Fellows Build Vital Mental Health Skills
“I was very uncomfortable,” admits Dr. Lisa Yee of Asian Health Services, describing how she felt when treating patients with severe mental illness.
Rita Davis-Marten, a nurse practitioner at West Oakland Health Council shared Yee’s unease. “I felt very hesitant.” She recognized a disconnect between practice and her deep professional interest in mental health. “I wanted to get into the psychological aspect of care.”
Both Yee and Davis-Marten sought skills and knowledge through Alameda Health Consortium’s UC Davis Primary Care Psychiatry Fellowship. Dr. Robert McCarron, co-director of the fellowship at UC Davis, cites a shortage of psychiatrists and inadequate focus on mental health in primary care training. “Up to 40% of primary care patients have primary, active psychiatric problems,” he says, adding, “It’s not realistic to build new residency programs” to manage the immediate need.
Community Health Center Network Chief Medical Officer Dr. Laura Miller shares an anecdote that illustrates scant provider preparation. As she studied for the Internal Medicine boards recently she noticed, “… In all of the (assessment) material to be covered, only 10 pages of 1,000 relate to mental health.” Day-to-day practice “is like living in a blender,” she says, stating that providers need practical grounding in mental health care. “Our patients have psycho-social needs, it’s better for them, it’s better for us.”
Eight months into the fellowship, four of Alameda County’s 8 fellows gathered with program supporters to share what they have gained and how they envision the future. This group represents the largest cohort of fellows in the 35-fellow statewide class. “I can be more empathetic and compassionate with severely mentally ill patients,” says Yee. “I’m not so stressed about what I’m supposed to do.”
Dr. Parveen Kaur of Tiburcio Vasquez Health center adds, “I’m screening more confidently, I understand the collaborative care model better.” She and other fellows also describe early results from training in motivational interviewing, medication management and cognitive behavioral therapy, citing less stress and fatigue after visits. Applying what they learn has allowed them to meet patients where they are.
Among its goals, the fellowship aims to prepare fellows to coach colleagues. Ameneh Moghaddam, a nurse practitioner at Axis Community Health, plans an upcoming role play session with her team, modeling patient and provider encounters. She and other panelists shared examples of passing on knowledge to their peers. They all agreed they need more time and experience before feeling comfortable in the trainer role.
According to fellows, a significant benefit of the fellowship lies in expert and approachable UC Davis faculty and mentors. “They understand what we are going through,” said Yee. “(UC Davis’ Dr. Shannon Suo) makes suggestions for what to explore with a patient if I feel stuck.”
Fellows also noted confidence in tapping existing resources. “I’m better able to…communicate with the psychiatrist for further consultation,” says Davis-Marten, referring to her work with the Alameda County consulting psychiatrist who is assigned to her health center.
The ultimate benefit, many echoed, is seeing positive changes in patients. “You become the integral seed to help that person who needed it,” says Davis-Marten. Organizers hope that a sense of confidence, accomplishment and professional growth will keep providers in the profession. “It has changed me…developing a new career path for me. It’s awesome.”
Alameda Health Consortium’s UC Davis Primary Care Psychiatry Fellows program is a joint effort of Blue Shield of California Foundation, UC Davis Department of Psychiatry and Behavioral Sciences, Alameda County Behavioral Health Care Services Agency and the Alameda Health Consortium. The 12-month program aims to increase primary care providers’ management of behavioral health conditions, practice of the collaborative care model, and coaching other PCPs and team members on psychiatric treatment. Fellows participate in two teleconference webinars per month, two in-person conferences, and one-on-one mentorship with UC Davis faculty.