Division of Public and Community Psychiatry

The Massachusetts General Hospital Division of Public and Community Psychiatry, led by Alex S. Keuroghlian, MD, MPH, encompasses Mass General psychiatry faculty, programs and community collaborations whose focus is providing clinical care to underserved and vulnerable populations with severe psychiatric disorders, as well as engaging in robust residency training and community-engaged research. Particular emphasis is placed on understanding the intersection of mental illness and psychosocial adversity (for example, homelessness and racism), recognizing the underlying structures that create and perpetuate these and addressing the impact at both the level of individual patients as well as complex systems.

Our Mission

The Division of Public and Community Psychiatry is grounded in its commitment to social justice and to addressing mental health inequities. We recognize that the social determinants of mental health impact health care access, treatment and outcomes, and our members use the lens of structural competency and cultural humility to advance our work.

We are particularly interested in:

• Severe and persistent mental illness
• Substance use disorders
• Trauma
• Homelessness
• Sexual and gender minority mental health
• Social justice, mental health and race equity

The Role of Collaboration

Collaboration is foundational to all our activities.

We continue to forge new collaborations within the Department of Psychiatry across existing programs and services. Beyond the hospital’s walls, we work collaboratively with community health and mental health centers, the Massachusetts Department of Mental Health (DMH), Boston Healthcare for the Homeless, community youth programs, the Department of Correction and individuals with lived experience. We pay close attention to the role of power and privilege in our relationships and strive to listen carefully and act with humility.

Clinical Care

As the once progressive and visionary public mental health delivery system in Massachusetts has become underfunded and fragmented, there are fewer community-based mental health providers and fewer state resources for those with severe mental illness, many of whom are already poor and marginalized. Demand for clinical services often outstrips supply, and existing programs and services are difficult to access and often confusing for both patients and providers to navigate.

The Division of Community and Public Psychiatry develops infrastructure support to help address some of these challenges. We work to promote improved access to care, identification of and intervention around the social determinants of health, graceful communication across systems and expansion of evidence-based treatment.

Inpatient and Outpatient Care

The Department of Psychiatry at Mass General has a number of programs that serve our target population, including:

• Mass General Community Health Centers
• Charlestown Mental Health & Social Services Clinic
• Chelsea Behavioral Health
• Revere Mental Health Department
• Acute Psychiatry Service (emergency psychiatry)
• West End Clinic (substance use disorders)
• Inpatient Psychiatric Service (Blake 11)

Mass General faculty also provide direct clinical care through the North Suffolk Mental Health Association (Freedom Trail Clinic), Boston Healthcare for the Homeless, and Fenway Health.

Improving Care Through Innovative Pilot Programs

Mass General is part of the Mass General Brigham's Medicaid ACO. This is an approach to health service delivery that improves the health and health care for a specific population while decreasing healthcare expenses. The Division of Community and Public Psychiatry participates in this program through clinical pilot programs to increase the use of gold-standard pharmacologic treatment for patients with schizophrenia.

Education

The Division of Public and Community Psychiatry at Mass General is deeply invested in inspiring the next generation of psychiatrists to develop careers whose clinical, care, teaching or research is focused on community populations and shaped by a commitment to social justice. We do this through a number of different programs.

Adult Psychiatry Residency: Community-based Clinical Rotations

Psychiatry residents in the Mass General/McLean Adult Psychiatry Residency have a range of clinical community psychiatry rotations as part of the standard curriculum.

In the PGY2 year, residents spend six weeks at a homeless shelter serving Department of Mental Health patients. Residents learn about the public mental health system and both conventional and unconventional approaches to clinical engagement and care. They gain experience working collaboratively with primary care clinicians and non-medical mental health providers and learn from individuals with lived experience.

In the PGY3 year, residents have three different rotations:

• A longitudinal community-based continuity clinic
• A specialty mental health clinic caring for patients with serious mental illness
• A correctional psychiatry rotation based at the Nashua Street Jail
• Through these structured rotations, the residents learn about:
• Non-office-based approaches to treatment
• Interdisciplinary models of care
• Unique sub-populations
• A spectrum of psychiatric illness less often seen in the hospital

Through this work, residents experience the intersection of mental illness, homelessness and the criminal justice system.

Electives

Psychiatry residents may pursue individually-tailored electives in their fourth year of training. Examples of previous electives include developing a behavioral health-primary care integration clinic at a community health center and telepsychiatry with a Native American population.

Adult Psychiatry Residency: Formal Didactics

The Division of Community and Public Psychiatry teaches in the formal residency didactic curriculum throughout residency training. Core content includes:

• Mental health policy
• Social determinants of mental health and structural competency
• Mental health inequities
• Racism and psychiatry
• Sexual and gender minority mental health disparities
• Recovery as a strength-based framework
• Community trauma
• Homelessness
• Mental health advocacy

Public and Community Psychiatry: Division of Child & Adolescent Psychiatry

Efforts are underway to expand the clinical, training and research opportunities in public and community psychiatry within the Division of Child & Adolescent Psychiatry. New initiatives include increased access to clinical consultation for community clinics, enhancing education and training for community-based clinicians and non-clinicians in schools and promoting resilience in children and adolescents. A new clinical rotation for child psychiatry residents began in July 2018 through a newly established collaboration with Bridge Over Troubled Waters, a community organization serving homeless youth.

Post-residency Fellowship in Public and Community Psychiatry

This PGY5 fellowship, established through a partnership between the Division of Public and Community Psychiatry and the Massachusetts Department of Mental Health (DMH), is open to MDs who wish to pursue advanced training.

The fellowship combines 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. The fellowship is situated in the Erich Lindemann Mental Health Center and emphasizes rehabilitation and recovery.

Learn more

Postdoctoral Community Psychiatry PRIDE Fellowship

The mission of Community Psychiatry Program for Research, Implementation and Dissemination of Evidence-based Treatments (PRIDE) is to reduce health disparities through the implementation of evidence-based treatments in under-resourced settings, ultimately bridging the gap between science and practice. This postdoctoral fellowship has a strong emphasis on translational research and fellows gain experience in conducting research on cultural adaptation of evidence-based techniques, clinical effectiveness trials, implementation treatments and community-based participatory research.

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Public and Community Psychiatry Annual Spring Symposium

The Public and Community Psychiatry Annual Spring Symposium brings together Mass General psychiatry faculty and trainees, hospital leadership, Mass General behavioral health center leadership, community collaborators, the Department of Mental Health and individuals with lived experience. The symposium includes a poster session and speaking program. Experts in the field address on a wide range of topics, including:

• The opioid crisis
• Family homelessness
• The role of organized psychiatry in mental health delivery transformation
• Minority mental health research
• Structural competence
• Racism and psychiatry

Research

Research is the third pillar of the Division of Community and Public Psychiatry. Our research portfolio is growing and includes both research and quality improvement projects focusing on:

• High-risk youth
• Sexual and gender minorities
• Racism and race equity
• Integration of psychiatric and medical care

Adults and children with serious mental illness and/or serious emotional disturbance

These activities are conducted by core division faculty, as well as by faculty whose departmental home is within a specific clinical and research program area (for example, schizophrenia or addiction). This research is wide in scope and breadth. For example, in 2017 there were approximately 150 presentations and 110 publications affiliated with the Division of Community and Public Psychiatry.

Research Programs

Community Psychiatry PRIDE

The Community Psychiatry Program for Research, Implementation and Dissemination of Evidence Based Treatments (PRIDE)’s mission is to reduce health disparities through the implementation of evidence-based treatments (EBTs) in under-resourced settings, ultimately bridging the gap between science and practice.

This program includes clinical care, training and research, and works to expand access to mental health care through innovation. The program enacts academic-community collaboration by creating real partnerships with community entities serving uniquely marginalized populations, such as young men of color who are exiting the criminal justice system.

Learn more

Sexual and Gender Minority Mental Health

Efforts to achieve health equity for sexual and gender minority (SGM) people include clinical, educational and scholarly activities in the Division of Public and Community Psychiatry. In fall 2018, we launched the Sexual and Gender Minority Mental Health Program. In addition, our faculty provide leadership of the National LGBT Health Education Center at The Fenway Institute, a federally funded program to improve health systems for SGM people at health centers nationally. A range of programs are underway to implement effective and culturally tailored interventions at 26 sites nationally for people living with HIV with four focus areas:

• Transgender women
• Black men who have sex with men
• Behavioral health integration into primary medical care
• Identifying and addressing trauma

Other implementation and technical assistance projects include:

• SGM competence training for New York City’s public health care staff and the City of Cambridge’s employees
• Establishing a gender-expansive youth practice in all New York City boroughs
• Enhancing sexual orientation and gender identity data collection in electronic health records

The Center of Excellence (COE) in Psychosocial and Systemic Research

The Center of Excellence (COE), which was established in 2018 through a multi-year grant from the Department of Mental Health, is jointly led by the Division of Public and Community Psychiatry and Mass General's Schizophrenia Clinical and Research Program. Its goals are to create research infrastructure and support to launch a range of community-based mental health research projects which will advance approaches to treatment and recovery for those with serious mental illness. The center will also create new community-academic collaborations, marrying the unique assets of community experience and wisdom with academic medicine and spawning innovation.