Statement of Linda Boone, Executive Director of the National Coalition for Homeless Veterans, before the United States Presidential New Freedom Commission on Mental Health. Washington, DC.

Tonight in America, more than 275,000 veterans will sleep under bridges, in alleys and abandoned buildings because they have no home. They are this nation's forgotten heroes ? men and women who once proudly served in a military uniform. Nearly 90% of them earned honorable discharges. Three of every four served during a period of armed conflict. Though only 9% of the current U.S. population has served in the armed forces, 23% of the homeless people in this country are veterans. The Department of Veterans Affairs estimates that more than 500,000 veterans experience homelessness at some time during the year.

Public Law 104-262 enacted in October 1996, required the VA to "maintain capacity to provide for specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the Department…."

However the VA has not maintained that capacity to serve these veterans and PL107-95 enacted in December 2001, is even more specific………….how will the VA respond? The reductions and curtailment of services are drastic in mental health and substance abuse disorder programs which concerns the National Coalition for Homeless Veterans (NCHV).

In the December 1999 report issued by the Interagency Council on the Homeless, it found that 76% of homeless veterans have a mental health and/or substance abuse issue. It is shocking to hear from the VA Advisory Committee on Care of Veterans with Serious Mental Illness (SMI) an estimate that over $600 million has been diverted from mental health programs over the last few years. During a period in which VA medical care appropriations increased 30%, the SMI Committee reports that 18 of the 22 regional networks showed a decline in inflation-adjusted dollars for the care of veterans with serious mental illness.

An April 2000 GAO (HEHS-00-57) report concluded that between 1996-1998 inpatient services to serious mental ill patients decreased by 19%. Substance abuse disorder inpatient treatment was reportedly decreased by 41% in the same GAO report.

Many communities do not have adequate resources to support this increase in demand that had once been provided by the VA and homeless veterans need safe and sober housing to go to when receiving treatment in an out patient model.

Additionally this GAO report concluded that VA managers are not specifically accountable for special disability programs and that responsibility for maintaining capacity is fragmented among organizational units. NCHV is concerned that the funding Congress intends to have used serving this vulnerable population has been redirected and VA accountability is lacking and veterans are suffering as a result. How many veterans are not receiving assistance? How many get turned away or virtually turned away by not having services available?

The VA has expressed concern that PL107-95 is an unfunded mandate and they do not have the resources to implement its provisions. In reviewing the history of VHA budget requests compared to Congressional appropriations since 1997, each year Congress has provided VHA more funding than they requested. So what is the real issue? Perhaps the internal priorities of the VA need adjustment. Since VHA resists having special purpose funding requirements made on the Department in order for them to have maximum flexibility to determine internal and local regional network priorities, even if funds were appropriated by Congress specific for homeless programs how would the money be internally allocated?

What types of veterans should the VA be serving? In PL104-262 it specified seven priority categories. At the time of this law's enactment, priority 7 veterans (non-service connected and typically higher income) made up 3% of those who used the health care system. The VA's budget submission for FY03 discloses that priority 7 veterans are expected to make up 33% of VA enrollees. These veterans often have other health care coverage but the VA is redirecting resources to serve these veterans (primarily prescription drug services). While VA mental health and substance abuse programs, which overwhelmingly serve service connected and low income veterans, have suffered severe cost cutting. The VA has allowed a redirection of funds to non-mental health care in clear violation of the capacity law. It is shocking to realize the VA has diminished its support to veterans who are most vulnerable and most in need and in doing so has altered its mission to serve an ever-growing number of those with the lowest claim to VA care.

The National Coalition for Homeless Veterans asks this Commission to make recommendations that will hold the Department of Veterans Affairs accountable for ensuring mental health services are available to veterans in a manner similar to primary care.

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