Defense Health Care

The Military Health Services System (MHSS) has more psychiatrists than it needs. As a result, GAO questions the military's plan to train psychologists to prescribe drugs for mental conditions, such as depression. MHSS needs no prescribing psychologists or any other additional mental health care providers authorized to prescribe psychotropic medications. Although the Defense Department (DOD) met its goal of training psychologists to prescribe drugs, it faced many difficulties in implementing the Psychopharmacology Demonstration Project. MHSS never had a clear vision of the prescribing psychologists' role, did not meet recruitment goals, and repeatedly changed the curriculum. The program's total cost is about $6.1 million, or $610,000 per prescribing psychologist. GAO cannot conclude that the benefits gained from training prescribing psychologists warrant the cost of the program. Training psychologists to prescribe drugs is not justified because MHSS has no demonstrated need for them, the cost is substantial, and the benefits unclear.

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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