Yale Psychiatry Grand Rounds: June 24, 2022

June 24, 2022

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"State of the Department"

John H. Krystal, MD, Robert L. McNeil, Jr. Professor of Translational Research and Professor of Psychiatry, Neuroscience, and Psychology; Chair, Yale Department of Psychiatry, Yale School of Medicine

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00:00Department psychiatry.
00:04As most of you know,
00:05my name is John Crystal.
00:06I'm the chair of the Department of
00:09Psychiatry and this is the. The number.
00:14The number 92 the 92nd birthday
00:18of the Department of Psychiatry.
00:20So we're we're almost getting
00:22up to 100 before we begin,
00:24I'd like to acknowledge our
00:26debt to the indigenous people.
00:29Peoples that have been displaced by our
00:31the creation of Yale University and
00:34our and the building of our community.
00:36And I've asked Doctor Stephanie Gilson to.
00:40To lead us in this so thank you Stephanie.
00:45Hot today my name is Stephanie Gilson.
00:48Like Doctor Crystal said,
00:49I'm really grateful to be here with you
00:53all today to take this moment to recognize
00:56the stolen land that we as Yale reside on.
00:59You know indigenous people were here long
01:01before colonists arrived, and if steward,
01:04this land and waterways for generations prior
01:07to when we even called this Connecticut.
01:09These tribes include the Mohegan,
01:12the mash tuck, Pequot eastern Pequot,
01:15the scanner coke, Golden Hill,
01:18Pogo set, Niantic, and the Quinnipiac,
01:21and many other Algonquin speaking nations.
01:25Although some of these nations are
01:27no longer with us due to genocide,
01:29displacement, boarding schools and other
01:34colonizing policies that were aimed to.
01:39They removed that indigenous
01:40people from this land.
01:42We are still here and we are still
01:44thriving here in Connecticut.
01:46We have five state recognized Tribes,
01:482 federally recognized tribes
01:50and tribes that have no U.S.
01:52government recognition.
01:53There's a big difference between that all,
01:55but that's a discussion for a
01:58later day of the two federally
02:00recognized tribes we have here.
02:01That's the mash truck Pequot
02:03and the Mohegan tribe.
02:05Some of you may have heard some
02:07exciting news that the chief.
02:09Of the Mohegan tribal and Malara
02:10has been announced to be appointed
02:12by Biden for the US Treasurer,
02:13so that's a big win for Indigenous
02:16people across the country.
02:18And really, a landing knowledgement is not.
02:21It's not enough.
02:23I really encourage everybody to learn
02:26about the tribes whose lands we are on.
02:29I will put a link in the in the chat
02:31so you can actually put in your
02:33address and find out who's who's
02:35tribal lands you're on and encourage
02:37you to attend cultural events,
02:38including pow wows.
02:40Power season is coming up of
02:42our local tribes,
02:43but even our Native American Cultural
02:46Center here at Yale has a powwow this fall.
02:48So solidarity can look like a
02:50lot of things donating time,
02:51money to indigenous causes,
02:53amplifying indigenous voices and
02:55and you know, returning the land.
02:58So I really appreciate Doctor
02:59Crystal you giving me this time
03:02and looking forward to hear how the
03:04department's doing predominate ado.
03:05Thank you so much.
03:06Thank
03:07you so much, Stephanie.
03:10I, as I did last year.
03:15I have asked a number of people to
03:18reflect on the year and to share.
03:21Share the their reflections
03:23with us in the form of videos.
03:26So before beginning my formal presentation,
03:30I'd like to I'd like to run
03:32the videos that were that were
03:35collected so Trisha would you,
03:37would you start those videos? I will.
03:51Hi, what a special year this has been.
03:56Let's just say it's been a year of an
04:00unexpected opportunity. Thank you John.
04:04And many unusual challenges.
04:08But one thing
04:10that's made this year so special
04:13has been the chance to reconnect
04:15with so many of you who have been my
04:19colleagues and mentors and friends.
04:21Throughout my career. Thank you
04:24for welcoming me back
04:26and for all of the kindness and support
04:29and advice you provided this year.
04:33I'm very grateful for that.
04:37And to my resident colleagues.
04:40What a talented,
04:41diverse and passionate group you are.
04:45I'm so grateful.
04:47For the patience and understanding and
04:51encouragement and honesty you showed me.
04:54As we work together on so
04:57many things this year.
04:59I am so honored and proud to serve
05:02as your interim program director.
05:05And to our faculty who are teaching and
05:08supervising in the classroom and across
05:11our many clinical sites every day.
05:14Thank you for inspiring our trainees.
05:18And for your commitment to training
05:20the next generation of psychiatrists
05:22and other mental health professionals.
05:25And of course,
05:26our staff who are working so hard every day,
05:30running our programs and meeting
05:32everyone's needs. Thank you.
05:35So what's made this year so special?
05:39It's really all of you.
05:42And on behalf of everybody in our program.
05:47Thank you for everything you do.
05:51And for supporting the educational
05:54mission of our department.
05:56Thank you.
05:58So what is this year meant to me?
06:01I've got to be honest,
06:03personally and professionally I have
06:06felt set back a bit and accelerating
06:10ahead and making progress and also in
06:13a holding pattern and moving at just
06:16the right pace all at the same time,
06:20though moving just at the right pace was
06:23a state that I felt that I only caught
06:26tiny glimpses of every now and then.
06:29Last year I felt so incredibly
06:32stretched so thinly stretched,
06:34like many of us,
06:36and maybe like we all were honestly the
06:39professional wear and tear was like
06:42nothing that I could have ever imagined.
06:46And I had this fantasy that the
06:48milestone of turning over a new year
06:51would bring with it some relief.
06:53And what I have found is that the
06:56challenges have not lessened.
06:58The uncertainty. Has not lessened.
07:03The terrible across so many
07:06dimensions has not lessened.
07:09There has been so much.
07:12And I could go on and on,
07:13quite literally because the experiences
07:16and their impact though on and on and me.
07:20But this year I knew I wanted to focus on
07:24amplifying and spotlighting the moments,
07:27the spaces, the energy,
07:29the people and relationships,
07:32and the work that gives me life.
07:34It was going to be a gift to
07:36myself and I don't mean this in
07:38like a toxic positivity way,
07:40but in a real way.
07:42And so this year I got to hug the
07:45necks of friends and swim in a
07:49waterfall and a rainforest and enjoy
07:52my daughter and really see her and
07:55know her day in and day out because
07:57we got to spend a lot of time and
08:00space and hours together and it
08:03was time and space and hours that
08:05I might not have otherwise gotten.
08:08I got to drink coffee on Friday mornings
08:11with Cindy, Cousteau and Beckham.
08:12And laugh and laugh about filling
08:14that coffee all over my desk or other
08:17things that might have been happening
08:19all while we were doing the incredibly
08:21important work of our getting our
08:24racism out of our work curriculum.
08:26I got to experience the bravery of
08:28trying to bring that work forward
08:30within the department to a group of
08:33incredibly receptive colleagues.
08:35I got you and still get you know,
08:38an incredible group of people in my work,
08:40in the anti racism task force.
08:42Shout out to Kirsten Wilkins and
08:45how hard conversations,
08:46which also interestingly gave me
08:50life and I had fun talking about
08:52measurement based care.
08:53Maybe too much fun talking about
08:54measurement based care with
08:56a powerhouse set of women,
08:58psychologists and the Y MBCC.
09:00Follow us on Twitter.
09:02I got to also know another inspiring.
09:05Of psychology trainees and witness
09:08their growth and change and get
09:10super hype on their achievements
09:12and hopefully support them in
09:14those difficult times when things
09:15were too much too.
09:16And now I feel the anticipation and
09:19excitement and the smell of the gift
09:21of doing this again with another
09:23group of trainees come July 1st.
09:26I got to celebrate being married
09:28for nine years and celebrate a
09:31number of professional milestones.
09:33There has been so much.
09:35And I could literally go on and on,
09:37because these experiences and
09:38their impact live on and me too.
09:42What has this event for me a procrastinated
09:45for a few weeks to answer this question.
09:48I think a more suitable question for
09:49me is what this year has been for me.
09:51It's been a year of much
09:53introspection and a lot of purposeful,
09:55overt action which is uncharacteristic of
09:58me as I'm an introvert and I'd like to
10:01achieve things quietly without much notice.
10:04Encounter a couple pregnant challenges in
10:06the past year in order to accomplish them,
10:09I had to actually talk to people I
10:11didn't know had to tell them who I was,
10:12and I had to ask for help.
10:15I had to have faith that people
10:16would not hate me, beat me,
10:18turn away from me if I opened up.
10:20Had to make sure that it would be
10:22safe because my past experience
10:23as other reason I'm closed up.
10:26When Russian leader Ukraine on Thursday,
10:28February 24th, I was not in disbelief,
10:31but I was known.
10:32But belief all weekend I hid from the news.
10:35My husband was keeping up with
10:36it and I would not.
10:38I would tell him not to expose me to it.
10:41On Monday, February 28th,
10:42my husband left for a work trip and I didn't
10:46have anyone to hide behind a protect me.
10:48Unless my kids were with me,
10:49I refreshed CNN and cried all week.
10:52And literally had my 14 year old mother sent
10:56me as I folded laundry so I would not cry.
10:59The whole experience was unreal.
11:02I was crying about the land and not one
11:04people of my ethnic and religious background.
11:06The whole reason I'm a refugee.
11:09I'm a person whose country
11:11of work does not exist.
11:13This country did not want her kind and
11:16made it very clear and a person who
11:19considers herself would probably American.
11:21And I was a person who cried for days
11:23over the tragedy that was happening
11:25on the land that rejected me.
11:27However,
11:28I was not going to be a person for
11:30seven to nothing about the genocide
11:31that was ensuing.
11:32The refugees who were forced from
11:34the land that they actually want
11:36from the places they called home.
11:38Regardless of my experience over
11:4030 years ago.
11:42I like to think that people change.
11:44Like you think they'd like to Jewish
11:46President Holding pride parade
11:48means that there are more good
11:49than bad people in Ukraine.
11:50No,
11:51I don't think that I can quote
11:53overcome cognitive dissonance
11:54and be a person who helps,
11:56but she also meant there had to be
11:58a person who opened up to people.
11:59I think a lot of you know the rest.
12:02With the help of my husband
12:03acting as my PR and many friends,
12:05family,
12:05colleagues and strangers who gave
12:07him the tightest hugs.
12:08And raised over 30,000 by soliciting
12:11donations from Ukrainian poppy seed bread.
12:15And then co-founded a nonprofit company
12:17with a couple other Ukrainian born Yalies.
12:20We have a team of wonderful people
12:21who have sacrificed their families and
12:23careers to help those fighting for democracy.
12:28Our company works directly with
12:29people on the ground in Ukraine and
12:32provides lifesaving medical equipment,
12:33trauma training and humanitarian aid.
12:37We are continuously fundraising
12:38things like ultrasound machines
12:40and ventilators trauma training
12:42for psychologists, volunteers.
12:44First, agents removed survivors and
12:46now displaced Ukrainians coming to US.
12:50Not have you made it safe for me to
12:53tell my story and I'm asking you to
12:55help me help others have stories.
12:57Please donate to dwighthall.org/united dot
13:01Ukraine and all of your money
13:03will go to saving lives.
13:06Professionally as well as personally,
13:07this year has taught me more
13:09about the meaning of perseverance,
13:11teamwork, and hope than
13:12any other year in my life.
13:14When the pandemic began
13:15more than two years ago.
13:16As difficult as that time was,
13:18with all that was unknown,
13:20the Yellow Haven Hospital,
13:21we face those unknowns together
13:23with a unified purpose.
13:24Keep everyone safe while continuing
13:26to provide the best care to
13:28our patients that we could.
13:30A unified purpose seemed to
13:32make things a bit easier.
13:34We implemented telehealth
13:35solutions overnight.
13:36Something we would have thought
13:38impossible just months earlier,
13:40we began addressing inequities in
13:42our care delivery and we worked
13:44with our residents to address hate
13:46speech on our adolescent unit.
13:48Last summer with the 1st and 2nd
13:50waves of COVID behind us and
13:53with vaccinations well underway,
13:55the academic year started with
13:57incredible hope for the future.
13:59Hope that we not only would
14:01resume expanding our services
14:02and improving access to care,
14:04but we would do it with the same
14:06vigor and speed that it allowed
14:08us to transform our services with
14:10COVID and home front and with it the
14:14fiscal realities of the pandemic.
14:16And for me personally these realities.
14:18Team at a time as my family
14:2219 personal struggles,
14:24suddenly everything seemed
14:27uncertain and would we recover
14:29from the loss of the pandemic?
14:31Would our young heaven faculty and
14:33staff be able to continue to persevere?
14:35How much longer could we continue
14:37doing our best for our patients
14:39with the limited resources
14:41available and personally?
14:42Could I continue to persevere and
14:44lead or young even services given
14:47the personal challenges I face?
14:51We know a few things about resilience.
14:53For instance, we know that we can
14:55improve our own personal resilience
14:57by facing challenges now facing those
15:00challenges together helps a lot.
15:01Looking back on this year,
15:03I'm proud of how our faculty and
15:06staff persevered and face the
15:09challenges together and humbled
15:10by how are you on the heaven?
15:12Physician leaders stepped up to the
15:14many challenges of this past year.
15:17And that leaves me incredibly hopeful.
15:19That the next generation of
15:20leaders that young the heavens,
15:22psychiatry will continue to
15:24expand services and meet what
15:26we all know is an ever growing
15:28need for behavioral health care.
15:31Alex, I am juling Armijo.
15:34I'm a research associate in
15:35the department psychiatry,
15:36where I have been for the past eight years.
15:39I was born in the Dominican Republic and
15:42migrated to the US when I was 16 years old.
15:45I am very honored to have been given
15:47the opportunity to speak to you all
15:48today and I hope to come to know
15:50many of you in the years to come.
15:51So what has the past year meant to me
15:54this year has meant I have gone to deepen
15:56my sense of purpose in my current role.
15:59I continue to see the
16:00struggles of people of color.
16:02In accessing evidence based treatment due
16:04to the social determinants of health issues,
16:07in my humble opinion,
16:08case management services need
16:10to be more inclusive in clinical
16:12treatment plans as well as culturally
16:14and linguistically adapted.
16:15My hypothesis is that it will help increase
16:18their attention rate of the public color.
16:19You may have a health treatment and
16:21I'm glad to see that my research
16:23team is part of the solution.
16:24When a computer based dreaming
16:26of cognitive therapy,
16:27which has been found effective in
16:29the Latino community and I hope it
16:31will be disseminated more broadly.
16:32Time.
16:33This year has men have come to
16:35feel and sense of belonging as a
16:37member of the Anti Racism Task
16:39Force Staff Subcommittee,
16:40calling member of the Presynaptic
16:42Workplace Survey Committee and also
16:44lately calling member of the Mission
16:46Vision and value steaming writing group.
16:48I'm starting to see a cultural shift
16:50where staff are being recognized.
16:52People that look like me are being given
16:54the opportunity to be at the table to
16:57help with systemic transformations.
16:58This makes me see there's an
17:00intention for change and I'm glad
17:02to be part of an organization of.
17:03And organizations striving
17:04to be inclusive and diverse.
17:07I hope to continue to be part of
17:09that change and very importantly
17:10I have come to meet and interact.
17:12We were colleagues from all levels good
17:14in faculty and leadership and trainees,
17:16which has been a wonderful
17:18and collaborative experience.
17:19Badly this year has been at going to
17:22realize I have made some significant
17:24accomplishment.
17:25My colleagues Brian Michelle Silva,
17:28many parties and the Lake Kathy
17:30Carol having instrumental in
17:31my professional growth.
17:32I am grateful for the support
17:34they have given me.
17:35That support has made it easier for
17:37me to go back to school to pursue
17:39that totally agree in public health.
17:41Mentorship,
17:41education and training are
17:42important to staff in order to have
17:45a feeling of belonging,
17:46and I can testify to that.
17:49Thank you once again for the opportunity
17:50to share my reflections with you all.
17:52I say, let's continue to make yell
17:55and inclusive workplace for staff,
17:56faculty and trainees all work together now.
17:59Welcoming and equitable environment
18:01where everyone can participate,
18:03prosper and reach their full potential
18:04and to the staff in the department.
18:06In a position like me,
18:08I can say even those who
18:09don't think their leaders
18:11can be leaders. There is a
18:12leader in all of us. Thank you.
18:15Good morning everyone.
18:16My name is Michelle Silva and I'm an
18:18assistant professor in the department
18:20and clinician at the Hispanic Clinic in
18:22West Haven Mental Health Clinic at CMHC.
18:24Thank you for the opportunity to offer
18:26some reflections on what the past year
18:28has meant to me sitting down to record
18:30this message serves as a reminder of
18:32our new normal where parts of daily
18:35life and connections to others continue
18:37to take place through a screen.
18:39I am humbled looking back at how life
18:41changed for all of us starting in March
18:43of 2020 and the immeasurable losses and.
18:45Being experienced by so many
18:47as mental health professionals,
18:49we understand that the experience
18:51of grief is universal and that
18:53it often comes with deep sadness,
18:54disbelief, and even confusion.
18:56It also comes and goes,
18:58and so demands patience and self compassion.
19:01It can be uncomfortable to sit with
19:03suffering both our own and that of others,
19:05and the last two years have challenged us
19:08to come face to face with our fragility
19:10as we've adjusted and then readjusted
19:12repeatedly to a change in reality.
19:14Get despite the challenges.
19:16We move forward optimistically,
19:18giving room to hope and the evolving
19:20opportunity for transformation.
19:21I'd like to share 3 themes that come up
19:24when I think of the past year first.
19:26The essential need for community.
19:27I would not be here without the
19:29blessing of a Community family,
19:31trusted friends and colleagues who
19:32have always been there to support and
19:35guide and my work with the Community
19:37Subcommittee of the Department's
19:38Anti Racism Task Force.
19:39I have found a new community of
19:42committed and energetic leaders
19:43ready to engage in effect change.
19:45As a clinician,
19:46I also work with people who struggle
19:48with experiences of rejection and
19:49belonging and others who find themselves
19:51disoriented in a new country and
19:53far from their support system.
19:55The resulting isolation was magnified
19:57during the pandemic and highlighted
19:59the importance of the services.
20:00We can offer.
20:01This leads to a second theme
20:03in the power of simplicity,
20:05support and community can begin
20:07with a kind word or action,
20:09and those are things we each
20:11can readily offer one another.
20:12I am fortunate to work alongside dedicated.
20:15And generous colleagues and
20:16friends who give up their talents,
20:18time and compassion even when
20:19they are are exhausted and trying
20:21to do more with less.
20:23The demand for mental health services
20:25remains particularly high for youth
20:26and Spanish speaking communities,
20:28but the commitment doesn't waver.
20:30Finally, the third theme is collaboration.
20:32We truly are more alike than
20:33we are different,
20:34and we can accomplish more
20:35together than we will.
20:36Separately.
20:37Collaboration allows us to see
20:38beyond the limits and borders
20:40that we may have for ourselves,
20:41and imagine new possibilities.
20:44In closing,
20:45I share a quote.
20:46I've embraced for difficult times and
20:47that reminds me of the importance of
20:50intentionally moving from asking why to now.
20:52What am I going to do about this?
20:54Change is inevitable,
20:55but transformation is by conscious choice.
20:58Thank you for listening and
21:00wishing you all a safe, healthy
21:02and enjoyable start to summer.
21:10Wow. I I want to thank.
21:15Although the people who made
21:17those videos that's Doctor
21:19Richard Belitsky Dr Amanda Child.
21:21Doctor Rina Estrellas,
21:22doctor Frank Fortunati,
21:24Miss Edelen Paramillo and doctor Michelle
21:29Silva for those wonderful impactful.
21:33And generous and brave videos,
21:36and I think I couldn't ask for
21:38a better start to this state
21:41of the department address.
21:44At this point I'm going to share my
21:48screen and and shift to the more
21:52formal part of the presentation.
21:56So again, welcome to the 2022
21:59state of the department address.
22:02Before I go forward,
22:04I want to acknowledge my financial interest.
22:08I have a stock in a company Biohaven
22:11Pharmaceuticals that is publicly traded
22:13and stock and some other startups.
22:16I consult the pharmaceutical
22:18companies I have.
22:20Yale has a share of patents that
22:23have been licensed to various
22:26pharmaceutical companies,
22:27in particular related to the use of
22:30intranasal ketamine for depression.
22:32And suicide risk.
22:36So I'm going to talk a bit about resilience,
22:39continuing the themes of the presentations
22:42that you just heard and talk a little
22:46bit about our department community,
22:48our educational mission,
22:49our clinical programs, our research,
22:52and then recognize some very important
22:54transitions in our department this year.
23:00This word cloud was created by.
23:06Members of our medical school
23:08community who completed a stress
23:10questionnaire and wrote certain words
23:13into their into the questionnaire,
23:16which expressed the themes that
23:19that they were struggling with.
23:22And as you can see our
23:25time over the past year.
23:30Recapitulates many of the themes that
23:32you just heard about and we continue
23:34to be in an evolving maelstrom in
23:37the sense that we just learned that
23:39the Supreme Court overturned the Roe.
23:41V Wade.
23:44Decision and and which is yet another.
23:50Challenge for our community.
23:55I wanted to thank Ayanna Jordan who
23:58delivered an incredible graduation address
24:00and we miss her in our community and at
24:04one point in her in her presentation,
24:07she asked people on the on the on
24:12the attending, the grand rounds
24:14presentation to contribute to the
24:16creation of a resilience word cloud.
24:19And here you see the themes of what
24:23people entered into that effort.
24:27And exercise family friends
24:31time saying no speaking up hugs
24:35wisdom biking therapy meditation.
24:37We're a resilient community
24:40and we draw on each other,
24:44and we draw on many personal activities
24:47that are provide us with pleasure
24:50and and help us to have a capacity to
24:54manage with the many challenges that
24:56we face personally and in our missions.
24:59Departmental missions.
25:02So overall, how are we doing as a department?
25:08Let me just say a little bit
25:09about our faculty.
25:10As you probably know,
25:11we're the second largest
25:13department in the medical school.
25:15We're about 70% Caucasian,
25:16and we're one of the only departments.
25:19Maybe the only department
25:22in the medical school,
25:23if not the university,
25:25which is majority female.
25:29About half of the department
25:31hold the MD or MD PhD degree,
25:34the department faculty.
25:36And the other half predominantly
25:39hold PhD degrees in psychology and
25:43neuroscience and other specialties.
25:46In terms of faculty tracks
25:49within the department,
25:50about 14% are in the clinician track.
25:53About half are in the
25:56clinician educator track.
25:57And about 20% are in the
26:01clinician scientist track and
26:03an equal percentage in the
26:05investigator or traditional tracts.
26:09In terms of our NIH direct costs
26:13attributable to the department,
26:15we went down a little bit this year,
26:17but still, an incredible research portfolio.
26:21A little over $91 million,
26:24which makes us #2 in the United
26:27States in terms of NIH grant support.
26:30And we have significant VA and
26:33Department of Defense support.
26:35Were among the top programs in
26:37the country and our psychiatry
26:39and psychology programs, and we.
26:44Continue to be drawing a very
26:47outstanding group of applicants
26:49for our trainee programs.
26:51Yale, New Haven Psychiatric
26:53Hospital was ranked number 11 in
26:56the country and we continue to be a
26:59safety net and a national referral.
27:02Uh, center?
27:07In terms of monitoring our the progress
27:10of of diversifying our department,
27:13you see at the assistant professor
27:16rank that there is a substantial
27:20female predominance currently.
27:23At the associate professor level.
27:28It is, it is not quite,
27:31but close to 5050 and still
27:33a gap at the professor level.
27:36And as you can see,
27:37the number of female professors
27:40in relation to the number of of
27:43male professors is gradually
27:44getting closer and closer to 5050.
27:50However, with regards to
27:53the departmental faculty,
27:54we still have a long way to go to
27:57achieve diversity at the this I'm
28:01currently showing the assistant
28:03professors where you can see that
28:05we're over 80% Caucasian, and.
28:12Lower rates of other
28:15racial and ethnic groups.
28:17And that disparity is even greater at the.
28:22I'm sorry those were numbers.
28:23Not not percentages.
28:25But the disparity is even greater at
28:28the associate and professor level,
28:30so this is an area that.
28:34Will require continued focused effort.
28:40In terms of the department's budget,
28:42the department's budget grew by about
28:4510 million from about 1:49 last year
28:48to about $159 million this year.
28:51And the majority of our department
28:54budget is about is like in prior years
28:58related to the research mission of
29:01the department and reflects grants
29:03from various sources contracts about
29:0634% of the department's revenues
29:09come from our clinical work.
29:12And a smaller percentage from other sources.
29:19As you've heard, a major.
29:24Effort in the department has been
29:27the Anti Racism task force and and
29:30we are extremely fortunate that the
29:33task force is Co led by Doctor Cindy
29:37Cousteau who's not only our deputy chair
29:40for DUI but also associate Dean for
29:42gender equity for the medical school.
29:45And as you've heard,
29:47reflects the work of 6 subcommittees that
29:50are Co led by the people of listed here.
29:54Each of these subcommittees has been
29:57working for a very long period of
30:02time and and and given of themselves
30:06to contribute to the anti racism
30:09work within the department.
30:12To my knowledge the anti racism
30:14task force is not only the
30:16largest departmental initiative,
30:18but also the most sustained
30:20initiative and in our department
30:23over 90 participants from faculty,
30:25staff and trainees and and also
30:29from our surrounding community.
30:31We now have reports from.
30:35Subcommittees and our consolidating.
30:37I believe maybe just one more group,
30:42needs to submit the report,
30:43and we're recommending we're
30:46consolidating the recommendations
30:48into a document that will enable
30:51us to focus our our anti racism
30:54efforts in ways that are likely to
30:57have the most impact so that we
31:00can prepare for implementation.
31:05One of the spinoffs of our of our department.
31:12Anti Racism Task force has been
31:14the recognition that we should
31:16develop a formal mission vision and
31:19value statement for our department
31:22because so much of what one does.
31:25In trying to develop the.
31:28Culture of our department needs to
31:32refer back to what it is that we're
31:34all trying to do and and to do that.
31:37To accomplish that,
31:38we need to have a clear mission
31:40and vision and value statement.
31:43A work group was led by Kyle Peterson
31:46and involved many people from the Anti
31:49Racism Task force which led to the
31:52creation of a writing group which.
31:56Included the 10 people listed here
32:01including Ukelin Karamu who just.
32:05Who's a video you just saw?
32:08And I want to thank the writing
32:10group for their efforts.
32:12The the writing group did build from
32:16a department wide survey in 2021,
32:19created a first draft,
32:21conducted some focus group feedback sessions,
32:23created, then a revised draft,
32:26and that revised draft is available for
32:29comment now and will continue to be
32:32available for comment until June 30th,
32:35and I hope you'll take the
32:38opportunity to to click on this link.
32:42And and anyone who would like to
32:45do so in and can't reach the link,
32:48please just contact my office and
32:51we'll provide the link for you.
32:53So that you can provide feedback on
32:55the mission vision value statement
32:57so that we can develop a final draft.
33:00Here is the current draft language.
33:03The Yale Department of Psychiatry
33:05is dedicated to enhancing holistic,
33:07well being,
33:08facilitating recovery and reducing
33:10the suffering and oppression
33:12associated with mental illness.
33:14We do this through the education
33:17of transformative leaders.
33:18Excellence in research practice and policy,
33:21and restorative and reciprocal
33:24community engagement.
33:25We embrace multiple approaches to learning
33:27levels of analysis and ways of knowing.
33:30Throughout this work,
33:31we strive to nurture a diverse
33:33community of trainees, staff,
33:34faculty and partnerships,
33:36characterized by compassion, inclusivity,
33:39humility, dignity and justice.
33:43So I look forward to receiving your feedback.
33:47If you've not already provided it through
33:50the site that I just showed earlier.
33:53I also want to acknowledge the
33:55hard work of Project Synapse,
33:57and I hope everybody attending the the
34:00grand rounds knows about projects and labs,
34:03which has been a wonderful initiative
34:06to build the staff community and is
34:09currently led by Amy Bradley and Kyle
34:12Peterson, Mr Kyle Peterson and and.
34:17And includes these.
34:20People who are contributing their time
34:23and effort to to building our staff
34:26community and our as a result helping
34:30us strengthen our department community.
34:35I'm going to shift now a
34:37little bit to education.
34:38This is a picture of of the
34:40department faculty from 1935.
34:43You'll notice it's now we're now
34:46obviously a much more diverse community,
34:49and I wanted to acknowledge the very
34:52important contributions of of doctor
34:53Bob Rohrbaugh to the development of
34:56our culture of education and mission
34:58of education in the department.
34:59As you know, he stepped down as the
35:03psychiatry program director after 15
35:06years of transformative leadership
35:08and and in the process brought
35:11the Department of Psychiatry to.
35:14Be ranked number one as the number one.
35:18Medical psychiatry department in the country,
35:21and we owe him a tremendous debt of
35:25gratitude and and and are deeply
35:28appreciative for all that he brought to
35:31the leadership of the residency program.
35:34Doctor Albaugh continues as deputy
35:37chair for education in the department.
35:40I also want to acknowledge our
35:43incredible interim leadership of the
35:45residency program over the past year.
35:47Doctor Richard Belitsky,
35:48as you heard earlier,
35:50has has.
35:53Come back from his time in the Deans
35:57office and stepped in seamlessly
35:59to the role of interim residency
36:03director and and done an amazing job
36:06in not only supporting our resident
36:10trainees during difficult year of
36:13transition but also helping us to
36:16move forward in the residency.
36:19I also want to thank Doctor Tobias
36:21Wasser who also stepped up.
36:24And who led the recruitment of another
36:29incredible class of psychiatry
36:32residents and who generously gave
36:34up his time to to help our residency
36:39during this year of transition so?
36:43Special thanks to both of you.
36:46We our residency is in transition.
36:49We conducted a year long research
36:52that has produced 3 exceptional
36:55finalist candidates.
36:57We are in the process of negotiating.
37:01To close the recruitment of the
37:05residency director position,
37:07it is not yet concluded.
37:11And in the meantime, Dr.
37:14Belitsky has as we try to conclude
37:18these negotiations. Dr.
37:20Belitsky has agreed to remain in the
37:22interim role until December if needed.
37:25And we will move forward with the
37:29recruitment of two additional associate
37:32program directors with a third.
37:36Associate program director
37:38Recruitment near closure.
37:43Shifting now to our clinical programs,
37:46these are campuses where we're
37:49providing clinical care.
37:51I want to acknowledge also that this is
37:54a time of new leadership in literally
37:56all of the servers in which we work,
37:59or at least most of the severes on the
38:02left here is doctor Nancy Navaretta,
38:03who is our new Commissioner of Mental Health.
38:06The Commissioner of the Department
38:08of Mental Health and Addiction
38:10Services for the State of Connecticut.
38:13Next to her is Mr Chris O'Connor,
38:16who is the new President of Yale,
38:18New Haven Health System.
38:20Next to him, Doctor Keith Churchwell,
38:23who is the President of Yale,
38:25New Haven Hospital and and next to him.
38:29Doctor Hunned pot.
38:30TWA, who is the new chief of staff for
38:33the VA Connecticut healthcare system.
38:35So these are each one of these are
38:38wonderful new leaders and it's a
38:41very exciting opportunity to work.
38:43With each of them in in creating a
38:47context in Connecticut where the all
38:50of our missions department missions
38:52can thrive and and move forward.
38:56As you heard from Doctor Frank
38:59Fortunati in his video,
39:00this has been a time of unprecedented
39:02pressure at both opportunity
39:04and pressure at Yale,
39:05New Haven Hospital and this has been
39:09a time of just unprecedented census in
39:11the Yale New Haven Psychiatry Emergency Room,
39:14and I want to particularly acknowledge Dr.
39:18Tao, Matos,
39:19Santana and his incredible team
39:22that have been holding the Fort.
39:26During this time as we try to initiate
39:30a number of of of steps to reduce the
39:35pressure on their team and to make
39:39the PS services at Yale, New Haven.
39:43Run.
39:45In a better way,
39:47our inpatient units continue to
39:49work with very high acuity,
39:51running full basically all the time,
39:54despite staffing gaps and our
39:58interventional psychiatry program.
40:00Somehow managing to continue to
40:02increase the throughput of that program,
40:05providing impactful treatments
40:07for which Yale is a distinctively
40:12known and particularly and,
40:15and providing a regional and
40:18national resource.
40:19And I also want to acknowledge
40:21the progress made this year under
40:24the leadership of Doctor Katie
40:26Klingensmith and Carol Cistaro to
40:29conduct a database transformation
40:31of ambulatory services,
40:33increasing both productivity and efficiency.
40:39And as Doctor Fortunati alluded to.
40:44He has built a basically
40:47over the past several years.
40:49A new leadership team for Yale,
40:51New Haven Psychiatry and I wanted
40:53to call out this group of section
40:55leaders who have all stepped up
40:57and are doing an incredible job.
40:59This is a very strong leadership team and
41:03bodes very well for Ian Leaven hospital,
41:06psychiatry and behavioral
41:07health moving forward.
41:09I also want to acknowledge our
41:11our young New Haven partners
41:13but we work hand in glove.
41:15With this team,
41:16there are some people whose pictures
41:18I didn't have and so couldn't include,
41:20but but I think we are really blessed
41:23to to have outstanding collaboration,
41:26which enables us to move
41:28forward constructively.
41:32It continues to be a
41:33challenging time clinically,
41:35from an economic perspective.
41:36On the one hand,
41:37clinical care revenues at Yale,
41:39New Haven continue to increase,
41:41but costs increase as well,
41:43and so we're really not gaining yet in
41:48terms of of generating net revenue.
41:52Although we're,
41:53we believe we're we're through incredible
41:56effort under adverse circumstances,
41:59certainly holding our own.
42:02Economically.
42:03From a research point of view.
42:05As I mentioned earlier,
42:07according if you follow who
42:09gets credit for grants,
42:10we've had a drop in our NIH
42:15portfolio attributable to psychiatry.
42:18Although we've played the tag team
42:21with the University of Pittsburgh as
42:23to who's number one in the country.
42:27And and, and there's quite a gap
42:30still between our level of funding,
42:32the top 2 departments and
42:34the rest of the country.
42:35But I'd like to highlight something that
42:38doesn't come across in those numbers.
42:40And this is the amount of money that the
42:43department actually expends on research.
42:46And as you can see,
42:47the amount of money that expends
42:49on research continues to rise,
42:51and what this really reflects
42:53this mismatch between how much
42:55we're spending and and the credit.
42:58They're getting from grants is somewhat
43:01attributable to a consequence of of
43:04the passing of doctor Kathleen Carroll.
43:08She LED a large research initiative
43:11called the Nyda Clinical Trials Network,
43:14Yale Site and with her passing that Grant
43:17moved from the Department of Sachitra
43:20to the Department of Emergency Medicine,
43:23decreasing our apparent amount of grant.
43:28Revenue by about $10 million,
43:31but if you actually look at what we're doing,
43:35the amount of research activity in
43:37the department hasn't really decreased
43:39at all and continues to grow.
43:41And that's because of the incredible
43:45resilience and productivity of our
43:49faculty who continue to be engaged
43:52in in innovation and finding new
43:55ways to push the field forward.
43:58Year after year.
44:01I want to also highlight incredible
44:03strengths in some transitions,
44:05so I'd like to acknowledge Dr.
44:06Sherrel Bellamy and her new leadership
44:10of the perch program and to thank Doctor
44:14Larry Davidson for his leadership and
44:17a founding leadership of the Approach
44:20program and leadership for for many,
44:23many years.
44:24I also want to highlight some of the major
44:27research initiatives in their apartment,
44:30such as the Pronet initiative
44:32for the schizophrenia program,
44:34led by Doctor Scott Woods in our department.
44:36The transcends initiative to identify
44:39novel treatment for cognitive
44:41impairments for schizophrenia led by
44:43Ellen and Petrovich in our department.
44:46The Yale Tobacco Center of Regulatory
44:48Science Co, led by doctors.
44:51Christian and Karen and O'Malley.
44:54These are three substance abuse
44:56related centers.
44:57The score on sex differences in alcohol use,
45:00led by Doctor Sherry McKee and the Center
45:03for the Translation or Science of Alcoholism.
45:07I also want to acknowledge that we have
45:10major initiatives that are happening
45:12at the VA or or involve the DAV a
45:16including a large national pain initiative.
45:20the VA Mirec led by Mehmet Sofuoglu
45:23and the National Center for PTSD,
45:27which has two divisions,
45:29one on neuroscience.
45:31Which Doctor,
45:32Petrakis and I lead and one on
45:35health services led by Doctor Hoff.
45:39And there are signs of growth.
45:41A new program in psychedelic Science,
45:43Science Co.
45:44LED led by Doctor Chris Pittenger
45:46and involving a number of faculty,
45:49particularly Ben Kelmendi.
45:52Yeah.
45:55Doctor Al Kay Alex Kwan, Dr Cyril D'souza,
46:00Mohini Ranganathan, and others,
46:02and funding through philanthropy to
46:05train people to provide treatment.
46:08The psychotherapy associated with psychedelic
46:12delivery of psychedelic treatments.
46:14We want to acknowledge expansion of an
46:17already strong and productive research
46:19group through two new recruitments.
46:22The recruitment of Doctor Laura Hawkins.
46:24And Doctor Albert Higgins Chen.
46:28Who will really bring new energy to an
46:33already group already doing exciting work?
46:37And also acknowledge expansion
46:39of the of the PTSD Brain bank.
46:42Our role in the PTSD Brain Bank consortium.
46:45National VA PTSD brain bank.
46:49Are are the research intramural program
46:51is led by Doctor Matrix Agenti in our
46:55department and we're in this work.
46:57We're linking postmortem brain
47:00research cellular models.
47:03Simple animal systems,
47:04particularly through a collaboration
47:06with Doctor Ellen Hoffman and the Child
47:09Study Center and with the establishment
47:11of Doctor Alicia Cheese Laboratory.
47:13We're now able to track genes
47:16identified through the postmortem
47:19brain research and genetics all
47:21the way through into simple animal
47:24models that can be used to help us.
47:27Develop new treatments for PTSD.
47:33Another major initiative
47:35is the Wood Sai Institute.
47:38You've probably heard something about it,
47:40but now it's actually come to
47:43beginning to come to exist.
47:45It's led by.
47:48Doctor Nick Turk Brown from the
47:51Department of Psychology and it involves
47:543 clusters of activity that are are
47:58based going to be geographically
48:01located in the 100 college building.
48:03The place where the Alexion company
48:07was previously located and this
48:09is this will involve a section
48:12of Neurocognition and behavior.
48:14A section on neurodevelopment and
48:17plasticity and a section on neural
48:20computation and machine intelligence.
48:23This center is going to bring
48:25together basic neuroscientists,
48:27cognitive neuroscientists, engineers,
48:30computational neuroscientists,
48:32to try to better understand the
48:34mechanistic basis of cognition,
48:36and develop a new strategies to enhance
48:40cognition and perhaps to remediate
48:43cognitive deficits and involves
48:45many faculty in the Department of
48:48Psychiatry working hand in glove
48:50with faculty from other departments.
48:52I'm really excited.
48:54That the establishment of the Woodside
48:56Institute in this building coincides
48:58with the move of the Department
49:01of Psychology to 100 College St.
49:03So psychiatry and psychology will be
49:08geographically reunited after after
49:10many years of geographic separation.
49:12I think this will foster wonderful
49:15collaborations between our two
49:17our two departments,
49:18along with the Department of Neuroscience,
49:20which is also going to be
49:22located along with several.
49:24Faculty members in our department.
49:25So I think this is a really
49:28exciting opportunity for our
49:31department to stimulate our our.
49:37New kinds of interactions
49:39of our department and other
49:42departments in the university.
49:44I also want to acknowledge 3
49:46faculty who received endowed
49:47professorships during the year.
49:49Doctor Nee Addy,
49:51the Albert E Kent professor the 1st.
49:56Endowed professor.
50:00From African American in the department.
50:03Doctor Chris Pittenger.
50:07Deputy Chair for Translational Research
50:10and Doctor Suchitra Krishnan Sarin,
50:13the Alberdi Kent Professor of psychiatry.
50:17So these are incredible people.
50:20I can say that there are many,
50:22many more people deserving.
50:26Endowed professorships in our department
50:29and it is something that is a.
50:33That I work on throughout the year to
50:36try to find ways to not only honor,
50:39but provide support to our
50:42our distinguished faculty.
50:47I'd like now just to briefly honor.
50:55And recognize people who have received
50:58a national honors within the department.
51:01There are so many people who have received
51:03so many important honors that there's not
51:06time to acknowledge all of them individually.
51:09But I do want, as I've done in prior years.
51:12I do want to give you a little bit of
51:15a flavor of the wide range of people
51:17in our department who are having a
51:20national impact and being recognized.
51:23Nationally and internationally and and so
51:28I'm going to just slowly scroll through
51:32the people and some of the honors.
51:36This is obviously can't recognize everybody,
51:39but but certainly give you a little bit
51:41of a flavor of people who have received
51:44these honors during the past year.
52:15I also want to acknowledge.
52:18A gift to this department from Doctor
52:22Vlad Church and Biohaven Pharmaceuticals
52:25that will enable the department to
52:28continue the Thomas Detrie Awards
52:31to residents engaged in research.
52:35This has been a program that has been
52:38in the department for over a decade.
52:41And and will now be able to continue.
52:45I also want to acknowledge a number
52:48of retirements in our department's
52:50recent or impending retirements.
52:53Dr Marshall Mandelkern,
52:55who was has been a long standing of
52:58a faculty member in our department.
53:00He was chief of the psychiatry
53:03services at Saint Raphael Hospital and
53:07has led the long term psychotherapy
53:09track from a number of years.
53:11We deeply appreciated his contributions.
53:14Doctor Tom McMahon.
53:15Led the West Haven division of CMHC
53:18and has been an instrumental mentor
53:21and educator in the department in the
53:25Sychology section, Joan Crecca the the.
53:31You know person who is.
53:33Held the psychology section together for
53:36many many years as the as the key Staff,
53:39staff, person and who is, you know,
53:43a beloved figure in our department
53:45and Karen Robotti,
53:46who similarly has has been.
53:51One of the cornerstones of our
53:53department for a very long time as
53:56an administrative staff member.
53:57I has played such a key role in the
54:01Department of Business Administration
54:03and a really valued colleague and
54:06contributor to the success of our
54:09department who also has retired this year.
54:14Also, when I acknowledge.
54:17My administrative assistant help
54:19in Donahoe who is retiring after
54:2225 years of working with me.
54:25There's probably no tougher job than putting
54:29up with me for 25 years and helping.
54:33Is just a remarkable.
54:37Contributor in so many ways to
54:40the success of the Chair Chair's
54:43office for the Department of
54:46Psychiatry and just a wonderful.
54:50Collaborator and partner in all that
54:51we do in the Chairs office for the
54:54department and I I can tell you,
54:56helping that we are in your in
54:59your debt as a department and I am
55:02personally deeply in your debt for
55:04all that you have brought to your
55:07work every day for the department.
55:09So thank you so much.
55:12I also want to acknowledge some people
55:15who passed away during the past year.
55:17Charlie Reardon,
55:18an expert in substance abuse
55:20research and treatment,
55:22who also was a chief of psychiatry
55:24at the Saint Raphael's Doctor
55:27Michael Stelman from CMHC.
55:30And particularly two people,
55:33Seth Axelrod,
55:34who passed away this year after a long
55:37and courageous battle against a long illness.
55:40Really an inspiring person.
55:43A person who trained with
55:46Doctor Marsha Linehan,
55:47the person who developed
55:49dialectical behavioral therapy,
55:50and who brought DBT TL.
55:53He also established and LED for many years,
55:57a national conference on borderline
56:00personality disorder and in so many ways,
56:02inspired, mentored,
56:05collaborated, taught.
56:07And treated so many people in our community,
56:11Seth,
56:12we miss you terribly.
56:17And lastly, Steve Southwick.
56:19This is a picture of Steve
56:22Southwick on the 9th floor of the
56:26VA Connecticut healthcare system.
56:28This is there's someone here you probably
56:32don't recognize due to his disguise.
56:35This is from the 1980s.
56:38Steve Rachel yehuda.
56:40One of his mentees,
56:42who has gone on to become a
56:45major figure in in PTSD research.
56:47Earl Giller,
56:48former chief of psychiatry at the VA.
56:53But but I I thought it was very fitting.
56:56To reflect on on all that Steve has
56:59contributed as a pioneer in in PTSD
57:03research and resilience research.
57:05His resilience parental principles
57:07are are really important for
57:10us to reflect on when we,
57:12ourselves, individually,
57:13our families and our Community are are
57:17tested by so many challenges these days.
57:22His his His 10 principles were
57:26to keep a positive attitude,
57:30to reframe stressful thoughts
57:33in more constructive ways.
57:35To develop one's moral compass.
57:38In ways that enable us to be
57:40connected to a broader and deeper
57:42and inspiring sense of mission.
57:45To find resilient role models.
57:48Who's whose behavior is we can
57:51emulate in in in learning ways that
57:54we can be individually resilient.
57:56To find ways to face our fears
57:59and in so doing.
58:02Work to manage them constructively.
58:06To develop active coping skills
58:09to help us to manage our stress.
58:14To nurture our support networks.
58:17That in turn,
58:19nurture us to prioritize our
58:21physical well being as we work to,
58:25to nurture our emotional and mental health.
58:29And to train our brains because
58:33being stimulated and challenging
58:35is one of the ways that we can.
58:39Become both most fully ourselves
58:43to achieve the impact that that
58:46we can achieve and and and to
58:50enjoy what we're doing.
58:52At the same time.
58:56And playing to our strengths so.
59:00In closing, I just want us all to remember
59:04that this is an incredible community.
59:07We are. We do so much for other people.
59:11We do so much for each other.
59:15We enjoy and and celebrate the
59:19accomplishments of everyone in our community.
59:24And we're evolving.
59:26We are changing. We are adapting.
59:31We are innovating. And.
59:36And we are having an impact.
59:39And we are all part of that process
59:42and everybody contributes to it so.
59:46I I really I I I am thrilled to continue
59:51to lead this department every day.
59:55I'm inspired by all that you all
59:58bring to this department and.
01:00:04In in closing, I want to again thank
01:00:07in particular the people that made
01:00:09the videos today and thank Chris
01:00:11Gardner for pulling those videos
01:00:14together and thank all of you and
01:00:18we have a little bit of time for
01:00:22questions so I will stop sharing my
01:00:25screen and see if there is a way.
01:00:31To answer questions.
01:00:38And to to state comments.
01:00:44So let me see the first.
01:00:47Some of the comments that I see are.
01:00:53One, a comment that Michelle Silva's
01:00:57statement needs to be corrected.
01:00:59As of Wednesday, she is now officially
01:01:02associate professor and congratulations
01:01:03to Michelle and her promotion.
01:01:08And then. Comments really about
01:01:14how wonderful the videos were,
01:01:17so moving. So, so wonderful.
01:01:22There's a comment from Charlie.
01:01:25Nice to everybody that there is a going
01:01:28to be a rally to denounce the Supreme
01:01:31Court decision and there's a link to
01:01:34people who want to get involved with that.
01:01:37A comment from. Directly to me,
01:01:41so since it was directly to me,
01:01:43I will omit the name of the person
01:01:45who named the count made the comment,
01:01:47which is that we also have the
01:01:50most diverse class of residents
01:01:51among Ivy League programs.
01:01:53Besides being the only of the
01:01:56eight programs who accept.
01:01:58Accepted in Internet International
01:02:01medical graduate this year.
01:02:04A and he said this person says
01:02:06I'm very grateful to be here and
01:02:09we're grateful to have you here.
01:02:16The yodelin put the survey
01:02:19link for the for the for the.
01:02:26Mission Vision value statement into the chat.
01:02:28So anyone who wants to go to that website
01:02:33should be able to provide. Comments.
01:02:37How Peterson corrected my slide in
01:02:40in saying that Yodelin is also one
01:02:42of the Co leads for Project Synapse.
01:02:45I apologize for that that error.
01:02:50And Amy Bradley, one of the Co leaders,
01:02:52says that if you'd like to join and
01:02:55become more a part of Project Synapse that
01:02:58there's a site project synapse at yale.edu.
01:03:02Best with best wishes to help
01:03:05in the amazing help and Donohoe.
01:03:08And who the question is,
01:03:12what will I do without you helping?
01:03:15And and I will.
01:03:18That's a great question,
01:03:21but I I can't say that we have.
01:03:23We will shortly announce a person
01:03:26who will step into house and help
01:03:29and's position later this year.
01:03:32And and I think you will get to know her.
01:03:37And as I have done very in
01:03:42the recruitment process so.
01:03:52I'm open to taking any questions
01:03:54that anyone has this point.
01:03:56I I see a question about
01:03:57whether the department could
01:03:58make a statement about Roe.