General Psychiatry Residency Clinical Services

The Harris Health System, primarily through its flagship Ben Taub Hospital, and its 13 Community Health clinics, and five pediatric and school based centers, provides mental health care to the Houston community without regard to insurance benefits or financial status. Within Ben Taub, there is a dedicated, 12-bed, psychiatric emergency room, with a similar capacity med psych emergency area, where over 800 patients are evaluated each month.

For those in need of more prolonged care, the hospital houses a 20-bed inpatient unit with a focus on care for those with comorbid mental illness and significant physical health concerns. Adult consultation and liaison service is also available to the general hospital patients, and is a very busy service with servicing 300-400 patients a month. Outpatient services are provided for those patients in need of all ages. In the adult outpatient clinic and in the child outpatient clinic, residents are responsible for the evaluation of new patients, maintenance pharmacotherapy, and limited group and/or individual psychotherapy.

Ben Taub is also home to intensive outpatient programs for personality disorders, mostly borderline personality disorders. Approximately 1500-2000 patients per month are evaluated in Ben Taub. In addition to the above mentioned hospital based services, district has the Community Behavioral Health Program which provides psychiatric and psychotherapy services as well as limited substance abuse services in an integrated care setting with primary care physicians at 18 primary care community health centers serving between 2000-3000 psychiatric patients per month.

All of the services within the Harris Health System present a broad exposure to the full range of mental conditions, to community and public psychiatry, to systems-based care, and to crisis intervention techniques. Additionally, there is an emphasis on research and clinical inquiry throughout all aspects of mental health care delivery within the greater Harris Health Care System.

Houston Methodist contains a recently remodeled 28-bed psychiatric service. Patients with a wide variety of disorders are admitted for brief and medium term pharmacotherapy and intensive individual or group therapy interventions. The unit is able to treat patients with both general medical and psychiatric disorders. A chemical dependency treatment program provides both inpatient and outpatient services.

Three adult psychiatrists and two board certified geriatric psychiatrists provide clinical supervision to PGY II, III and IV residents who rotate at The Methodist Hospital.

The Michael E. DeBakey VA Medical Center is the largest training site for residency programs at Baylor College of Medicine, including the psychiatry residency program. Approximately 18 psychiatry residents rotate at the MEDVAMC per month. These residents assist staff in the Mental Health Care Line, as well as Medicine and Neurology care lines, in providing care to our veteran patients.

The breadth and scope of clinical experience offered at the MEDVAMC is reflected in the following statistics:

• 1,000 admissions/year to 45 acute beds
• 107,000 outpatient visits/year
• 5,000 emergency visits/year
• 600 inpatient consultations/year with
• 2,500 follow-up visits

The Baylor Psychiatry Clinic is an outpatient clinic located in the Baylor College of Medicine Medical Office Building and offers a wide range of outpatient psychiatric services. Residents have a broad range of experiences within the clinic including individual psychotherapy, group psychotherapy, medication management, and specialized assessment of a wide variety of patients. All third-year residents participate in a weekly psychodynamic psychotherapy case conference with the clinic faculty leadership.

This clinic case conference is consistently rated as one of the residents' favorite seminars. Experience with multidisciplinary care is another advantage of the clinic. In addition to psychiatry residents, psychology interns and social work trainees participate in the care of patients and didactic activities.

The clinic offers a unique opportunity for residents to care for a wide range of patients and severities of psychopathology. The clinic allows residents to follow patients for the duration of their training and even beyond, encouraging the resident to experience a long term treatment relationship. Residents are expected to carry between 4 and 8 long term therapy cases during their third and fourth years. Faculty members offer specialized clinics in mood disorders, anxiety and OCD, eating disorders, transplant patients, and children and adolescents.

Texas Children's Hospital is the largest children's hospital in the country. With 715 licensed beds, over 20,000 children are hospitalized here each year. Over 75,000 visits are made to the Emergency Center and over 425,000 outpatient visits are made annually. The Psychiatry Service provides round-the-clock consultation services to the Emergency Center, as well as to the in-patient and out-patient services. Both psychology and psychiatry personnel participate in consultations. In addition, liaison activities are an important part of our relationships with many of our pediatric colleagues.

Out-patient activities for the Psychiatry Service include the Pediatric Psychopharmacology Clinic and the Clinic for Attention Problems. After a comprehensive evaluation, patients who have neuropsychiatric conditions that may be ameliorated by the use of psychotropic medications are followed in the psychopharmacology clinic. The Clinic for Attention Problems is a multi-disciplinary clinic staffed by developmental pediatricians, pediatric neurologists, child and adolescent psychiatrists and pediatric neuropsychologists. Patients in this clinic must be referred by their physicians and their symptoms often present as complicated diagnostic challenges. Another out-patient clinic which will focus on disorders in the autistic spectrum is currently under development. This clinic will also be multi-disciplinary, drawing on the expertise of multiple disciplines, including child and adolescent psychiatry, pediatric neurology, developmental pediatrics, neuropsychology, genetics, gastroenterology, physical medicine and rehabilitation, speech and language pathology, occupational and physical therapy.

Limited psychotherapy services are also available. In general, these services are directed toward patients seen by other services at Texas Children's Hospital. The focus of many interventions is on the adjustment to serious medical disorders. Several different models of therapy are utilized as patient needs dictate.

The Menninger Clinic moved its entire clinical and administrative operations from Topeka, Kan., to Houston, Texas, on May 31, 2003. General psychiatry and child psychiatry residents began clinical rotation assignments at the Menninger Clinic in Houston in July 2003. PGY-II or IV general psychiatry residents will rotate 0.75 FTE for two-six months to a variety of subacute clinical services including Comprehensive Psychiatric Assessment Service, Professionals in Crisis Program, and the Compass Program for Young Adults.

In all services, the resident is a member of a multidisciplinary treatment team.