The Behavioral Health Education Center of Nebraska: A Creative Solution to a Persistent Behavioral Health Workforce Shortage.

States all across the United States are experiencing a shortage in their behavioral health workforces. Although many studies have suggested factors that contribute to or mitigate the shortage-particularly in rural and underserved areas-no nationwide guidance exists on best practices to develop a behavioral health workforce that can meet community need. The Behavioral Health Education of Nebraska (BHECN) can serve as an exemplar for others looking to take a multifaceted approach to develop the behavioral health workforce in their community. Evidence from published studies is reviewed, and BHECN's approach and practices are explained.

Disability Inclusion in Psychiatry: Strategies to Improve and Increase Diversity Within the Psychiatrist Workforce.

The number of psychiatrists with disabilities is not well studied but the inclusion of mental health providers with disabilities is integral for the betterment of psychiatry and patient care.

Parental postpartum depression among medical residents.

The study aimed to quantify and compare rate of parental postpartum depression (PPD) among medical residents to that of the general population and identify potential areas of further support for resident parents. Our team, University of Nebraska Medical Center (UNMC) OB/GYN and Creighton Psychiatry departments, developed and disseminated 22 item anonymous survey distributed via email link to targeted specialties as well as the "Physician Mom's Group" on Facebook. The survey included both quantitative and qualitative measures on medical resident and resident partner mental health, demographics, specialty, year in residency, support from residency program, parental leave, and an open comment section. Seventy-two resident parents, 64% of whom were female, completed the survey. 42% of female respondents reported feeling they suffered from PPD symptoms, representing more than four times the rate of PPD within the general population (11%). Only 12% of these women reported having sought treatment or were diagnosed with PPD. Male residents did not report an increased rate of depressive symptoms; however, 19% of respondents believed their partner's symptoms were consistent with PPD. Responses from the survey and open-ended questions emphasized need for emotional support, transparency in programmatic leave policy, breastfeeding accommodations, and additional parental leave time. This is the first study of its kind to examine PPD among both male and female medical resident parents. Limitations of the study included small sample size, which impacted statistical significance. The data and commentary are nonetheless useful in highlighting risk of PPD amongst medical residents and indicate further study is warranted.

The Behavioral Health Education Center of Nebraska: A Creative Solution to a Persistent Behavioral Health Workforce Shortage.

States all across the United States are experiencing a shortage in their behavioral health workforces. Although many studies have suggested factors that contribute to or mitigate the shortage-particularly in rural and underserved areas-no nationwide guidance exists on best practices to develop a behavioral health workforce that can meet community need. The Behavioral Health Education of Nebraska (BHECN) can serve as an exemplar for others looking to take a multifaceted approach to develop the behavioral health workforce in their community. Evidence from published studies is reviewed, and BHECN's approach and practices are explained.

Disability Inclusion in Psychiatry: Strategies to Improve and Increase Diversity Within the Psychiatrist Workforce.

The number of psychiatrists with disabilities is not well studied but the inclusion of mental health providers with disabilities is integral for the betterment of psychiatry and patient care.

How to Transition Patients Back From Psychiatric Care to Primary Care: An Access Initiative Protocol Development.

This column describes the initial steps to develop a bidirectional access initiative between outpatient psychiatric and primary care clinics within an academic medical center. The authors analyzed electronic health record data (N=2,837 patients), interviewed psychiatric and primary care providers, assembled a work group, and identified five patient tracks (treatment optimization, psychiatric continuity, specialty clinic, psychotherapy, and community referral). Over 16 months, the number of patients scheduled for new psychiatric diagnostic evaluations with medical services increased from 62.5 to 116.0 per month without significant change in the no-show rate for evaluations within the psychiatric outpatient clinic.

Cultivating mental health education in obstetrics and gynecology: a call to action.

Mental health disorders are common and have a significantly negative impact on the health and well-being of women. For example, perinatal mental health disorders such as anxiety and depression are widely understood to be the most common complications of pregnancy and childbirth. Untreated mental health disorders are associated with significant obstetrical and psychiatric sequelae and have a long-lasting impact on neonatal and childhood outcomes. As front-line providers for women during times of elevated risk of psychiatric morbidity, such as pregnancy and postpartum, obstetricians and gynecologists are compelled to have familiarity with such disorders. Yet, a wide gap exists between the level of education in mental health disorders that obstetrician and gynecologist providers receive and the clinical need thereof. The objectives of this commentary are to describe the urgent need for mental health education for obstetricians and gynecologists providers and to introduce our vision for a concise, evidence-based and accessible set of digital educational materials designed to convey core concepts in women's reproductive mental health.

Case report: domperidone use as a galactagogue resulting in withdrawal symptoms upon discontinuation.

We present a case of domperidone withdrawal in a woman using the medication as a galactagogue. Our primary goal is to increase the literature available to providers who work with women who are breastfeeding. We evaluated a woman presenting to our reproductive psychiatry clinic for consultation regarding anxiety and agitation in the context of domperidone discontinuation. We evaluated the available literature regarding domperidone as a galactagogue, as well as the literature regarding adverse effects. The patient presented with withdrawal symptoms after gradual taper and discontinuation of domperidone. After restarting the medication, her symptoms resolved. She was able to successfully discontinue domperidone with a slow, gradual taper. Domperidone is occasionally used as a galactagogue in women with inadequate milk supply. We report a case in which a woman experienced withdrawal symptoms after domperidone discontinuation.

Demographic and Personal Characteristics of Male and Female Chairs in Academic Psychiatry.

OBJECTIVE: Despite the strong representation of female psychiatrists in residency and early-career positions, the number of female faculty sharply decreases in tenured or executive leadership positions. Why there exists a marked change in representation at the level of senior leadership within academic psychiatry is unclear. The authors investigated the causative factors contributing to this observation and gathered information about the personal characteristics of women in executive leadership roles. METHODS: The authors surveyed psychiatry chairs at academic institutions. They identified all female chairs and randomly selected a group of male chairs to serve as a control group. The survey assessed perceived barriers, strengths, and weaknesses and differences in demographics and leadership styles between female and male chairs. RESULTS: Ten percent of psychiatry chairs were female. Male chairs were more likely than female chairs to head large departments (p = 0.02, confidence interval (CI) -17.1-69.1) and had a higher H-index (p = 0.001, CI 6.6-37.2). Female chairs were more likely than male chairs to perceive barriers in their career development (p = 0.01, CI 0.7-2.2), citing little or no mentorship (p = 0.04), gender discrimination (p = 0.0001), and family obligations (p = 0.001) more often. CONCLUSION: Academic institutions must incorporate programs to decrease barriers and work to achieve equitable representation of women in upper-level leadership positions. Moreover, academic medicine must evolve to cultivate a family-friendly environment that successfully supports both genders.