What is Public Psychiatry
Public Psychiatry encompasses the myriad service delivery systems and public funding mechanisms that support services provided to underserved populations, adults and children with complex needs, serious mental illness or who suffer from other issues of public concern. (Adapted from Yale Textbook of Public Psychiatry, edited by Selby Jacobs and Jeanne Steiner, Oxford Press 2016)
The title “Public” Psychiatry distinguished this program from earlier programs more typically called “Social” or “Community” Psychiatry during the 1960s and 70s. Social Psychiatry had taken over a largely academic meaning, as a conceptual framework for the practice of Community Psychiatry, which in itself had generally come to mean “grassroots” work. Public Psychiatry refers to the use of clinical techniques, management skills and evaluation strategies within established institutions serving populations with social as well as psychiatric needs: patients with severe mental illness and other major social psychiatric problems such as substance abuse, homelessness and AIDS, as well as members of poor urban and suburban minorities. These groups cannot or do not purchase services of their own choosing, and must rely on public funding and services.
The United States has a cherished tradition of attempting to keep government out of people’s affairs as much as possible. As a result, the “public” system functions largely out of sight, with government money funding myriad services in countless voluntary (not-for- profit) and even private (profit-making) institutions. In fact, 73% of the approximately $23 billion spent by all mental health organizations in the US in 1988 came from public funds. A relatively small percentage (35%) of the services funded by this public money takes place in what most people think of as public institutions: state, municipal, and federal hospitals and clinics. For the most part, public funding is funneled to both voluntary and private institutions which in turn provide public services even though neither patients nor providers may think of them as “public”. As an example, US general hospitals (mostly not-for- profit institutions) received 59% of their funding from public sources in 1988, and private psychiatric hospitals (in which 62% of funding came from client fees, including private insurance) constituted the only category of mental health provider for which public funding constituted less than 50% of all funding. In fact, the public sector is appropriately defined as constituting those agencies, programs and services financed primarily by public funds with mandates to serve the poor and other patients with severe mental illness. By this definition, many programs provided by public, not- for-profit hospitals and agencies can be meaningfully called public sector programs. Public money inevitably comes with strings attached (e.g. contracts for specific services to mandated target populations, certification and accreditation standards, and mechanisms of fiscal accountability).
Professionals running and working in these agencies and programs need to know what kinds of services will best fulfill the mandates that justify these public expenditures, how to create and maintain organizations to deliver these services, and how to deal with the myriad requirements incumbent upon functioning with public funds.
The Public Psychiatry Fellowship was created to prepare young psychiatrists to meet this challenge.
Why Apply to the PPF?
- If you get frustrated with the short comings of our current systems of care and you want a road map to fix them
- If you find that you are drawn to informal and formal leadership roles
- If you are curious about resource and fiscal management of organizations and how you can use these concepts to drive change
- If you are committed to working with people who have SMI and/or are underserved
- If you want to join a group of 10 likeminded fellows who will help each other to grow as public psychiatrists and be part of a growing network of alumni
Structure of Fellowship
The PPF is a one year fellowship.
Fellows spend two days a week at the NYSPI, learning the major principles and practices of public psychiatry (see curriculum for more details):
- Academic seminars are taught by core faculty
- Prominent leaders in the field are invited guest speakers
- Alumni of the fellowship are closely involved in teaching and collaboration projects
- Fellows give 7 presentations throughout the year and get weekly 1:1 supervision and consultation with an assigned faculty mentor
o The Peer Advisor program is a unique feature of the fellowship and consists of monthly individual meetings with people with lived experience in the behavioral health system, as well as small group activities.
o Site visits to community programs from Riker’s Island to homeless shelters and supported housing programs enhance the practical aspect of training
Fellows apply concepts learned in supervision and didactics, three days a week, at a community- or hospital-based public behavioral health organization that they have selected as a job site. In this job the fellows:
- function as attending psychiatrists
- are encouraged to take on administrative roles
- meet minimally twice a month with a field site supervisor who provides onsite clinical and administrative guidance
The salary range is site specific and usually between 90K and 110K.
Applicants must have:
- Graduated from accredited psychiatry residency training programs
- A NYS license before the start of the academic year July 1st
- Demonstrated interest and experience in public mental health issues, especially those concerned with achieving better care for poor and otherwise disadvantaged adults and children with serious mental illness
- Interest and ability to work as part of an interdisciplinary team
- Demonstrated psychiatric leadership, internal program evaluation and other academic endeavors
The selection committee complies with the intent of the Affirmative Action Program and the Americans with Disabilities Act.
There is a 3-step application process:
- Submit a completed application form (link above) including the answer to the 3 essay questions and an updated CV
- Interview with the Fellowship Core Faculty
- Once accepted into the fellowship- decide on and interview separately for a job in community behavioral health. The Core Faculty work closely with Fellows in the process of choosing a job.
We begin accepting applications on August 1st and we accept fellows on a rolling basis until positions are filled. Interviews are scheduled starting in September and final acceptances are given by December 31st. We maintain a waiting list until March 1st.
Interviews for the job sites are usually from December to February but fellows are encouraged to begin this process as soon as they are accepted into the fellowship.