Recommendations for Primary Care Provided by Psychiatrists.

Recent studies have shown that people with severe mental illness have a dramatically lower life expectancy than the general population. Psychiatrists have not traditionally been very attentive to or involved with physical health issues and there has been growing emphasis on integrated care for physical and mental health and access to primary care for all members of the population. This paper examines the role of psychiatrists in the provision of primary care to the patients they treat. Some recommendations are offered for their involvement in the provision of primary care at three levels of complexity: Level 1--Universal Basic Psychiatric Primary Care; Level 2--Enhanced Psychiatric Primary Care; and Level 3--Fully Integrated Primary Care and Psychiatric Management. Some of the obstacles to the provision of primary care by psychiatrists are considered along with some suggestions for overcoming them.

A community engaged curriculum for public service psychiatry fellowship training.

Transforming the mental health system into a recovery oriented, integrated system of care requires a psychiatric work force that understands the relationship between recovery processes and community living. Fellowship programs in public and community psychiatry contribute to this transformation by educating psychiatrists about recovery, system dynamics, leadership, effective administration and community involvement. This paper describes a novel approach to fellowship programming that accomplishes these aims through an organizational strategy that emphasizes community engagement. After describing the administrative background for the program, we describe how the content curriculum and teaching process focus on the engagement of community members-both service users and service providers-as participating faculty. The faculty includes over 100 consumers, family members, advocacy group representatives, clinicians, and administrators. We present evaluation data obtained from 45 of the 100 community and university faculty who participated in the first 2 years' of the fellowship and conclude with a critique and recommendations for further progress in community engaged fellowship training.

Public psychiatry fellowships: a developing network of public-academic collaborations.

In response to the expanding public behavioral health care system, a network of 15 public-community psychiatry fellowships has developed over the past six years. The fellowship directors meet yearly to sustain and develop fellowships to recruit and retain psychiatrists in the public sector. This column describes five types of public-academic collaborations on which the fellowships are based. The collaborations focus on structural and fiscal arrangements; recruitment and retention; program evaluation, program research, and policy; primary care integration; and career development. These collaborations serve to train psychiatrists who will play a key role in the rapidly evolving health care system.

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.

American Association of Community Psychiatrists' views on general features of DSM-IV.

OBJECTIVE: The authors report on a survey of the American Association of Community Psychiatrists (AACP) about improving DSM-IV. METHODS: An anonymous survey was sent to 600 psychiatrists of the AACP via Survey Monkey technology. RESULTS: Respondents (N=152) answered questionnaires regarding the general features of DSM-IV. Reliable interclinician communication was valued most highly. A majority of respondents (92%) reported using axis 1, 75% used axes 2 and 3, and approximately 50% used axes 4 and 5. AACP members were less keen on using the tool to inform patient management planning. Least valued were usefulness for a national statistical base or to indicate prognosis. CONCLUSIONS: AACP respondents' views suggest modification to the DSM system to improve clinical utility. Most favored fewer than 100 diagnostic categories. Many were concerned about the current systems' cultural sensitivity and accessibility to patients. These considerations should guide DSM-V deliberations.

Transforming systems of care: the American Association of Community Psychiatrists Guidelines for Recovery Oriented Services.

Thinking about recovery has grown significantly over the last 70 years, and particularly in the past fifteen. Promotion of recovery has recently been recognized as an organizing principle for the transformation of behavioral health services. Recovery is a personal process of growth and change which typically embraces hope, autonomy and affiliation as elements of establishing satisfying and productive lives in spite of disabling conditions or experiences. Recovery oriented services replace paternalistic, illness oriented perspectives with collaborative, autonomy enhancing approaches and represent a major cultural shift in service delivery. Recovery oriented services replace the myth of chronicity and dependence with a message of individualism, empowerment and choice in the context of collaborative relationships with service providers. The American Association of Community Psychiatrists has developed Guidelines for Recovery Oriented Services to facilitate the transformation of services to this new paradigm. The guidelines are divided into three domains: administration, treatment, and supports, each consisting of several elements for which recovery enhancing characteristics are defined. Several example indicators are also provided for each element. This paper presents these guidelines and discusses their application.

American Association of Community Psychiatrists' principles for managing transitions in behavioral health services.

Continuous engagement in treatment and recovery services is one of the most important aspects of addressing acute episodes of severe behavioral health problems and the ongoing disabilities associated with them. Traditionally, fragmentation in systems of care has been common, and the transition from one provider, location, or intensity of service to another has not been prioritized in treatment planning. The authors describe a set of guidelines for maintaining continuity of care that was developed by the American Association of Community Psychiatrists. These guidelines embrace a progressive conceptualization of an integrated service system. For each element of the guidelines, a sample outcome indicator is presented that could be used to measure implementation. These guidelines can be used to help form transition plans, quality improvement initiatives, and program evaluations.