Established in 2009, the MGH Division of Public and Community Psychiatry is the home for clinicians, educators, researchers, trainees and advocates whose primary focus is public sector and community psychiatric populations, disorders and programs, and who embrace the social mission of medicine. We are particularly interested in those suffering from severe and persistent mental illness, addictions, trauma and homelessness, and recognize the contribution of the social determinants of mental health on healthcare access, treatment and outcomes. We are deeply invested in residency training, hoping to inspire the next generation of psychiatrists to develop careers whose clinical care, teaching or research is shaped by a commitment to social justice.
The Division has approached its work through establishing structures and processes and, to the extent possible, aligning and embedding its activities in the core pillars of the MGH. The Division works to strengthen existing collaborations with MGH/Mass General Brigham and relevant federal, state, and local programs and agencies involved in the provision and funding of mental health services in the community. We are particularly committed to underserved and marginalized populations. The Division is led by Dr. Alex Keuroghlian, the Michele and Howard J Kessler Chair in Public and Community Psychiatry at MGH.
The MGH Division of Public and Community Psychiatry harnesses the depth and breadth of resources at MGH and in the community to provide excellence in clinical care, teaching research and system improvements for underserved and vulnerable populations with serious mental illness. We work collaboratively with the Massachusetts Department of Mental Health (DMH) and a range of community mental health and medical providers. We seek to understand the complex interplay between serious mental illness and the social determinants of health, and we recognize racism as a unique social determinant of mental health. We focus on those suffering from severe and persistent mental illness, addictions, trauma and homelessness. Our efforts extend beyond community mental health centers, the historic locus of care for seriously mental illness, to community health centers embracing integrated approaches to primary and mental health care, to addiction treatment services and to the correctional system. We emphasize recovery-oriented approaches to care including non-hierarchical relationships, shared decision-making and strength-based care, values which are embedded in our clinical rotations and didactic lecture series.
The PGY2 Community Psychiatry Rotation is a 6-week, immersive, public-sector outpatient experience that introduces residents to recovery-oriented, integrated healthcare for people with serious mental illness. This rotation is sited in a transitional homeless shelter run by the Massachusetts Department of Mental Health. Residents follow patients through multiple systems of care, including a community mental health center, an addictions treatment program, and an organization that provides healthcare for homeless individuals. Residents work in an interdisciplinary care team to provide care and resources to the most vulnerable of patients.
The PGY3 Community psychiatry experience spans three discrete ambulatory training experiences: a community mental health center focused on patients with severe mental illness, a longitudinal community-based clinic, and the Nashua Street Jail. All rotations require knowledge of the specific community and effects of the social determinants of health. Residents rotate at longitudinal community clinic sites one half-day per week for 8 months. These sites serve diverse sections of the greater Boston community and allow residents to engage in the unique models of integrated care delivery; this clinical experience complements the resident’s MGH or McLean-based outpatient clinics. Community mental health center sites include the Freedom Trail Clinic and East Boston Counseling Center, where residents spend one day per week for four months. The Nashua Street Jail rotation exposes residents to the structural and social factors that result in the mass incarceration of disenfranchised groups, while focusing on the clinical treatment of detained persons. Residents spend one day per week for two months learning about the role that jails serve in providing mental health care and the unique challenges of being a clinician in a non-clinical setting.
A Clinical Fellowship in Public and Community Psychiatry is available for MDs to provide advanced training during a PGY5 year. In partnership with the MGH Division of Public and Community Psychiatry and sponsored by the Massachusetts Department of Mental Health (DMH), this fellowship combines direct evidence-based clinical care with emphasis on longitudinal treatment, mentorship, peer learning, scholarly work and immersive leadership training to prepare the fellows to become leaders in this area. Consistent with the mission of DMH, the fellowship is situated in the Erich Lindemann Mental Health Center and its emphasis is on rehabilitation and recovery.
The Division of Public and Community Psychiatry teaches in the formal residency didactic curriculum throughout residency training. Core content includes:
Established in 2013, the Public and Community Psychiatry Annual Spring Symposium brings together MGH psychiatry faculty and trainees, hospital, community health, and health center leadership, community collaborators and the Department of Mental Health for an afternoon of presentations and a poster session. Both internal and external experts have spoken on topics ranging from the opioid crisis, family homelessness, the role of organized psychiatry in mental health delivery transformation, minority mental health research and mental health inequities. Both the Massachusetts Commissioners of the Departments of Public Health and Mental Health have spoken here, as well as the Massachusetts Secretary of the Executive Office of Health and Human Services. The poster session showcases a range of public and community psychiatry-related projects, and it includes submission from numerous programs in the department.
The Division created a Special Interest Group that meets quarterly at a faculty member’s home. It is open to all residents, and to interested psychiatry and psychology faculty. What draws people to this group is mission—understanding that public and community psychiatry is a vehicle for social justice. It is a place where trainees and faculty meet each other, learn about the wide range of work germane to this area, and often pursue projects together. Most recently the group is focused on race equity, and specifically identifying opportunities in our workplace to improve access and quality of care.
