Authority Health Psychiatry Residents Sees Future in Public and Community Psychiatry

By Dennis Archambault

Dr. Nicholas Fletcher’s future seemed uncertain a year ago, having been accepted into the Authority Health Teaching Health Center. What made his future so uncertain was not that he had selected the Authority Health Psychiatry program, but because the field of psychiatry had chosen him.

A year later, he was accepted by the American Psychiatric Association Foundation (APAF) as a Leadership Fellow in Public and Community Psychiatry.

“Detroit has been the most amazing blessing I’ve ever received,” he wrote on his LinkedIn page.

The two-year APAF program provides support for a group of outstanding residents interested in the field of public and community psychiatry. Fellows will engage thought leaders in the specialty area of public psychiatry, a form of population health. The Fellowship is designed to provide experiences that will contribute to the professional development of residents who will play leadership roles within the public sector in future years and to heighten awareness of the psychiatric residents of the many activities of psychiatry in the public sector and of the career opportunities in this area.

Dr. Fletcher’s first year as an Authority Health’s residency, which is focused on community-based training among vulnerable populations, has helped clarify his interest in public and community psychiatry.

“The vision I have outlined for my career is rooted in being an advocate for my patients, community, and my specialty. Knowing I want my specialty and profession to be the foundation for positive change I seek in my community and be recognized in this manner is humbling. I am grateful for the knowledge, skills, and networks this fellowship will provide, and I look forward to meeting the unique challenges ahead.”

In the future, Dr. Fletcher envisions working with low income, underserved populations with complex psychiatric needs. “If you’re fortunate enough to have your own insurance, you can go to your primary care physician or hospital, but for the more complex patient who are on public services and get their care through Medicare and Medicaid, they tend to move around a bit and are more mobile. This Fellowship focuses on that population group and how best to manage their care. We know that a lot of them are falling through the health safety net. By the time we see them they’re the sickest of the sick, from a psychiatric standpoint.”

Not many psychiatrists select this area of practice, but for Dr. Fletcher it’s part of his personal mission as a physician.

“I’ve always believed that if you’re doing something for the right reason, the money aspect will take care of itself. That’s never really been a big focus of mine.”

When he applied for the Authority Health residency, one of the questions Dr. Theadia Carey, program director, asked him, was “What is your five-year plan?”

“I had three things,” Dr. Fletcher told her. “I wanted to provide for my family, be good at my job, and to be a leader in my community. This Fellowship addresses all three of those. If it’s going to be challenging, great. I love a challenge. I like the patients I’m working with because I can tell, for a lot of them, it’s the first time they’re being seen, and they’re being heard by someone who looks like them. That, in and of itself, is very gratifying – even at this young stage of my career.”

The mental health crisis facing all aspects of American culture, is even more acute among low-income people from African American and other minority communities. The pandemic has made it that much worse. “In a lot of patients I see, you don’t have to dig very hard into their physical history to know that they were impacted pretty significantly by the pandemic. They, themselves, may not be able to identify it. You may need to ask more specific questions like, ‘What have you been doing for 12 months?’”

For many people, it’s sometimes difficult to recount what happened and when during the pandemic. Dr. Fletcher suggests that during an initial patient interview that physicians ask, “What were you doing during the pandemic? How did the pandemic affect you? I think it needs to be part of the history you take with your patients. That’s going to be a period of time that will have ripple effects on the rest of their lives.”

For those who have struggled with emotional and mental health issues, possibly complicated by substance use disorder, there may have been support groups, church groups, or other sources of community that help people function.  “That was all taken away from them. Those who didn’t have the means to ride this out, they were almost trapped in their mental challenges. Prior to COVID you understood the world one way. Everybody as a human species understood the world one way. And then all of sudden there’s this unknown, unseen , not understood virus that is killing people. For someone who struggles with mental health challenges, it would be enough to make them feel unstable and unable to deal with the real world. Then you compound that with the world shutting down and then seeing that not only are you scared, but everyone else is scared. It’s enough to make them question – what does this all mean?”

Public and community psychiatry also involves advocacy, something that Dr. Fletcher has been interested in. “I’m a policy wonk. To me, I believe policy is how you get things done that nobody wants to do. Usually, policy comes from somebody’s individual passion for whatever they feel is unjust or needs to be remedied or spotlighted. Our country is based on laws that come from ideas. A lot of people don’t wake up thinking about policy, but everything we do is based on policy in some form.

“I view this Fellowship as an opportunity for me to speak on behalf of this psychiatric population. I love to use the profession of medicine for social change. I love the ability to use medicine and medical justice for advocacy work. At the end of the day, I don’t care how much money you have, health is the great equalizer.”

Dennis Archambault is the Director of Public Affairs at Authority Health