Cpsylink-a Regional Community Psychiatry Listserve in North Carolina

North Carolina has a large network of public sector providers, including 250 community psychiatrists. This workforce is spread across a wide geographical expanse ranging from rural coastal plains to large metropolitan areas to Appalachian mountains. Distance and weak central coordination have often thwarted effective regional and statewide communication and workforce organization. In an effort to overcome these barriers, cpsylink, a community psychiatry listserve, was launched in 1997. Cpsylink was jointly conceived by the University of North Carolina (UNC) and Duke Divisions of Community Psychiatry, and is cosponsored by the North Carolina Area Health Education (AHEC) program. E-mail fileserver services were provided free of charge by UNC. We mailed invitations for free membership to all psychiatrists working full or part time in mental health centers. Requests to join have continually increased, and membership gradually expanded to include not just community and state hospital psychiatrists, but also academicians from all four North Carolina psychiatry departments, trainees, non-psychiatrist mental health providers, advocates, and administrators at both local and state levels. Cpsylink currently has 111 subscribers. Cpsylink is a private list, meaning that access is limited to registered subscribers.

Cpsylink serves three main goals: 1) to facilitate spontaneous communication within the public mental health community on a variety of topics; 2) to provide free, asynchronous educational content targeting community psychiatric practice; and 3) to stimulate policy-oriented discussion about major issues affecting community mental health in North Carolina.

Across its four years of operation, cpsylink has exceeded our initially modest expectations for all three objectives. Cpsylink now receives 60-100 messages monthly. It has become the state’s main ‘bulletin board" for posting local community mental health news, clinical and administrative problems and solutions, job openings, and chit-chat among colleagues who see each other only infrequently. The academic departments collaborate in mounting focused case discussions in which community practitioners post real CMHC cases for discussions led by an ‘expert’ located in one of the departments of psychiatry. These discussions have a much greater emphasis on the specific treatment dilemmas encountered in community psychiatric practice than do typical psychopharmacology e-mail lists. For example, an upcoming case discussion will focus on psychiatric advance directives. New CME guidelines now allow participants to count time spent on cpsylink as a ‘physician directed’ CME activity. Finally, vibrant and heated policy discussions now occur regularly on cpsylink. These discussions have been enriched by the fact that many of the main ‘movers and shakers’ in public sector mental health in North Carolina have joined the listserve. For example, in a recent discussion on access to community hospital beds, system planners in the state administration were able to test ideas with experienced front line providers who ultimately provided necessary ‘reality testing’ for some questionable approaches.

Regional virtual ‘psychiatric communities’ hold immense potential for unifying the easily fragmented community mental health workforce. Listserves such as cpsylink can be easily set up and maintained with minimal resources. Most universities provide free listserve tools to their faculty. Developing academic-community partnerships, such as that embodied in cpsylink, should be feasible in most states. Listserve tools are also available through many proprietary internet service providers for negligible cost. Computer dummies even as ignorant as myself can easily train themselves to serve as list owners.

Interested readers who would like to get a first hand look at how cpsylink works can email me at john.haggerty@css.unc.edu.