VA Testimony of Dennis Lewis before Congress on August 17, 2007

United States Department of Veterans Affairs

STATEMENT OF
DENNIS M. LEWIS, FACHE
NETWORK DIRECTOR, VISN 20
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE
SENATE VETERANS AFFAIRS COMMITTEE

August 17, 2007

Good morning Senator Murray. Thank you for the opportunity to be here today to discuss the Department of Veterans Affairs ( VA) Northwest Health Network and the mental health services we are honored to provide our nation's veterans.

Veterans Integrated Service Network ( VISN) 20 is fortunate to employ some of the most respected mental health professionals in the country, a number of whom have joined us today. Through their efforts, and those of a cadre of equally dedicated staff, we have expanded mental health capacity and programs tremendously in recent years. In fact, since fiscal year ( FY) 2005, we have increased mental health program staffing by over 50 percent to a total of 125 positions.

Sixty-three of these positions have been added in Washington State, and include psychiatrists, psychologists, registered nurses and nurse practitioners, social workers, rehabilitation specialists and suicide prevention coordinators. Throughout the VISN, these additions have allowed us to improve coordination care delivery in the following program areas: Post Traumatic Stress Disorder ( PTSD); Substance Abuse; Mental Health/Primary Care Integration; Homeless programs; the evaluation and treatment of Traumatic Brain Injury and the re-entry of incarcerated veterans. In all, 40 new initiatives, supported by over $4 million in enhanced funding, have been introduced in VISN 20's Washington facilities since FY 2005.

To achieve our goal of increasing access wherever possible, Mental Health services have also been expanded at each of the VISN's 23 Community Based Outpatient Clinics ( CBOCs) (9 of which are in Washington). In FY 2006, VISN 20 was #1 in VHA for mental health access in CBOCs, achieving 100 percent of Department goals.

VISN 20 is also a national leader in Care Coordination and Telehealth, serving almost 1,700 veterans, including 792 in Washington, with the latest technology. We have also introduced tele-mental health at close to half of our CBOCs, reaching into homes and community clinics, allowing us to evaluate and follow patients without them having to travel long distances. This treatment method is especially effective in rural areas, and one we will continue to expand.

Throughout VHA, and certainly in the Northwest, there is a sense of urgency in reaching out to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans, engaging them in their care, screening them for mental health conditions and making diagnoses when appropriate. Through the end of FY 2006, VISN 20 facilities had treated 12,164 OEF/OIF service members and veterans, approximately 68 percent of whom were seen in Washington facilities. In FY 2006, 2,849 veterans were seen in Washington, with 24 percent of whom were diagnosed with PTSD.

For these veterans, we have the opportunity to apply what has been learned, through research and clinical experience, about the identification and treatment of mental health conditions; to intervene early; and to work to prevent the chronic or persistent courses of illness that have occurred in veterans of prior eras. Generational differences are also being taken into account as VISN 20 delivers 21st century care to 21st century combat veterans. Many are young, many have young families, and vast numbers have had traumatic experiences on the battlefield.

We have been aggressive in our outreach efforts to these soldiers, participating in out-briefings and making individual contact with those identified by DoD as injured. As early as 2004, the VA Puget Sound Health Care System pioneered a collaborative effort with 8 state agencies - including DoD, the State of Washington and other state, Federal and community entities - creating a Memorandum of Understanding focused on coordinating services for returning veterans. These efforts have now been duplicated in Oregon and Idaho with much success. Our medical centers also actively collaborate with state National Guard and Reserve components to ensure that no returning soldier slips through the cracks. We are also working hard to reduce the stigma associated with receiving mental health treatment.

In 2005, VA Puget Sound activated a Deployment Health Clinic, an effort now being modeled across the system. The Deployment Health Clinic consists of an integrated combat care team-with a social worker and both primary and mental health care providers who serve as entry points for returning veterans. All other VISN 20 facilities are developing integrated teams as post-combat care clinical "experts."

To assist veterans and active duty personnel facing lasting disabilities due to Polytrauma and Traumatic Brain Injury, VISN 20 has established a regional Polytrauma System of Care. Puget Sound has been designated the Polytrauma site, working directly with VA's Polytrauma Rehabilitation Center in Palo Alto. Our Boise and Portland facilities have established Polytrauma Support Clinic Teams, and each of our facilities have a designated Polytrauma point of contact. This combined system of care consists of doctors, therapists, nurses, case workers and other experts who work closely with patients, and their families, to provide individualized care and the highest possible level of recovery and functioning, as close to home as possible.

The Vet Center program also provides readjustment counseling and community outreach to combat veterans and their families. Several of these Centers are within our geographical area, and by the end of 2007, a new Center will open in Everett, Washington.

In summary, VISN 20 is committed to providing world class mental health care to all veterans, regardless of the era in which they served. We remain keenly aware of the importance of our mission and the challenges which lie ahead. I believe that our current and planned efforts go a long way toward meeting this challenge, I am extremely proud of our staff, and I thank you again for your continued support.

This concludes my statement. At this time I would be pleased to answer any questions you may have.