Educational Programs

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

To enrich residents’ understanding of mental health and mental health care as they exist outside the US and in underserved areas within the US.
To foster residents’ capacity to apply psychiatric knowledge internationally and in underserved areas within the US.
To develop residents’ knowledge of cultures and the complex interplay between culture and mental illness.
To explore the variety, nuance, and social implications of definitions of mental illness.
To understand contemporary social issues as they relate to mental health.
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