Closing a Primary Care Training Gap
Sep 18, 2019
Cedars-Sinai supports training to strengthen safety net for mental health.
Carrying backpacks filled with medical supplies, a trio of Venice Family Clinic primary care providers offers large doses of compassion along with on-the-spot health screenings and services to people who have no address, no doctor and, all too often, no idea where to turn for help.
La Chune F. Price, MPAS, Carrie Kowalski, MPAP, and Ebony Funches, DNP, share a passion for street medicine that provides a lifeline to people who suffer from multiple undiagnosed and untreated health challenges.
Physician assistants Price and Kowalski and nurse practitioner Funches are part of a team partnering with community organizations to fight homelessness. Acutely aware of a gap in their medical education that makes it difficult to address the mental health issues faced by many who experience homelessness, these clinicians were eager to take advantage of an opportunity to supplement their training.
They began a yearlong psychiatry fellowship in January. Within a couple of months, the trio was approaching outreach work with more confidence and new diagnostic tools.
Beyond the Basics
Price, Kowalski and Funches are among 30 local community clinic healthcare professionals participating in the UC Irvine/UC Davis Train New Trainers Primary Care Psychiatry Fellowship. Cedars-Sinai funded the 2019 Los Angeles cohort of the nationwide program. The fellowship seeks to strengthen the ability of primary care providers to conduct psychiatric assessments and administer the most effective treatments for common psychiatric conditions, such as mood, anxiety, psychotic and substance use disorders.
Most of the Los Angeles participants in the fellowship work at clinics that are part of the Cedars-Sinai Community Clinic Initiative, which offers grants and training programs to strengthen L.A.’s safety net. By the end of the fellowship, the clinicians are prepared to share their newfound skills with colleagues and enhance their clinics’ ability to meet the mental health needs of the underserved.
Knowing only the basics is not enough. I'm learning to recognize what I'm up against and determine the most appropriate treatment.”
La Chune F. Price, MPAS
Primary care providers are on the front line of mental health treatment nationwide, despite a gap in psychiatric training. An estimated 30% of primary care patients have psychiatric disorders, and more than 70% of patients taking medications for mental health issues get their prescriptions from their primary care provider, according to the American Psychiatric Association.
For Price, Kowalski and Funches, being able to quickly assess mental health and addiction issues is vital because they never know how much time they’ll have to make a difference for someone who is homeless.
Price notes that it’s often a mental health problem that prevents people from taking advantage of services that can enable them to get housing and healthcare and turn their lives around.
“The majority of people I encounter who are experiencing homelessness have some kind of mental illness—and addiction is also a big issue. Knowing only the basics is not enough,” Price says. “I’m learning to recognize what I’m up against and determine the most appropriate treatment. This program will take me where I want to go.”
The items she and her colleagues carry in their backpacks—devices for checking vital signs, medications, wound dressings—can be conversation starters. Something as simple as checking someone’s blood pressure may open the door to long overdue treatment for mental health issues. “We gain their trust by addressing their medical needs first,” Kowalski says.
“A lot of physical complaints ultimately may be a result of untreated mental illness,” Funches adds, noting people usually don’t announce they are depressed, but instead they often complain of a physical symptom.
Inspiring Positive Change
Kowalski recalls a patient with no identification papers who didn’t know her name or birth date. With her mentor in the fellowship program, Kowalski developed a treatment plan that includes medication for schizophrenia and tests to diagnose memory problems. She hopes that treating the patient’s mental health condition will help her establish the patient’s identity and begin the process of applying for supportive housing.
“Many of the patients we see on the streets have untreated schizophrenia,” Kowalski says. “They’re really helpless. If we can get them back on medication, they can get housed.”
Funches has found it particularly helpful to learn how to ask questions that can inspire people to begin making positive changes.
She explains: “People get acclimated to their environment and certain behaviors. Asking questions like this helps them recognize what’s important to them and how their life could be different.”