Public/Community Psychiatry Fellowships

Abstract

Training in psychiatry is typically focused on a private practice model as well as on acute care. However, most early career psychiatrists work in publicly funded outpatient or community, nonacute, organizational settings. Public and Community Psychiatry Fellowships were developed to address this educational void. Public money, is distributed via a political process and comes with strings attached, such as contracts for specific services to mandated target populations, certification and accreditation standards, and mechanisms of fiscal accountability. As these public funding streams changed over time, so did the need to train clinicians to run and work in these publicly funded organizations. The political and social changes from the 1960s to 2020s swings from social consciousness and civil rights, to medicalized mental health care, to criminalization of people with behavioral health needs, and the recovery movement. Fiscal changes, prompted by these political and social changes, greatly influence clinical services. Clinical leaders must know what kinds of services will best fulfill the mandates of the time and justify public expenditures. Clinical leaders and managers, therefore, must know how to create and maintain behavioral organizations as political/fiscal needs change. Postdoctoral fellowships in public/community psychiatry provide the academic and clinical expertise needed to function in these changing environments.