Clinical Services and Subspecialty Sections

Adult outpatient psychiatric services are delivered in two clinical venues; Northridge Outpatient Psychiatric Clinic (Northridge) and the Adult Psychiatric Clinic (APC) in the West Hospital. The APC is located in the West complex also known as the old hospital. Faculty, fellows and residents provide services to individuals with mental health and substance use disorders. The transitional care clinic is held on Wednesdays to provide care for those individuals recently discharged from the UVA inpatient psychiatric unit. The APC is also home to the outpatient based opioid treatment clinic. The mission of the Northridge Outpatient Psychiatric Clinic is to provide an environment for clinical training of our advanced psychiatry residents. Northridge is predominantly a resident clinic. Two attending physicians supervise 8 to 12 residents each year. A psychologist specializing in CBT supervises one day a week. Specialty clinics for women’s health, geriatric psychiatry, cognitive behavioral therapy, and thought disorders are held each week. Competency in psychotherapy as mandated by ACGME accreditation is a major focus of the clinic. Patients are referred from across Virginia and West Virginia due to the understaffing of community mental health clinics, and the University’s commitment to providing care to the indigent. Adult psychiatric services are also provided in a variety of clinical settings to include the HIV clinic, Cancer Center, Pain Clinic, the Behavioral Medicine Center and the Neuropsychology Laboratory.

Northridge is the resident clinic for PGY III and IV residents and geriatric fellows and is therefore structured to accommodate educational activities while insuring high quality clinical care. Residents receive two hours of individual indirect supervision weekly in accordance with ACGME regulations, in addition to direct and participatory supervision as mandated by medical center policy, HSF compliance, third party payer agreements and federal regulation. In addition to patient focused training, residents receive seminars and lectures in cognitive behavioral psychotherapy, dynamic psychotherapy, supportive psychotherapy, brief and long term models of psychotherapy, pharmacotherapy, clinical research, couples therapy, child psychiatry, forensic psychiatry, history of psychiatry, geriatric psychiatry, and administrative psychiatry.

To make an appointment please call 434-243-4646. Our scheduling specialists will make the appointment and direct you to the appropriate clinic.

Our goal is to provide comprehensive, state-of- the-art evaluations and treatment of the emotional and behavioral disorders found in children and adolescents.  Available services may include individual therapy, play therapy, behavioral management, family therapy, group therapy, parent training,  psychopharmacology, and neuropsychological testing depending on the needs of each patient. Consultation services are also available to Kluge Children’s Rehabilitation Hospital (KCRC), Children’s Medical Center at the UVa Main Hospital, and via Telemedicine to rural areas of Virginia. Our faculty and trainees are involved in an active learning and research environment.  Components include: The Child and Family Psychiatry Outpatient Clinic and the Child and Adolescent Neuropsychology Testing Service.

Our consultation-liaison service is the most utilized medical consult service at the University of Virginia Medical Center and is involved in providing consultations to all specialties with focused liaisons in the emergency department, intensive care units, and transplant services.

In addition to our general consultative services, our consult team plays a crucial role in the Behavioral Emergency Response Team (BERT). As part of BERT response team, our residents are designated first responders to any behavioral emergencies that arise within the hospital. They work closely with primary teams and offer in the moment expertise in de-escalating these emergencies.

Furthermore, our outpatient services extend to specialized clinics, including those focused on epilepsy, HIV, oncology, and transplant care. Our dedicated team members provide tailored support and interventions to patients in these clinics, addressing the intersection of mental health and complex medical conditions.

Our department provides psychiatric services to the Charlottesville-Albemarle Regional Jail and has been doing so since 2002. About 18% of all jail inmates have a significant mental illness, including substance abuse, mood and anxiety disorders, and even severe psychotic disorders such as schizophrenia, and yet many jails in Virginia provide no specific psychiatric services.  The jail environment can be a challenging one, as the clinician has to balance treatment issues with security concerns and has to liaison with correctional staff, community services workers (such as Region Ten Community Services Board), and also with the court system.

Residents rotate through this site as an elective. Fellows use this as a part of a correctional experience.

UVA is the major provider of electroconvulsive therapy services in the central Virginia area. Patients come to UVA from throughout the state (and even out of state), including as far as Lexington, Winchester, Harrisonburg, Fredericksburg, Williamsburg, and Virginia Beach.   The majority of treatments are provided on an outpatient basis, although patients who do require inpatient psychiatric care also can receive ECT while on our inpatient unit.  UVA also provides ECT services to patients from Western State Hospital in Staunton, Virginia.

ECT requires more complex clinical services since: (1) Patients who receive ECT tend to have more severe psychiatric symptoms; (2) These patients tend to be taking several medications in addition to receiving ECT; (3) Services must be coordinated with the patient’s local psychiatrist; (4) Patients must be continually monitored for safety and provided with education and advice not only for their psychiatric illness but from the potential side-effects of ECT (e.g., monitoring for driving safety and ability to function in the community) and family members and/or friends typically also need to be involved in these discussions.

UVA psychiatry residents rotate through this service and receive supervision and didactics specific to the practice of ECT.  ECT competency is required for graduation.

The number of recommended treatments is tailored to the individual patient’s needs.  During an acute course of therapy, patients typically receive 2 to 3 treatments per week and typically receive between 6 to 12 treatments during the entire course of therapy.  Patients who have responded well to ECT have the option of receiving further maintenance sessions (one session every few weeks) in addition to their usual psychiatric treatment (medications and/or psychotherapy) to provide additional benefit in preventing a relapse of symptoms.

ECT has been safely performed for patients who are medically frail, are elderly, are pregnant, or have had difficulty tolerating various psychiatric medications.  The most common post-treatment side effects are headache, muscle aches, and nausea. If these side effects do occur, they can be addressed with medications administered either during or after the procedure.   Some people experience short-term memory loss during the course of treatment.  This usually improves following completion of the acute course of treatment, although rarely some patients do experience memory problems for a longer period of time.  The treating psychiatrist discusses potential side effects with patients in greater detail during the initially consultation and throughout the course of therapy. Because of the potential for impaired concentration and memory, patients should refrain from driving or making important personal or business decisions during or immediately after the ECT course or on the day of a maintenance ECT therapy session.

The ECT Service is directed by Bruce Cohen, M.D.  To schedule an ECT consultation, prospective patients should have their treating psychiatrist contact Dr. Cohen at 434-924-2241 and should fax clinical information to 434-924-8496. 

Our inpatient capacity is 20 adult beds with services for consumers with acute severe mental illness, geriatric inpatient services and ECT. Services are provided to adults eighteen years and older.

Patients are referred to our unit from the Emergency Department and regional community health clinics. Our outpatient services and local psychiatrists also refer. We provide general psychiatric care on coed wards.

The inpatient wards serve as a major educational venue for our residents and medical students. Over the course of training residents will spend nine months on inpatient services in accordance with ACGME requirements. Clinical training is supplemented by two hours of individual indirect supervision per week as well as didactics and seminars. Residents participate in two weekly case conferences, a monthly journal club, twice a month Grand Rounds, a weekly psychiatry survey seminar, a monthly peer education seminar, a monthly interdisciplinary seminar addressing systems of health care, a process group and an administrative meeting. Medical students attend these seminars with the exception of receiving a separate lecture series. The inpatient wards also serve as a teaching venue for second year medical students in the Psychopathology course. For eight sessions in the fall, 140 students take turns interviewing patients on our wards under the supervision of our faculty, fellows and senior residents.

Behavioral Medicine Center

Faculty:

• Virginia Andersen, PhD, ABPP
• Heather Bruschwein, PsyD, ABPP
• Casey Cavanagh, PhD, ABPP
• Lauren Ehrlich, PhD
• Brian Ludwin, PhD
• Jaclyn Shepard, PsyD, ABPP – Director
• Joanna Yost, PhD, ABPP

The Behavioral Medicine Center provides outpatient psychological assessment, intervention, and consultation services for a wide variety of patient populations and presenting problems. Referral sources include UVA medical clinics and providers in the community. Patients referred present with psychological factors that impact medical symptoms or conditions, including, but not limited to:

• Insomnia
• Diabetes
• Gastrointestinal conditions
• Obesity
• Cancer
• Chronic pain
• Cardiovascular disease
• Neurological conditions

Common goals for treatment include:

• Improving adjustment to, and coping with, emotional and behavioral demands of acute, chronic, and life-threatening medical problems
• Reducing anxiety and/or improving mood within the context of health
• Increasing adherence to medical regimens
• Improving quality of life as it relates to the patient’s overall health

The Behavioral Medicine Center fosters a collaborative approach to patient care and provides comprehensive assessment and treatment guided by each patient’s presenting concerns and goals for treatment.  Patients’ ages range from early childhood to older adults. Presenting problems are typically treated with evidence-based treatment protocols that are individually-tailored to a patient’s personality and needs. A cognitive-behavioral approach to treatment is typically utilized with the course of treatment averaging between 12-24 sessions.

The Behavioral Medicine Center faculty members have primary responsibility for training postdoctoral fellows and advanced doctoral-level psychology students. These faculty members are also clinical supervisors for psychiatry residents and fellows.

The Behavioral Medicine Center faculty members also engage in research in the areas of: diabetes, pediatric bladder and bowel dysfunction, cystic fibrosis,  cardiology, weight reduction surgery outcomes, and consultation liaison.

Neuropsychology Assessment Center

Faculty:

• Donna K. Broshek, PhD, ABPP-CN (Director)
• Stephanie Bajo, PsyD, ABPP-CN
• Scott D. Bender, PhD, ABPP-CN (part-time)
• Racheal Smetana, PsyD

Psychometrists:

• Pamela McArdle (Supervisor)
• Jessica James
• Merry Kelty

Clinical: The Neuropsychology Assessment Clinic specializes in the assessment of brain health, providing information about cognitive and behavioral strengths and weaknesses in relationship to neurological and medical conditions, and offering recommendations for treatment and rehabilitation. Neuropsychological assessments consist of standardized, individually administered tests that provide a profile of each patient’s strengths and weaknesses as well as pattern of performance. Adult patients are referred for outpatient assessments by many medical specialties including Neurology, Neurosurgery, Internal Medicine, and Psychiatry. The most common referral questions relate to the following:

• Traumatic brain injury and other neurological trauma
• Sports-related concussion
• Epilepsy
• Cerebrovascular accidents (i.e., stroke) and vascular disease
• Neoplastic disease
• Central nervous system infection
• Memory impairment in individuals under the age of 65
• Neuropsychological aspects of general medical conditions (e.g., organ transplant, lupus)
• Post-operative cognitive dysfunction
• Living organ donation

Education: The Neuropsychology Assessment Clinic faculty members have primary responsibility for training postdoctoral fellows in Clinical Neuropsychology. These faculty members are also primary supervisors for psychology graduate students, as well as psychiatry residents who rotate through our service. They provide supervision and training to these fellows, students, and residents in clinical neuropsychological assessment.

Research: The Neuropsychology Assessment Clinic faculty are involved as Co-Investigators and consultants on many research projects in the areas of epilepsy surgery, traumatic brain injury and concussion, and symptom validity and effort assessment.

Perinatal Mental Health Clinic

Mental health services before, during, and after pregnancy

Location and Contact Information

2955 Ivy Rd, Suite 210
Charlottesville, VA 22903
Phone: (434) 243-4646
Clinic Hours: Mon 8am-5pm, Tues 8am-12pm, and Wed 12pm-5pm

Preparing for and welcoming a new child into your family can inspire feelings of joy and love. But sometimes, depression, anxiety, or even intrusive thoughts can appear. When this happens before, during, or for a year after delivery, this is called a perinatal mood disorder.

You’ve probably heard of postpartum depression. But emotional and mental health challenges can happen before you give birth, too. “Perinatal” refers to the time you’re pregnant and the first year after giving birth. The entire perinatal period is full of physical and mental changes and challenges. If you’re struggling, you’re not abnormal, and you’re not alone.

You might want to brush off postpartum depression and other difficult feelings as normal new parent issues. But these are serious conditions.

Ignoring them, or hoping they’ll get better over time, can cause ongoing issues. Left untreated, perinatal mood disorders can go on for months or even years. This can cause bonding issues with your new child, ongoing mental health issues, and other health concerns.

UVA Health’s Perinatal Mental Health Clinic offers help for perinatal mood disorders. Some of the mental health conditions we treat include:

· Postpartum depression (PPD)-Feeling overly depressed after giving birth

· Postpartum anxiety (PPA)-Feeling overly anxious after giving birth

· Postpartum psychosis – Experiencing hallucinations, delusions, paranoia, or other significant behavioral changes

Pre-Pregnancy Consults

All patients can schedule a one-time pre-pregnancy consult. During this consult, you and your provider will talk about your concerns, medications, and ways to protect your mental health.

Talking to someone before you get pregnant can help you avoid or prepare for problems that come up along the way.

Who Should Get a Consult?

While anyone can develop a pregnancy-related mental health issue, some things do increase the chances. Those include:

• First-time parents
• Between the ages of 18-24
• Previously diagnosed with depression or anxiety
• Having a traumatic birth
• Having a child with health issues
• Giving birth to twins

Schedule an Appointment

Perinatal mood disorders can sneak up on you. Waiting for a regular postpartum visit to get diagnosed can delay treatment. If you’re a parent who has given birth within the previous year, you don’t need a referral to be seen. Please contact our clinic at (434) 243-4646 if you would like to make an appointment.

The Department of Psychiatry and Neurobehavioral Sciences of the University of Virginia School of Medicine, in partnership with the UVA Office of Telemedicine, offers a comprehensive telepsychiatry program that provides access to excellent mental health care throughout the Commonwealth of Virginia.  This successful program providing over 2500 clinical encounters per year can serve as a model for academic teaching hospitals across the nation.  Our success is grounded in our excellent faculty and extensive network of more than 85 sites located throughout the Commonwealth of Virginia.

The Department of Psychiatry and Neurobehavioral Sciences is a pioneer in tele-mental health services and began providing Adult Psychiatry in 1998 and Child Psychiatry Telemedicine services in 2000. As a result, the UVA Telepsychiatry Program has been at the forefront of telemedicine at UVA and a leading provider of services to adults and children in the Commonwealth, especially those who live in rural underserved regions.  Since we initiated services, we have seen more than 8,000 patients in multiple counties and cities in the Commonwealth.   In 2009 we began seeing geriatric patients in Appalachian Southwestern Virginia and in 2011 doubled our Adult Telepsychiatry services as well as offered other additional services.  Our expanded capacity allows us to now serve over 200 patients per week.

Telepsychiatry services are provided from the Telemedicine Offices in the Primary Care Center at the University of Virginia, the Child and Family Psychiatry Clinic at 310 Old Ivy Way, the Adult & Geriatric Psychiatry Clinic at Northridge on Route 250 West, and will soon be offered from the Hospital West Clinic at 1215 Lee Street.

Services provided through the University of Virginia Telepsychiatry Program:

• Child and Adolescent Psychiatry including diagnostic evaluations and medical management visits.
• Adult Psychiatry including diagnostic evaluations and follow up therapy and medical management visits.
• Geriatric Psychiatry including diagnostic evaluations and follow up therapy and medical management visits.
• Educational sessions for Marriage and Family Therapy.
• Diagnostic evaluation services for patients considering lap band or gastric bypass surgery.
• Diagnostic evaluation and follow up therapy visits for patients with encopresis.
• Diagnostic Neuropsychological Testing and/or follow up therapy visits for patients:
  1. with Traumatic Brain Injury (TBI)
  2. with suspected neurocognitive effects of other cerebral causes (i.e., stroke, dementia, etc.
  3. needing neuropsychological evaluations as part of a comprehensive diagnostic medical examination
• In addition to the above, we have the capacity to:
  1. Sub-contract with clinicians licensed in other states (Maryland, West virginia, etc.) to provide telemedicine services to patients in those states.
  2. Partner with health care companies and/or hospitals to provide outpatient clinic appointments, inpatient consultations, and 24/7 Emergency Services.
  3. Provide diagnostic and follow up care to Community Service Boards, Prisons, Jails,  Third Party Carriers, Hospitals, Federally Qualified Health Clinics, Nursing Homes, Rural Health Clinics, the Department of Defense, and federally funded Government Programs such the PACE program.

Physicians in our Department are all board certified and specialize in either adult, child/adolescent, forensic, geriatric, or addiction psychiatry.   Our Ph.D., LSCW, LPC, and Nurse Practitioner faculty are certified by their respective agencies.  All faculty members are credentialed at the University of Virginia and licensed in Virginia by their respective agencies as well.  For additional information on specific faculty members, please visit the Departmental Faculty section of our website.

For additional information on our clinical telemedicine and telepsychiatry services, please contact Dr. Larry Merkel (434-924-2241, rlm3u@virginia.edu ).

In addition to our outstanding clinical services, we provide an excellent educational and training program in Telepsychiatry for University of Virginia Medical Students, Psychiatry Residents and Fellows, and Psychology Fellows.  For additional information on our teaching and training programs, please visit the Residencies and Fellowships section of our website.   Each section has contact information listed.

The University of Virginia’s Center for Leading Edge Addiction Research or CLEAR clinic is the site of ongoing research studies on substance abuse for the Department of Psychiatry and Neurobehavioral Sciences’ Division of Neurobiological Studies.

More information on UVA C.L.E.A.R.

Reproductive Psychiatry Studies are conducted under the Reproductive Psychiatry Research Program (RPRP), a division of the University of Virginia’s Department of Psychiatry and Neurobehavioral Sciences, under the direction of Dr. Jennifer L. Payne, MD.

Reproductive Psychiatry is a sub-specialty that focuses on the mental health needs and treatment of people who experience a psychiatric illness that is influenced by times of reproductive hormonal change, which can include the pre-menstruation, pregnancy and postpartum, and perimenopause time periods.

The RPRP performs cutting edge research studies on mood disorders related to these reproductive hormone fluctuations to help understand the genetic, biological, and psychological underpinnings of these disorders and to identify best practices for the management of these disorders.

Reproductive related mood disorders include:

• Postpartum depression
• Premenstrual dysphoric disorder
• Perimenopausal depression
• Other related disorders

This 2-year ACGME accredited Subspecialty Program prepares trainees to evaluate and treat the mental health issues present in children and adolescents. There are a total of six training positions (3/year). The eclectic curriculum includes child development, child psychopathology, psychopharmacology, and exposure to treatment modalities including individual therapy, CBT, play therapy, family and group therapy. Fellows train in our out patient clinic, the telemedicine clinic, the in patient site at Commonwealth Center for Children and Adolescents, various community sites including the Region Ten CSB, the UVA Child Neurology Clinic, and provide consultations to pediatrics. All training is carefully supervised by our faculty who are skilled in facilitating the clinical and career development of trainees allowing them additional autonomy as their skills expand. Fellows attend a comprehensive lecture and seminar series covering all aspects of the field. Teaching and research activity involvement are an expectation, and mentoring is available. In our various rotations, Fellows develop their teaching skills by supervising medical students and junior residents, and expand their collaborative abilities with trainees from other specialties including Child Neurology Residents, General Psychiatry Residents, Pediatric Residents, and Developmental Behavioral Pediatric Fellows. Applications can be obtained by contacting Dr. Burket rcb8n@virginia.edu

Child Psychiatric Consultations and Liaison activities are provided on the Pediatric and Child Neurology Units at the UVA Medical Center (ages 13 and under). Frequent consultation diagnoses include traumatic brain injury, depression, anxiety, post traumatic stress disorder, behavioral problems, and adjustment disorders. Ward consultation requests should be telephoned to 434-243-6950 during work hours, and referred to the Child Psychiatry Fellow On Call after hours and weekends.

Our telepsychiatry service provides comprehensive child psychiatric evaluations, medication management services, and 24/7 emergency on call coverage for our patients. Based in two fully equipped telemedicine offices in our out patient clinic, this service has provided approximately 5000 patient visits over the past 3 years to rural areas in southern and south western Virginia. The full range of child psychiatric diagnoses are commonly seen to include ADHD, depression, anxiety disorders, substance abuse, and learning disabilities. Requests for ongoing block telepsychiatry services are handled by contract and may be arranged by contacting Dr. Tucker at 434-243-6950. Individual case requests are arranged by contacting the UVA Telemedicine Center.

The Child and Family Psychiatry Clinic provides a wide array of services to children, adolescents and their families. Evaluation and treatment services are available for attention-deficit/hyperactivity disorder (ADHD), anxiety and depression, obsessive compulsive disorder, eating disorders, adjustment issues (e.g. divorce, school problems), behavior difficulties, and other mental health needs of children, adolescents and their families. Treatment modalities available include play therapy, individual therapy, family therapy, parenting, and medications when appropriate. Outpatient services are conveniently located at 310 Old Ivy Way, Suite 104, and appointments may be scheduled by calling 434-243-6950.

The Developmental Disorders Section has in recent years conducted clinical research projects including questionnaires in our OPC, a stimulant medication clinical trial, and several collaborative projects with Pediatrics and the Behavioral Medicine Center in our own Department. This has resulted in over three dozen publications, posters, and presentations at local, regional, and national meetings over the past few years.

Telepsychiatry – In collaboration with the UVA Karen S. Rheuban Center of Telehealth (UVA Karen S. Rheuban Center for Telehealth – Home | Facebook), the Division of Outreach has developed a wide range of telepsychiatry connections with Primary Care Providers, FQHCs, Free Clinics, PACE Programs, OBOTs, and SNFs.  We are using the Collaborative Care model to foster cooperation between the remote providers and psychiatry residents, fellows and attendings.

Project ECHO – Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring program which connects community healthcare providers with specialists for case collaboration, guided practice, and professional networking.  The ECHO model provides educational content and case-based learning to expand the capacity of primary care providers to manage complex patients in their own practice in their own community without having to refer or transfer care to specialists at large hospitals or academic medical centers.

UVA Project ECHO Series

Appalachian Telemental Health:  Connects rural providers in Central Appalachia and their patients with behavioral health and telepsychiatry resources to expand access to mental health services in the region.

Opioid Use Disorder and Addiction Medicine:  Providers from office based opioid treatment programs receive training in the most up to date clinical practice guidelines and best practices through case based learning and collaboration with colleagues.

Neonatal Abstinence Syndrome:  Content for providers who care for patients with substance use disorders during all stages of fertility and reproduction addresses the care of pregnant and parenting patients and their infants.

COVID-19 in Long Term Care Facilities:  Updates to testing, vaccination, and infection control guidelines disseminated to nursing, medical, and administrative staff at long term care facilities throughout Virginia from April 2020 until March 2021.

COVID-19 Updates for Primary Care Providers:  Updates on local case data, testing, vaccination, and infection control guidelines disseminated to primary care providers around Virginia to expand their capacity to manage and advise their patients during the COVID-19 pandemic.

Clinica Latina – Free Clinic – Is the Spanish language arm of the Free Clinic of Charlottesville (Home • Charlottesville Free Clinic (cvillefreeclinic.org)).  We provide psychiatric assessment and care two evenings a month for Spanish Speaking patients.   GMHT and other Psychiatry residents may serve there with adequate Spanish language background.

Haven (The Haven) – Is a local organization which strives to overcome homelessness in the larger Charlottesville area.  It offers help with housing, training in self-care, and support.   The Departments of Family Medicine and Internal Medicine have established a primary care access clinic at the Haven.  In 2019 the Department of Psychiatry joined this effort to provide psychiatric assessments and referrals.

International Family Medicine Clinic (International Family Medicine Clinic | Family Medicine (virginia.edu)) –  Since 2002 the UVA Department of Family Medicine has provided initial and ongoing medical care for refugees.  This is done in conjunction with the International Rescue Committee and the health Department.  Starting in 2010 the Department of Psychiatry started providing mental health care for the refugees.

Region X Community Services Board (Region Ten Community Services Board – Charlottesville, VA) – Collaborative arrangement to provide clinical and didactic training in various elements of Community Psychiatry, such as Crisis Intervention, etc.

Strength in Peers (Strength In Peers – Your Recovery. Your Path.) and On Our Own (On Our Own (onourowncville.org)) – Through telepsychiatry we collaborate with these Peer Support Organizations to provide clinical Psychiatric evaluations and care and support for their recovering members.

Appalachian Telemental Health Network, Virginia Telehealth Network and Telehealth Village

UVA Karen S. Rheuban Center of Telehealth (Telemedicine Experts Providing Regional Care | UVA Health), For decades, the UVA Karen S. Rheuban Center for Telehealth has led the way in technical innovation that gives healthcare to those in need. The center makes care possible for stroke patients in the back of an ambulance. We help world-class cancer care reach people in small Appalachian towns. With our support, patients receive monitoring in their homes to reduce the need for hospital readmission. And through our virtual platforms, women with high-risk pregnancies deliver healthy babies.

Region X Community Services Board (Region Ten Community Services Board – Charlottesville, VA) Established in 1969, Region Ten Community Services Board is part of a statewide network of 40 Community Service Boards working to provide mental health, developmental disability and substance use services where they are needed – in the local community.

International Rescue Committee (Rescue lives in Charlottesville, VA | International Rescue Committee (IRC)) – Provides opportunities and support for refugees, asylees, victims of human trafficking, survivors of torture, and other immigrants to thrive in Charlottesville. Through the IFMC we partner with the IRC to provide support for their clients mental health needs. In addition, we coordinate mental health workshops for the IRC staff in order for them to better understand different mental health disorders within the diverse cultural and social contexts.

Creciendo Juntos (HOME | Cj Network (cj-network.org)) – Is a local non profit organization that provides a platform for the voices, needs and wants of the Latinx community in Charlottesville and surrounding counties through education and leadership development. We work with CJ in partnership with two of their programs, Cultiva and La Cultura Cura. 

• Cultiva is CJ’s Mental Health Work Group which seeks  to promote the availability, coordination and quality of mental health services for the Spanish-speaking community in our region. The group supports education, outreach and advocacy initiatives to ensure access by members of the Hispanic community to mental health services.
• La Cultura Cura is an intergenerational social support group that centers Latina women and Latinx femmes, in connecting, healing, and learning together. The goal of this group is to create a space for cultivating healing and joy through the power of cultural celebration, sisterhood, social solidarity and self actualization.

The Women’s Initiative (The Women’s Initiative (thewomensinitiative.org))-  Is a local organization that provides mental health services for women regardless of ability to pay. The mission of The Women’s Initiative is to provide women with effective counseling, social support and education so they can transform life challenges into positive change and growth. We partner with one of TWI’s programs, Bienestar, which creates a safe space for Latina women to find solutions to their problems by honoring their own truth.

Cultivando Tu Bienestar (‎Cultivando tu Bienestar on Apple Podcasts) – Is a podcast which we helped establish in partnership with TWI’s Bienestar Program and CJ’s Cultiva Program. The podcast aims to promote dialogue about mental health, highlight the importance of self-care, and build resilience in the Latinx community.

The Latino Health Initiative (UVA Latino Health Initiative | (virginia.edu))- is an organization of the University of Virginia that aims to improve the health and wellbeing of the Latino community in the Charlottesville area. We work in partnership with LHI to bring clinical services in la Clinica Latina at the Charlottesville Free Clinic as well as coordinate and bring community mental health workshops.

Health Wagon/Appalachia Center for Excellence in Health (The Health Wagon | Wise, Virginia) – The Health Wagon’s mission is to provide compassionate, quality health care to the medically underserved people in the Mountains of Appalachia in Virginia. Our values are inclusiveness, community outreach, collaboration, spirituality, and empowerment.

Healthy Appalachia, University of Virginia at Wise (Healthy Appalachia Institute | Restoring Health Through Community) –  The Healthy Appalachia Institute is working to improve the health, education, environment and prosperity for residents of Central Appalachia by collaborating across communities and organizations, generating and implementing new ideas, and engaging the social, economic and scientific issues that exist at the interface of health and the Appalachian culture.

One Care of Southwest Virginia (One Care – of Southwest Virginia, Inc. (onecareva.org)) – One Care of SWVA serves as a consortium of 16 substance abuse coalitions working throughout the 21 counties and cities in the region. The 25 member Board of Directors includes representatives from community service boards, faith based organizations, social services and the health care, higher education, law enforcement and recovery communities. Outreach to business and industry and senior services organization sectors is ongoing. The One Care of SWVA Board operates collaboratively and is committed to undertaking a broad based strategic planning initiative – a Blueprint for the control and mitigation of substance abuse and misuse in southwest Virginia facilitated by the Healthy Appalachia Institute and with the encouragement of the Southwest Virginia Health Authority, regional partners and elected officials.

Appalachian Regional & Rural Studies Center, Radford University – Theresa L. Burriss, PhD, Director (Appalachian Studies | Radford University) – The Appalachian Regional & Rural Studies Center (ARRSC) provides students with an understanding of the heritages, environments, and cultures of the Appalachian region. Moreover, ARRSC faculty and support personnel engage in various forms of community outreach and are available to support student and public research. 

Division of Diversity and Health Equity, American Psychiatric Association (Diversity & Health Equity (psychiatry.org)) – APA members represent a diverse and culturally responsive community of psychiatrists that promote mental health equity through the provision of quality mental health care to all persons regardless of race, ethnicity, age, gender identity, sexual orientation, national origin, religious orientation, and/or disability status.

Commonwealth of Virginia Department of Health (VDH)

GLOBAL MENTAL HEALTH TRACK

Track Director:  Larry Merkel, M.D., Ph.D

Global Mental Health Track (GMHT) is a program available to psychiatry residents in order to help them prepare as physicians to become leaders in global mental health practice, research, policy and education.  The Global Health Leadership Track is the umbrella organization for all the global health tracks in the participating departments of the medical school.  The Global Health Leadership Track combines didactic learning with clinical experience to develop future leaders in Global Health.  Psychiatry residents may join the Global Health Leadership Track/ Global Mental Health Track in the PGY I or II years of their residency.   There can be a maximum of 5 residents from each year.  If you are going to Fast-track into Child Psychiatry you cannot enter the Global Mental Health Track.  There is an increasing realization that mental health issues are among the most frequent severe public health issues facing the world today.  Yet it is also becoming clear that the present day health care system, including psychiatry, is not prepared to meet this need, where many question the appropriateness and effectiveness of western based mental health care in non-western societies.  Some of the largest barriers to adequate mental health care are cultural.  Both social science, especially anthropology, and biomedical science, including psychiatry, have valuable perspectives on these issues and both are needed, if the world is to improve the quality of life for those with mental illness. Residents may declare their interest by November of their PGY I year and take part in an application and selection process, which is in December.  This is the website for the University’s Global Health Leadership Track  http://www.medicine.virginia.edu/clinical/departments/medicine/grad-ed/im-residapp/application.    

OBJECTIVES

1.       To enrich residents’ understanding of mental health and mental health care as they exist outside the US and in underserved areas within the US.
2.       To foster residents’ capacity to apply psychiatric knowledge internationally and in underserved areas within the US.
3.       To develop residents’ knowledge of cultures and the complex interplay between culture and mental illness.
4.       To explore the variety, nuance, and social implications of definitions of mental illness.
5.       To understand contemporary social issues as they relate to mental health.
6.       To foster relationships and collaborate with other providers who share an interest in global health.

TRACK STRUCTURE

DIDACTIC LEARNING

Didactic learning will take place through:

•         Global Health and Public Policy Courses
•         World Mental Health ANTH 5360
•         Round Table Dinners
•         General GHLT Journal Club
•         GMH track Psychiatry Journal Club
•         International Rounds

•         Global Health Courses. A two week intensive course in Policy and Practices in Global Health is offered.  This course will focus on the social, political, and economic context of common global health challenges with lectures from many guest speakers who are experts in their field.  It is given every other year.
•         World Mental Health (ANTH 5360) is a semester long course offered by Dr. Merkel in the spring of each year.  The purpose of this class is to bring together social science and medically oriented students to learn from and with each other about the role of culture in mental illness. This course will examine mental health issues from the perspectives of both biomedicine and anthropology, emphasizing local traditions of illness and healing as well as evidence from epidemiology and neurobiology.  Included topics will be psychosis, depression, PTSD, Culture Bound Syndromes, and suicide.  Issues of racism, social inequality and structural violence in relation to mental health will be explored.  We will also examine the role of pharmaceutical companies in the spread of western based mental health care, as well as examine culturally sensitive treatment efforts, combining western biomedical treatments with traditional methods.
•         Round Table Dinners. Quarterly evening lectures by a guest speaker involved in Global Health are scheduled with dinner provided. These are opportunities to learn and to meet with other members of the GHLT.
•         Global Health Journal Club. A monthly, informal journal club with dinner occurs at the home of one of the GHLT leaders.
•         GHLT Psychiatry Journal Club. An informal journal club in which psychiatry residents meet to discuss pertinent mental health topics.  It is held most months on the fourth Monday of the month at 5:30 in the evening in the department library.  At these meetings we discuss the business of the track as well as have a discussion of a selected global mental health issue.
•         International Rounds. Monthly International Rounds occur as part of the Family Medicine didactic series on Tuesday afternoons. Attendance is welcomed but optional for Psychiatry residents due to scheduling.
•         Society for the Study of Psychiatry and Culture.  Residents are encouraged to join this organization and to attend at least one of the annual meetings. http://psychiatryandculture.org/

CLINICAL LEARNING

Clinical learning will occur through experiences in international or underserved US immersion, telemedicine psychiatry, refugee clinic, and/or research.

Global Health Clinical Immersion

•         GHLT members must participate in an off-site, either international site or an underserved area within the US (such as rural Appalachian or Indian Health Service sites), during their residency.  These will be supervised experiences.
•         Clinical experience may be obtained through direct on-site immersion or telemedicine.

Global Health Research

•         During their time abroad or working with underserved populations within the US, residents who identify needs of a community may work on a project to answer questions or improve care related to that need.  Residents may also choose to take part in larger, established projects. Although research is encouraged, it is not required.  There is an expectation that residents in the program will produce some sort of scholarly product, which may include a narrative description of their experience, a qualitative description of a facet of their experience, or a case example.

International Family Medicine Clinic (IFMC)

•         Psychiatry residents will participate in providing outpatient psychiatric care to refugees within the clinic during their fourth year of residency.

INTERNATIONAL CLINICAL SITES:

Uganda – We are collaborating with the Department of Psychiatry at the Mbarara University of Science and Technology in Mbarara Uganda.  GMHT residents have visited for up to a month, attending inpatient rounds, out-patient clinics, remote clinics, and hospital consultations.  In turn they teach through informal discussions, as well as giving lectures.  They may also take part in research.

Guatemala – in conjunction with the UVA-Guatemala Initiative, we have developed a rotation involving various mental health experiences in Xela, Guatemala and nearby facilities.  The GMHT residents spend time at the Totonicapan Hospital outside Xela working with clinical psychologists and hospital staff.  Fluency in Spanish is required, but we have mechanism to help interested GMHT residents gain Spanish fluency.

 We are investigating other options for the future including sites in St. Kitts-Nevis, South Africa, and Nepal.

TELEPSYCHIATRY SITES

We have Televideo connections with sites in Guatemala, Uganda, and Southwest Virginia/Appalachia to provide psychiatric consultations and case conferences.  We also have ECHO programs in Virginia dealing with mental health and substance use disorders.

OTHER SITES

Program for Survivors of Torture and Severe Trauma in Falls Church, VA.  We have partnered with George Washington University and their refugee clinic in Falls Church to teach GMHT residents asylum assessments.

COMMUNITY TELEPSYCHIATRY FELLOWSHIP Fellowship Director – Larry Merkel, MD, PhD

The University of Virginia Department of Psychiatry and Neurobehavioral Sciences is proud to announce the establishment of a new fellowship in Community and Telepsychiatry.  The Department is uniquely positioned in Virginia to provide this fellowship program. It is designed to create psychiatric leaders working in public sectors, as opposed to private practice or hospital-based care.  There is an emphasis on developing community/public-academic partnerships, policy development, integrated care, systems of care development, concern for the social determinants of illness especially in relation to severe and chronic mental illness, substance abuse, trauma and homelessness, psychosocial rehabilitation, and psychopharmacological treatments.  In the present move toward population-based health care and the increased recognition of the importance of mental health care, it is imperative that we train psychiatrists who are experts in working in the community setting in collaboration with other health care providers, providing not only excellent psychiatric diagnosis and treatment, but also leadership, education, and consultation to other systems involved with mental health care.  The UVA Community and Telepsychiatry Fellowship is designed to do this.

In conjunction with our partners at the Region X Community Service Board who are practicing community based, collaborative and integrated psychiatry, we will be able to offer a wide array of training sites to facilitate the development of young psychiatrists who are experts in aspects of community and public psychiatry.  This includes programs for working with those with severe mental illness at several levels of care intensity, such as outpatient clinics and assertive community treatment teams.  In addition, they have programs for bridging the transition of those with severe mental illness from incarceration to community life.  They also offer experience in crisis intervention.

This program will work toward overcoming mental health shortages throughout the state, especially in rural areas.  In conjunction with the Karen S. Rheuban Center of Telehealth and the extensive telepsychiatry connections of the Department of Psychiatry and NBS, we have excellent training in telepsychiatry and integrated psychiatry.  There are several different clinical options already available – FQHCs, CSBs, substance abuse treatment programs, and other community services.  We provide psychiatric assessments and care throughout the state, as well as providing training and supervision to local providers caring for those with mental health and behavioral concerns.  The inclusion of telehealth training provides our Fellows a unique experience, becoming leaders in the rapidly growing area of telepsychiatry and e-mental health.

Through the Division of Outreach in the Department of Psychiatry and NBS the fellowship will provide experiences in community-based settings.  Related to the importance of telepsychiatry, is the growing importance of ECHO programs in primary care, especially in rural settings, through case-based video training and consultation.  It will be important for any public psychiatrist working in such settings to be facile with the capacity building capability of ECHO type programs.  We have also developed partnerships with several other community providers – The Haven, Strength Through Peers and On Our Own peer organization, The Free Clinic of Charlottesville, and the Women’s Initiative. We have also developed a connection with the Commonwealth of Virginia Department of Behavioral Health, which will provide experience in the legislative and financial aspects of mental health care at a state level.  These will all be part of the Fellow’s training to develop expertise working with many community-based organizations.  Through these various partnerships we will be able to develop Fellows who are well trained in many aspects of community and public psychiatry.  We aim to be flexible and can shape the program to the fellow’s interest.  The Fellowship will be one-year in length and is fully supported.

For interest in the program please contact Mariana Araujo: MA7YP@hscmail.mcc.virginia.edu 

Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda (Mbarara University of Science & Technology – Succeed We Must) – Since 2015 we have partnered with the Department of Psychiatry of MUST in international training and research.  Psychiatry residents have participated in rotations at the Department of Psychiatry at MUST, experiencing in-patient, outpatient, clinical consultations, and community clinic psychiatric care.  They have been paired with MUST psychiatry residents to collaborate in research.

Guatemala Initiative UVA/GI (UVA – Guatemala Initiative (UVA-GI) | Emergency Medicine (virginia.edu)) – The UVA-GI was formed over 10 years ago to promote the development of mutually beneficial and sustainable relationships between UVA and the peoples and communities of Guatemala. We have developed a relationship with the psychology team in Totonicapan Hospital, outside of Xela Guatemala and have an ongoing televideo case conference partnership. The GMHT residents spend time at the Totonicapan Hospital outside Xela working with clinical psychologists and hospital staff. The goal of this global health elective is to help expand mental health capacity in Central Guatemala.

Citations of related work with doi.

1. Snell-Rood, C. Merkel, RL. and Schoenberg, N. Negotiating the Interpretation of Depression Shared Among Kin. Medical Anthropology. 37(7):538-52. 2018.
2. Robinson, D.M.; , J.; Torbey, S.; Moreno, M.;  and Merkel, R.L. From Transcultural Psychiatry to Global Mental Health: The Development of a Global Mental Health Program at the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia,  Innovations in Global Mental Health. S. Okpaku (ed.) Springer Nature Switzerland AG 2019 https://doi.org/10.1007/978-3-319-70134-9_70-1
3. Archbald-Pannone, D. Harris, R. Steele, J. Kaur, K. Albero, J. Mutter, D. Cattell-Gordon, K. Rheuban.” Virtual Daily Rounding for COVID-19 Facility Outbreaks: A standardized, telehealth-centered approach may reduce hospital transfers and mortality.” Telemedicine and e-Health, In press 3Mar2021.
4. Harris D, Archbald-Pannone L, Kaur J, Cattell-Gordon D, Rheuban K, Ombres R, Albero K, Steele R, Bell T, Mutter J, “Rapid Telehealth-Centered Response to COVID-19 Outbreaks in Postacute and Long-Term Care Facilities.” Telemedicine and e-Health, January;27(1): Jan 2021.102-106. http://doi.org/10.1089/tmj.2020.0236.
5. L. Archbald-Pannone, D. Harris, K. Albero, R. Steele, A. Pannone, J. Mutter. “COVID-19 collaborative model for an academic hospital and long-term care facilities” J Am Med Dir Assoc. 2020, Online publication 25 May 2020, https://doi.org/10.1016/j.jamda.2020.05.044.

Building Resilience and Deconstructing Opioid Use Disorder (OUD) Stigma through Life Narratives in Central Appalachia

iTHRIV Community Organization and Research/Academic Partnership – Our project “Building Resilience and Deconstructing Opioid Use Disorder (OUD) Stigma through Life Narratives in Central Appalachia” aims use qualitative research methods to collect life narratives of people in SWVA who have been affected by the opioid crisis. Our goal is to reduce stigma associated with OUD and improve treatment and prevention programs in the area. This project is done in partnership with One Care of Southwest Virginia and Radford University.   It is presently ongoing.

UVA Patient Preferences on Telepsychiatry During COVID-19 Quarantine

The COVID-19 Pandemic has exacerbated many people’s mental health issues and presented urgent challenges for the US health service system to address mental illness in a safe and effective manner. During quarantine, telemedicine has rapidly evolved to provide increased access to high-quality and cost-effective healthcare. Telepsychiatry is a unique and unfamiliar mode of engaging in various aspects of psychiatric care during the pandemic. However, little is known about the factors that influence patients’ preferences on virtual versus in-person sessions during a public health crisis. Through survey-based investigation of participants in UVA telepsychiatry, we aimed to better understand patients’ experience of virtual healthcare during this pandemic. Our team performed a chart review to select patients seen by UVA psychiatry before July 2019 (when UVA established telepsychiatry appointments) and in April 2020, as these patients had experienced both in-person and virtual modalities of psychiatric care. Eligible patients were contacted to participate in a brief Qualtrics survey. The survey, consisting of multiple-choice and open-ended questions, collected information on patients’ demographic characteristics and preferences on various aspects of their telepsychiatry experience. We defined six dimensions of patient experience as preference towards telepsychiatry, ease of convenience, perceived safety, feeling understood, ability to be emotionally open, and feeling more connected with their therapist. We contacted 867 patients and received 240 responses, a 28% response rate. Middle-aged, white, heterosexual cisgender women constituted the largest sample population. We began our analysis by computing participants’ mean scores of the aforementioned six dimensions on a scale of 1 (prefer in-person) to 5 (prefer virtual). One-way ANOVA indicated that age, gender, and employment status had a significant influence on their preference towards virtual appointments. Specifically, employed, middle-aged, female patients exhibit a more favorable attitude towards telepsychiatry sessions, primarily due to convenience, feeling understood, and ability to open up during their sessions. Based on intersectional analysis, patient-therapist gender match contributes to patients’ more favorable attitude towards telepsychiatry sessions. Among patients with female therapists, female patients felt more connected to their therapists; among patients with male therapists, male patients felt more understood and heard by their therapists. Our study did not show that race, sexual orientation, or the number of dependents as significant influences on patients’ experience. There is limited research on the correlation between patients’ specific demographics and preference for telepsychiatry during the COVID pandemic, and this research project sought to address this gap. The open-response feedback provided personal anecdotes of technical issues with UVA’s telepsychiatry process as well as qualitative support for/against virtual sessions. However, sampling bias was likely present in this study since surveys were completed voluntarily, undermining the external validity of these conclusions. Overall, this observational study promotes telepsychiatry as a safe (socially-distanced) and convenient method of fostering doctor-patient connections that create avenues for emotional vulnerability during the pandemic. Future research would extend the participant cohort to later months in 2020-21 and investigate how preferences on telemedicine may have changed after enduring a prolonged quarantine.

Poster presented at MATRC 2021

Director

Richard Lawrence “Larry” Merkel, Jr., MD, PhD. (Link to CV)

Professor of Psychiatry

Director of Outreach for the UVA Department of Psychiatry and Neurobehavioral Sciences

Training:  Larry graduated from University of Virginia School of Medicine and then did a residency in psychiatry at the University of Pennsylvania.  Afterwards he was a Robert Woods Johnson Clinical Scholar and a Senior Fellow at The Leonard Davis Institute of Health Care Economics at the University of Pennsylvania.  He later received his PhD in Anthropology from the University of Pennsylvania.

Clinical Interests:  While at the University of Pennsylvania he worked at the Student Mental Health Center focusing on international and minority students.  He was also coordinator of the Transcultural Psychiatry Clinic at the University of Pennsylvania and director of the refugee mental health center in conjunction with the Nationalities Service Center refugee resettlement agency.  Since coming to the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, from 1990 to 2012 he was Director of Psychiatric Medicine and Specialty Care Core of the Southeastern Mental Health Research Center at UVa.  In 2015 he was appointed Director of the Division of Outreach.  In 2018 he became Professor of Psychiatry.

Research Interests:  Besides International and minority university students, he has had clinical and research experience with various refugee groups, the Maori of New Zealand, and is presently focusing on Appalachian populations.  He has also worked with Middle Eastern Psychiatrists in establishing training programs for Middle Eastern Primary Care doctors in diagnosing and treating mental health concerns. He is presently working on a cultural psychiatry understanding of “Nerves” in the Appalachian populations of SW Virginia.  He also has done research in the cultural construction of suicidal behavior.

Teaching:  He presently spends about half his time teaching psychopathology, social and cultural psychiatry, the history of psychiatry, and psychotherapy to psychiatry residents.  He is a clinical supervisor in the out-patient clinic, as well as seeing patients.  He teaches a yearly course on World Mental Health through the Anthropology Department of UVA.  He has won teaching awards at the University of Virginia and is a member of the Academy of Distinguished Educators at the University of Virginia.  He is a Distinguished Life Fellow of the American Psychiatric Association and in 2007 was presented with the Irma Bland Award for Excellence in Teaching Psychiatry Residents, by the American Psychiatric Association.

Research Program Director 

Samuel Collins, DrPH —  [link to CV]

Samuel Collins is a research director within the Department of Psychiatry and Neurobehavioral Sciences. He leads the Project ECHO initiative at UVA, with a focus on provider and community education related to substance abuse and mental health. His time at UVA has included working with UVA Telehealth, Clinical Informatics, and the Department of Medicine. His areas of focus are inter-professional communications, asynchronous care delivery, and clinical workflow innovation through provider engagement and increasing access. Other areas of research interests include military medicine, emergency response and management, and culturally driven approaches to public health intervention. He serves on the advisory board of the Mid-Atlantic Telehealth Resource Center.

Program Manager

Mariana Araujo – (link to CV)

Mariana Araujo is the Program Manager for the Division of Outreach. In this capacity she works in the intersection of academic and community mental health outreach for underserved communities. Mariana earned her Master’s Degree in Sociocultural Anthropology with a focus on International Development from George Washington University. She worked in the United States Institute of Peace in support of the Colombian peace process for projects regarding the inclusive participation of groups such as women, youth, Afro-Colombians, and indigenous people. Her work as Program Manager has established community partnerships with the Latinx community, the refugee population, and the Appalachian region. In addition, she has expanded qualitative research efforts to reduce OUD stigma in Central Appalachia and has strengthened collaborative efforts with the Guatemala Initiative and the Latino Health Initiative.

Director of Finance and Research: Angela S. Rogers 

The Institute of Law, Psychiatry, and Public Policy (ILPPP) works to help the mental health disciplines to provide sound, reliable clinical and scientific information to civil and criminal courts. The ILPPP is the primary site for UVA’s Department of Psychiatry and Neurobehavioral Sciences training programs in forensic psychiatry and forensic psychology. The ILPPP also works to Develop and shape laws and public policies related to mental health and human development. ILPPP scholars work to understand, assess, prevent, and manage violence in society, with particular emphasis on violence among people with mental disorders. Finally, the ILPPP works to promote human rights by developing and strengthening the ethical and legal foundations of the rights of persons who have, or are perceived to have, mental illnesses and disabilities.