AACP Newsletter, Volume 7,
Number 2, Spring 1993
The Public Psychiatry Fellowship of Columbia University: A Public-Academic Liaison
The fellowship’s organizing principle is systems theory; supervised work and didactic experiences focus on two major areas: (1) the clinical modalities most effective in public mental health services, and (2) the managerial skills needed to assume a leader ship role in the public sector and make these services work well.
Field placement sites are carefully selected to provide in depth knowledge of how a particular mental health service works and how the psychiatrist as clinician/manager contributes to its effort. The fellowship has carefully developed a list of community mental health agencies from which fellows select a training site. Increasingly, fellows choose to develop new sites designed to meet special interests. In conjunction with a supervisor, who is a responsible professional inside the training site, each fellow negotiates a contract to perform certain duties. The duties usually include participation on a clinical team and a combination of direct patient care, supervisory consultation, administration and program evaluation. Through direct patient care fellows have an opportunity to master the clinical skills specially required by public psychiatrists. These include assertive community treatment, partial hospitalization, psychiatric rehabilitation and psychoeducational multiple family groups. Through supervisory consultation and management experience, fellows have the opportunity to develop themselves as leaders in a team-based clinical setting.
Didactic Seminars provide the systemic framework for the knowledge base necessary to support this work. Using this framework, fellows organize and present their clinical, management, fiscal and program evaluations efforts at the placements sites. The Academic Seminar is a year long comprehensive overview of major topics in public psychiatry, taught by the core faculty. Separate modules cover each of the following: the structure of public psychiatry in the United States, management methods and strategies for public psychiatry, model service programs for adults with severe mental illness, program evaluation, fiscal and regulatory issues, service to special populations (substance abuse, AIDS, homelessness, trauma victims), capitation and other managed care models. Fellows provide written evaluations of each module. In response to this feedback, as well as to incorporate the changing challenges and knowledge base in the field, the curriculum is updated each year, and new modules are constantly being added.
Each week the fellowship is addressed by a guest speaker currently active in the field of public psychiatry. These talks are coordinated with concurrent topics in the Academic Seminar and cover areas of interest in public policy, delivery of services, specialized clinical work and research. Once a month fellows visit a public sector treatment program of special interest in the New York area. These have included Fountain House, FEGS-Altro Workshop, Rikers Island Prison Mental Health Services, Family Court, Heights House (a residence for the homeless), and the Huguenot and Guidance Centers in New Rochelle (a suburban mental health system). The field visits are followed by a discussion evaluating the special significance of that program.
The quality and quantity of applicants to the fellowship has increased steadily, especially over the past five years. Next year’s class reflects this trend: we will have 8-10 fellows, of whom 6-8 are currently chief residents. A recent survey of fellows from the last five years revealed that our graduates continue to rate their experience in the fellowship as crucial to their development as public psychiatrists. Over 90% identify their primary work setting as a public agency (state, federal, CMHC, municipal, public voluntary). Over three-quarters have academic appointments. Almost all work essentially full-time at these sites, and more than one-third have primary management responsibility. This is in sharp contrast to the 1988-89 APA survey in which 45% reported private practice as their primary work site. Our survey confirms that we fulfill our mandate to train psychiatrists committed to public sector work, and is testimony to the vitality of the commitment of young psychiatrists to actively participate in the shaping and delivery of mental health services in the public sector.
Jules Ranz, MD
Program Director
New York, NY
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