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Atlanta VA Medical Center

The mission of the Atlanta VAMC Mental Health Service Line (MHSL) is “to provide comprehensive, compassionate, and continuous healthcare to veterans with emotional and mental conditions in different settings (community, home, outpatient and inpatient) following a bio-psycho-socio-cultural-spiritual approach in search of a balanced and harmonious quality of life.”

The Mental Health Service Line maintains academic affiliations with Emory University, Medical College of Georgia, Georgia Perimeter College (AD nursing program) and Dekalb Technical School (LPN program), in support of medical, physician assistant and nursing residents.

Service Line Structure and Functions

The Mental Health Service Line of the Atlanta VAMC provides psychiatric care to veterans primarily in Atlanta and surrounding regions, but also serves those veterans living in all the Atlanta Network area including Georgia, Alabama and South Carolina. The Atlanta VAMC MHSL provides a broad scope of services, based on the following structure:

1) Overall clinical services are provided by 4 multidisciplinary general psychiatry teams which treat the whole range of psychiatric disorders on an inpatient and outpatient basis, in strict application of the continuity of care philosophy. Each team is comprised of between 8-10 healthcare providers, a group that includes psychiatrists, psychologists, CNS, LCSW, Chaplain, RN's and two Addiction Specialists (either CARN or NCAC). Each team is assigned a cohort of patients (approximately 1200 per team) of whose integral care the team is responsible at all times.

2) The inpatient psychiatric unit has 40 beds consisting of 12 beds in the Psychiatric Intensive Care Unit (PICU) for patients who have been just admitted or whose clinical condition requires special observation and surveillance, 4-6 detoxification beds depending upon need, and 24 beds for general psychiatry patients. The Service can also use two observation beds for 23-hour stays.

3) The Outpatient Mental Health Clinic is also structured following the team distribution outlined above. Each team has multi-disciplinary staff seeing assigned patients (new or follow up cases) everyday. There are at least 2-4 staff members (case managers and MDs) scheduled in the Mental Health Clinic (MHC) on a daily basis. Other clinical activities in the outpatient clinic include group therapy, depot-neuroleptics clinic, anger management groups, and additional patient educational activities.

4) The following special programs are also cardinal components of the MHSL:

a. A multidisciplinary Substance Abuse Treatment Program (SATP) which provides inpatient detoxification treatment, aftercare and evening treatment (the latter provided to veterans who work during the day), Halfway House funding for veterans who may be homeless, and outreach measures. The SATP provides treatment based on level of intensity required.

b. Intensive Case Management Program (ICM) (formerly known as Intensive Psychiatric Community Care Program) provides intensive care to up to 53 veterans meeting specific criteria (hospitalizations of 30 or more days a year in the past, diagnosis of schizophrenia or other severe, chronic psychoses). The ICM Program has a staff of a psychiatrist, full-time Clinical Social Worker, Social Work Associate, Clinical Nurse Specialist and Licensed Practical Nurse, as well as one full-time clerk. The ICM approach allows the continuous insertion of veterans in the community, and is a very effective means to prevent long-term institutional/residential care.

c. Posttraumatic Stress Disorder Clinical Team (PCT) provides specialized and intensive treatment to PTSD patients. Its staff comprises full-time personnel that include a psychiatrist, psychologist, a clinical Social Worker and a clerk. Treatment approaches range from intensive two days a week, three-hours a day for four months, to once a week group therapy sessions for patients grouped in cohorts of no more than 16 individuals. The program, in operation since 1995, serves veterans from World War II, Vietnam war, and the Persian Gulf Conflict.

d. Consultation/Behavioral Health Team (CBH) provides specialized treatment in areas such as smoking cessation and sexual dysfunction; at the same time it provides consultation services to evaluate and treat patients in other services of the Medical Center who may present psychiatric problems.

e. Mental Health/Primary Care Clinic (Platinum Team), established to attend the medical and physical problems of MHSL unique in a comprehensive context. The Platinum Team is currently composed of two internists, one pharmacist, one Nurse Practitioner, two Registered Nurses and one clerk.

f. Mental Health Care in Community Based Outpatient Clinics (CBOC's). Mental Health services are currently provided at two CBOCs with a Social Worker and a Psychiatrist in each site.

g. The acquisition of a state-of-the art Electroconvulsive Therapy (ECT) equipment will guarantee the availability of this procedure to patients in need. An experienced group of MHSL staff psychiatrists (with assistance of the VAMC’s Anesthesiology Division) administers the treatment.

h. The Therapeutic Recreational Activities (TRA) program provides recreational activities and lunch to our chronically mentally ill veterans for four hours per day, five days a week and assists them in conducting socialization skills, leisure events, and structured activities within a mental health clinic milieu.

5) The research portfolio of the Atlanta VAMC MHSL includes:

a. The use of a novel technology, Virtual Reality, has been utilized for the management of PTSD. This has been expanded into chronic pain studies. Pilot studies and pertinent publications are completed. A large grant proposal with a number of neurobiological and neuropsychological correlates for PTSD and Virtual Reality are is in the planning stage.

b. Substance abuse research is rapidly expanding with a recent award of a grant from the Drug Abuse Scholars Program in Psychiatry, a collaboration between NIDA and the APA, to a SATP staff psychiatrist (Karen Drexler, MD) in our service for the study of neuroimaging of emotion and impulsivity in cocaine abuse

c. The Pharmaceutical trials program based at the VAMC will likely expand.

d. The paradigm of startle response in schizophrenic patients has been set up by Erica Duncan, MD. She recently has been funded with a VA merit award to support this research.

e. The Homeless research program including scrutiny of clinical diagnosis, social support, medical complications and impact of several management modalities.