xxAACP Newsletter, Volume 11, Number 4, Autumn 1997
Birecree & Wicker 1997 AACP Award Winners
The annual recognition award for a non-psychiatrist went to Larry Wicker who is well knnown in Los Angeles for his patient and persistent advocacy of quality health care for the mentally ill. He has worked with the County of Los Angeles Department of Mental Health for 33 years. He is responsible for the delivery of services at the Edmund D. Edelman Westside Mental Health Center as well as the oversight of, and coordination of all contract facilities in his service area (the costal region from the Ventura County line to the airport and east to La Cienega).
He came to what was then Santa Monica West and under the leadership of the director of the Department of Mental Health, Dr. Areta Crowell, built a reputable mental health center that is a valued training site for psychiatry residents, fellows in child and community psychiatry, interns in psychology, social work, occupational therapy, art therapy, and students of nursing and medicine. Together they recognized that in order to attract quality psychiatrists an academic enviornment and organizational structure that gave psychitrists some clinical programmatic authority needed to be created. The vision extended beyond their immediate needs, understanding that an investment would yield future results if a quality program could interst trainees from all disciplines in community mental health centers. The academic affiliation with UCLA was patiently nurtured. The center's medical director became the direcor of community psychiatry programs at UCLA and functioned collaboratively with Larry and the program manager. All of the psychiatrists under his supervision are on the clinical faculty in the Department of Psychiatry and Biobehavioral Sciences at UCLA-NPI and have time for supervision, teaching, and research or other academic activities.
In addition to his administrative and leadership skills, Larry is an astute and sensitive clinician. It is most evident in his concern for the well-being of the providers he supervises, recognizing that his ultimate mission of caring for our consumers can happen only if clinicians feel secure.
This year the winner of the AACP award for outstanding community psychiatrist was Dr. Elizabeth Birecree. Dr. Birecree grew up in New York, went to medical school at Vanderbilt and finished her training in Psychiatry at Oregon Health Sciences University in 1991. She worked as staff psychiatrist for Clackamas County Mental Health in Oregon City for three years and then was hired as faculty by the Public Psychiatry Training Program at OHSU to be the psychiatrist and clinical director for a consumer operated assertive community treatment research project. This project was designed to replicate earlier studies which compared consumer vs non-consumer teams of case managers to determine the relative effectiveness and feasibility of utilizing mental health consumers in professional roles. Other research has compared ACT teams based in separate agencies. This project based both teams in an entirely consumer operated agency. Each team had 5 staff and 40 patients assigned randomly. There was also a "usual care" control group which consisted of 40 patients or so who were randomized to the local system of care. Results have yet to be published but after three years showed no significant difference between the two ACT teams but both with better client retention than the usual care group. The project was funded with a federal grant which ran out early this year.
The job of psychiatrist and clinical director for both ACT teams was fraught with difficulty since the agency became very unstable after its executive director took a different job and a series of other consumer directors lacked various skills needed to maintain a stable organization. Since this was an assertive community community treatment project, everything was done in the streets, under bridges, and in the rooms of some of the area's most difficult and disabled clients. Dr. Birecree had to provide "in vivo" clinical care for these folks while at the same time providing support and leadership for a demoralized staff half of which were suffering themselves from long term mental illness. In fact one of the so-called normal staff became bipolar during the project and was hospitalized. Dr. Birecree handled all of this brilliantly and thet project was a success although not without some scary moments. Her enthusiasm, flexibility, creative spirit, excellent clinical skills, and respect for the rights of consumers made the whole thing possible. There could not have been a project without her.
The multiple responsiblities associated with this job are indicative of the continuing need to have dedicated people like Dr. Birecree in community psychiatry. The need for this kind of leadership continues to exist even with managed care becoming the predominant funding mechanism.
The AACP and Community Psychiatrist salute Elizebeth Birecree and Larry Wicker for their outstanding efforts and important contributions to community mental health.
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