breckler, PhD
On behalf of the American Psychological Association

Submitted March 30, 2005 to the
United States House of Representatives Committee on Appropriations
Subcommittee on Military Quality of Life and Veterans Affairs
The Honorable James T. Walsh, Chair

Fiscal Year 2006 Appropriations for the Department of Veterans Affairs

Mr. Chairman and Members of the Subcommittee, I am Dr. Steven Breckler, Executive Director for Science at the American Psychological Association (APA), a scientific and professional organization of more than 150,000 psychologists and affiliates. Many of these psychologists work within the Department of Veterans Affairs (VA) as research scientists and clinicians committed to improving the lives of our nation's veterans. APA's testimony focuses on gaps in support for both VA research and mental health care in the President's FY06 budget proposal, and provides recommendations for funding to more adequately meet the tremendous and increasing needs of our veteran population.

Psychological Research in the VA

Through its Medical and Prosthetic Research Account, the VA funds intramural research that supports its clinical mission to care for veterans. VA psychologists play a dual role in providing care for veterans and conducting research in all areas of health, including high-priority areas particularly relevant to veterans such as mental health, substance abuse, aging-related disorders and physical and psychosocial rehabilitation.

For example, VA psychologists continue to be at the forefront of cutting-edge research on, assessment of and treatment for Post-traumatic Stress Disorder (PTSD). The care of veterans suffering psychological wounds as a result of military service is at the heart of the VA's mandate "to care for him who shall have borne the battle," and preventing and treating PTSD has become an even more important priority within the VA given the current conflicts overseas. VA psychologists are responsible for the development of the most widely respected and used diagnostic instruments and therapeutic techniques for assessing and treating PTSD.

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Another Administration-Proposed Cut to VA Research in FY06

Clearly investments in research projects at the VA have led to an explosion of knowledge that promises to advance our understanding of disease and unlock new strategies for prevention, treatment and cures. After many years of flat funding and a cut in FY05, the Administration again proposed a cut in VA research funding for FY06. The President's budget proposal included $393 million for the direct costs of the VA Medical and Prosthetics Research program, a decrease of $9 million (2.2%) from the current FY05 post-recission level of $402.3 million. This proposal estimates funding 62 fewer grants than in FY05 and eliminating 270 FTE research positions.

Request for FY06 VA Research Support

APA joins the Friends of VA Medical Care and Health Research (FOVA), a coalition of over 50 organizations concerned about veterans' health, in recommending that Congress reverse this proposed cut and provide $460 million for the VA Medical and Prosthetic Research Account in FY06. The impact of potential cuts to the psychological research program would be particularly dangerous, given reports of elevated incidences of suicide, domestic violence and significant mental health problems (particularly trauma-related anxiety disorders, depression and substance use) in post-deployed military and veteran populations.

APA also encourages Congress to direct the VA to call upon its psychological researchers to design and begin a longitudinal study of mental health in a cohort of returning servicemembers and veterans. Funding should be provided to the VA to work in collaboration with the Department of Defense on this study, which represents the most methodologically sound way of investigating potential mental health needs in our military and Reserve personnel and veterans.

Request to Expand VA Mental Health Services to Meet Increasing Need

A strong VA psychological research program provides the base for high-quality care within the VA system. VA psychologists are leaders in providing effective diagnosis and treatment for all mental health, substance use and behavioral health issues; less well-known are the profoundly positive impacts of psychological interventions on the care of veterans undergoing physical rehabilitation and those suffering from other chronic illnesses such as cancer, cardiovascular disease, HIV and chronic pain.

VA psychologists also have used their expertise in program development and evaluation to successfully improve the VA's coordinated service approach. This includes models and practices of care that encompass inpatient, partial hospitalization and outpatient services including psychosocial rehabilitation programs, homeless programs, and geriatric services in the community. VA psychologists have initiated and evaluated innovative programs, such as tele-mental health services, that will dramatically expand the VA's continuum of care for veterans.

APA is deeply concerned that the current and proposed budgets for VA mental health care will not be sufficient to meet what appears to be an increasing need for these services by returning military and Reserve personnel and veterans. APA strongly urges this Subcommittee to provide additional funding in FY06 for the VA to implement recent recommendations from the VA's strategic plan for mental health, as well as findings from Department of Defense (DoD) and Government Accountability Office studies regarding mental health research and services.

In the short-term, additional funds should be provided for the VA and DoD specifically to develop appropriate mental health screening instruments and methodologies and to increase access to high-quality mental health services for military and Reserve personnel and their family members.

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Suggested VA Report Language for FY 2006 Appropriations

Below is APA's recommended FY06 appropriations report language regarding support for VA psychological research and health care:

Department of Veterans Affairs:
Medical and Prosthetic Research Account: Psychological Research in the VA: The Committee recognizes the unique and important role played by psychologists in providing care for veterans and in advancing scientific research in areas particularly relevant to veterans, including mental health, physical and psychosocial rehabilitation, substance use and abuse, and aging-related conditions. In light of reports of elevated incidences of suicide, domestic violence and significant mental health problems (particularly trauma-related anxiety disorders, depression and substance use) in post-deployed military and veteran populations, the Committee directs the VA to call upon psychological researchers within the VA to design and begin a longitudinal study of these issues in a cohort of returning servicemembers and veterans within sixty days.

Medical Care Account: The Committee is extremely concerned about reports of elevated incidences of suicide, domestic violence and significant mental health problems (particularly trauma-related anxiety disorders, depression and substance use) among post-deployed military and Reserve personnel and veterans. Therefore, the Committee requests that the Department of Veterans Affairs, in collaboration with the Department of Defense, immediately implement recommendations from internal VA, DoD and Government Accountability Office studies regarding mental health research and services. The Committee directs the VA and DoD to develop appropriate mental health screening instruments and methodologies and to increase access to high-quality mental health services for military and Reserve personnel and their family members.