Public Psychiatry

[shinystar2014]

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Besides NYU and CHA what are some of the programs with strong public psychiatry exposure/training that you think of?

 

[notdeadyet]

UCLA Harbor and UCSF are the names of two strong residency program with an emphasis on public psychiatry on the West coast. UCSF also has a public psychiatry fellowship.

 

[tishage]

San Mateo County also has a strong community psychiatry program, located in Northern CA

 

[SmallBird]

I think that Yale is a good place for someone with an interest in public psychiatry, as you can choose to do some of your PGY-2 year, and all of your PGY-3 and PGY-4 year at the Connecticut Mental Health Center, which is a great facility that treats uninsured patients. There is also a public psychiatry fellowship program, and a lot of public psychiatry research happening (such as through the Program for Recovery and Community Health, or the Divsion of Prevention and Community Research). Depending on your specific interests within public psychiatry, there are also a lot of opportunities for working on transcultural psychiatry, with a large Hispanic Clinic that also does both clinical work and research (they were one of the major sites piloting the DSM-5 cultural formulation).

 

[shan564]

I can't speak for other places, but here in PGY1 at WashU in St. Louis, a majority of my patients are uninsured or are on some sort of public assistance program. We also do several rotations in PGY2 in purely public facilities (drug/alcohol rehab, day hospital, etc.), as well as a couple of rotations in purely private facilities (eating disorders, etc.), with the rest of the rotations at our main monolith hospital, which is full of public patients in psych. PGY3 is spent almost exclusively seeing public patients in clinic. There's no fellowship in public psychiatry, but I suspect that this is because you get so much exposure during residency. Also, this is probably one of the few programs where you go to court as an expert witness starting in PGY1.

 

[splik]

well what do you mean by public psychiatry? you could have VERY different experiences at the two places you mentioned - the Cambridge Hospital is different to Bellevue and the training experience is different.

There is a difference between seeing a bunch of homeless uninsured patients and working in non-academic outpatient community mental health centers for example. If you are interested in public psychiatry, I would suggest looking for programs that give you exposure to community mental health centers rather than just ivory towers (which provide a different sort of community care).

I will also add UCSD and UW on the west coast. They both have community psychiatry fellowships. The latter has lots of inpatient and outpatient time at a county setting, community VA experiences, multiple elective opportunities at different community mental health centers, as well as multiple collaborative care and primary care consultation opportunities and a community leadership track.

 

[notdeadyet]

There is a difference between seeing a bunch of homeless uninsured patients and working in non-academic outpatient community mental health centers for example. If you are interested in public psychiatry, I would suggest looking for programs that give you exposure to community mental health centers rather than just ivory towers (which provide a different sort of community care).

This is a fine point. Going to big name programs that see primarily insured patients and operate mostly as psychiatric tertiary care is not the ideal. But going to a community program that focuses on just providing services to their county is not ideal either. I would target academic programs (which focus on training leaders for the field) that emphasize community psychiatry, and if they don't have a primary training site that is a county hospital, they're mostly aspirational. You want to roll-up your sleeves and work with the in-need populations, but you also want to do it with national thought leaders (otherwise you may as well train anywhere and pick up a county job after residency). The ideal is forest and trees.

 

[JHusky86]

I'm a current resident at San Mateo, and the posters above make some great points. My experience is that it depends on what, exactly, your interest in public or community psychiatry is. If you are interested in learning about the delivery of mental health care to the underserved/underinsured population, then a community program such as San Mateo (there are several others on the west coast as well) might be a better fit. The treatment of the severely mentally ill who lack resources involves a great deal of community outreach, home visits, substance use treatments, coordination of care with social workers and community workers, etc, and it is difficult to grow comfortable with this sort of approach without experiencing it.

That said, getting to see these patients -only- in an inpatient center (which is the case at some residencies) limits the scope of your interaction. By and large, in an inpatient setting, you see people in acute crisis, and your focus is purely on stabilization and attempting to establish some sort of connection to outpatient services. A large portion of the 'work' of community psychiatry is done on an outpatient basis, and so it is important that there be a strong outpatient component to any public psychiatry/community psychiatry program.

Hope this is helpful! I'd be happy to try to help further if you have any other questions!

 

[FrasierMD]

I am also very interested in public service psychiatry. I'm very impressed with UCSF and Yale from what I've researched thus far. Can folks speak to public service psych at the boston programs- MGH, CHA, and Longwood in particular?

 

[Soggun]

I am also very interested in public service psychiatry. I'm very impressed with UCSF and Yale from what I've researched thus far. Can folks speak to public service psych at the boston programs- MGH, CHA, and Longwood in particular?

Although not where I see my career headed personally, I believe the public psychiatry training at Longwood is exceptional. We have a ton of exposure to Mass Mental Health Center (choice between CBT or DBT partial hospital programs during 2nd year, 6 months of outpatient work during 3rd year including choices between adult outpatient, premorbid psychotic disorders, post-first break psychotic disorders, DBT, or homeless outreach, and options to do either a chiefship at MMHC or a selective in homeless outreach [and probably other selective options I'm blanking on] during 4th year). MMHC, by and large, serves an extremely psychiatrically ill portion of the population and provides a great way to learn about not just how to manage these patients' illnesses in the room with them but also how to coordinate care within a system that includes many group homes, homeless shelters, community support teams, clubhouses, etc.

Anyway, not having experience with MGH and CHA, I'll leave those programs for others to comment on, but I'd stack our public psychiatry training against any other program's.

 

[Doctor Bagel]

OHSU historically has a strong community psychiatry emphasis. We have a built in community psychiatry rotation for half of third year with the ability to rotate in various community mental health locations and a half day of community didactics for that portion of the curriculum. We've had a few residents recently who've also gotten the APA public psychiatry fellowship.