Last month's General Accounting Office report criticizing the program to train military psychologists to prescribe medication received a powerful echo from past APA President Jerry Wiener, M.D.

Testifying before the Subcommittee on National Security Appropriations of the House Committee on Appropriations, Wiener said the GAO report should put the Psychopharmacology Demonstration Project (PDP) in the grave for good.

Wiener emphasized that the project was the brainchild of Patrick DeLeon, Ph.D., legislative aide to Senator Daniel Inouye (D-Hawaii) and a member of the board of trustees of the American Psychological Association.

"The report is a clear, thorough, and dispassionate examination and analysis of the PDP and shows that the program is exactly what APA has been saying since the program's inception," Wiener told the subcommittee. "It is a major boondoggle which was never needed and never requested, except by one powerful Senate aide who happens to be a psychologist--which has wasted millions of taxpayer dollars while putting the care of military personnel and their families at risk.

"It was a lose-lose program from the beginning," Wiener concluded.

Yet Wiener noted that organized psychology has already mounted a concerted lobbying effort to reinstate the program.

"[A]s you each may be all too aware, a major lobbying and advertising campaign is being waged to have Congress reinstate this costly and needless program, which from its inception was only a sad monument to a psychologist's wish to be a physician," Wiener told the subcommittee members. "Reinstatement would fly in the face of the findings of the federal government's own independent watchdog group and would perpetuate the public's perception that the military spends millions of dollars on personal privileges and needless programs.

"APA urges that no funding be provided to continue any program to train clinical psychologists to prescribe medications," he said.

Wiener's remarks underscored the findings of the GAO, which appeared to shred the credibility of the training program on every count (Psychiatric News, April 18).

The GAO noted, as did Wiener in his testimony, that the program to train military psychologists to prescribe cost more than $6 million since its inception in 1991 and has produced only 10 graduates. At the same time, the report found that there is no need for additional professionals with prescribing authority in any of the services.

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

Wiener also warned the congressional panel about pitfalls for care of the mentally ill in the military as the armed forces move to managed care.

"For psychiatry, more than other areas of medicine, managed care systems pose a number of additional barriers for service personnel and their dependents who need clinical care for mental illness," Wiener said. "While managed care systems require cost containment and generate savings on the part of the insurer, these benefits require limiting access to quality mental health care. We know that the financial incentives lead to denial and underprovision of services, deterioration of the quality of services, and subsequent adverse effects on patient management and health."

Wiener especially cited what he called "arbitrary limits" on psychotherapy in the military's managed health care system, and he stressed the importance of including a "point-of-service" option in the military's menu of health care plans.

(Psychiatric News, May 16, 1997)