Public Psychiatry Research Articles

A Discipline Like No Other: Marginalized Autonomy and Institutional Anchors in French Public Psychiatry (1945–2016)

Abstract Research on psychiatry in the United States has shown how, since the 1980s, the discipline has sought to increase its prestige and preserve its jurisdiction by embracing biomedical models of treatment and arguing it is a medical specialty like any other. While this strategy is consistent with what the literature on professions would expect, this paper analyzes an alternative case: French public psychiatry, which has remained in a position of marginalized autonomy, combining low status and economic precarity with state recognition of its specificity. Drawing on Bourdieu’s theory of fields, I analyze how the persistence of specialized psychiatric hospitals in France—most of which have closed in the United States—has shaped the conflict between psychiatrists favoring autonomy and actors in university hospitals and the Ministry of Health seeking to reduce it. These specialized hospitals have functioned as institutional anchors that contribute to maintaining the discipline’s autonomous position in the medical field in three ways: by socializing psychiatrists into viewing themselves as a distinctive branch of medicine, linking psychiatry to powerful actors in the state interested in maintaining the discipline’s distinctive role in social control, and concentrating a population of chronically ill persons not amenable to traditional medical interventions. This analysis expands on the literature on professionals and field theory by emphasizing the role of institutions in structuring the reorganization of jurisdictions and relationships between fields.

Examining the clinical effectiveness of continuation and maintenance electroconvulsive therapy in schizophrenia

ObjectiveThere are few studies that examine the effectiveness of Continuation/Maintenance Electroconvulsive Therapy (C/M-ECT) in schizophrenia, despite the documented effectiveness of acute ECT treatment. We aimed to investigate the clinical effectiveness of C/M-ECT for in-patients with Schizophrenia in a naturalistic setting. We examined the medical records of 46 in-patients who were diagnosed with Schizophrenia and had received C/M-ECT belonging to non-acute extended care service in a public psychiatry hospital in Sydney, Australia. The focus of analysis was on 138 treatment cycles (71 acute only cycles and 67 acute-continuation/maintenance cycles) across 45 subjects. A linear mixed effects model was used to describe the change in clinical global impression-severity (CGI-S) over time 4 time points viz., pre-post acute and pre-post continuation/maintenance ECT. ResultsAcute-only cycles and acute-continuation/maintenance cycles had identical pre- (M = 5, C.I. = 4–6), post-cycle CGI-S scores, and identical CGI-S difference scores (M = 0, C.I. = −1 – 1). Broadly in each continuation/maintenance cycle, we observed an initial sharp decrease in CGI-S scores followed by a logarithmic increase in scores over time, with satisfactory CGI-S score maintenance observed for approximately 6 months. Bitemporal ECT influenced CGI-S across maintenance ECT (p < 0.05) indicating smaller declines in CGI-S scores over time. ConclusionIn schizophrenia, C/M ECT preserves effects on illness severity for at least upto 6 months following an acute course of ECT. Bitemporal ECT vis a vis other electrode positions differentiated clinical severity over time.

State Racial Justice Learning Collaborative Seeks Diverse Public Psychiatry Workforce

State Racial Justice Learning Collaborative Seeks Diverse Public Psychiatry Workforce

APA Foundation Welcomes 2023 Class of Fellows

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Foundation Welcomes 2023 Class of FellowsSearch for more papers by this authorPublished Online:24 May 2023https://doi.org/10.1176/appi.pn.2023.06.7.13The American Psychiatric Association Foundation has announced the names of its 2023 class of fellows. With a total of 116 members, the 2023 class is its largest ever, as well as its most diverse—over 77% of participants self-identify as people of color, 61% as women, and 24% as LGBTQ+.The APA Foundation Resident Fellowship Program complements psychiatry residency training by providing experiential learning, mentorships, and professional development opportunities. Twenty-seven U.S. states and 80 medical institutions are represented in this class.“We couldn’t be more excited to add this impressive class into our community of fellows and fellowship alumni at this critical time in mental health care,” said APA Foundation Executive Director Rawle Andrews Jr., Esq. “This cohort has already proven themselves to be a valuable source of talent and innovation. The future of psychiatry is in good hands.”Each fellow participates in one of nine fellowships on such topics as child and adolescent psychiatry, psychiatric research, and public psychiatry. They will join 61 second-year fellows for a total of 177. ■The names of the fellows. ISSUES NewArchived

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

‘Please Don’t Do This to Us’: TV Show Illustrates Importance of Families in SUD Care of Youth

Obituary: Vale Dr Carlyle Perera: 1938 - 2022: Reflections on a life devoted to public psychiatry.

Obituary: Vale Dr Carlyle Perera: 1938 - 2022: Reflections on a life devoted to public psychiatry.

APA Foundation welcomes its largest class of fellows

The American Psychiatric Association Foundation (APA Foundation) proudly welcomed 116 future psychiatric leaders into the 2023 class of fellows, marking the largest class in its program history, according to an APA news release. The APA Foundation Resident Fellowship Program complements psychiatric residency training by providing experiential learning, mentorships, and professional development opportunities. Twenty‐seven U.S. states and 80 medical institutions are represented in this class. The 2023 class is also the most diverse in the fellowship's history, with over 77% of participants self‐identifying as people of color, 61% as women, and 24% as LGBTQ+. “We couldn't be more excited to add this impressive class into our community of fellows and fellowship alumni at this critical time in mental health care,” said APA Foundation Executive Director Rawle Andrews, Jr., Esq. “This cohort has already proven themselves to be a valuable source of talent and innovation. The future of psychiatry is in good hands.” Each fellow is assigned to one of nine different fellowships, encompassing topics from child and adolescent psychiatry to psychiatric research and public psychiatry. They will join 61 second‐year fellows for a total of 176. “We are looking forward to working with and training these future leaders of our field,” said Vedrana Hodzic, APA Foundation's director of fellowships, mentorship, and medical education, who oversaw the recruitment of this year's class.

Juvenile Delinquency around the World: Public Psychiatry

Delinquency population in the world increased from 18 million to 250 million between 1992 and 2007. The World Health Organization (WHO) reported that approximately 200,000 youth homicides occur among individuals aged between 10 and 29 years old, with the main perpetrators being youths themselves. For many young people today, traditional patterns guiding the relationships and transitions between family, school, and work are being challenged. Lifestyle trajectories are becoming more varied and less predictable. The restructuring of the labor market, extension of the maturity gap, and limitation in the opportunities to become an independent adult are all challenges. About 70% of delinquent youth are affected with the mental disorder, and 1 in 5 suffers from mental illness so severe as to impair their ability to function. Treatments that include professional clinical care, psychopharmacology, and psychotherapy and psychosocial interventions are helpful. The WHO advocates a need to develop a comprehensive guideline to deal with almost every social area with main environmental and socialization processes including family, school, and community to prevent and treat juvenile delinquency.

German Velez, M.D., Appointed RFM Trustee

Back to table of contents Previous article Next article Government & LegalFull AccessGerman Velez, M.D., Appointed RFM TrusteeSearch for more papers by this authorPublished Online:26 Apr 2023https://doi.org/10.1176/appi.pn.2023.05.5.45German Velez, M.D., has been appointed the APA resident-fellow member (RFM) trustee for the 2023-2024 term on APA’s Board of Trustees.Velez attended medical school at the Universidad Militar Nueva Granada in Bogota, Colombia, where he served as a public policy advisor for the city. He is a third-year resident at Boston University Medical Center. He has focused his research on the topics of resilience, systems of care, and health inequities, producing publications on social determinants of child and adolescent mental health and participating in several international youth organizations that promote community well-being through informal education. For example, he presided over the Agora Foundation in Bogota, an organization that develops social, cultural, educational, research, and recreational projects through sports.Velez is the chair of the APA Public Psychiatry Fellowship; a member of the migration work group of the APA Council on Children, Adolescents, and Their Families; and a member of the APA Presidential Workgroup on the Future of Psychiatry. ■ ISSUES NewArchived

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

IMG Track Offers Advice, Counsel, and Guidance for International Graduates

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Clinical and material aspects of public psychiatry in France: The case of professional-user interactions

Clinical and material aspects of public psychiatry in France: The case of professional-user interactions

Altha Stewart, M.D., Honored With Pardes Humanitarian Prize

Altha Stewart, M.D., Honored With Pardes Humanitarian Prize

The proceduralization of relational work: the case of French public psychiatry

L’objectif de cet article est de faire, sur la base d’enquêtes empiriques, un état des lieux de la procéduralisation du travail de soin dans les services psychiatriques pour adultes en France. Les processus de rationalisation procédurale de l’activité se développent en psychiatrie comme dans l’ensemble du travail de relation, depuis les années 1980, mais de manière spécifique, tardivement et en suscitant des polémiques. À partir d’enquêtes qualitatives dans plusieurs pôles de psychiatrie publique, et à l’aide d’une grille de niveaux de procéduralisation, les pratiques les plus touchées par la rationalisation procédurale sont décrites, les facteurs d’acceptation ou de résistance sont identifiés. Des hypothèses peuvent en être inférées pour l’ensemble des métiers relationnels.

Community MH Must Include Care for Incarcerated Individuals, Released Prisoners

Community MH Must Include Care for Incarcerated Individuals, Released Prisoners

An Inclusive Approach to Geriatric Specialization: The Society for Post-Acute and LTC Medicine AMDA Certified Medical Director Program as a Model for Association-based Training

This symposium addresses a critical need to grow the field of geriatric expertise by creating multiple learning options that reach clinicians at all phases of practice. The AAGP Strategic Planning meeting of September 2019 articulated several future goals including 1) Develop our own competency-based certificate program and 2) Offering a pathway to clinical expertise for clinicians (Tampi R, et al 2020). The strategic plan also strongly emphasized partnerships with like-minded organizations. This symposium highlights the success of the AMDA Certified Medical Director (CMD) Program. Dr Meenakshi Patel will discuss how AMDA developed the certification; she will review the core curriculum, the development of the initial certification and the subsequent recertification procedures. She will also discuss the advantages of the certification for other providers (e.g., PCPs, NPs). Discussion will address how new geriatric certification programs may supplement training conducted in traditional post-graduate settings and allow for critical workforce growth. Association-based certifications permit inclusivity for providers who are not able to avail themselves of post-graduate fellowships but wish to gain geriatric expertise. The value of “clinical pathways” to expertise will be discussed and stakeholders will be invited to explore ways for the AAGP to help create more diverse learning pathways in geriatric psychiatrySpeaker Meenakshi Patel will discuss the AMDA CMD certification program. She will review the core curriculum, development of the initial certification and subsequent recertification program.Panelists: Dr. Amita Patel will review an AAGP-based geriatric certification that was in development several years ago under her leadership and may be ready for a revitalized effort.Dr. Schultz will discuss possible targeted certifications (e.g., Geriatric Psychopharmacology) and models such as the AACP Board Certification In Community & Public Psychiatry, endorsed by the APA. Other training models (NIH T32, HRSA-based) will be noted.Dr. Lantz: Will address how an AAGP-sponsored certification may complement traditional post-residency fellowship programs in a productive way that meets growing workforce needs.Dr. Padala will discuss new VA programs to share geriatric expertise in case-based “Ask the Expert” and other on-line training formats. Growth in training programs offered by the VA and other healthcare systems will be discussed.The symposium will include audience discussion to begin a planning process that may include stakeholder input from clinicians, educators, association leaders and staff.

A prospective study of adverse drug reactions of antipsychotic drugs in a tertiary care public psychiatry hospital

A prospective study of adverse drug reactions of antipsychotic drugs in a tertiary care public psychiatry hospital

Conceptual framework of psychiatric care in India: moving from community psychiatry to public psychiatry

Conceptual framework of psychiatric care in India: moving from community psychiatry to public psychiatry

Joseph Raphaël Lalanne (1871-1930), membre de la Société Médico-Psychologique (1901) et médecin chef de l’asile de Maréville et son fils Jean Lalanne (1906-1978), médecin à l’asile des Bas-Foins près de Dinan (Partie II)

J. Lalanne (1906-1978) was born in the Maréville asylum where his father Raphaël Lalanne (1871-1930) worked. After receiving most of his schooling at residential schools in Lectoure and Agen (Gers and Lot-et-Garonne), he earned his bachelor's degree in Nancy (1925). In this town, he started his medical education in the faculty of medicine. Then, J. Lalanne was an intern at the Maréville asylum from November 1930 to July 1936. In 1933, he was a doctor in medicine and a graduate in forensic medicine and psychiatry. Two years later, he passed the competitive examination for the recruitment of physicians in insane establishments in France (1935). After declining two item proposals, he was appointed to the private asylum was used as the psychiatric hospital of Léhon called at the time “Les Bas-Foins”, a short distance from Dinan (Côte-d’Armor). He worked there until his retirement in 1976. His passion for psychiatry led him to create therapeutic activity out-side the hospital before that the psychiatric sectorization was put in place. He practiced the Electro Convulse Therapy with this friend and work colleague Victor Godard (1888-1952) and also with a home-care team. In the Cote-d’Armor Department, he also inaugurated the mental hygiene dispensaries in the Saint-Brieuc, the consultations in the General Hospital (Dinan), in old people's home and the Saint-Brieuc Prison. J. Lalanne succeeded to V. Godard as doctor at the Dinan Rehabilitation School and the Notre-Dame de Guildo annex (1953). In 1975, he was appointed director of clinical education at the University of Rennes. Lalanne codified the rules of the psychosurgery with Daniel Ferey (1898-1956), professor of neurosurgery at Rennes and V. Godard. According to him, it supplanted electroshock, insulin coma and psychoanalysis in the treatment of schizophrenia. J. Lalanne was awarded the Order of Public Health (1947), the Legion of Honor (1950), the Order of Academic Palms (1957) and the Public Health Officer (1958) during his career but he has been above a committed and tenacious psychiatrist, dedicated heart and soul to the Public Psychiatry.

Workforce Development in Public Psychiatry: Impact of the Yale Fellowship.

Workforce Development in Public Psychiatry: Impact of the Yale Fellowship.