Recovery/capabilities oriented psych residencies

[NoNoNoNo]

I realize that a psychiatry residency is not going to be predominantly recovery oriented, but I was wondering if anyone is aware of programs that do teach in this regard. I see some mention of it on the websites of UWashington, MGH/McLean, and Yale. I would like more information on these (or any other) programs that might teach about and/or function - at least partially - from a recovery standpoint. And perhaps any details of how they do so, people doing research in the area, etc.

Thanks in advance.

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[splik]

I don't think you will find any psych residencies that are recovery oriented as sadly social psychiatry is not as big here as it is in europe. much of the social psychiatry research is done by non-psychiatrists or is housed within schools of public health rather than departments of psychiatry. you will find (as you probably already have) that may community mental health centers are using models of recovery/rehabilitation/resilience and so community based psych residencies (cambridge health alliance is the one that springs to mind) might be more up your street, or those that have an emphasis of community psychiatry. That said even academic supercenters that are often thought of as ultra-biological have community mental health clinic affiliates that use the recovery model (WPIC springs to mind here).

 

[OldPsychDoc]

Illness Management and Recovery is the big buzzphrase for our OTs and SWs here on inpatient, so it does behoove one to know a bit about it.

It's probably not going to be a major emphasis of the academic research powerhouses, but if one goes to a clinically-oriented community program, I think you're likely to get the exposure, especially if you pay attention to our interdisciplinary colleagues.

 

[BobA]

My understanding is that most community psychiatry is recovery oriented these days. Also, I think comparing "biological" vs. "recovery" orientated programs creates a false dichotomy. People who are in "recovery" from mental illness often take medication - just of the their own free will. Moreover, a good "biologically" oriented psychiatrist would recognize the limits of their medications (although sadly many do not).

At my own program we have a mix of everything -and the community experience is strongly recovery oriented. There is some research in this area and I will PM you with more info.

I also got a good vibe from the community oriented approach at Cambridge Health Alliance - probably had the strongest community experience of any place I looked at.

 

[dl2dp2]

Illness Management and Recovery is the big buzzphrase for our OTs and SWs here on inpatient, so it does behoove one to know a bit about it.

I'll have to agree with the posters above and I just want to say most of the academic research powerhouses are very "recovery oriented". The recovery model IS the model for community mental health programs country-wide. I'm not sure where you get the idea that people don't teach it during residency. In fact, this is written down as part of the ACGME competency called "systems based practice."

Most of the academic programs also have research in this field, usually under the rubric of "mental health services research." This deals with outcomes, implementation and policy oriented questions in community mental health. There is a Robert Wood Johnson fellowship in this field as well. I would say that this is generally speaking one of the dominant streams of research in psychiatry today.

Biological psychiatry is not at all a dichotomized opposite to a recovery based community mental health model. In fact these two streams of work distribute along a spectrum of translational research (i.e. http://www.utsouthwestern.edu/research/utstar/index.html). This is actually a major new initiative at NIMH in establishing centers of excellence in implementation science in psychiatry.

 

[notdeadyet]

It's probably not going to be a major emphasis of the academic research powerhouses, but if one goes to a clinically-oriented community program, I think you're likely to get the exposure, especially if you pay attention to our interdisciplinary colleagues.

I'd be really curious about the actual differences between "research powerhouses" and "clinically-oriented community programs."

At least at my program, the former seems to be pretty much the latter with a strong research track and a tertiary care psych center. We still spend much of our time at the county hospital and VA.

Are there really "research powerhouses" in which they shy away from clinical community-focused exposure? I'd wonder how they get much valid research.

 

[OldPsychDoc]

I'd be really curious about the actual differences between "research powerhouses" and "clinically-oriented community programs."

At least at my program, the former seems to be pretty much the latter with a strong research track and a tertiary care psych center. We still spend much of our time at the county hospital and VA.

Are there really "research powerhouses" in which they shy away from clinical community-focused exposure? I'd wonder how they get much valid research.

Having trained at the former and worked at the latter, I would say that *my* experience is that at the former there might be a person or group working to research the implementation of "recovery goals" in order to write papers and present stuff at meetings, but that it is not being emphasized in the day to day practice at the main hospital and clinic. At the latter we are attempting to "do it" daily in our team meetings and clinical visits. YMMV.

 

[notdeadyet]

*my* experience is that at the former there might be a person or group working to research the implementation of "recovery goals" in order to write papers and present stuff at meetings, but that it is not being emphasized in the day to day practice at the main hospital and clinic. At the latter we are attempting to "do it" daily in our team meetings and clinical visits. YMMV.

Hmmmm... I wonder if there is a geographic variance on this. I keep getting the impression that the gap between community and academic is more of an issue on the East Coast than out West.

Maybe it's the fact that there seem to be so many programs in closer proximity of one another in the East, making the distinction between community or academic more pronounced. Or maybe it's the fact that the distinction is pretty minimal, since almost all West coast programs are academic, so they're picking up most of the community slack. Or maybe it's hippy left coast attitudes?

Or just maybe just in my head. Always a risk...

 

[billypilgrim37]

Our research powerhouse program is remarkably recovery oriented, but our SMI service line is essentially the county service line. I'd be surprised if there were any tremendous rules of thumb about this. Some programs train "systems psychiatrists." If you use that particular catchphrase during the interview, and the PD has to ask you to clarify, that probably tells you most of what you need to know.

 

[notdeadyet]

Our research powerhouse program is remarkably recovery oriented, but our SMI service line is essentially the county service line. I'd be surprised if there were any tremendous rules of thumb about this. Some programs train "systems psychiatrists." If you use that particular catchphrase during the interview, and the PD has to ask you to clarify, that probably tells you most of what you need to know.

Hmmm... This is probably good fodder for applicants to keep in mind now during interview season.

I notice that a lot of applicants get pulled down the path of wanting to go to a "top residency," often without knowing what that means (evidence: folks talking about wanting to go to an "Ivy League" program in psych. Huh?).

Asking the right questions to determine if the academic research powerhouse neglects clinically-oriented service to community is absolutely vital for many folks. I personally would be banging my head against a table if I ended up somewhere with a fancy name and poor clinical focus.

And I'm sure even the most research-obsessed programs can point out a clinic they run on ____ street for the homeless. The trick is to find out if recovery oriented services is just a catchphrase they throw around or if they have the structure and services already in place that they can point to to show their commitment.

 

[NoNoNoNo]

Having trained at the former and worked at the latter, I would say that *my* experience is that at the former there might be a person or group working to research the implementation of "recovery goals" in order to write papers and present stuff at meetings, but that it is not being emphasized in the day to day practice at the main hospital and clinic. At the latter we are attempting to "do it" daily in our team meetings and clinical visits. YMMV.

Yes, this is essentially the distinction that I'm trying to tease out. (And not between medications and recovery, which I view as complementary to one another.)

 

[NoNoNoNo]

Our research powerhouse program is remarkably recovery oriented, but our SMI service line is essentially the county service line.

I apologize for my ignorance, but can you please explain that a bit more?

 

[NoNoNoNo]

Hmmm... This is probably good fodder for applicants to keep in mind now during interview season.

I notice that a lot of applicants get pulled down the path of wanting to go to a "top residency," often without knowing what that means (evidence: folks talking about wanting to go to an "Ivy League" program in psych. Huh?).

Asking the right questions to determine if the academic research powerhouse neglects clinically-oriented service to community is absolutely vital for many folks. I personally would be banging my head against a table if I ended up somewhere with a fancy name and poor clinical focus.

And I'm sure even the most research-obsessed programs can point out a clinic they run on ____ street for the homeless. The trick is to find out if recovery oriented services is just a catchphrase they throw around or if they have the structure and services already in place that they can point to to show their commitment.

Exactly.

I do think there is a big difference between articulated guidelines and actual day-to-day practices and approaches. I am in a "top" med school at one of the biggest places (quote unquote) for recovery-oriented mental health research (which is what I have also done all of my research in), but I still don't think it's implemented or actually accepted very well among practitioners or trainees. I would say 99% of med students, even residents and some of the community fellows here, that rotate through psychiatry (even community rotations) don't even know what it is. I think there's a difference between doing community mental health and bringing up the term "recovery" - and actually being a capabilities and empowerment focused provider or teacher and thus training residents in it. For example, we all know everyone needs psychotherapy training, but we also all know that there's a large distribution among programs of how such requirements are mandated, taught, and accepted. Anyways, that's why I'm asking the question.

Thank you so much for the responses, everyone.