PROGRAM

Sponsoring Institutions

BETH ISRAEL DEACONESS MEDICAL CENTER

Beth Israel Deaconess Medical Center (BIDMC) is the new name for the merged Beth Israel and Deaconess Hospitals, two Harvard-affiliated teaching hospitals located across the street from each other in the Longwood Medical Area. Serving as a tertiary/academic resource, Beth Israel Deaconess Medical Center is home to several nationally recognized clinical centers of specialized expertise, including solid-organ transplantation, diabetes/ vascular surgery, obstetrics, cardiology and cardiac surgery, oncology, women's health, and treatment of people with AIDS. The medical center hosts complementary new state-of-the-art inpatient and outpatient facilities, as well as two regional outpatient centers and primary-care offices in 30 communities. Beth Israel Deaconess Medical Center, West Campus, is the former Deaconess Hospital. Historically, the West Campus has had expertise in affective disorders and neuropsychiatry, and it has added to that expertise a specialization in psychotic disorders. The inpatient services admit patients who present with the full range of psychiatric diagnoses and are closely affiliated with emergency and aftercare programs at other Longwood Medical Area hospitals.

Beth Israel Deaconess Medical Center, East Campus, the former Beth Israel Hospital, has had a Department of Psychiatry with a long tradition of clinical care, teaching, and scholarship of the highest quality. Prior to the development of the Harvard Longwood Program, the Department sponsored its own accredited residency training program for many years, which attracted superb physicians, many of whom have gone on to positions of leadership in the psychiatric community. In addition, it is one of the major sites for clinical training in psychiatry for Harvard Medical School students.

Residents can participate in all clinical services at BIDMC and routinely do rotations in the inpatient psychiatric services, the emergency psychiatric service, the urgent care service, the consultation-liaison service, and the outpatient services.

The emergency service functions around the clock as part of the hospital's general emergency unit. Approximately 2000 patients are evaluated each year, many of whom are subsequently treated by the inpatient or urgent-care services at BIDMC or other Longwood Medical Area sites. There are 30,000 visits per year to the outpatient psychiatric services and 1200 patients seen by the consultation-liaison service per year.

Research is conducted at BIDMC in a range of specialties, including eating disorders, anxiety disorders, affective disorders, dissociative disorders, hypnosis, psychotherapy, AIDS, psychiatric issues related to medical illness, computers in psychiatry, clinical psychobiology of monoamine neurotransmitters, neuroimaging, psychiatric chemistry studies, psychosocial issues regarding diabetes (carried out at the Joslin Diabetes Center), and the relationship of medical illness to mental illness. In addition, BIDMC is in the forefront of treating patients previously cared for in the public mental health system.

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BRIGHAM AND WOMEN’S HOSPITAL/FAULKNER HOSPITAL

Brigham and Women’s Hospital (BWH) is a 702-bed academic general hospital with an international reputation for excellence in clinical care, research, and medical education. A founding member of the Partners Healthcare System, BWH represents the 1975 merger of three Harvard-affiliated teaching hospitals whose histories go back to the early 19th Century: the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women. BWH is the site of extensive medical research, with more than $200 million in research grant funding per year, and it has 32 ACGME-accredited specialty and subspecialty training programs in a broad variety of medical fields. It is also the primary hospital for medical, surgical, and ob/gyn care for Harvard Vanguard Medical Associates, New England's largest staff model HMO.

Faulkner Hospital is a 150-bed community teaching hospital serving the Jamaica Plain, Hyde Park, and Roslindale neighborhoods of Boston and other surrounding communities. It offers complete adult medical and surgical inpatient care, psychiatric and substance abuse inpatient and partial hospital care, and a full range of out-patient, emergency and diagnostic services. In addition, the Faulkner has two nationally renowned Centers of Excellence: the Faulkner Sagoff Breast Imaging and Diagnostic Center and the Faulkner Breast Center. It is also the site for numerous academic medical training programs affiliated with BWH, HMS, and Tufts Medical School - New England Medical Center.

In 1998, BWH and the Faulkner Hospital created a new entity, Brigham and Women's/Faulkner Hospital. In 2001, the Departments of Psychiatry at the BWH and Faulkner merged to form the Brigham and Women's/Faulkner (BWF) Department of Psychiatry. This merger has broadened the range of services available to patients in the system and has brought psychiatric residency training back to the Faulkner: First year residents rotate through the Inpatient Addictions program and second year residents serve on the Inpatient Psychiatry unit. It has proven to be a successful merger that holds even further promise for the future.

The BWH side of the BW/F Department of Psychiatry is devoted to working at the interface between psychiatry and medicine to provide integrated health and mental health care. Here the Department is divided clinically into the Outpatient Psychiatry Service, the Medical (C-L) Psychiatry Service, and the Addictions Psychiatry Service. Outpatient Psychiatry includes the Brigham Behavioral Neurology Group (an interdisciplinary neuropsychiatry service co-sponsored by the Departments of Psychiatry and Neurology), and the Psychiatry in Primary Care Unit which provides psychiatric evaluation, consultation and short-term treatment for Brigham Internal Medicine Associates (BIMA), the Hospital's large primary-care teaching unit.

The Medical Psychiatry Service provides consultations to and co-management of medical, surgical, and ob/gyn inpatients throughout the Hospital. For a quarter century it also provided all adult psychiatric services for the Dana-Farber Cancer Institute (whose inpatient beds are at BWH), and in recent years it has worked closely with Dana-Farber's Adult Psychosocial Oncology Service, whose psychiatrists are part of the Medical Psychiatry faculty. The Medical Psychiatry Service also consults with the Emergency Department and specialized BWH medical/surgical programs (e.g., heart transplant team, brain tumor center, burn trauma unit, etc.).

The Addictions Psychiatry Service provides consultations to medical, surgical, and ob/gyn inpatients with co-morbid substance abuse through its Addiction Consultation and Education (ACE) Team. The ACE Team provides bedside consultations for early and accurate recognition, diagnosis, treatment, and referral of inpatients with substance abuse problems, helps inpatient physicians manage these problems in coordination with their care of the patient's medical or surgical disorder, and also educates the Hospital's clinicians about substance abuse. The outpatient arm of the Addictions Psychiatry Service provides substance abuse consultations, evaluations and referrals for treatment of patients in BIMA, the Emergency Department, ob/gyn, and other outpatient units. The Medical Psychiatry Service and the ACE Team together provide over 2,000 new inpatient consultations and 7,000 visits per year, making it the busiest consultation service at BWH.

The Faulkner side of the BW/F Department of Psychiatry has for many years provided a full-range of psychiatric services to the surrounding communities in a highly respected manner. The services include a secure 24-bed Inpatient Unit for patients 16 years and older, a Partial Hospital program for patients who need intensive evaluation, management, and treatment and are capable of living safely at home or in a community-based residence, the Outpatient Service which provides the full range of treatments including individual, couples, family, and group psychotherapies and psychopharmacology, and the Consultation-Liaison Service, providing consultation to the busy medical and surgical services and the Emergency Department at the Faulkner. Besides the above services, the Department collaborates closely with the Addiction Recovery Program (ARP) to assist in the treatment of the dually-diagnosed patient. The ARP offers a full range of addiction recovery programs including an inpatient unit, partial hospital, day and evening programs, and outpatient care to treat a wide range of addictions.

For over a quarter of a century the Department of Psychiatry has sponsored a post-residency PGY V Fellowship in Psychosomatic Medicine (C-L Psychiatry). For the last few years, BWH psychiatrists have directed and been the primary teachers for the Dana-Farber Cancer Institute Psychosocial Oncology Fellowship which trains one fellow per year. In addition, for the past 30 years the Faulkner has sponsored a highly regarded and competitive half-time psychotherapy fellowship for two PGY V residents per year, the Adams House Fellowship, which is now affiliated with HLPRTP.

Prior to the start of the HLPRTP, the Department of Psychiatry also served as the C-L psychiatry training site for the McLean Hospital and the Massachusetts Mental Health Center residency programs. BWH was one of the founders of the HLPRTP in the early 1990's and the Department's faculty psychiatrists and doctoral level psychologists are devoted to teaching residents. Half of our HLPRTP residents undertake their three-year longitudinal outpatient training on the BWH Outpatient Psychiatry Service, and half of the HLPRTP residents have their consultation-liaison psychiatry training on the Medical Psychiatry Service. All PGY II residents do half of their inpatient training on the Faulkner Inpatient Unit. In addition to providing clinical and didactic teaching and supervision for the Harvard Longwood residents, BW/F faculty also teach Harvard medical students at both the pre-clinical and clinical levels, as well as internal medicine and ob/gyn residents and faculty.

The Department has many research studies at the interface of psychiatry and medicine, with currently funded grants on hypochondriasis, alcohol abuse in pregnancy, ego development over the life cycle, screening for alcohol abuse in managed primary-care populations, and cognitive functioning in menopausal women. The BW/F Psychiatry Neuroimaging Laboratory uses state-of-the-art modalities such as functional and structural MRI, diffusion tensor imaging (DTI), and transcranial magnetic stimulation (TMS) to examine brain abnormalities in mental illnesses such as schizophrenia, schizotypal personality disorder, and PTSD.

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MASSACHUSETTS MENTAL HEALTH CENTER

The Massachusetts Mental Health Center (MMHC), now formally affiliated with the Department of Psychiatry at Beth Israel Deaconess Medical Center, is one of the oldest public teaching hospitals in the United States and has trained several generations of leaders in American psychiatry. Located within the Longwood Medical Area for over 90 years and temporarily sited at the Lemuel Shattuck Hospital in Jamaica Plain and at the Landmark Center in the Longwood Area, it is both a state mental health facility and a center of excellence in academic psychiatry, combining public service with outstanding clinical and research programs. MMHC serves an ethnically diverse catchment area of about 285,000 people in several Boston neighborhoods, with a strong commitment to care of the mentally ill regardless of their financial circumstances. Patients seen at MMHC suffer from the full range of psychiatric illnesses: schizophrenia, affective disorders, serious personality disorders, trauma and anxiety disorders, co-morbid substance abuse, and disorders of psychological development. Thus, our patient population runs the gamut from homeless individuals with chronic psychosis to students and working people.

The Massachusetts Mental Health Center Partial Hospital, an ambulatory service through which all PGY-II residents rotate, is a unique program with a one-month or longer typical length of stay. This service functions both as a step-down program from inpatient care and also a hospital diversion program for sub-acute outpatients. Residents treat patients in state-of-the-art group and individual therapy programs of social skills training and other cognitive-behavioral approaches for psychotic disorders, dialectical behavior therapy for borderline personality disorder, and dual diagnosis treatment for co-morbid psychosis and substance abuse. Some Partial Hospital patients live in the community, while the Fenwood Inn, co-located with the Partial Hospital, provides a temporary supervised residence for patients being treated in the Partial Hospital who are otherwise homeless. Excellent psychodynamic, forensic, and psychopharmacologic consultation and supervision complement the overall cognitive-behavioral approach to treatment planning on the Partial Hospital.

The Outpatient Department at MMHC, one of the largest outpatient psychiatric facilities in the city of Boston, serves over 1000 active patients each year. Included in the outpatient system of care are a variety of programs designed to help individuals with serious and persistent mental illness live as independently as possible in the community, and the Southard Clinic, a training clinic where trainees see healthier individuals and where psychosocial treatments are emphasized. The Outpatient Department provides clinical care, psychosocial and vocational rehabilitation, and outreach and housing programs ranging from supervised group homes to apartments for independent living. All clinically appropriate treatment modalities, including psychopharmacology and psychodynamic or cognitive-behavioral individual, group and family therapy, are available in each service. MMHC has also recently begun a late adolescence/young adult program designed to serve transitional age youth with major mental illness and those at risk for developing mental illness. These services are based in a new MMHC Young-Adult Center, which is located in a ‘store-front’ along the Jamaica Plain/Roxbury line of Boston.

Consistent with MMHC's mission to serve the most disadvantaged, the PGY-III Community Psychiatry rotation offers residents the opportunity to serve Boston's homeless and chronically mentally ill population in a variety of community settings. Residents are psychiatric consultants to The Boston Health Care for the Homeless Program (BHCHP), a nationally recognized program that operates in a variety of settings. Residents also work with specialty programs that treat individuals with severe affective and non-affective psychotic disorders, Mentally Ill individuals with Problematic Sexual Behaviors (MI/PSB program), patients with Borderline Personality Disorder as part of the DBT (Dialectical Behavioral Therapy) program, and adolescents, young adults and their families in the Prevention and Recovery in Early Psychosis (PREP) and Transitional Age Youth (TAY) programs.

MMHC is a major center for psychiatric research. The Commonwealth Research Center (CRC), a "Center of Excellence in Clinical Neuroscience and Psychopharmacological Research", funded by the Commonwealth of Massachusetts for cutting-edge research on serious mental disorders, is based at MMHC. Most recently, the CRC has been a center for understanding neurocognitive deficits in schizophrenia and how to treat them psychosocially and pharmacologically, including clinical trials of a new generation of atypical antipsychotic medications. MMHC researchers are investigating a vast array of subjects, including understanding the path into first episode psychosis (the "prodrome"), vulnerability to progression in schizophrenia (funded by a National Institute of Mental Health Center grant), and studies related to health and wellness.

MMHC has 22 full or part-time psychiatrists, as well as more than 40 supervisors who are in practice in the Boston area and volunteer their teaching time in the residency training program. MMHC had its own psychiatry residency training program for many years, and its faculty is renowned for its commitment to the teaching of residents and Harvard Medical School students. National and international leaders in psychiatry teach residents as they rotate through MMHC and in the larger HLPRTP curriculum. These dedicated MMHC faculty teachers include Drs. Thomas Gutheil (forensics), Larry Seidman (neurocognition in psychosis research), Matcheri Keshavan (Harvard Medical School Stanley Cobb Professor of Psychiatry, neuropsychiatry and schizophrenia research), Elizabeth Simpson (DBT), Robert Goisman (CBT), Carl Salzman (psychopharmacology) and Ken Duckworth (medical director for the National Alliance of the Mentally Ill and past commissioner of the Massachusetts Department of Mental Health).