A growing number of psychology training programs are homing in on the treatment of serious mental illness--an area where relatively few psychologists are specialized despite evidence that their psychosocial interventions boost recovery rates.

Indeed, the President's New Freedom Commission on Mental Health, in a report issued in July 2003, called for more empirically validated rehabilitation programs and recommended that they focus on recovery and resilience instead of symptom management--all recommendations drawn from psychological research and practice. Bringing that shift to fruition, however, requires that more psychologists be specifically trained to provide and study serious mental health (SMI) treatments.

"It's vitally important that psychologists play a much more prominent role in the care of people with serious mental illness," says APA President Ronald F. Levant, EdD. "Outside the U.S. Department of Veterans Affairs and public care systems, there are actually very few psychologists involved."

But developing psychologist experts in SMI is tricky, as most doctoral training programs don't offer an emphasis in SMI. Also, new professionals who've not been exposed to SMI treatment methods while in school or on internship often do not have the interest or skills to successfully step into SMI postdocs, notes Levant. Furthermore, most psychology students aren't introduced to SMI research paths until they've developed some other research interest, written their dissertation and made plans for future academic work--too late to risk switching paths, say Levant and other observers.

However, there are signs of progress. Several pre- and postdoctoral training programs have popped up and sharpened their focus, Levant notes. Yale University, Nova Southeastern University in Florida and the University of Maryland at College Park are examples of institutions preparing new psychologists to be a vital part of SMI rehabilitation. Here's how they're making progress.

Clinical focus

The Yale Program for Recovery and Community Health trains predoctoral interns and postdoctoral fellows to work with people affected by urban poverty, homelessness and SMIs such as schizophrenia and bipolar disorder.

Too often, students start clinical work with SMI patients without appropriate supervision, knowledge or skills, says psychologist Larry Davidson, PhD, director of the Connecticut Mental Health Center-based program. As a result, he says, the first time they encounter such a patient, they may take the wrong tack and be discouraged by the experience.

Created in 2000, the program at Yale aims to change that while moving patients toward meaningful roles as workers and family members within their communities, Davidson says.

Through opportunities to work with patients in real-world settings and consultations with faculty, Yale's program provides students with practical information on working with SMI clients while they interact with them directly, adds psychologist Maria O'Connell, PhD, who was a postdoc in the program. She says this ensures that once students get started, they'll feel effective and learn to identify progress in ways not always available in traditional settings. She adds that another program asset is its flexibility.

"I was able to work with clients wherever the client and I felt it was best, be that taking a walk or over at the Dunkin Donuts or in my office," she notes. "That flexibility allowed me to stretch my wings, connect with clients as real people and feel like I was making professional progress."

Another program feature is its emphasis on research.

"We're training students who will not only be able to treat people with serious mental illness, but who will also conduct research and make the argument for the value of psychological interventions in promoting recovery," Davidson says.

Research opportunities include work on how state and national models of public policy initiatives develop and function. For example, students develop mental health plans for public housing and evaluate the use of intensive peer outreach between recovered and recovering SMI patients as alternatives to inpatient commitment and incarceration.

SMI instruction

At Nova Southeastern University, doctoral students can specialize in the psychology of long-term mental illness--a track that provides general clinical training as well as an early course focus on the treatment and evaluation of adults with SMIs, like schizophrenia and bipolar disorder, and their families.

"Students are learning the newest information out there on how we treat SMIs, like advanced use of social learning methods and community interventions," Levant says. "It's an exciting vein of work because every aspect of treatment touches on both policy and science issues."

Coursework there stresses treatment of SMIs through community support, partnering with psychiatrists for thoughtful use of medications and highly specific assessment and diagnosis--all methods that require psychological expertise to research and employ, says psychologist Stacey Lambert, PsyD, an assistant professor. Students also get a well-rounded series of other courses in psychology.

"With serious mental illnesses, a lot of the topics overlap with other topics in psychology," Lambert says. "So the specific SMI courses aim to both give students specific information but also give them a sense of treatment as a multidisciplinary system."

The program educates students on multiple aspects of rehabilitation, including work issues, social security, housing and families, Lambert says. It also prepares students for leadership roles by teaching broader professional skills, such as management, grant writing and fund raising. After their classroom training, Nova students do two yearlong practicums, one in a general topic such as family counseling and one working directly with SMI clients.

Prepared researchers

Especially key to SMI growth is catching students' research interest early--before the doctoral level, says psychologist Jack Blanchard, PhD, who seeks to do that through directing the two-year-old Schizophrenia Research Training Program at the University of Maryland, College Park.

"What we've sought to do is address the lack of development in researchers studying serious mental illness," Blanchard says of the National Institutes of Health National Research Service Award-funded program.

The program features five components: core courses in schizophrenia involving both psychopathology and aspects of functioning and treatment; other science courses in the behavioral, cognitive, developmental and neurosciences that help students work and think from an interdisciplinary perspective; weekly seminars from faculty and visiting scientists; a yearlong clinical externship on assessment of people with schizophrenia; and intensive, mentored research experiences.

The program can offer such diverse research and clinical experiences because of its local resources, says Blanchard. For example, students can work with patients at the University of Maryland School of Medicine's Center for Behavioral Treatment of Schizophrenia, the Baltimore Veterans Administration and the Maryland Psychiatric Research Center.

By providing such opportunities, says Blanchard, the program is giving SMI "the full attention of some of our brightest young psychology researchers."