Postpartum psychosis is the most severe psychiatric disorder associated with childbirth. Although rare, it is considered a psychiatric emergency that warrants immediate medical attention and inpatient care to ensure safety, complete diagnostic evaluation, and treatment initiation. This article describes the phenomenology of postpartum psychosis, clinical evaluation, treatment guidelines, and prevention strategies.

BACKGROUND:Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. OBJECTIVE:Describe a formal clinical fellowship devoted to professional development for the integrated care psychiatrist role. METHODS:The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics. RESULTS:We successfully recruited 3 classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All 5 graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n = 5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n = 581) and the mean quality of the talk was 5.35 (n = 582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows). CONCLUSIONS:The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing consultation-liaison psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.

Integrated behavioral care, and in particular, the collaborative care model, has been working to improve access and treatment for people with mental health disorders. Integrated care allows for adaptable, scalable, and sustainable practice that addresses the mental health needs of the public. During the pandemic several challenges emerged to delivering integrated care. This disruption happened at a systems level, team-based care level, scope of care level, and patient access level. This article looks through the lens of those various levels to identify and some of the lessons learned to help build a more resilient and flexible integrated care program.

Background: Telepsychiatry has the potential to help address the uneven distribution of psychiatrists between urban and rural areas. While telepsychiatry has been used for several decades, employing video conferencing technologies to conduct psychiatry consults to the medical wards of rural hospitals is a more recent application. Objective: To develop the first US program wherein psychiatrists covering the consult service at a public, academic medical center also delivered same-day consults to patients on the medical wards of unaffiliated, rural hospitals. Methods: We describe the rationale, workflow, technology, case distribution, benefits, and lessons learned from the first 24 months of the service. Results: The program resulted in 156 initial and follow-up consults wherein patient interviews were conducted via live videoconference. An additional 19 "curbside" consults were done via hospitalist-to-psychiatrist phone calls. Though the initial impetus for the development of the program was to manage involuntarily-detained patients awaiting the availability of a psychiatric bed, the availability of the psychiatrists resulted in the service being used for a wide range of situations and diagnoses. Conclusion: Given the benefits noted by consultants, patients, and community hospital medical staff the program could be replicated by other institutions.

Back to table of contents previous chapternext chapter No AccessChapter 38.Integrated and Collaborative CareEdited by:https://doi.org/10.1176/appi.books.9781615372980.lr38AboutSectionsView chapterExcerptView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View chapterSectionsModels of Integrated Care | Principles of Collaborative Care | Collaborative Care Team | The Psychiatrist's Role in Collaborative Care | Preparing Psychiatrists for Careers in Integrated Care | Conclusion | ReferencesExcerptMental disorders are responsible for significant morbidity and mortality, accounting for about 25% of disability worldwide (Murray et al. 2012). However, in the United States, only 12% of people with psychiatric disorders see a psychiatrist, and only 21% see any mental health specialist (Wang et al. 2005). Most people do not seek any medical care, and of those who do, more than half are seen in general medical settings, which have a low rate of adequate mental health care (Unützer and Ratzliff 2015). Access to specialty mental health care is poor, and only about half of the patients referred from primary care to specialty mental health care follow through with the referral (Grembowski et al. 2002). At the same time, patients with chronic severe mental illness have shorter life spans and higher rates of chronic medical conditions, primarily as a result of socioeconomic factors, side effects of psychotropic medications, and limited access to effective primary and preventive health care (Druss et al. 2011). These gaps in access to and quality of care have led to efforts to integrate behavioral and general medical services so as to improve both mental health and medical outcomes for patients. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone The American Psychiatric Association Publishing Textbook of Psychiatry Information©American Psychiatric Association Publishing History Published online 8 October 2019 Published in print 2 May 2019