During the past quarter-century or so, community behavioral health
organizations (CBHOs) have found it increasingly difficult to recruit or
retain psychiatrists.
Prior to the 1980s, the National Institute of Mental Health provided grants
to train psychiatrists to work in community mental health settings. Since
then, very few psychiatry residency training programs have trained
psychiatrists to work in such settings, and many training programs that
provide marked community and public training experience have been forced to
reduce that portion of their curriculum, David Pollack, M.D., a professor for
public policy at Oregon Health and Science University, said during an
interview. Moreover, there have been very few postgraduate fellowships in
community or public psychiatry, he added.
That's the bad news. The good news, however, is that two different, but
complementary, programs are emerging to fill this need, he reported.
One is the Psychiatric Leadership Development Program (PLDP). It was put
together primarily by Anita Everett, M.D., section director of community and
general psychiatry at Johns Hopkins University, with input and collaboration
from Pollack; Hunter McQuistion, M.D., an associate clinical professor of
psychiatry at Columbia University; and business and public health faculty at
Johns Hopkins University and the National Association of State Mental Health
Program Directors. Kenneth Thompson, M.D., an associate professor of
psychiatry at the University of Pittsburgh and associate director of medical
affairs at the Substance Abuse and Mental Health Services Administration
(SAMHSA) Center for Mental Health Services, has also participated, both as a
mentor/faculty member and in helping secure SAMHSA funding for the first two
years of the project. The program is coordinated by staff from the National
Council for Community Behavioral Healthcare.
The purpose of the PLDP is to train psychiatrists who are CBHO medical
directors to be more effective in their positions. "These
organizations," Pollack explained, "are larger, more complex, and
more businesslike than the community mental health centers of a few years ago
because of the advent of managed care, because of the tightening of resources,
and because staff now have to be much more accountable for their clinical
activities. Furthermore, the organizations have taken on a broader range of
services than just mental health services, including treatment for
co-occurring substance use disorders."
The first group to participate in PLDP—15 physicians, mostly
psychiatrists, from all over the United States—began their leadership
training and quality-improvement guidance in April 2008 and completed it in
December 2008. SAMHSA funded a second round that started last month and will
go for a year.
The second program designed to enhance participation by psychiatrists in
CBHOs is the Community Psychiatric Practice Mentorship Service (CPPMS). It was
developed by Pollack and other members of the board of the American
Association of Community Psychiatrists (AACP). Its purpose is to provide
psychiatrists who are new to working in CBHOs with the management and
leadership skills that will enable them to succeed in these centers.
Specifically, the CPPMS program will send a seasoned community
psychiatrist, selected from a group of mentors recruited by AACP, to a
particular CBHO to improve the management and leadership performance of the
psychiatrists who are new there. The mentor may also provide organizational
consultation on clinical or program issues identified by the CBHO
psychiatrists as particularly important to them—for example,
co-occurring mental disorders, the integration of behavioral health and
primary care, or criminal-justice linkage issues. The consultation will
involve an initial site visit followed by regular consultation meetings at
least several times a month via phone calls, e-mail, or videoconference. The
CBHO will pay the mentoring psychiatrist for his or her mentoring
services.
To date, 14 seasoned community psychiatrists have signed up to be CPPMS
mentors. "We might call them the all-star team of community
psychiatrists," said Pollack. He and his colleagues will now work with
various national organizations, including the National Council for Community
Behavioral Healthcare and the Mental Health Corporation of America, to recruit
CBHOs to purchase the service. They have developed a process to bring together
mentors whose geographic location and areas of expertise match CBHOs'
particular needs.
In essence, these two programs are a "rational and hopeful response
to some of the medical-leadership difficulties facing community-based mental
health programs," Pollack said.
The two programs will be discussed during a workshop at the forthcoming APA
annual meeting titled "Becoming a Public Psychiatry Leader: Mentoring
Models for Everyone, From Residents to Medical Directors." The workshop
will be held on May 18 from 11 a.m. to 12:30 p.m. in Room 226, Mezzanine Level
East, Moscone Center. ▪