Specialty Registrar in General Adult Psychiatry
South London and Maudsley
NHS Foundation Trust
Placement: Columbia University’s College of Physicians and Surgeons/New York State Psychiatric Institute
Mentor: Harold Pincus, M.D (Columbia University's College of Physicians and Surgeons)
Co-mentor: Joshua Breslau, Ph.D., Sc.D. (RAND Corporation)
Project Title: Finding ‘Win’ Factors for People with Severe Mental Illness: A Qualitative Analysis of Behavioral and Primary Care Integration in New York State
Parashar Ramanuj, M.B.B.S., M.R.C.Psych., is a 2015–16 U.K. Harkness Fellow in Health Care Policy and Practice. He completed his residency in general adult psychiatry at the St Thomas’ and Maudsley Hospitals in London and was shortlisted for the Royal College of Psychiatrists’ Higher Specialist Trainee of the Year 2015. He is an Honorary Clinical Fellow at Public Health England and was senior clinical attaché to the Policy Unit at the Royal College of Psychiatrists (RCPsych), where he evaluated the ability of the current ‘Payment by Results’ model to adequately fund long-term psychiatric rehabilitation. Ramanuj previously helped draft the RCPsych’s response to NHS England’s Urgent and Emergency Care Review, detailing how liaison and crisis mental health services could help reduce pressures on emergency departments. An alumnus of the National Medical Director’s Fellowship and an Honorary Research Fellow at the Institute of Psychiatry, Psychology and Neuroscience, his research examines how vulnerable people receive care at the interfaces in health. Analysis he conducted on an innovative commissioning program to incentivize physical health monitoring of people with serious mental illness was cited as a gold standard mechanism to integrate physical and mental health care by the NHS Confederation and helped roll out the program nationally. Ramanuj received his medical degree from King’s College London
The physical health status of people with severe mental illness (SMI) is a public health crisis. Although this population uses health services more, it receives less care for physical conditions. There is growing recognition that the challenges of providing care for people with highly complex, multimorbid illness cannot be met without tackling the needs of those with mental illness. A leading proposal to challenge this disparity is to integrate primary care services into specialist behavioral health systems. New York State has invested heavily into expanding such efforts through both federal and state policy initiatives. These include use of a federal grant to comprehensively redesign services for people with SMI, a Medicaid expansion and redesign program to integrate mental and physical health systems and an expansion of reimbursement mechanisms to allow physical health examinations and monitoring be performed by behavioral health providers. Ramanuj will analyze the decision-making process in the uptake of these initiatives by conducting site visits and key informant interviews at high impact sites – those with extensive provision of physical health services to people with SMI and those with little provision, identified through claims data. He will identify the structural, process and contextual factors that influence the provision of physical health services to this population and the contextual factors influencing the adoption and sustainability of integration mechanisms.
Career Activity since Fellowship:
Current Position: Consultant Psychiatrist, Royal National Orthopaedic Hospital (updated 04/2017)
Harkness Related Publications:
H. A. Pincus, M. Li, D. M. Scharf, B. Spaeth-Rublee, M. L. Goldman, P. P. Ramanuj, E. K. Ferenchik. “Prioritizing quality measure concepts at the interface of behavioral and physical healthcare,” International Journal of Quality in Health Care. 2017
P.P. Ramanuj, J. Breslau, B. Spaeth-Rublee, G. Strathdee, H.A. Pincus. “Carrots and Sticks on Opposite Sides of the Atlantic: Integration Incentives for People with Serious Mental Illness in England,” Psychiatric Services. 2016.
M.L. Goldman, B. Spaeth-Rublee, A.D. Nowels, P.P. Ramanuj, H.A. Pincus. “Quality measures at the interface of behavioral health and primary care,” Current Psychiatry Reports. 2016.
H. Pincus, B. Spaeth-Rublee, G. Sara G, E. Goldner, P. Prince, P. Ramanuj, W. Gaebel, J. Zielasek, I Großimlinghaus, M. Wrigley M, J. van Weeghel, M. Smith, T. Ruud, J. Mitchell, L. Patton. “A review of mental health recovery programs in selected industrialized countries,” International Journal of Mental Health Systems. 2016.