Our stance on H.R. 1544...

After reviewing the Veterans Mental Health Accessibility Act and data from various journals, we further understand the importance of this bill becoming a law and are in full support.  With research, we have discovered a repetitive theme of an increase prevalence of mental health disorders, including PTSD and depression, among soldiers returning from Operation Iraqi Freedom and Operation Enduring Freedom.   In one study found here, researchers found a continued linear increase in the cumulative prevalence of new mental health diagnoses in veterans who have been home for at least two years.  This suggests that soldiers are still experiencing symptoms, if not an increase in symptoms, of PTSD and depression months to years after they have finished touring.  This is a huge concern and it is imperative that they have immediate access to screenings and mental health care in order to prevent further debilitating symptoms.   If the Veterans Mental Health Accessibility Act becomes a law, veterans can be seen earlier and more readily with a greater range of services and resources to assist them in returning to wellness.

We will work to see that the Veterans Mental Health Accessibility Act is passed.   As mentioned earlier, since this bill is so young and has not moved from the subcommittee on health and there has been little publicity about it.  It important to spread information to the people, especially current soldiers, veterans and their families, so they can become more informed and involved.  We will raise awareness among nursing peers, through this blog and word of mouth, as this issue is related to nursing and the healthcare practice as previously outlined.  The Virginia Nursing Association will also be contacted in hopes that they will participate in the cause and raise awearness among nursing thoughout the state.  We will start our work locally by contacting local newspapers and media in hopes of gaining the people’s attention and sharing our passion for this legislation.  Also, we will contact Virginia state legislators and key stake holders.  This blog will be used as a tool to spread information about the bill and its importance over the internet to populations throughout the nation.  By spreading information and increasing publicity locally and throughout the web people will recognize the prevalence of mental health issues among veterans and the good that this bill will do if passed.  Once the people are talking, hopefully legislators will start to consider the importance as well. 

Key stakeholders and legislators in passing H.R. 1544 include the following people and groups:

1.    Veterans and families of veterans

2.    Department of Veterans Affairs

3.    Representative Steve Driehaus of the 1^st district of Ohio

4.    Subcommittee on Health including these legislators:
Democrats— Chairman Michael H. Michaud (ME), Corrine Brown (FL), Vic Snyder (AR), Harry Teague (NM), Ciro D. Rodriguez (TX), Joe Donnelly (IN), Jerry McNerney (CA), Glenn C. Nye (VA), Deborah L. Halvorson (IL), Thomas S. P. Perriello (VA)
Republicans—Henry E. Brown. Jr. (SC), Cliff Stearns (FL), Jerry Moran (KS), John Boozman (AR), Gus M. Bilirakis (FL), Vern Buchanan (FL)

5.    Fellow nurses and other health care professionals, including the Virginia Nurses Association. 

H.R 1544 Can Change the Lives of Veterans

As previously discussed in the first posting, the primary governmental objective Steve Driehaus is seeking to fulfill is to ensure that through the Veterans Mental Health Accessibility Act, “any veteran who served on active duty in a theater of combat operations during World War II, the Korean conflict, the Vietnam era, the Persian Gulf War, Operations Iraqi Freedom or Enduring Freedom, or any other period of war after the Persian Gulf War, or in combat against a hostile force during a period of hostilities, is eligible for hospital care, medical services, and nursing home care for any mental illness through the Department of Veterans Affairs (VA), notwithstanding insufficient medical evidence to conclude that the mental illness is attributable to such service,”. 

Currently the only mental health services that are exempt from inpatient and outpatient copays are military sexual trauma cases, and related mental health services to PTSD (Post Traumatic Stress Disorder). However, in addition to those services the Department of Veterans Mental Health services encompasses care for all of the following topics: Homelessness, Veterans at Work, Returning Veterans, Substance Abuse, Depression, Women Veterans, and Mental Health Recovery. To receive these comprehensive services, a veteran must be termed as “eligible” or “referred by a physician” for these services. Driehaus’s goal is for veterans to be eligible and receive the rest of these services if they feel they need or want them.

Veterans who are currently receiving care under TRICARE (the health care program serving Uniformed Service members, retirees and their families worldwide, this includes retired service members i.e veterans) may receive mental health care “if they need it”. Veterans may only seek outpatient mental health services without referral for a limit of eight visits. Veterans are also required to receive physician referrals and pre-authorization screening before receiving such mental health services.

The purpose of the Veterans Mental Health Accessibility Act is to ensure that for whatever need or reason veterans require mental health services, they receive it, regardless of previous approval that their illness is “attributable” to the services. With H.R 1544 veterans will not have to have physician referrals or pre-authorization screenings in order to receive eligibility for mental health care services.

Regarding the publicity surrounding this act, in all actuality, there isn’t much. This bill is still only in the Committee Referral stage, the committees it has been referred to include the House of Veterans’ Affairs and House of Veterans’ Affairs Subcommittee on Health; therefore given its young age, it hasn’t been released over several mediums. Most influences come from online media such as Waiting Room USA Magazine-Online Edition. One particular website states that, “No news coverage is found for this bill at this time. This means that this bill has not yet been mentioned on a publicly-searchable news website.”

Potential political influences include the democratic party, as Steve Driehaus (the bill’s representative sponsor) is listed as a moderate democrat, and both Chair of the House of Veterans’ Affairs, Representative Bob Filner, and Chairman of the Subcommittee on Health, Michael Michaud, are both democrats. However, the bill has not moved from the subcommittee on health, so political influence in terms of voting and political parties, is not fully determined at this time. More people and political need to be involved in this bill so that our veterans can get the care that they indefinitely deserve.

This bill is a necessary, key component and important piece of legislation in creating effective changes in the current standards of mental health services provided to veterans, the following will describe it's potential beneficial impact.

The bill is meant to modify our current code, found here. The current code provides the rules of eligibility for a veteran who has suffered physical ailments but has no mention of mental health within the section (1710). There are provisions for "readjustment counseling and related mental health services" as described in section 1712A of the same subchapter, found here. In section 1712A, a veteran is able to receive screening and treatment in an outpatient setting for readjustment counseling and related mental health services. From these two sections we can learn the following: Mental health issues are not being addressed at in-patient care settings. Screening and care is limited to readjustment counseling and related mental health services screening and care is limited to government employed or appointed staff at government facilities.

How do we fix this?

The text of the bill, found here, states that a veteran is, "eligible for hospital care, medical services, and nursing home care under subsection for any mental illness". This recognizes and corrects the following areas: Mental health issues will be treated in short and long term facilities, both in and out-patient, for greater access to care screening and care will not be limited to government resources, further supporting greater access to care screening and care will not be limited to readjustment counseling and related mental services, appreciating the breadth and depth of psychological/mental health illnesses.

What does this mean for the veteran, nurse, and healthcare system?

A veteran no longer has to wait for an assigned health care provider at an assigned facility. The veteran can be seen more readily and with greater resources than before, having access to greater range of services to assist them in returning to wellness. As a nurse we will have access to more resources, both to treat and refer a client towards. We will also have increased access to clients, as additional avenues of receiving veterans will now be open. The health care system will become more flexible and more efficient. With a greater diversity of resources available, a veteran may be treated with care best suited for his or her needs, allowing for efficient distribution of remaining resources to other patients. Flexibility comes both through the financial management, but also the ability to receive and delegate patients and staff wisely.

Our future depends on what we do now, and if we are to improve the wellness of our veterans HR 1544 will give the healthcare system, nurses, and veterans the tools they need to promote better access and management of care, leading to better outcomes for all of our military, and our nation.

Introduction to H.R. 1544

H.R. 1544 The Veterans Mental Health Accessibility Act, introduced by Representative Steve Driehaus in March of 2009, proposes to expand mental health care to retired United States veterans. The bill stipulates that veterans who served on active duty during World War II, the Korean conflict, the Vietnam Era, as well as those who served during and following the Persian Gulf War are eligible to receive hospital care, medical services, and nursing home care for any mental illness.

Many veterans suffer from varying mental illnesses due to the intense conditions to which they are exposed in hostile combat. Current legislation does not provide enough access to mental health services for our veterans. This bill, if passed, would provide for mental health services in various healthcare settings to our veterans.