UCSF Psychiatrists Bring OB-GYN Care to Patients With SMI

Most health professionals are aware that adults with serious mental illness (SMI)—such as schizophrenia, bipolar disorder, or severe depression—typically die younger than people without SMI, often due to comorbid conditions and limited access to health care.

For women with SMI, this lack of access extends to OB-GYN services. Yet, many efforts to provide better health care access to the SMI population have overlooked this important area of care.

Starting in 2015, a group of psychiatrists at Zuckerberg San Francisco General Hospital, one of the primary teaching hospitals at the University of California, San Francisco (UCSF), decided to address this oversight. Following the mantra of “Let’s meet them where they are,” the team established a small, satellite OB-GYN clinic in the hospital’s psychiatric inpatient unit.

Once a week, a standard exam room is converted into a modest but fully functional OB-GYN exam room, where between one and four women receive care weekly on an appointment basis. Here, residents from the psychiatry and OB-GYN departments team up to offer services that include Pap smears, breast exams, reproductive counseling, contraceptives, sexually transmitted infection testing, and prenatal care to women who have been admitted to the inpatient unit. (The OB-GYN residents perform the services, but the psychiatry residents help screen the patients and educate the OB-GYN doctors about how to effectively work with people with SMI.)

The clinic was the brainchild of Monique James, M.D., who at the time was a PGY-4 psychiatry resident at UCSF. James was looking for a way to combine her interests in women’s mental health with her desire to help underserved populations. She had heard numerous stories about how women with mental illness lack access to basic preventive health services and decided to follow up on it.

When James reviewed the health data of the women who were hospitalized in the psychiatric unit at Zuckerberg (the city’s primary safety-net hospital), she found that only about 25% of them were up to date on preventive services such as a Pap smear or breast exam, far below the national averages. “It was really quite dismal,” she told Psychiatric News.

“Organizations like SAMHSA fund programs to provide primary care for people with SMI, but they generally do not include specialty OB-GYN services or family planning,” said Christina Mangurian, M.D., a professor of psychiatry and vice chair for diversity and health equity at UCSF, who mentored James to help her get the project going.

The idea of bringing OB-GYN to psychiatry patients was not completely novel at UCSF, however. In the 1990s the school briefly had a program in which a nurse traveled to emergency rooms across the city to provide some basic OB-GYN services and education to patients. James thought this concept could be revamped: Instead of just having one nurse, why not bring a whole office? Since Zuckerberg Hospital had an OB-GYN center on-site, James figured it would be manageable to outfit the unit with needed equipment, such as an exam bed, lighting, and instruments.

Another favorable logistic was that the inpatient psychiatric unit at Zuckerberg had dedicated space that could accommodate a mini-clinic. The clinic was set up in the sub-acute area of the unit. This allowed the team to set up and dismantle the clinic each week without disturbing patients who had yet to stabilize.

There were still hurdles to overcome, such as coordinating schedules of the psychiatry and OB-GYN residents, ensuring proper billing, and following up with patients who had been discharged. However, a pilot evaluation of project PETIT (for inpatient Psychiatry women’s health Education and Testing Integration Team) found that both patients and physicians found the embedded clinic to be a valuable addition. “The patients by and large felt so cared for by this service,” Mangurian said. “It helped reinforce that we believed they deserved to be better treated.”

James, who has since moved on to become a psychiatrist at Memorial Sloan Kettering Cancer Center, also recalled many heartfelt patient testimonials. “The patients really appreciated that we took the time to explain what we were doing,” she said. “Many told us that they stopped going to OB-GYN doctors because they felt vulnerable and misunderstood.” Mangurian and James both credit the collaborative efforts of everyone involved for PETIT’s success; this includes members of the OB-GYN and psychiatry departments as well as the nurses, social workers, and other frontline staff who oversee the patients. “There were champions in every department who made it possible,” James told Psychiatric News. “And I’m so juiced that it’s still going strong four years later.”

There’s even a plan to expand the effort. UCSF currently has a program in which a mobile mammography machine (called the MammoVan) drives around to Bay Area clinics in underserved communities. Mangurian has teamed up with another young and ambitious UCSF resident—Allison Hwong, M.D.—to adapt this mobile unit for use at outpatient psychiatry settings. ■

More information about the Project PETIT pilot program is posted here.