Vets' Mental Health Bill Becomes Law

The Senate on September 27 passed what may be the first ever veterans' mental health bill. The Joshua Omvig Veterans' Suicide Prevention Act is named after a young man who came home from Operation Iraqi Freedom with posttraumatic stress disorder (PTSD) and was unable to get mental health care from the Department of Veterans Affairs (VA). A member of the US Army Reserve's 339th Military Police Company from Davenport, Iowa, Omvig took his life in the driveway of his parents' home with his mother looking on in horror from the front window.

The House had passed a slightly different version of the bill on March 21 by a vote of 423-0, but it subsequently accepted the Senate version and sent it on to President Bush, who signed it into law on November 5.

The Omvigs' story was, sadly, only one of a number that were told on the floors of the House and Senate when HR 327 came up for a vote. Sen Tom Coburn (R, Okla) forced the Senate to strip 2 provisions from the bill. One would have required all veterans coming into a VA medical facility for any medical checkup to receive a mental health assessment. The other would have required the VA to track veterans who received mental health care. "Veterans who need assistance will receive it, but the bill will not force veterans to undergo mental screening when they seek routine care," Coburn said. "I'm also pleased that changes in the legislation will help protect the privacy of veterans' medical records and prevent the unnecessary tracking of veterans."

The requirements left in the Omvig bill include mandatory training on suicide risk factors and crisis response protocols for every VA health professional and outside contractor who comes in contact with veterans. Each VA medical facility will be required to designate a suicide prevention counselor to work with local emergency departments, police departments, mental health organizations, and veterans' service organizations to engage in outreach and to improve the coordination of mental health care to veterans.

The bill mandates that the VA provide mental health care availability to veterans on a 24-hour basis. It also requires the VA to set up a peer support counseling program, under which veterans shall be permitted to volunteer as peer counselors to assist other veterans with issues related to mental health and readjustment and to conduct outreach to veterans and the families of veterans. The Omvig bill does not authorize any additional funding for the VA to carry out these mandates.

During debate on the House floor in March, Rep Jeff Miller (R, Fla) claimed that "the VA is already fulfilling many of the requirements of HR 327."

Two bills in the Senate would go further than the Omvig bill. The Veterans Traumatic Brain Injury Rehabilitation Act of 2007 (S 1233) requires the VA to provide a veteran with a "preliminary mental health evaluation as soon as practicable, but not later than 30 days after such request." That bill passed the Senate Veterans' Affairs Committee on August 29. The House version passed by a vote of 421-0 in March; however, it does not include the mental health screening provision.

The chairman of the Veterans' Affairs Committee, Sen Daniel Akaka (D, Hawaii), introduced a bill (S 2162) on October 15 that has a number of mental health components and, equally important, accompanying funding authorizations. There would be a new mental health services grant program offering funds to VA facilities for programs ranging from increasing weekend and evening hours to creating programs that encourage urgent care physicians-who are often gateways for new patients-to quickly refer those whom they believe may have a mental health disorder. The legislation would require the VA Secretary to designate 6 inpatient facilities to provide recovery services for veterans with comorbid PTSD and substance use disorders. The legislation would also require a comprehensive review of the VA's residential mental health facilities.

In a statement to Psychiatric Times, Akaka said: "S 2162 will improve VA mental health care by ensuring better care and a better understanding of current practices. It will also set mental health care standards and encourage innovation such as concurrent treatment for mental illness and substance abuse as necessary."

Postpartum Depression Bill Also Likely to Pass

Given the House's 382-3 vote in favor of additional funding of services for women with postpartum depression, it is highly likely the Senate, too, will pass the Melanie Blocker-Stokes Postpartum Depression Research and Care Act (HR 20). The House passed the bill on October 15. The bill uses fairly weak language, however. In its section on research, it says the director of NIMH is "encouraged to continue" current efforts.

The bill also establishes a new federal grant program and authorizes $3 million annually for the Department of Health and Human Services. The money would go to "projects for the establishment, operation, and coordination of effective and cost-efficient systems for the delivery of essential services to individuals with postpartum depression or postpartum psychosis." A top priority of those systems would be services for the diagnosis and management of postpartum conditions. Congress would have to appropriate money for this separately.