The United States and Oregon specifically, have experienced a severe shortage of Behavioral Health (BH) resources for decades, intensified by the Covid-19 pandemic. There are serious supply issues for all BH providers, including community health workers, LCSW, PsyD, and Primary Care physicians, exacerbated by exceptional shortages of Psychiatrists. St Charles Health System (SCHS) is the only hospital system and the only source of specialty psychiatric care (emergent, inpatient) in Central Oregon. SCHS is the only resource east of the Cascades that offers emergent Psychiatry inpatient services, and a psychiatric inpatient treatment center. Regional SCHS outpatient clinics have BH workers at facilities in Bend, Redmond, and through our two Critical Access Hospitals in Prineville and Madras. Because psychiatrists are at the apex of care services – relied upon for diagnosis, patient care, consultation, and management of complex patient populations – this severe shortage of psychiatrists constrains the entire system. Psychiatric physicians (MD/DO) are the only members of the behavioral health team who can safely implement and direct sophisticated integrated services to patients- including psychoactive/psychiatric medications, counseling, and other emerging therapies (Ketamine, psilocybin, ECT, cranio-magnetic therapy). These professionals are essential in managing the most complex mental health issues such as Schizophrenia and bipolar disease, each of which affects approximately 1% of the US population and is accompanied at least 50% of the time by serious secondary diagnoses such as substance abuse and addiction.
2020-2024 Regional Health Improvement Plan Priority Area
Behavioral Health: Increase Access and Coordination
Future State Measure
Improve availability of behavioral health providers in rural areas
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- This project is funded through the 2020-2024 Regional Health Improvement Plan's Behavioral Health: Increase Access and Coordination workgroup.
- The project received $498,546.00 in funding and is implemented by St. Charles Health System.
- Learn more about the importance of the measures from the Behavioral Health: Increase Access and Coordination priority area.
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- The long-term goal of the SCHS-OHSU Psychiatry Graduate Medical Education (GME) program is to increase the number of highly trained, compassionate psychiatrists in the Oregon workforce by 2030. Achievement of this goal will improve community access to quality behavioral healthcare, including specific expansion of services for our most vulnerable and marginalized populations.
- Create meaningful community linkages to enhance program quality, inclusivity, and diversity, including the engagement of behavioral health groups such as the Behavioral Health Consortia, and enhancing services to underserved communities including Warm Springs and others by the end of year 2.
- Successfully complete and fulfill all the requirements for the SCHS-OHSU psychiatry residency program to apply and achieve ACGME accreditation (program staff, facilities enhancements, supply procurement, etc.) by end of year 2.
- Outline and prepare all necessary academic components (curriculum design, clinical rotation site identification and implementation, hiring faculty, etc.) for the program.
- Submit the ACGME application by the end of year 2 and receive ACGME accreditation.
- Begin training the first (PGY-1) class of psychiatric residents
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By supporting the establishment of a new Psychiatry GME program, COHC grant funding, in conjunction with HOWTO funding will directly increase access to trained psychiatrists and their services in central Oregon and the surrounding rural/frontier areas of the state and would double the supply of specialty psychiatry graduates likely to practice here and throughout the state. Psychiatric access will be enhanced, and care will be delivered through integrated consultation services, expanding access to the most vulnerable populations by providing consultation and patient care services modeled after those developed for Native Americans/indigenous living on Warm Springs reservation, the Latinx community, and migrant farmworkers in Madras and Prineville-all served by SCHS. A significant proportion of training occurs in a culturally diverse environment; adding Psychiatric trainees will directly educate them to meet the needs of these under-served populations. Following the highly successful model of RTT family medicine GME for Madras, Warm Springs and rural central Oregon (a project jointly funded and supported by HRSA, HOWTO funds, OHSU and SCHS) this program will be institutionally sponsored by SCHS. Ongoing financial sustainability will be supported by federal funding, bolstered by educational sponsorship by OHSU. Joint planning between SCHS and OHSU for expansion of psychiatric training has been ongoing for a year. This SCHS/ OHSU Psychiatry Residency Program will transform psychiatric care in the state, as it becomes the first psychiatry residency training site in Central Oregon. It is the intent of this program to grow and expand training for all psychiatric/behavioral health programs, including the training of Psychiatric Nurse Practitioners. One of the fundamental tenets of the Psychiatry residency is to deliver care in rural communities in central Oregon, not just limited to the IHS/Tribal clinic located in Warm Springs. There is a demonstrated and recognized need to expand services to all central Oregon rural sites, including La Pine, Prineville and Madras. These communities will be prioritized to benefit from psychiatry services through the residency program as soon as it is feasible to do so. -
Integral to increasing the number of highly trained, compassionate psychiatrists in the Oregon workforce, by June 2027 we are graduating 6 psychiatry residents annually from the fully ACGME accredited residency program in Central Oregon.
From June 2022 - June 2027, the residency program will develop a relationship with the Behavioral Health Consortia, obtain commitments from community partners, and create a subcommittee for rural partnership with RTT Program/ Warm Springs community.
From June 2023 to June 2024, interviews will be offered to Residency applicants; final recruitment of the first class of residents will be completed and the residency training program will officially begin.
From June 2022 to June 2025, job descriptions for necessary roles will be developed, hiring for those roles will be initiated, a facilities plan will be developed, and any necessary supplies and equipment will be purchased.
By June 2023, design curriculum- including cultural competency and decolonizing practices, specialty, and inter- professional training; develop rotational site plans; and faculty development
By June 2024, an initial program design using the ACGME Program Requirements and Program Information Form will be completed, as well as ACGME site visit.
A Year One Report will be available in July 2023 and a Year Two Report will be provided July 2024
A Year Three Report will be available in July 2025 and a Year Four Report will be provided in July 2026
A Final Report and outcomes will be shared under “What We’re Learning” after August 2027