Clinical Sites

The major clinical teaching sites for the residency program are the University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), the VA Puget Sound Health Care System, Seattle Division (VA), and Seattle Children’s Hospital (SCH). Residents in the Spokane program also complete clinical rotations at Sacred Heart Medical Center, Eastern State Hospital, and Spokane Mental Health Center (see Spokane Track), while residents in the Idaho program do clinical rotations at the Boise VA, St. Alphonsus Regional Medical Center, and St. Luke's Regional Medical Center (see Idaho Track). Other sites, including selected community mental health centers, community clinics, correctional facilities, the state hospital, and sites in Alaska, Montana, and Wyoming are available for elective rotations.

University of Washington Medical Center (UWMC) is a 450-bed tertiary care hospital consistently rated among the top dozen in the nation. Psychiatric services include inpatient, outpatient and consultation-liaison services. The inpatient psychiatry service is a 14-bed voluntary unit.

Outpatients are seen at the University of Washington Psychiatry Outpatient Center (UWPOC), which offers psychotherapy, pharmacotherapy, and combined therapy to a largely middle class, insured population. The consultation-liaison service provides in-hospital consultation for medical and surgical patients, with a particular emphasis on somatization and psychiatric aspects of tertiary care, including oncology and transplant patients. The outpatient consultation-liaison service provides integrated, multidisciplinary behavioral health care (psychiatry, psychology, social work) for the UWMC Family Medicine, General Internal Medicine, Women’s, Maternal and Infant Care, Geriatrics, Diabetes, and Heart clinics, and for the Outpatient Transplant and Seattle Cancer Care Alliance Clinics.

The patient population of UWMC is 60% female, 67% Caucasian, 6% African-American, 6% Asian/Pacific Islander, 3% Hispanic, 1% Native American, and 17% of unknown ethnicity. Most patients are employed. UWMC houses active research programs in basic neuroscience, health services research, mood and anxiety disorders, geriatric psychiatry, addictions, consultation-liaison psychiatry, and psycho-oncology.

Harborview Medical Center (HMC) is a busy 413-bed county hospital and regional Burn and Trauma Center, serving a largely indigent multicultural population. About 30% of patients are homeless. 55% are male, 51% are Caucasian, 26% African-American, 9% Asian, 6% Hispanic, 2% Native American, and 7% unknown. Psychiatric services include inpatient, consultation-liaison, outpatient, and emergency programs. There are three inpatient psychiatry units, with a total of 61 beds and about 3000 admissions per year. These include a locked intensive treatment unit for acutely psychotic, involuntary patients; another locked unit for predominantly involuntary patients with psychotic and affective disorders; and an open unit with specialized programs for high utilizers (primarily patients with borderline personality disorder), and dual diagnosis patients.

The HMC emergency room is the major psychiatric receiving facility for the county and is the site of the residents’ emergency psychiatry rotation. Consultation-liaison services include evaluations of inpatients, with an emphasis on assessment of suicide risk and competency, as well as consultation to the HMC outpatient Adult Medicine, Family Medicine, Women’s, International medicine, HIV/AIDS, and Liver clinics.

HMC provides a wealth of outpatient psychiatry clinic experiences through an affiliated county mental health center located two blocks from the hospital. Specialized programs include crisis intervention, dual diagnosis, geriatric, psychopharmacology, and outreach services, as well as HIV/AIDS, Sexual Assault and Trauma clinics and programs for the homeless and for intensive treatment of patients with borderline personality disorder using dialectical behavior therapy. There are active basic and clinical research programs at Harborview, including studies in the areas of health services, dual diagnosis, geriatrics, seasonal affective disorder, repetitive transcranial magnetic stimulation, suicide and parasuicide, dialectical behavior therapy, post-traumatic stress disorder, schizophrenia, and the role of serotonin receptors in depression and antidepressant drug effects.

VA Puget Sound Health Care System (VA) is closely affiliated with the University of Washington School of Medicine and has the third largest research budget in the entire VA health care system. Psychiatric services are provided across a spectrum of inpatient and outpatient mental health programs. At the Seattle Division, inpatient services include a 14-bed High Intensity Acute Unit, a 12-bed Post-Traumatic Stress Disorder (PTSD) Unit, and a 6-bed Addictions unit. The VA has busy emergency and consultation-liaison services. Outpatient programs include a Mental Health Clinic, PTSD clinics for men and women, a Chronically Mentally Ill/Day Treatment Program, Geriatric Clinic, and an outpatient Addiction Treatment Center.

The Primary Care Mental Health Program provides mental health consultation to the VA General Internal Medicine Clinic. The VA has been awarded three national research, education, and clinical centers which have a mental health focus. These include a GRECC (Geriatric Research, Education, and Clinical Center), a Center of Excellence in Substance Abuse Treatment and Education (CESATE), and a VA Mental Illness Research, Education, and Clinical Center (MIRECC), focusing on psychiatric genetics, PTSD and schizophrenia.

The patient population at the VA is 83% male; predominantly lower middle class; 50% Caucasian, 14% African-American, 2% Asian, 2% Hispanic, 1% Native American, and 31% unknown or unreported.

Seattle Children’s Hospital (SCH) is a 250-bed regional pediatric tertiary care facility. The Division of Child and Adolescent Psychiatry has a commitment to provide services for and conduct research in populations of underserved, acutely ill children and adolescents treated in the public sector. General psychiatry residents complete Child rotations on the 20-bed inpatient Child Psychiatry unit or on an outpatient basis at one of a variety of sites. These include the SCH Outpatient Clinic, the residential Child Study and Treatment Center at the state hospital, and Echo Glen Center for sentenced youthful offenders. Child fellows train at these sites, as well as the SCH consultation-liaison psychiatry service, and a variety of community clinics, outreach services, and the King County juvenile detention facility. The SCH patient population has an equal gender distribution, a wide variety of socio-economic levels, and is 60% Caucasian, 25% African-American, 10% Asian, and 5% Native American.