GAO Condemns DoD "Prescribing Psychologists"

Article ID: 2170

Released: 10-Apr-1997 12:00 AM EDT

Source Newsroom: American Psychiatric Association (APA)

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NEWS RELEASE American Psychiatric Association
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FOR IMMEDIATE RELEASE
Contact:
Jay Cutler (202) 682-6142
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Gus Cervini (202) 682-6142

GAO CONDEMNATION OF DEFENSE DEPARTMENT "PRESCRIBING PSYCHOLOGIST" PROGRAM DRAWS APA PRAISE

An independent Government Accounting Office report condemning the Department of Defense program to train psychologists to prescribe medication reinforces the American Psychiatric Association's long-standing opposition to the program.

"Training psychologists to prescribe medication is not adequately justified because the MHSS (Military Health Services System) has no demonstrated need for them, the cost is substantial, and the benefits uncertain," says the watchdog Government Accounting Office in an April 1 report critical of the controversial Department of Defense program. APA Medical Director Melvin Sabshin, M.D., called the report "a clear, thorough, and dispassionate debunking of the Psychopharmacology Demonstration Project (PDP) for what it has been all along: a major boondoggle which wasted millions of taxpayer dollars while potentially jeopardizing appropriate care of military personnel."

Sabshin noted that, according to the GAO evaluation, DoD spent $6.1 million or about $610,000 for each of the ten "prescribing psychologists" in the program.

In its blunt assessment of the PDP, the GAO found that there is no shortage of psychiatrists to justify training psychologists to prescribe drugs. "The MHSS has more psychiatrists than it needs to meet its current and upcoming readiness requirements...Therefore, the MHSS needs no prescribing psychologists or any other additional mental health providers authorized to prescribe psychotropic medication."

The project began in 1991 at the instigation of Senator Daniel Inouye (D-HI), then chair of the Senate Committee on Armed Services.

In February, 1996, President Clinton signed a law terminating the program effective June 30. Despite a major public relations campaign to revive the PDP now being waged by organized psychology, the GAO study concluded that there is "no reason to reinstate the demonstration project..."

"We believe the GAO findings completely validate last year's decision by Congress and the President to terminate the PDP," said Sabshin. "There is absolutely no justification for reviving this experiment."

Among the GAO report's other major findings:

. . . "None of the services needs additional mental health providers capable of prescribing
medications to meet either current or upcoming medical readiness requirements

. . . Each service has more than enough psychiatrists, as well as clinical psychologists, to care for its anticipated wartime psychiatric caseload. Given this surplus, spending resources to provide psychologists with additional skills does not seem justified."

. . . "Because psychiatrists practice medicine, they can diagnose organic as well as mental conditions and treat each with medication. They consider a full range of possible organic causes for abnormal behavior

. . . Therefore they can distinguish between mental conditions with an organic cause . . . and organic conditions which have symptoms that mimic a mental disorder. Organic mental disorders are best treated through a combination of medication and psychotherapy . . ."

. . . In contrast, "Because medical training is not required to practice clinical psychology, psychologists are not qualified to prescribe medication . . . Clinical psychologists practice
psychology, not medicine."

. . . ."Psychologists cannot be substituted for psychiatrists . . . Even if trained to prescribe drugs, psychologists are not as equipped as psychiatrists to distinguish between actual combat stress and certain neurological disorders that appear to be combat stress. Psychiatrists are also better able to treat more severe or complicated combat stress cases."

. . . . "The total cost of the PDP . . . is about $6.1 million, or about $610,000 per prescribing
psychologist . . ."

In the wake of the GAO findings, Sabshin said the PDP ought to win a "golden fleece" award for fleecing taxpayers: "The $610,000 prescribing psychologist makes the military's $600 toilet seat look like a bargain. For the $610,000 of taxpayers' money that's been wasted on just one prescribing psychologist, you could send nearly 10 clinical psychologists to medical school to become physicians."

Noting that organized psychology continues to press for prescribing privileges, Sabshin said that he expected the GAO report would help settle the issue of psychologist prescribing once and for all: "The ill-founded efforts by some psychologists to legislate prescribing privileges and bypass appropriate medical education and training has been enormously divisive. Psychiatry and psychology need to work together in common purpose to end discrimination against our patients. It's my hope that the GAO Report will hasten that end by highlighting the baseless efforts of a few psychologists to become medical doctors by legislative fiat."

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The American Psychiatric Association is a national medical speciality society, founded in 1844, whose 42,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.


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