Training In Community Psychiatry Research Articles

The Expert Patient Clinic (QI Project): A Meaningful New Community Psychiatry Training Experience for Medical Students

The Expert Patient Clinic (QI Project): A Meaningful New Community Psychiatry Training Experience for Medical Students

A. Rodney Nurse (1928-2022).

This article memorializes A. Rodney Nurse (1928-2022). Rod was an innovator in the fields of clinical, counseling, assessment, family, and community psychology. Rod was a life fellow of the APA divisions of Family Psychology, Clinical Psychology, and Trauma Psychology and a member of the divisions of Independent Practice, Psychotherapy, and the Society for the Study of Men and Masculinity. He was a life fellow of the Society for Personality Assessment. Rod authored hundreds of articles, chapters, and papers, many with collaborators, including his wife, family psychologist Peggy Thompson. One of his most impactful achievements was getting substance abuse included as an integral component of mental health treatment while assistant director of the Center for Training in Community Psychiatry of the California State Department of Mental Hygiene. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Residents Interested in Public Sector Career Would Benefit From Geriatric Training

Back to table of contents Previous article Next article ProfessionalFull AccessResidents Interested in Public Sector Career Would Benefit From Geriatric TrainingHana Ali, M.D., Melanie Scharrer, M.D.Hana AliSearch for more papers by this author, M.D., Melanie ScharrerSearch for more papers by this author, M.D.Published Online:3 Mar 2021https://doi.org/10.1176/appi.pn.2021.2.31AbstractThe U.S. population is rapidly aging, and many have serious mental illness. Psychiatry residents should consider geriatric training to augment training in community psychiatry.“Do you like it?” Ms. M asked, fluffing her newly permed hair. It did seem unbelievable that several months ago, she had been referred for hospice care. At the time, the patient rarely spoke or ate during her frequent discharges and readmissions to the state geriatric psychiatric hospital and the university hospital nearby. Slowly, through collaboration among specialists from geriatric psychiatry, palliative care, and geriatric primary care, her multiple comorbid conditions were addressed, and her complex psychotropic medication regime was simplified. She experienced a remarkable recovery and was now ready to go on living.Community psychiatrists constantly use the skills acquired during a geriatric psychiatry fellowship, which can allow them to provide more comprehensive care for aging patients with serious mental illness (SMI), most of whom have multiple psychiatric and medical comorbidities.As the nation’s population ages, so too are individuals living with SMI. These individuals have unique needs that fall at the intersection of the subspecialties of public psychiatry and geriatric psychiatry. Today, many older patients with SMI receive care at public mental health clinics where they are cared for by community psychiatrists and in Assertive Community Treatment programs. However, the shortage of geriatric psychiatrists in this country is well known, and more public-sector psychiatrists with expertise in geriatric psychiatry are needed.In the last decade, fellowship programs in public and community psychiatry have gained popularity among psychiatry residents. A survey of psychiatry trainees found that most had a significant level of interest in public psychiatry. Since 2006 the number of public and community psychiatry fellowship programs in the United States has expanded from two to 21 programs, according to the American Association for Community Psychiatry. These programs equip trainees with skills needed to navigate increasingly complex public mental health infrastructures to provide care for individuals living with SMI. To provide more comprehensive and high-quality care for the rapidly aging population in the United States, trainees who intend to work in public mental health clinics will benefit from geriatric psychiatry training and should consider completing a postgraduate fellowship in geriatric psychiatry.Geriatric psychiatry and public psychiatry already overlap significantly. Geriatric psychiatrists care for patients with complex disease presentations that require collaboration with other medical specialists. They work on interdisciplinary teams to navigate complicated behavioral health and social service systems and are often at the forefront of developing innovative systems of care to meet the needs of our nation’s aging population. In many ways, geriatric training is a natural fit for residents interested in working in the public sector.The challenges that excite individuals interested in public and community psychiatry are the same challenges that exist in the field of geriatric psychiatry: working collaboratively with health care professionals in other disciplines; navigating complex health systems; effectively utilizing local, state, and federal resources; and developing other structural interventions to meet the mental health needs of underserved populations. The overlap is clear. Exposing trainees who have an interest in community and public psychiatry to experiences in geriatric mental health can help alleviate the geriatric workforce shortage and ultimately result in better treatment for our aging SMI population. ■To learn more about geriatric training and other opportunities in the field, please visit the American Association for Geriatric Psychiatry (AAGP) website here.Psychiatry residents and medical students are also encouraged to apply to the AAGP Scholars Program. Both authors are alumni of the AAGP Honors Scholars Program.Hana Ali, M.D., is a PGY-4 psychiatry resident at Yale University.Melanie Scharrer, M.D., is a community psychiatrist who recently completed her geriatric psychiatry fellowship training at the University of Wisconsin School of Medicine and Public Health. ISSUES NewArchived

Training in community psychiatry

Training in community psychiatry is an essential aspect of psychiatric education in Europe. Community psychiatry is a branch of psychiatry that focuses on the prevention and treatment of mental illness in the community, with an emphasis on promoting recovery and social inclusion. Training in community psychiatry in Europe typically involves a combination of didactic and clinical experiences, including classroom lectures, group discussions, and supervised practice in community-based mental health services. The curriculum covers topics such as community mental health policy, community-based care, social determinants of mental health, and recovery-oriented approaches to care. The training also emphasizes the importance of inter professional collaboration and the need to work closely with other healthcare professionals, service users, and family members. Overall, training in community psychiatry in Europe is designed to equip psychiatrists with the knowledge, skills, and attitudes necessary to provide high-quality, person-centered care to individuals with mental illness in the community.

Integrated Care: Should It Count as Community Psychiatry Training for Psychiatry Residents?

Psychiatry residents are required to be exposed to community psychiatry. Historically, this occurred in public hospitals or assertive community treatment (ACT) teams. A new model of psychiatric care delivery, integrated care, has become prevalent. While integrated care shares some features with traditional community psychiatry rotations, no research exists to demonstrate if integrated care rotations can accomplish the aims of traditional rotations. This pilot study compared learning outcomes in ACT team rotations versus integrated care rotations. Pre- and post-rotation surveys were disseminated to third-year psychiatry residents (N = 8) who were randomized to complete a rotation with an ACT team or an integrated care team. By rotation end, many in both settings changed how conservative they were in treatment philosophies, but this did not result in a difference between groups. Residents in both groups were satisfied with their rotations. Training in integrated care may be a reasonable alternative to traditional community psychiatry rotations.

Community Psychiatry Tracks for Residents: A Review of Four Programs

Many psychiatry residency graduates end up practicing at least in part in community settings. However, declining funding and other issues prevent many residency programs from offering robust community psychiatry training to all of their residents. Accordingly, some residency programs have developed Community Psychiatry Tracks, with the goal of developing future leaders in public sector psychiatry. We cataloged US psychiatry residency programs offering Community Psychiatry Tracks by reviewing the literature and surveying training directors and members of the American Association of Community Psychiatrists. Authors from each of the four programs found to be actively offering such tracks describe their track curricula, from which we elucidated common and variable elements as well as strengths and weaknesses and then make recommendations for other programs wishing to start a track. A Community Psychiatry Track preliminarily appears to be a well-received way to offer enhanced Community Psychiatry training to interested residents, to recruit medical students to residency programs, to offer opportunities for collaboration between residents and faculty members, and to expand opportunities for scholarly work by residents.

Education and Training in Psychiatry in the U.K.

Recent training and education changes have raised important issues in delivery of psychiatric education at all levels. In this article, the authors describe the current status of mental health education in the training of all doctors and postgraduate training and education in psychiatry in the U.K. The authors explore and describe some of the initiatives that are being used in order to increase exposure to mental health placements in the Foundation Program, and they then describe the existing specific mental health opportunities within general practice and other specialist training programs. After graduation from medical school, a two-year Foundation training program is a must, and, at the end of the first year, trainees become eligible for full registration with the "regulator," the General Medical Council; after finishing the second year, they become eligible to undertake specialist training. Psychiatry training takes up to 6 years, and six specialties are recognized as leading to certificates for completion of training before independent practice. These six specialties are 1) general and community; 2) child and adolescent; 3) medical psychotherapy; 4) forensic psychiatry; 5) psychiatry of old age; and 6) psychiatry of learning disability. Also, three subspecialties-liaison psychiatry, addictions, and rehabilitation-form a part of the training in general and community psychiatry. The authors discuss advantages and disadvantages of such an approach and raise key issues related to ongoing work to improve recruitment, progression, and retention of trainee psychiatrists.

Expanding the Playing Field: Public and Community Psychiatry Fellowship and Beyond

Fellowship training in public and community psychiatry has been shown to both extend career tenure and promote leadership attainment. While starting and sustaining a successful fellowship involves overcoming several hurdles, a successful fellowship can serve as a foundation for developing a viable academic division. Case Western Reserve University has redesigned and expanded its public and community psychiatry fellowship. At the same time, it has retained several fellowship graduates by developing a division of public and community psychiatry with a unique academic identity. This model could serve as a blueprint for other programs looking to establish or expand similar programs.

Community Psychiatry: What Should Future Psychiatrists Learn?

Community psychiatry training is required by all adult psychiatry residency training programs. Unlike other core elements of training, the specific content is not clearly articulated, leaving program design and content up to individual programs. At the same time, the meaning of "community psychiatry" is increasingly in the eye of the beholder; traditional structures and systems have lost funding, services are more diffuse, and the traditional medical model is becoming less valued. In this column we describe an approach to training in community psychiatry that is intended to prepare future psychiatrists for the clinical and systems challenges they will undoubtedly face and that achieves this goal through trainees' caring for an especially vulnerable subpopulation--homeless individuals with severe and persistent mental illness. We describe how this model teaches residents to think simultaneously at both the individual and the systems levels and enables them to understand the critical need to use nontraditional treatment approaches in order to provide comprehensive care for this marginalized population. We believe that this clinical and training paradigm can be replicated and might guide other residency training programs in their approach to teaching community psychiatry.

Progress in Workforce Development Since 2000: Advanced Training Opportunities in Public and Community Psychiatry

A crisis in the behavioral health care workforce has drawn considerable attention from consumers, families, advocates, clinical professionals, and system administrators at local, state, and federal levels in the past decade. Its effects have been felt in the recruitment, retention, and performance of psychiatrists in the public sector, where a focus on biological aspects of illness and efforts to cut costs have made it difficult for public psychiatrists to engage meaningfully in leadership, consultation, prevention, and psychosocial interventions. An array of training opportunities has recently been created to meet the needs of community psychiatrists at various stages of their careers, from psychiatrists just beginning their careers to those who have been working as medical directors for several years. This article describes the development of these initiatives and their impact on public psychiatry in four key areas--training of experienced psychiatrists, ensuring retention of psychiatrists in community programs, providing fellowship training, and creating professional identity and pride. Although these programs constitute only initial steps, opportunities for psychiatrists to obtain advanced training in community psychiatry are much greater now than they were ten years ago. These initiatives will enhance the professional identity of community psychiatrists and provide a solid foundation for future development of public service psychiatry in the behavioral health workforce.

Training residents for community psychiatric practice: the resident perspective.

To capture the views and experiences of psychiatry residents in 5 Canadian training programs with respect to community psychiatric training. We sent a questionnaire regarding respondent demography, career interests, and community psychiatry training experiences to psychiatry residents at 5 training programs in Ontario. We undertook descriptive analyses and frequency comparisons on the returned data. The overall response rate was 48%, with considerable variation between programs. With respect to career planning, respondents indicated highest interest in urban hospital-based practice. An interest in additional community psychiatry training was, however, expressed, particularly by junior residents. Residents' suggestions for improving community psychiatry training included better promotion of training opportunities, improved quality of supervision in community settings, and more didactic teaching. Psychiatry residents are obtaining training experiences in community psychiatry, but objectives and guidelines are quite variable, as is reflected in their understanding of the definition of "community psychiatry." Residents' career paths are still focused on urban hospital-based practice or solo private practice, which likely reflects their prevalent training experiences. There is, however, interest in community psychiatry training. Junior residents may be more open to this type of practice, and curricula should allow more exposure to community psychiatry at this stage of training.

A three-decade perspective on community and public psychiatry training in Oregon.

The public psychiatry training program at Oregon Health Sciences University, established in 1973, educates psychiatric residents to work in community mental health centers and state hospitals. The authors present a brief history of this program, which spans three decades, and describe recent developments in its operation, with special attention to financing, administrative structure, and educational elements. Several program graduates have chosen careers in public-sector work. The program is founded on the principle that just as dollars should follow patients in health care systems, so should residents in training follow patients. Administrative and fiscal arrangements must be flexible to support this mobility.

Training in community psychiatry: new opportunities.

The authors describe the impact on training that accompanied an assignment of senior (PGY-4) residents to work one-half day each week for a six month period at a community-based agency concerned with the care of persons with severe and persistent mental illness who were formerly homeless. As the goals and methods of psychiatric training are rethought and adapt to programmatic shifts and economic pressures, new opportunities open up to move treatment and training to the "front lines" in the community where an innovative therapeutic armamentarium for persons with severe and chronic mental illness is developing.

Suggestions for implementing community psychiatry training in existing residency programs.

To demonstrate how an experience of partnership evolved when a group of psychiatry residents moved beyond the traditional hospital setting and began to question their current training. We describe our experience in the context of the current literature and suggest ways of implementing community psychiatry training in existing residency programs. Principles of community psychiatry--partnership, respect and shared responsibility--are good standards in psychiatric care. Community psychiatry training may be possible in existing resident rotations, although teaching in the community setting may also be of value. Research and clinical work in "community psychiatry" need to be valued. Problems may be enriching if they are resolved collaboratively.

Community psychiatry in Scotland

Several trainees have described their experiences of training in community psychiatry (Lock, 1991; Malcolm, 1989; Naismith, 1989; Shah, 1991). Their reports indicate disadvantages as well as advantages in this type of training but are generally positive.

Community psychiatry training for general psychiatry residents: results of a national survey.

Through its residency training committee, the American Association of Community Psychiatrists (AACP) surveyed residency training programs throughout the country with the goal of discovering what training is currently in place to prepare psychiatrists for work in "community" or "public" settings which serve traditionally underserved populations. The authors summarize the results of the survey and offer suggestions for further steps needed to improve residency training curricula and to address the need for well qualified psychiatrists to choose careers in community psychiatry.

Comments on ?community psychiatry training for general psychiatry residents: Results of a national survey?

Comments on ?community psychiatry training for general psychiatry residents: Results of a national survey?

Response to ?community psychiatry training for general psychiatry residents?

Response to ?community psychiatry training for general psychiatry residents?

Developing a liaison project in the community

It is considered valuable for senior registrars to have experience of liaison with other agencies and of setting up and evaluating projects as part of higher training in community psychiatry (Guthrie, Black & Osborn, 1991; Royal College Of Psychiatrists Working Group, 1990). However, this may not be easy to arrange due to, for example, lack of suitable opportunities and insufficient time for initiating a project and carrying it through. Such projects are often difficult to establish and the trainee may find that a good idea founders on a variety of unexpected problems.

Community Psychiatry Training

Community Psychiatry Training