Defense Health Care:

Need for More Prescribing Psychologists Is Not Adequately Justified

HEHS-97-83: Published: Apr 1, 1997. Publicly Released: Apr 1, 1997.

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Stephen P. Backhus
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Pursuant to a legislative requirement, GAO reviewed the Military Health Services System's (MHSS) Psychopharmacology Demonstration Project (PDP), focusing on the: (1) need for prescribing psychologists in the MHSS; (2) implementation of the PDP; and (3) PDP's costs and benefits.

GAO noted that: (1) the MHSS has more psychiatrists than it needs to meet its current and upcoming readiness requirements, according to GAO's analysis of the Department of Defense's (DOD) health care needs; (2) therefore, the MHSS needs no prescribing psychologists or any other additional mental health care providers authorized to prescribe psychotropic medication; (3) moreover, DOD does not even account for prescribing psychologists when determining its medical readiness needs; (4) although DOD met its goal to train psychologists to prescribe drugs, it faced many difficulties in implementing the PDP; (5) not all of these were resolved; (6) for example, the MHSS never had a clear vision of the prescribing psychologist's role, did not meet recruitment goals, and repeatedly changed the curriculum; (7) consequently, the American College of Neuropsychopharmacology recommended in 1995 that unless these issues were addressed, the PDP should end; (8) the total cost of the PDP, from start-up through the date the last participants will complete the program, is about $6.1 million or about $610,000 per prescribing psychologist, according to GAO's estimate; (9) ultimately, the PDP will have added 10 mental health care providers who can prescribe drugs to an MHSS that already has a surplus of psychiatrists; (10) opinions differ on the effect of adding these prescribing psychologists to the MHSS concerning such issues as quality of care and collaboration between psychologists and physicians; (11) without a clear purpose or role for prescribing psychologists and given the uncertainty about the extent to which they would replace higher cost providers, GAO cannot conclude that the benefits gained from training prescribing psychologists warrant the costs of the PDP; and (12) training psychologists to prescribe medication is not adequately justified because the MHSS has no demonstrated need for them, the cost is substantial, and the benefits are uncertain.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: Before action on this recommendation could have been initiated, a determination would have to be made that DOD needed prescribing psychologists to meet its medical readiness requirement. Also, the Congress would have to authorize or mandate DOD to reinstate the Psychopharmacology Demonstration Project (PDP). The reauthorization would have had directed DOD to follow the requirements stated in GAO's recommendation. However, to date, neither the Congress nor DOD has determined that prescribing psychologists are needed to meet DOD's medical readiness requirement. Further, a meeting with the staff of the Senate Armed Services Committee, disclosed that this report was used by the Committee as a basis for the decision not to reauthorize PDP. The Subcommittee's senior staff member indicated that there is no interest on the part of the Committee to reauthorize this program in the future.

    Matter: In the future, should prescribing psychologists be needed to meet DOD's medical readiness requirements, the Congress should require DOD to: (1) clearly demonstrate that the use of those MHSS psychologists who have been trained to prescribe has resulted in savings; (2) clearly define a prescribing psychologist's role and scope of practice in the MHSS compared with other psychologists and psychiatrists; (3) design a curriculum appropriate to this role and scope of practice; and (4) determine the need for and the level of supervision that prescribing psychologists require.


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