Academic and public system collaborations: opportunities in a changing environment.

Since the early days of psychiatry, academic centers have had collaborative relationships with the public mental health system. These public–academic collaborations have been relatively unique to psychiatry, as compared with other departments in academic medical centers. Many psychiatry programs have used public settings as the primary training sites for residents. However, these relationships have been transformed over time as the public system and academic settings have undergone significant changes. The evolution of these relationships between academic departments and the public system has been documented in previous publications (1, 2). The purpose of this article is to discuss current and future opportunities that could develop from academic and public collaborative efforts despite this changing environment. As we will note, such relationships have been important to academic centers for a variety of reasons, including the fact that they yield opportunities for enhanced training experiences and sources of financial support for residents and faculty. There have been a variety of initiatives over the years to foster such relationships. One important example was the National Institute of Mental Health (NIMH)-sponsored Public–Academic Liaison program (PAL) (3). This program was responsible for the funding of a number of research grants linking public and academic programs as well as a fellowship program that helped to build research capacity in a number of state mental health agencies. In the early 1990s, NIMH research programs were placed back into the National Institutes of Health (NIH), and the service programs, formerly a part of NIMH, were incorporated into the new Center for Mental Health Services (CMHS) under the Substance Abuse and Mental Health Services Administration (SAMHSA). This created a split between the research and services programs, and the PAL program ceased to exist in its previous format. Despite repeated meetings and reports calling for more collaboration between these agencies and their programs, there have been only minimal efforts to do so during the past several years (3, 4). Also, there is growing concern among some that academic programs and psychiatry in general have been less engaged in the issues facing the public mental health system and concern among some in psychiatry that the public sector is not as welcoming of psychiatrists as it was in the past. Despite these uncertainties, there is increasing interest among all parties in enhancing and growing such collaborative efforts. The term “public” as used here represents not only the state public mental health agency but also the local community mental health system. Today, many state public systems are focused primarily on specific populations, such as those needing forensic care or intense residential treatment, whereas the public community programs may provide services for more-diverse populations previously under the care of the state systems. Also, the changing roles of many state mental health systems and the growth of community programs have altered the types of services and settings formerly associated with the public state mental health system. Medicaid waivers have allowed states to provide more community-based services away from institutions and set up a variety of programs for substanceabuse treatment. Some public systems have carved out services to private managed behavioral healthcare companies. State budgetary problems have led to further declines in some relationships with academic departments that were strong in past years. Despite the changes in the public system and a decline Received November 16, 2009; revised January 7, 2010; accepted February 1, 2010. Dr. Norquist is Chair, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, in Jackson, MS; Dr. Miller is affiliated with the University of Arkansas for Medical Sciences, and is Medical Director, Arkansas Division of Behavioral Health Services. Address correspondence to Grayson Norquist, M.D., University of Mississippi Medical Center, Psychiatry and Human Behavior, 2500 North State St., Jackson, MS 39216; gnorquist@umc.edu (e-mail). Copyright © 2011 Academic Psychiatry