FEATURE | Posted April 13, 2016

Treating patients, brain to toe

New medical training program bridges primary care and psychiatry

Robert McCarron demonstrates a psychiatric interview  © UC Regents
Robert McCarron demonstrates a psychiatric interview (bottom photo) for participants in the primary care psychiatry fellowship program, some of whom participate through video conference (top photo).

Sara Teasdale is a newer UC Davis physician who has already noticed a trend in her medical practice: Patients with conditions like diabetes, asthma, cardiovascular disease or arthritis also often suffer from mental health issues like depression, anxiety, bipolar disorder or post-traumatic stress disorder.

“To me, it makes sense to treat all of my patients’ health issues at once, rather than limit my help solely to their physical illnesses,” said Teasdale, who works at the Sacramento County Primary Care Clinic. “My internal medicine residency was stellar, but it didn’t cover as much psychiatry as I need now.”

To fill this gap, Teasdale is participating in a new UC Davis School of Medicine training program designed to help doctors like her treat patients comprehensively and expertly. Launched in January, the program — called the UC Davis Train New Trainers / Primary Care Psychiatry Fellowship — is led by UC Davis physicians Robert McCarron and Shannon Suo, who practice both primary care medicine and psychiatry.

Expanding access to mental health care

According to McCarron, the program is crucial given issues with access to psychiatric treatment. The American Psychiatric Association reports that demand for mental health care services in California far outpaces the number of psychiatrists and allied mental health professionals, a disparity that is expected to widen significantly in the coming decade.

The result? Most adults with mental illness do not get the treatment they need. Those who do, get it from their primary care physicians.

Sara Teasdale © UC Regents“It makes sense to treat all of my patients’ health issues at once, rather than limit my help solely to their physical illnesses.”
— Sara Teasdale

“We started the fellowship to expand and improve mental health care delivery where we see it most — in primary care settings,” McCarron said. “We are hoping the program will become a model for medical schools throughout the U.S.”

The fellowship is the first in the nation to provide intensive, yearlong training in primary care psychiatry. It fits well with UC Davis’ strong tradition of linking psychiatry and primary care in medical education, including two combined residency programs: one in internal medicine and psychiatry and another in family medicine and psychiatry, which take five years to complete.

“The fellowship is ideal for providers who want to incorporate basic psychiatry services into their practices, but who don’t want or need to become board certified in two specialties,” McCarron said.

Learning to assess, treat and refer when necessary

Through more than 50 hours of individualized mentorship, classroom teaching and case-based discussions, 35 physicians, nurse practitioners and physician assistants are learning to conduct psychiatric interviews and then diagnose and treat mood, anxiety, psychotic and substance misuse disorders. They also gain insights for knowing when to proceed with treatment and when a psychiatric referral is essential, as in the case of schizophrenia or suicide risk.

Robert McCarron © UC Regents“We are hoping the program will become a model for medical schools throughout the U.S.”
— Robert McCarron

A significant part of the process involves teaching participants to be trainers, or champions, who share what they learn with colleagues.

“Everyone is learning to communicate best practices in meaningful, usable ways,” McCarron said. “Our hope is that graduates will expand the mental health workforce by becoming comfortable and efficient with the assessment and treatment of common psychiatric conditions, and then coaching their colleagues to do the same.”

After just four months, the program has already helped Teasdale.

“I am more comfortable screening patients and educating them about conditions like depression and anxiety, even within the time constraints of a primary care visit,” she said.

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