The Department of Psychiatry at Grady Memorial Hospital functions as The Central Fulton Community Mental Health Center, providing mental health care to chronic and severely mentally ill patients in central Fulton County. Additionally, we provide emergency and inpatient psychiatric services for patients residing throughout Fulton and Dekalb Counties in our role as the psychiatry department of Grady Memorial Hospital, which provides medical services to the bi-county area, as well as surrounding parts of the State of Georgia.
There are approximately twenty five full-time Emory faculty and five Morehouse School of Medicine full-time equivalent to oversee the work of approximately thirty residents, several psychology predoctoral interns and postdoctoral fellows, medical students, social work students and various other trainees. The service is among the most comprehensive community mental health programs in the country, providing adult, adolescent, and services for children in a large number of venues. The department is an integral part of the State of Georgia mental health system, functions as the psychiatry department of a large community general hospital, and is integral to the Department of Psychiatry and Behavioral Sciences of the Emory University School of Medicine. It provides approximately 65% of all psychiatric residency training for the department and additionally is a major training site for the Morehouse School of Medicine Psychiatry training program. The service is approximately 85% outpatient and community outreach services.
The service runs the only 24-hour Psychiatric Emergency Service in the region. This is a full service psychiatric emergency program separated in space and structure from the hospital emergency service. It is staffed by full time faculty, 1st year, 3rd year and 4th year psychiatric residents, psychology trainees, a large number of mid level providers, nurses, and mental health associates. The emergency room sees approximately 1,430 patients per month. It is intimately integrated with our Temporary Observation Unit, which has an average length of stay of less than 24 hours, and the Crisis Stabilization Unit, which has an average length of stay of 72 hours. The Crisis Stabilization Unit, consisting of 8 beds, treats patients who require short-term intervention and reintegration into ambulatory programs.
We also provide 23 inpatient psychiatric beds staffed by two full-time attendings, four 1st year psychiatric residents, and a 4th year chief resident in psychiatry who directs the day to day clinical activities of the unit. It is directed by Robert Cotes, MD, Assistant Professor. Each resident carries approximately six patients on the unit, with four residents being on service at any one time. Additionally there is one psychology postdoctoral fellow, many medical students and other trainees. Preference for admission to this unit is given to patients experiencing first psychotic episodes, patients with complex medical problems in addition to psychiatric problems that are beyond the capabilities of other parts of the state mental health system, patients followed in our outpatient clinics and research subjects in our many ongoing studies. The patients are treated with multiple evidence-based modalities, almost invariably including psychopharmacologic agents, individual and group psychotherapeutic efforts, as well as family treatment whenever possible. Emphasis is also placed on objective, quantifiable measurements of psychopathology and standardized diagnostic tools. The average length of stay on this unit is approximately one week.
The department maintains a Consultation and Liaison Service led by Ann Schwartz, MD, Associate Professor. This service provides acute consultation throughout the hospital as well as specialty liaison services to many parts of the Grady Health System. The Consultation Service in the hospital sees 100 patients per month. It is staffed by two full time equivalents and often a PGY-IV resident on an elective basis. Perhaps the largest specialty liaison service is the Mental Health/Substance Abuse Treatment Service within the Grady Infectious Disease Program, which is staffed by psychiatrists, psychologists, nurse practitioners, substance abuse counselors, and various trainees. This service, which provides mental health evaluation as well as ongoing treatment (including medication management, psychotherapy, and substance abuse counseling) to patients with HIV disease, has approximately 1,350 total patients enrolled in the program and averages approximately 1,300 service visits of all types per month.
By far the largest of our services is the Adult Ambulatory Service. This is comprised of many subservices to be described below. The Central Program is our Adult Ambulatory Outpatient Program housed at 10 Park Place, a few blocks from the general hospital. This service is run by Jennifer Wootten, MD, Assistant Professor and staffed by three additional full time equivalent faculty. It sees 2800 patients per month. These are primarily chronically and severally mentally ill patients who are seen for thirty-minute ongoing appointments for medication management, supportive psychotherapy and other psychosocial interventions. This program is the primary training site for PGY-III psychiatric residents as well as many other trainees. In addition to the medication management services, some of the other therapeutic interventions offered to patients include illness management recovery, psychosocial rehabilitation, process groups, and individual therapy. Starting in October 2012 there will be a primary care clinic housed within the behavioral health clinic staffed by Dr. Martha Ward, a graduate of the med/ psych program. Residents rotating thru the service have an opportunity to participate in an elective half day. Some options include the Treatment Resistant Schizophrenia clinic, Assertive Community Outreach, trauma research with the Grady Trauma Project.
The department has extensive community outreach programs. We provide psychiatric services to homeless shelters, supportive living facilities, geriatric living facilities, and other community based programs serving patients who are unable or unwilling to come to Grady Memorial Hospital on a regular basis for mental health care. All PGY-III residents rotate through this service and many 4th year residents take electives in various clinical venues that are part of our outreach services.
The department runs a child and adolescent psychiatry outpatient service which provides training for child and adolescent psychiatry residents, adult residents doing their child psychiatry rotations, psychology pre and postdoctoral trainees and other interested trainees. A comprehensive description of these Child and Adolescent services are described in detail later in this section.
The department includes the Psychiatry and Law Service, directed by Peter Ash, MD, Associate Professor. This program has two full time equivalent faculty members, one or two psychiatric forensic fellows per year as well as other trainees in psychology and other disciplines. It provides services to courts, to the jail system, to the state mental health system and to other community agencies.
The child and adolescent psychiatry service provides outpatient psychiatric services to children, adolescents, and families in its clinic and in the community. Services include evaluations, psychotherapy (individual, group, family), medication management, classroom observation, psychological testing, and liaison with other agencies (school, pediatrics, child protective services, and juvenile justice). Community services include on-site consultation and treatment at City of Atlanta Schools and work with DeKalb County Juvenile Court. Faculty include Vivianne Aponte-Rivera, MD, Peter Ash, MD, Marianne Celano, PhD, Marietta Collins, PhD, Arden D Dingle, MD, and Priya Jacob, MD. The general psychiatry residents rotate on the service during their second and third years. The child and adolescent psychiatry residents rotate on the service during their second year.