PPF Alumni Spotlight

For Sacha Agrawal, MD, meeting monthly with Maria Edwards, a person in recovery and peer support team leader, was a transformational learning experience during his Public Psychiatry Fellowship.

“Our conversations were unscripted, candid, and powerful,” recalls Agrawal, a fellow in 2011-2012. He met Maria at Connecticut Mental Health Center, where he also provided clinical care. “Working with Maria, I became deeply curious about the untapped potential of mental health service users to participate in clinical education.”

Today Dr. Agrawal, Assistant Professor of Psychiatry at the University of Toronto, is a community psychiatrist and education scholar at the Center for Addiction and Mental Health where he continues to expand his education research.

His scholarly interests lie in developing better ways of teaching and delivering person-centered, recovery-oriented services for individuals recovering from significant mental health and addiction issues. Since leaving Yale, Dr. Agrawal has won a number of medical education grants and awards in the areas of service-user led education and teaching humanistic care.

At the University of Toronto, he has developed a novel service user advisory course for fourth year psychiatry residents. This course creates a space for critical reflection on professional knowledge and practice. Dr. Agrawal has since developed with others numerous collaborative educational initiatives within the broader mental health system, including a series of facilitated workshops for service user educators like Maria Edwards. The service user education model, he says, has enormous potential for catalyzing systems change by disrupting traditional professional training, which can lead clinical providers to a “narrow, skewed and fundamentally oppressive understanding of people with mental health and substance use challenges.”

In the Jackson Heights neighborhood of Queens, New York, Jennifer Traxler, DO, works with one of the most diverse patient populations in the world.

After graduating from her Public Psychiatry Fellowship in 2015, Dr. Traxler went to work at Elmhurst Hospital Center as the psychiatrist for the ACT (Assertive Community Treatment) Team. She and her interdisciplinary staff of social workers and nurses provide a variety of home-based services—medication management, vocational support, case management—for people with chronic psychiatric disorders. Forty percent of Jackson Heights residents are foreign born; Elmhurst is part of New York City’s Health + Hospitals system.

As a Public Psychiatry Fellow at Yale, Dr. Traxler says she learned a huge amount in two broad areas: clinical work and public systems. On the clinical side, she focuses on bringing evidence-based care to an underserved population, including the latest in medication management and the theory and practice of recovery-oriented services.

On the systems side, Dr. Traxler is working on a project to bring together Elmhurst’s ACT team and mobile crisis unit in an effort to improve culturally responsive home-based services to an internationally diverse population. Both teams visit people in their homes; ACT provides long-terms care while mobile crisis responds to emergencies. Their patients often overlap. “Our clients are people whose needs were not met by the traditional service delivery models,“ she explains. “We hope to explore how to meet the needs of different populations through mobile delivery services.”

A native New Yorker, Dr. Traxler was impressed by the high level of creativity and innovation in the public mental health system in Connecticut. At Elmhurst, she has organized recovery-oriented treatment planning workshops for the staff, led by the Center for Practice Innovations. She is enjoying working with her colleagues on transforming the philosophy of care. “I really feel we’ve moved in a good direction,” she says. “There has been a dramatic change.”

Since graduating from the Yale Public Psychiatry Fellowship program in 2014, E. Francisca García-Aracena, MD, has pursued a multi-faceted career as doctor, educator, and advocate in her home country of Chile.

As a psychiatrist at Sótero del Río Hospital, one of the biggest public hospitals in Chile, she works with underserved populations with complex health and social needs. In addition to providing clinical care on the inpatient and outpatient units, Dr. García-Aracena is also a member of the outreach team where she works to embrace recovery-oriented care. Recently, she helped put in place a modified ACT team (Assertive Community Treatment), the only one of its kind in Chile.

“Most important of all,” she reports, she is teaching: as adjunct professor and coordinator of the university-based psychiatry residency program at Universidad Diego Portales, Dr. García-Aracena motivates residents to continue their work with vulnerable populations and pursue their own careers in public psychiatry. In addition to preparing residents for excellence in their practice, the program offers special courses related to issues in public psychiatry. Enthusiastic residents have stepped up to create and run new groups and offer community-oriented activities for people in recovery.

Dr. García-Aracena is also a collaborator with the online Epistemonikos, which she describes as “one of the largest databases for multilingual systematic reviews relevant for health decision-making.”

“One of the goals of Epistemonikos,” she explains, “is to generate high-quality systematic reviews highlighting the relevance of psychiatry topics for medical practice.” Her team plans to review many topics related to public psychiatry, including ACT Team models and public health policies impacting vulnerable populations.

“In my work as a Public Psychiatry Fellow at Yale,” reflects Dr. García-Aracena, “I was able to gain the tools to integrate clinical practice for a very challenging population within the public health setting. My patients’ needs usually are not met by the traditional way of care delivery. The unique experience I had at Yale has allowed me to provide well-rounded, recovery-oriented care based on evidence, without feeling overwhelmed.”