Mental Health Services Research Training for the Next Generation of Leaders in the Public Health Sector: A Case Study of the UCSF/SFGH Public Psychiatry Fellowship

Community mental health centers serve over 3.5 million adults with severe mental illness annually.1 However, a chronic shortage of well-trained community psychiatrists perpetuates difficulties in providing effective, evidence-based services in community mental health settings.2 To increase the number of community psychiatrists able to implement high quality care, a sustainable clinical leadership training program with a health services research emphasis was created in San Francisco County. The University of California, San Francisco/San Francisco General Hospital (UCSF/SFGH) Public Psychiatry Fellowship is a public-academic partnership between UCSF and San Francisco's Community Behavioral Health Services (CBHS). The UCSF/SFGH Department of Psychiatry has had a long and close relationship with CBHS. The fellowship was initially funded by Mental Health Services Act (MHSA) dollars allocated to San Francisco County. The MHSA, commonly referred to as “the Millionaires Tax,” was passed by statewide referendum in 2004 and places a 1% state surcharge tax on annual incomes of over $1 million.3 Revenue is earmarked by to provide mental health services and new workforce education and development programs to “remedy shortage of qualified individuals to address severe mental illnesses.”3 Being aware of these funds, we developed a business plan estimating that the clinical revenue generated by fellows would generate sufficient dollars to cover the costs. In addition, the fellowship would train psychiatrists interested in working in CBHS clinics, which was important because CBHS frequently had difficulty filling openings. In 2011, CBHS agreed to use a portion of their allocated MHSA money to fund the UCSF/SFGH Public Psychiatry Fellowship for a two year trial period. Funding covers salaries and benefits for two fellows, a portion of two faculty salaries, some research assistant time and administrative costs. In return, fellows work as psychiatrists in CBHS clinics four days a week. The primary fellowship goals include: 1) recruitment of well-trained psychiatrists dedicated to working in community mental health settings; 2) generation of Medicaid revenue sufficient to cover the costs of the program, 3) completion of mental health services research projects addressing CBHS priorities, and 4) placement of fellows in leadership roles in public mental health settings. After the program showed initial success, we have secured continued funding through CBHS and created additional funding arrangements with local community based organizations to support additional fellows. Of the 15 Public Psychiatry Fellowships in the country, our program is unique in having fellows implement and complete a mental health services research study during the fellowship year.4 This research component both improves the capacity to evaluate services provided in community settings, and also addresses many of the goals outlined in the 2006 NIMH report on the future of mental health services research.5 For example, the fellowship focuses on the importance of true public-academic partnerships to bridge science and service, and emphasizes the importance of research that incorporates public health significance, practical utility, and acceptability to participants.5