Nearly 43 million adults in the United States have a mental health condition. Of those, approximately 60% do not receive care [1]. Even those who are treated frequently receive fragmented care. As a result, mental health disorders cost the United States more than $450 billion annually [2]. Moreover, underdiagnosis, undertreatment, and lack of access to services contribute to approximately 40,000 suicides annually [3].
North Carolina has an inadequate distribution of psychiatrists, as well as an insufficient number of mental health and substance abuse professionals [4, 5]. Between 1999 and 2004, two-thirds of North Carolina's counties experienced a decline in availability of psychiatrists. Unfortunately, the overall supply of psychiatrists per 10,000 population has not changed significantly over the past decade. Recent data indicate that 27 counties across North Carolina did not have a practicing psychiatrist in 2012, and 18 counties had only 1 practicing psychiatrist [6]. Due to the state's rapid population growth, the situation may worsen unless action is taken to increase the supply of psychiatrists.
Carolinas HealthCare System (CHS) offers comprehensive treatment programs that make it one of the region's most noteworthy behavioral health providers. Nonetheless, CHS continues to face significant challenges in recruiting qualified psychiatrists, and this issue led to a delay in opening the 3rd unit of the CHS Mindy Ellen Levine Behavioral Health Center in Davidson. This challenge focused CHS on the need to train our own providers, and we successfully appealed to the Leon Levine Foundation for support in launching a residency program in psychiatry.
Offering training through 21 accredited residency programs, CHS has a long history in graduate medical education and is nationally recognized for its high-quality, innovative programs. With support from the Leon Levine Foundation, CHS plans to establish a residency program in general psychiatry that will enrich the educational curriculum and patient care. Specifically, residents and faculty will provide enhanced training in patient interviewing, screening for mental health issues, screening for abuse, and psychiatric consultation. Graduates of the Sandra and Leon Levine Psychiatry Residency Program will be fully equipped for the practice of modern psychiatry, which integrates traditional modalities with state-of-the-art treatment strategies.
An accredited psychiatry residency training program at CHS will increase the supply of psychiatrists and enhance the overall quality of behavioral health care provided across our region. Because the majority of CHS trainees remain in state to practice after graduation, a psychiatry residency program will enhance patient care by increasing access to high-quality psychiatrists and health care teams. Additionally, it will improve CHS' ability to recruit and retain talented clinician educators. The CHS behavioral health service line includes diverse teaching talent. Thanks to CHS' skilled medical educators, its Charlotte campus psychiatry rotation for medical students at the University of North Carolina has been consistently recognized as the top program in the state.
The mission for CHS' psychiatry residency program will be to provide a pipeline of psychiatrists to address critical workforce shortages; to provide excellence in clinical care, education, training, and research in the field of psychiatry; and to serve as a community and regional resource that advocates for patients and citizens with mental health issues.
With a focus on integrating behavioral health into primary care, CHS' behavioral health team has created a forward-thinking approach to caring for patients with mental health conditions. The program will also focus on improving population health by expanding awareness and access to high-quality behavioral health care; providing early intervention through integration with primary care and virtual services; and providing an excellent patient and family experience through quality care at all points along the care continuum.
Psychiatry has changed considerably in recent years. While tomorrow's leaders must be steeped in the traditions of psychiatry, they must also be savvy about advances in the basic and clinical sciences, and they must embrace treatment settings that have not been a part of more traditional programs—sites where many patients will be treated in the coming decades. Thus, they must master treatment modalities that will be of the most help to patients in both traditional and new treatment settings. This belief is consistent with CHS' commitment to enhancing behavioral health care for the region and integrating services into primary care.
By ensuring a pipeline of high-quality, highly trained specialists, CHS can better ensure that patients in our region will always be able to obtain the right care in the right place at the right time.
Acknowledgments
The authors would like to thank John Santopietro, MD, chief clinical officer, Behavioral Health, Carolinas HealthCare System; Martha Whitecotton, SVP, Behavioral Health Services, Carolinas HealthCare System; and Lisa Howley, PhD, AVP, Medical Education.
Potential conflicts of interest. The authors have no relevant conflicts of interest.
- ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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