Training military psychologists to prescribe medicine is a waste of taxpayer money.

That's the conclusion of a General Accounting Office report to Congress this month on the Department of Defense Psychopharmacology Demonstration Project (PDP).

The report, addressed to Senator Strom Thurmond (R-S.C.), chair of the U.S. Senate Armed Services Committee, and Representative Floyd Spence (R-S.C.), chair of the House Committee on National Security, appears to shred the program designed to train psychologists in the military to prescribe.

Costly and unnecessary is how the GAO characterized the program, instigated in 1991 with the backing of Patrick DeLeon, Ph.D., a member of the board of the American Psychological Association and a legislative aide to Senator Daniel Inouye (D-Hawaii), former chair of the Armed Services Committee.

Among other findings, the GAO report noted that the demonstration project, since its inception, has cost more than $6.1 million while just 10 psychologists completed the training program.

The PDP should win a "golden fleece" award for fleecing taxpayers, suggested APA Medical Director Melvin Sabshin, M.D., after hearing the results of the GAO report.

"The $610,000 prescribing psychologist makes the military's $600 toilet seat look like a bargain," he said. "For the $610,000 of taxpayer's money that's been wasted on just one prescribing psychologist, you could send nearly 10 clinical psychologists to medical school to become physicians."

He called the report "a clear, thorough, and dispassionate debunking of the Psychopharmacology Demonstration Project for what it has been all along--a major boondoggle which wasted millions of dollars while potentially jeopardizing appropriate care of military personnel."

Sabshin said he hopes the GAO report will 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," Sabshin said. "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."

APA Director of Government Relations Jay Cutler echoed Sabshin, calling the GAO report a "significant victory for quality patient care."

He added that the report should "send a clear signal to state legislatures across the nation to just say 'No' to those seeking a medical degree by legislative fiat rather than medical education and residency training."

DeLeon, when called to comment on the report, said only that he "no longer handles" the PDP.

A spokesperson for Senator Inouye's office said a "strong point" in the GAO report was the fact that the Department of Defence did succeed in training psychologists to prescribe. However, the fact that the GAO found no need for the prescribing psychologists will make it difficult to justify continuing the program, the spokesperson indicated.

Russ Newman, Ph.D., director of the American Psychological Association Practice Directorate, sharply questioned the validity of the GAO report in an interview with Psychiatric News, and suggested that there should be an investigation of the way it was conducted.

"There was no objectivity to this at all," Newman said.

He refuted both the contention that there are enough psychiatrists in the military, and that the training program was too expensive to warrant continuation.

The GAO report appears to debunk one of the rationales repeatedly put forward by organized psychology for the demonstration project: that the military lacks psychiatrists.

"According to DoD's needs assessment, the Military Health Services System (MHSS) has more psychiatrists to care for. . .patients than needed to meet medical readiness requirements," the GAO report says. "Therefore, the MHSS has no current or upcoming need for clinical psychologists who may prescribe medication. In addition, the cost of producing 10 prescribing psychologists was substantial. Regardless of the cost, spending resources to produce more providers than the MHSS needs to meet its medical readiness requirement is hard to justify. . . .

"Given DoD's readiness requirements, the PDP's substantial cost and questionable benefits, and the project's persistent implementation difficulties, we see no reason to reinstate this demonstration project," the GAO concludes.

A spokesperson for the House National Security Committee told Psychiatric News that the report is the product of a House-Senate compromise two years ago.

At that time, the committee had explicitly terminated the training program in the Defense Department authorization bill, while the Senate's version of the authorization bill was silent on the future of the program.

The final House-Senate conference committee report called for termination of the PDP no later than June 30, 1997, and required that the GAO submit a report to Congress.

The report released just two weeks ago is likely to fuel efforts to terminate the program, the spokesperson indicated.

In background information on the demonstration project, the GAO report also drew a clear distinction between the clinical abilities of psychiatrists and psychologists.

After detailing the rigorous medical school and residency training undergone by psychiatrists, the GAO report notes: "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 when diagnosing a condition. Therefore, they can distinguish between mental conditions with an organic cause, such as schizophrenia and bipolar disorder, and organic conditions, such as diabetes and thyroid disease, which have symptoms that mimic a mental disorder. . . .

"Clinical psychologists, on the other hand, practice psychology, not medicine," the report continues. "Clinical psychologists are trained in theories of human development and behavior, so their general approach to diagnosing and treating mental illness is psychosocial rather than medical."

(Psychiatric News, April 18, 1997)