Community News
Community Psychiatry Experts Hope Mentorship Will Boost Their Ranks
Psychiatric News
Volume 44 Number 9 page 12-12

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. ▪

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