Feature

An article in this month's Professional Psychology: Research and Practice takes a new look at evaluations of the U.S. Department of Defense (DoD) Psychopharmacology Demonstration Project (PDP), which trained 10 military psychologists to prescribe medications through a two-year program.

In the paper, "Evaluation of the Psychopharmacology Demonstration Project: a retrospective analysis," the article's authors conclude that, although the objectives of the evaluations differed, they validate that the PDP "successfully achieved a primary objective for which it was established by demonstrating that licensed psychologists can be trained to provide safe, high-quality pharmacological care."

The article's authors, Russ Newman, PhD, JD, and Randy Phelps, PhD, of APA's Practice Directorate; Morgan T. Sammons, PhD, and Debra L. Dunivin, PhD, who were among the 10 PDP participants; and Elizabeth A. Cullen of APA's Practice Directorate, look at several independent evaluations of the project:

  • The 1996 Vector Research, Inc. (VRI) report, which concluded that the PDP was not only feasible, but also cost-effective. VRI found that the yearly life-cycle costs per provider were significantly lower for psychologists than psychiatrists, internists and family physicians. Most DoD primary-care physicians, psychologists, clinical social workers and medical beneficiaries supported the project and thought that adding prescribing psychologists would improve the quality of care and access. However, most psychiatrists disagreed.
  • The 1997 U.S. General Accounting Office (GAO) report, which concluded that prescribing psychologists were unnecessary to meet the medical readiness mission of the Military Health Services System, so there was little benefit from the demonstration project. GAO contended that an existing oversupply of military psychiatrists made prescribing psychologists unnecessary. However, critics argued the report was methodologically flawed and there was a critical shortage of psychiatrists.

Despite its findings on military readiness, the GAO did find that the training program was successful in its goal of training already licensed military clinical psychologists to prescribe. However, the report questioned the cost-effectiveness of the PDP.

  • An independent report conducted by APA, which suggested that VRI's estimates of the cost of training psychologists to prescribe were more accurate than the GAO report, and that the program could save the Department of Defense as much as $8.5 million in lower salaries and benefits than psychiatrists over those psychologists' lifetimes.
  • A second GAO report, required by the 1999 National Defense Authorization Act, which focused primarily on the PDP graduates' performance. The report acknowledged that PDP graduates were well-integrated into their treatment facilities and that they were well regarded by supervisors and other providers. This second report focused less on combat readiness, recognizing that psychotropic drugs are generally not the treatment of choice in combat, and, therefore, PDP graduates would have little effect on combat readiness. The report also noted that PDP graduates contributed to peacetime readiness by increasing patient access to care.
  • A 1998 report by the American College of Neuropsychopharmacology (ACNP), which was the most comprehensive study of the PDP. ACNP concluded that PDP graduates "filled critical needs, and performed with excellence wherever they served." Although their medical knowledge was not judged to be comparable with psychiatrists, ACNP evaluators found the graduates "medically safe" with no adverse effects on care. The program had not turned out "minipsychiatrists" or psychiatrist-extenders, as some had feared, but rather "extended psychologists with a value added component prescriptive authority provides," ANCP found.

Because the PDP was a highly politicized program, the importance of demonstrating the feasibility of training psychologists to safely prescribe was often clouded during the project's tenure. Opponents, including organized psychiatry, seized on costs of the program and other issues to advocate for the program's termination.

In addition to concluding that the PDP demonstrated that psychologists can--with the proper training--provide safe and high-quality pharmacological care, the authors conclude that arguments against psychologists prescribing based on the GAO's cost-effectiveness findings are irrelevant because civilians most often pay for their own training. Most importantly, noted the authors, the evaluations provide an empirical basis to refute arguments over the cost of training psychologists to prescribe, concerns about quality of care and patient safety and arguments dismissing the findings as limited to military health care.