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Andrew McRitchie, PsyD recently joined the staff at Massachusetts General Hospital (MGH) as a Clinical Child Psychologist in the Acute Psychiatry Service (APS). Housed within the Emergency Department (ED), the APS is a specialized, short-term inpatient unit that offers immediate crisis stabilization and support for patients in psychiatric distress. When a child who is in crisis comes into the ED they often wait several days, sometimes longer, for a placement in an inpatient unit. Rather than having that child wait in the ED, they are diverted to the APS where a team of psychiatrists and psychiatry fellows can immediately conduct a psychiatric evaluation and start on medication management while they wait for an appropriate inpatient placement. 

McRitchie鈥檚 role, in addition to being present for these psychiatric evaluations, is to provide tangible interventions such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and relaxation skills to help with distress tolerance while a child is in the APS. In his role at MGH, he spends as much time as needed with the child to provide the services that will most effectively stabilize them and provide coping skills. The impact is noticeable for his patients, even in the short time they work together. These interventions through the APS can ultimately reduce the amount of time a child may have to spend in an inpatient hospital unit. 

McRitchie is the first full-time psychologist at MGH in this role, which had previously been held by two part-time clinicians for only a fraction of the hours McRitchie now covers. 鈥淲hat was important to me in taking this position,鈥� McRitchie said, 鈥渨as to recognize that this department had functioned just fine without this role for years. There is a need for this role, we can all see that, and I am here as a resource to the staff鈥攖o help them grow and expand鈥攏ot to undo all of the great work they have been doing.鈥�

McRitchie is in the APS four days a week providing direct care to children and working in close collaboration with the APS nursing staff and psychiatry team. One day a week, McRitchie provides virtual visits in the short-term care clinic for people who have recently been discharged from the APS or one of MGH鈥檚 inpatient units. His function is to provide short-term bridge therapy to these individuals while they wait to connect with a therapist, which can often take up to a month.

McRitchie has always enjoyed working in inpatient units. Early in his training, he did a lot of community-based work, including in-home therapy, early intervention, and assessment. The turning point was his rotation on the inpatient unit at Franciscan Children鈥檚 Hospital. 鈥淚t was like the clouds parted and things made sense to me,鈥� said McRitchie. 鈥淎ll of a sudden the training I was receiving at WJC clicked and I knew I had found my calling.鈥� 

McRitchie graduated from the 91香蕉视频成人在线 MA in Clinical Mental Health Counseling program with a concentration in Couples and Family Therapy, becoming a Licenced Marriage and Family Therapist (LMFT). He continued his education, graduating from the College's Clinical Psychology PsyD program in 2020, then went on to complete a full-time APA internship at an inpatient facility in Missouri. During his post-doc year, he worked with the Department of Veterans Affairs in their community reintegration program before joining the counseling staff at Phillips Academy Andover to aid in their development of a standardized suicide prevention protocol. 

In addition to his full-time role at MGH, McRitchie also has a thriving private practice in which he primarily sees couples and, in an unexpected outgrowth of that work, prepares psychological evaluations for immigration cases. McRitchie lights up when describing the immigration work. 鈥淭his is an aspect of my practice that I never expected to do, but I find this work really rewarding,鈥� he said. 鈥淚 am helping people in a very concrete way.鈥� 

While things were slow at first, psychological evaluations for immigration cases have become such a large part of McRitchie鈥檚 practice that he is winding down his couples therapy to focus on these evaluations. These cases fall into two categories: psychological evaluations to obtain waivers for people facing deportation and medical certifications for disability exemptions for green card holders who, for various reasons, are unable to take their citizenship test. 

For the medical certification cases, only medical doctors and clinical psychologists can complete them; however, in McRitchie鈥檚 experience, these professionals are often reluctant to complete the burdensome paperwork or risk the high stakes for the applicant. For instance, if the evaluator fills out the form incorrectly, it gets denied, and a denial counts as one of the applicant鈥檚 two attempts at taking the citizenship test. If the form is filled out incorrectly a second time, an applicant鈥檚 entire application is denied, triggering a 90-day wait to start the process all over again. While the evaluations are not covered by insurance, McRitchie has found a niche with a pricing model that works at scale and a steady increase in referrals through his relationships with immigration lawyers.

The deportation cases, on the other hand, are what initially attracted McRitchie to this work. In particular, he works with asylum seekers who have entered the country without documentation or immigrants who came to the US legally, but whose original visa is no longer valid. For example, McRitchie will conduct psychological evaluations for immigrants actively working with law enforcement because they have been a victim of a crime while in the United States. McRitchie works to establish the level of stress the victim is under due to the crime and provides a report to their attorney as part of an application to adjust their status to that of lawful permanent resident. 

He also conducts psychological evaluations for hardship waivers or 鈥渃ancellation of removals.鈥� In these instances, McRitchie is interviewing a US citizen鈥攏ot an immigrant鈥攚ho would face extreme hardship if they were separated from their family due to deportation. McRitchie鈥檚 role is to show what the impact would be on the US citizen if they were to be separated. 鈥淭hey haven鈥檛 actually been separated yet, so the presentation in the evaluation is not quite as apparent. But I can say that I see the pieces and how I think it鈥檚 going to affect them. You really feel like you鈥檙e doing some investigative work.鈥�

The psychological evaluations that McRitchie conducts most frequently are those under the Violence Against Women Act of 1994 (VAWA), although any gender is eligible for this waiver. If an immigrant is eligible to stay in the US through marriage to a US citizen and is a victim of domestic violence, they become eligible for a VAWA waiver because they are unable to leave the relationship without facing deportation. 

McRitchie explained, 鈥淚t feels very impactful doing this work. You feel like you are doing good. I鈥檓 not evaluating the legitimacy of their claims. I am documenting, from their perspective, what they have said happened, and offering a psychological evaluation.鈥� 

McRitchie鈥檚 entrepreneurial spirit and a willingness to try the untested is what drives him to find meaningful work and explore new opportunities. In his role at MGH, McRitchie embraces the challenge of being the first full-time psychologist to be hired into the position. He calls the role 鈥渁 true collaboration鈥� in which both sides know 鈥渢hat plans will change and that we鈥檒l need to stay flexible.鈥� 

This month, McRitchie and the team in the APS will welcome the first-ever group of child psychology interns completing their APA internships. In the past, APA interns in the child psychology track rotated into the adult inpatient unit at MGH, which doesn鈥檛 align with their training needs. McRitchie is enthusiastic about the opportunity to work with the interns and is hopeful that the APS can meet the need for a child inpatient rotation within MGH.

In addition to his role as the Clinical Child Psychologist in the APS, McRitchie has also been appointed by MGH as a clinical instructor at Harvard Medical School. 鈥淭his is exciting as I鈥檇 like to get more into teaching,鈥� he said. 鈥淭his is another aspect of my work that I never expected to do, but I find it really rewarding.鈥�

Even when plans haven鈥檛 turned out as expected, McRitchie doesn鈥檛 let that stop him from trying new ideas. For example, he started a consultation group for professionals last year with the goal of creating a space where people could come together to discuss cases, learn from guest speakers and conduct informal training. As it turned out, it was difficult to coordinate the schedules of a dozen people and the in-person group transformed itself into an online discussion forum. 鈥淚鈥檓 not sad about that, although it didn鈥檛 quite work out as I鈥檇 initially envisioned it,鈥� McRitchie explained. 鈥淵ou have to try, and if it works it works and if it doesn鈥檛 it doesn鈥檛.鈥�

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