Yale Psychiatry Grand Rounds: June 4, 2021

June 04, 2021

"State of the Department"

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

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00:00Hi everybody, it's John Crystal.
00:02I'm chair of the Department of
00:04Psychiatry and I'm thrilled to
00:06welcome you to our state of the
00:08department address for 2021.
00:11I missed the opportunity to.
00:14To do a state of the department
00:17address in 2020 because of COVID.
00:19So it's really nice to be able to get
00:22back together and and to reflect on
00:25what we've been through as I always do
00:28before the stated of the department,
00:29I want to acknowledge my financial
00:32interests in particular,
00:33that I consult to a number of
00:36pharmaceutical companies related
00:37to the development of of drugs
00:40for psychiatric disorders.
00:41I have stock in a company called Bio Haven,
00:44couple of other.
00:46Companies and patents that have
00:48been licensed to some companies.
00:50Particularly,
00:50a share of patents related to the use
00:54of intranasal cada mean for treatment
00:57resistant depression and suicide risk.
01:00So this has been just a
01:03remarkable year a year.
01:06Like no other in my lifetime,
01:09and one where we were forced to deal
01:15with challenges in literally every
01:17aspect of our work and family lives.
01:20What I'm showing you here is a a
01:23word cloud created by comments.
01:25That people made on a questionnaire.
01:28A stress survey from doctors in the
01:31Medical Center and hospital and you
01:34can see the issues that come up.
01:36Family health, politics, election,
01:39leadership, burnout access.
01:44And so many other issues.
01:48And and I didn't feel that I personally
01:53could capture the all of the issues
01:56that we were dealing with as in
01:59the Community over the past year.
02:02And So what I did was to ask a
02:04number of people in our department.
02:07To share what this past year has meant
02:10to them, and if you'll bear with me,
02:12it will take me just a minute to
02:15get this video up and running.
02:21So I'm I'm really thrilled
02:23to share with you this video,
02:26which has been made by a number of
02:28people in our department to talk about
02:31what the past year has meant to them.
02:40So as I reflected on the question,
02:41what this year means to me,
02:43the two themes I came
02:45up for me where struggle
02:47and freedom. I
02:48think it has been a year of struggle for
02:51us as a community for me personally,
02:55as we reckon with
02:56COVID-19 and the
02:58effects that that
02:59has had for
03:00the mental health community as
03:03we struggle to reckon
03:04with the legacy of
03:06racism and white supremacy,
03:07not just in the country but
03:09in the department. There have been
03:12a struggle. But
03:14there's also been opportunity,
03:16and I've been really inspired by my
03:17colleagues, not just in the residency
03:19program, but in other
03:20places in the department who are
03:22not only consistently showing
03:24up as themselves and
03:25being free within our spaces,
03:27but also trying to create a space
03:29for others you know, to be creative
03:32to reimagine and to be free. There's a
03:35song by the ancestor, Donny Hathaway
03:37that talks about this idea of finding
03:40freedom despite struggle, and that
03:42that's something that
03:43you know we can all be collectively.
03:44So I'm going to do a little
03:46bit of that. School soon.
03:59This spins around.
04:05John stones
04:10did you die?
04:23Just hold on tight
04:25and you will.
04:28Take it from me someday.
04:45Hello. Last year was about change.
04:48It was painful to see the
04:51suffering and the loss.
04:54But I remained hopeful and inspired,
04:57by the way that we came together.
05:00To deliver services and teaching
05:03in new and creative ways.
05:07From our social distance and
05:09a long way for the vaccine,
05:11we're now ready to emerge.
05:14With a brother perspective that
05:16will be useful for our lives.
05:19Thank you for all the support
05:21to each other and welcome back.
05:38I struggle to find the words to
05:41describe what this year has meant to me.
05:43It has been a year of
05:46unimaginable challenges.
05:47The challenges have been many
05:50and on different fronts.
05:51From the first news stories about deadly
05:54virus spreading across the world,
05:56I had a sense that we were in
05:58for a roller coaster ride.
06:00I just had no idea how many
06:01twists and turns it would take.
06:04By the beginning of March,
06:05I had a sense that it was a
06:07matter of days before we would
06:09be in the grip of the pandemic.
06:12I recall seeing a patient on contact
06:14precautions and as I took off
06:16and discarded my gown and gloves,
06:18I decided to keep my mask.
06:20I had a feeling that I would be needing it.
06:23It turns out I was right.
06:25And for the next month,
06:27that was a mask I wore.
06:28Every time I had to see a concert
06:31in the hospital.
06:32During those first few weeks and months,
06:34uncertainty became a blanket they
06:37carried with me every moment of the day.
06:40The only time I was able to shed
06:43the weight of that blanket was
06:45during family movie time.
06:46Which had become a nightly protein.
06:50April came in with it.
06:52My husband's placement in the step
06:54down unit caring for COVID positive patients.
06:57We work 12 to 14 hour days,
06:59six days a week for the entire month.
07:02And while he cared for COVID patients,
07:04I stayed home and cared for school
07:07aged children doing distance learning.
07:09And for my clinic, patients via Tele Health.
07:12Also,
07:12much of our lives have been
07:14turned upside down,
07:15was comforting to know that I could still
07:17be there for my patience and at times,
07:20in a much more intimately than before.
07:23I still remember helping a
07:25patient say goodbye to his father.
07:27His health slowly deteriorated in home
07:29and he refused to seek medical care.
07:32We spoke two times a week,
07:34sometimes more,
07:35until his father passed and then
07:38came the work to help him heal.
07:41During this time I also join an
07:44effort with palliative care in which
07:46we began providing decompression
07:48hurdles for the staff and I see you.
07:51It was yet another way in which
07:53I could help give back.
07:55A sense of purpose and meaning
07:57in the things I was doing propel
08:00me forward and help me overcome
08:02the fear and uncertainty.
08:04Then came summer in the civil
08:07unrest that sparked.
08:08Start by the murder of George Floyd.
08:10And countless other black Americans,
08:13every ignited a national
08:14conversation about basis something.
08:16So we do.
08:18I struggled with anger and frustration.
08:22For many of my patients who
08:24had lost brothers,
08:25sons and partners at the hands of police,
08:27it was re traumatizing.
08:29A roller coaster had just
08:31taken an unexpected twist.
08:33This was another moment when my
08:36resolve was tested and I had a
08:39choice to give it to the anger
08:42and despair of person.
08:44As we know,
08:44the year was far from over and
08:46many challenges lay ahead between the
08:48political unrest over the election in
08:50the second wave of COVID among them.
08:52So I kept going. My family,
08:55my sense of responsibility.
08:57And my faith in our shared humanity
09:00would help us build the path forward.
09:03So when I think about what the
09:05last year has meant to me.
09:07Has really been a year of challenge that
09:10has pushed me to grow into overcome.
09:14It has been a year of resilience.
09:30Can I stay my name is Stephanie Wilson.
09:33I am Dakota soon, as well as Swedish.
09:37I am a fourth year psychiatry resident,
09:41outgoing as well as public psychiatry fellow.
09:44I'm originally from new sort of college also.
09:48Known as Minnesota Insulated
09:49by peoples also join people.
09:53Currently I'm on could be a planned.
09:58This year you have this year for me
10:02has really stretched me.
10:03Think about how to maintain
10:06community virtually,
10:07whether that's here at Yale,
10:10New Haven or with the indigenous communities
10:12that I work with in the Midwest.
10:15And get creative on how to support them.
10:17And I think most importantly,
10:19listen to to what I can do from afar.
10:23You know we saw a really disproportionate
10:26rate of COVID-19 on our communities of
10:30color and are not white communities.
10:33Specifically, our indigenous community
10:35knighted states we were hit hard
10:37with the pandemic and a lot of the
10:40numerous issues that came along,
10:42as well as being unable to
10:44participate in ceremonies and.
10:46Things that are really kind
10:50of the core of our culture.
10:53But we also saw.
10:55Some really magnificent magnificent things.
10:58As past year we saw the first
11:01Native American to be department of.
11:05Secretary of interior step hauling
11:07we saw the years of advocacy to
11:11dismantle the racist mascots.
11:13Finally,
11:14have some resolution with our
11:16youth and elders.
11:18Protest the oil pipelines that
11:19are going through our land.
11:21We even saw a slight return of
11:23of our land to our communities.
11:26Anything was importantly,
11:28we saw how our communities use centuries of
11:32accumulated knowledge to fight this pandemic.
11:35We saw her tribes early on shop
11:38orders containing quarantine,
11:39their tribal members,
11:40provided food, water, medicine,
11:42transportation.
11:42We saw communities like the Cherokee
11:45Nation who right away when the vaccine was
11:49available start getting 500 people a day.
11:52We saw the Navajo Nation call
11:54Doctors Without Borders and to
11:56provide additional medical care.
11:57When the Indian Health Service could not.
12:00With our communities in the Midwest,
12:03prioritize our elders who spoke our
12:05indigenous language to get vaccinated first.
12:08Our elders are very important to us
12:10and they are vital and continuing to
12:12pass on the knowledge and tradition
12:15of our culture.
12:19And I think that one
12:21of the biggest things to recognize
12:23is that we are one of the fastest
12:25growing minorities in United States.
12:26And although media and popular culture
12:28constitute picked us as figures of the past,
12:31wearing headdresses or
12:32looking like Pocahontas,
12:34most of us live in urban areas.
12:38And despite the centuries of attempted
12:42genocide or reischer forces,
12:45simulation native people continue to adopt.
12:49And survive, and we're still here.
12:54We continue to pass on the knowledge that
12:58we've learned to the next generation.
13:01So that being said. I'm proud.
13:05I'm proud to be indigenous.
13:08Tell me know thank you.
13:17Grateful to have the
13:20opportunity to really reflect on
13:22what has this past year.
13:26Meant for me. It has been one of
13:32intense pain. Vicarious trauma?
13:39Joy. And also.
13:44A time of reckoning.
13:46Let me explain just a bit.
13:50Intense pain given all of the losses,
13:54unexpected losses of mentors.
13:59Patience. Friends and family.
14:03All related to Cobit 19.
14:08As an addiction dog,
14:11it is really.
14:14So hard to stomach all of the
14:19unnecessary deaths related to.
14:22Poor drug policy.
14:26I also think as a black woman.
14:30Living in America. One cannot minimize.
14:36Be intense. Frustration. Watching.
14:43People that look like you being terrorized.
14:49It seemed almost daily, really culminating
14:53and assassination of George Floyd.
14:58And one of my mentors,
15:00Doctor Overbeck they talked about.
15:04George Floyd is a St Saint George Floyd and
15:07I really appreciate that framing because.
15:11Really thinking about how his death will
15:14not be in vain and as a result of the
15:18public display of what happened is murder.
15:22There has been a reckoning.
15:25Across this country internationally.
15:28But even in our community at Yale
15:32in terms of how do we commit to
15:35anti racist practices for sure.
15:38But go a step further to really
15:41fight for racial justice, right?
15:43The existence really building
15:46structures that are more equitable.
15:50On a personal note.
15:53As I mentioned,
15:54I lost an amazing mentor and colleague
15:59and friend Kathy Carroll and think about.
16:06How I want to continue her legacy
16:10and producing excellent scholarship.
16:12Anne, really pouring into the next
16:16generation of young people and
16:19pursuit of scholarly excellence.
16:23I will say that the resilience of who
16:28we are as a community was really.
16:33Magnified through the town halls
16:35during the height of the cold and
16:38COVID-19 pandemic was so grateful.
16:412. Work with amazing colleagues.
16:45In order to hold space to allow
16:49people to process that pain and
16:51think about collectively how
16:53we might get through a really,
16:56really tough time.
17:01Personally, it was a professional
17:04milestone because I got awarded my first
17:10NIH grant are 01, and so that was.
17:15Really, a time of celebration, it doesn't.
17:20Ball the gravity of that situation is huge.
17:26Realizing that I am one of the
17:29less than 1% of NIH funded
17:32researchers who are black and so.
17:35It's a bittersweet a time of celebration,
17:38but also a time that just reminds
17:42us of how far we have yet to go.
17:46So I leave you with those thoughts.
17:51This is the state
17:52from my point of view or where of
17:54where we are an in terms of where
17:58we need to go. I think we have.
18:02Obar way ahead, but like. You know?
18:09Structural racism did not.
18:13Start overnight has been in the
18:16process of at least 400 years.
18:18I know that we have to collectively
18:21commit to dismantling these structures
18:25and I am excited about the opportunity
18:27for people who are really serious
18:30about doing things differently
18:32to join in as we move forward.
18:35So thank you, thank you for the
18:37opportunity to share my reflections.
18:49Hi everyone, my name is Karima Robinson.
18:52I am the coordinator of medical and
18:55professional staff here at CMAC
18:57in the Department of Psychiatry.
18:59I'm delighted to be asked to talk
19:02about what this year has meant to me,
19:04so I want to thank Doctor Krystal
19:07for inviting me to share a
19:09little bit of my personal story.
19:11So this year this past year has been really,
19:15really horrible. Sorry to say,
19:18but it's it's been pretty horrible.
19:21We all have suffered great
19:23loss because of COVID.
19:25Loss of people that we love and
19:27loss of just personal freedom.
19:30As you know we had to wear masks
19:32out of her own safety and I
19:35support the mask wearing even now.
19:38We had all sorts of travel restrictions which
19:40we had to comply with so it was a very.
19:42It was a big change of lifestyle
19:44for us dealing with COVID.
19:46So that was.
19:48You know it was challenging,
19:49but it wasn't horrible.
19:50I think the horrible part was not
19:53being able to visit family members.
19:55Because of Kobid family members
19:56who ended up some of them died,
19:58some of them didn't,
20:00but so that restriction was especially
20:03painful during this past year.
20:05So I had two aunts who had colored,
20:09one survived and one did not and we were
20:12not able to visit her in her final days,
20:16which is heartbreaking.
20:17I have two uncles who passed away
20:20this past year and I lost my father,
20:22which was a huge loss to me and my family.
20:25So it has been a really,
20:27really tough and painful year this year.
20:32So carbon has not been kind to any of us
20:35and they were not all cold related deaths,
20:38but they happen to happen during this
20:41COVID time time that we are now living in.
20:45Also this year we had this re emergence
20:49of Black Lives Matter movements which.
20:53You know is born out of tragedy, right?
20:55So we had to sort of indoor.
20:57The tragedy of that video of George
20:59Floyd over and over and over again,
21:01which was incredibly painful
21:03to watch and to witness.
21:05And to realize that this is
21:08happening again and again and again.
21:10Years and years and years after
21:12Emmett Till and so many other people
21:15that were still experiencing this.
21:17So that was a different kind of
21:20pain of 2020 and the COVID era is.
21:24Having to live through that
21:27whole experience of his loss.
21:29Other people who died in similar
21:31ways occluding Brianna, Taylor,
21:32and and then going through the whole trial
21:36was incredibly painful for so many of us.
21:39And we all had to suffer.
21:40Suffer that together.
21:43And it forced me to think about two questions
21:46that I had to ask myself as a result of that,
21:49and one is.
21:52How do I in my everyday life
21:55so uplift white supremacy?
21:58That was a tough question because
21:59I don't think of myself as someone
22:01who's who's doing that, but.
22:03You know we all survive in this
22:06society which does do that,
22:07so I had to question myself
22:09as a gatekeeper and and how do
22:11I contribute in some ways,
22:13even unwillingly, how do I contribute?
22:15And so I realized that my silence
22:18when I see racial bias happening
22:21is a contributing factor.
22:23Even though I know sometimes that science
22:26silence is for my own protection,
22:28right to continue to survive
22:30in the Sprite society silence.
22:32Sometimes there very often required,
22:35so I had to just name that acknowledge
22:38that this year the other question is
22:41what am I doing to dismantle racism?
22:43So on one hand I'm complicit
22:45like like we all are,
22:46I think,
22:47and on the other hand I am have
22:50to really think about how I'm
22:53working to dismantle racism so.
22:56It made me recommit to my other outside.
23:02Part time students work with different
23:04nonprofit organizations that I'm part
23:06of that are committed to social justice.
23:08So I felt even more committed to those
23:11organizations to volunteer my time.
23:13Where and when I can to support my community.
23:18And also I guess the silver lining
23:21is that I was invited to be part
23:23of the Department of Psychiatry
23:26Anti Racism Task Force.
23:28Which sort of was brought about in
23:30part because of George Floyd's death.
23:33So having a seat at the table
23:37is kind of a first.
23:38That staff have not really been included
23:41in departmental affairs at that level,
23:43so being invited to participate
23:44was an honor and I'm very proud to
23:47serve and happy to be part of it.
23:50So that is a silver lining for me.
23:51Having a seat at the table,
23:52not just for me, but for all staff
23:55and having staff participation in
23:57that group is really important to me.
24:00And I think it's sort of symbolizes,
24:02like the opening of a door. Like.
24:04Maybe there's more room in the
24:06department for staff to participate
24:07in different things that happen.
24:09And maybe there's more room for people
24:11of color to have different sorts of
24:14leadership roles in the department.
24:16So I think that's the silver
24:17lining of this here.
24:18It's been a it's been a horrible tragic here,
24:20but I think the silver lining is that people
24:24are more conscious of systemic racism.
24:26And trying to be more thoughtful about
24:29how we could combat systemic racism.
24:32And I'm really proud to be
24:34part of that effort.
24:36So that's my silver lining after this.
24:38Very horrible,
24:39tragic here that I am part of
24:42the solution I hope and I try
24:44to be part of the solution to
24:47dismantling systemic racism.
24:49So thanks again for the opportunity to share.
24:54Again,
24:55I'm delighted to serve and
24:56happy to be part of it.
25:07Hello everyone. It's nice to be with you.
25:12I retired over two years ago.
25:16Nearly my entire social movie revolves around
25:20the L psychiatry department and the VA.
25:23I no longer had an office.
25:26Are good reasons to visit you
25:28or the VA in a regular basis?
25:31And with the start of kovid, it looked as
25:34if the situation would get even worse.
25:37I also started to feel guilty about not
25:40being in the hospital on the frontline.
25:43Having no way to contribute.
25:47I like being on the frontline.
25:50And felt that my role as a physician
25:53and caretaker. Is slipping away.
25:57Even though I tried to internalize
26:00my father's lifelong model.
26:02I'm not OK, you're not OK, it's OK.
26:08I still felt pretty girl.
26:12Engine called.
26:14He asked if I would consider
26:17becoming a member of a COVID-19
26:20mental health task force.
26:22It is meaningful.
26:23And asked if I might join her
26:25to get a talk about resilience.
26:27Two VA Danielle interests.
26:32Then I got married to Bernadette.
26:35My partner of 20 years.
26:38I was back.
26:41Back with my teammates.
26:42Back with a renewed sense of purpose,
26:45perhaps I could contribute,
26:48even if in a small way.
26:51Which brings to mind Helen Keller's list.
26:55I long to accomplish a
26:57great and noble task,
26:59but it is my chief duty to
27:02accomplish small tasks as if
27:04they were great and noble.
27:08And recently I learned that the
27:11Yale Department of Psychiatry
27:13has been rated the number one
27:16department in the United States.
27:18Just think about that.
27:21You and I have the opportunity
27:23to work for a great department
27:26whose clinical, educational,
27:28and research mission is to help those
27:32who are suffering with mental illness.
27:36What could be better than that?
27:40So this year, in a way,
27:41I rejoined the department
27:43by joining the task force,
27:45giving the talk with his many,
27:47and also teaming up with colleagues to
27:51investigate the impact of the pandemic
27:54on frontline health care workers.
27:57Here's a passage from the manuscript
28:00that we recently published about
28:03frontline healthcare workers.
28:05I quote from that because it is
28:08relevant to how I personally
28:11experienced this past year.
28:14Call Navy seals and special forces.
28:18Soldiers often attribute their own
28:21cursed resilience to the power
28:24of team members who have each
28:26others back and will even risk
28:29their life for one another.
28:31The message from healthcare leaders
28:34should be clear Team team team.
28:38You are your brother and sisters keeper.
28:41We're all in this together
28:43fighting for a common mobile cause
28:46is a privilege to be working
28:49alongside such remarkable comma.
28:53For me, this year has been filled
28:57with distress and great concern
29:00for all those who have suffered
29:03from the devastating impact.
29:04Of the pandemic.
29:06And for the toxic political
29:08divisions in our country.
29:11And for longstanding and
29:13pervasive social, racial,
29:15economic and healthcare disparities.
29:21But this year has also been
29:24filled with renewed purpose.
29:25Wages and resilient role models.
29:28Gratitude and the privilege to
29:31work with and care deeply about my
29:35wonderful colleagues who are both
29:38teammates and cherished friends.
29:41Thank you for having my back.
29:55One day in February this year I got
29:58a text message from one of my medical
30:02school friends and I learned our mutual
30:05friend passed away in April 2020.
30:08It was the first person I met
30:11when I came to this country.
30:13He helped me move,
30:15gave me right to grocery shopping,
30:18and taught me how to drive.
30:21He was younger than me.
30:24So breathing of his mouth
30:27has been very challenging.
30:30The most difficult part for me
30:32is I didn't know his past until
30:3610 months later because we were
30:39disconnected in past several years.
30:42Like many friends in this country,
30:44we didn't talk for several years
30:47due to our different point of view.
30:51After lost his friend I ask myself.
30:55Is this worth it?
30:58So those this friend make me happy.
31:01Better understanding of complexity
31:04of breathing in 2020.
31:07I hope this make me become
31:11a better psychiatrist.
31:13As a scientist,
31:152020 was exciting and inspiring.
31:19With all vaccines developed,
31:23we have a hope into this pandemic.
31:26I hope one day our work can contribute
31:29to improve human life as well.
31:33Overall,
31:34I'm very fortunately my life has not
31:38been greatly negatively impacted by the
31:43pandemic day in day out seems similar.
31:48Yeah,
31:49everything seems changed
31:51because everything seems to
31:53have a different meaning now.
31:56I think.
31:57As long as we're kind and
32:00generous to each other,
32:02I think we're going to be OK.
32:15Everyone. I want to thank.
32:19I want to thank.
32:22Aza Elsa, Esperanza Diaz,
32:24Ari Edna for a, Stephanie, Gilson,
32:27Ayanna Jordan, Kareem Robinson,
32:30Steve Southwick in khushoo for these
32:34moving important and inspiring statements.
32:38I think they help us to
32:41grapple with the enormity.
32:43And of what we've been through
32:46over the past year.
32:48So. Continuing.
32:50The discussion I'd like to begin
32:54by reviewing this past year.
32:56And then talking a bit about the
32:59state of the department.
33:01As you've heard, this has been a year
33:03where we faced enormous challenges,
33:06social isolation,
33:07pandemic loss of family,
33:09friends and colleagues.
33:11The complications of dealing with COVID,
33:14such as wearing masks,
33:16the murder of George Floyd,
33:18and the killings of bipac individuals
33:21by police, plus the overt
33:23expressions of racism's racism.
33:26Violence against Asian and Pacific Islanders.
33:30Separation incarceration of families.
33:32Attempting the US at the border.
33:35Right wing insurrection in
33:37attempts to overturn the election.
33:39The destructive practices are
33:43prior presidential administration,
33:45resulting in the polarization contributing
33:48to the polarization of our society.
33:51The economic challenges that we face.
33:54The environmental challenges that
33:56we've dealt with over the past
33:59year in which seemed to be growing.
34:02The disparities in our society and
34:05the ongoing challenges that we face
34:08around the effort to have access to voting.
34:14These challenges have had enormous
34:16impact on on us personally on
34:19our families on our department,
34:21on the medical school, in the hospitals,
34:24and the clinical settings that we work.
34:27And a group of us in the medical school.
34:31Try to get together to grapple with this
34:35and to provide some support services.
34:38In an effort led by Rajita Sinha
34:40in our department and Christine
34:43Olsen in the hospital.
34:44Developed a questionnaire called
34:46the Yale Stress Self Assessment.
34:49Which was started at least 24,500
34:55times beginning in May of 2019 and
35:01continuing all the way up to the present.
35:08And what I'm showing you here are
35:11answers to some of the questions
35:13that were on this survey.
35:15So for example, when asked about their
35:18exposure to race related violence,
35:21victimization discrimination,
35:22or other adverse experiences,
35:25about 13% of the.
35:31Overall employee group that that
35:33contribute to this from the medical
35:36school and the hospital said that
35:39they had been exposed to this.
35:41But obviously the percentage of
35:44exposure the people who felt
35:46a lot of stress related.
35:48This was obviously much.
35:52Higher, almost double among
35:55underrepresented groups of employees,
35:58faculty, staff, and trainees.
36:02Similarly,
36:03concerns about economic uncertainty.
36:06We're high, about 22.6%.
36:09But at a higher rate.
36:13Particularly among the employees,
36:16the staff employees.
36:19And concerns about child care.
36:21Again, a common stress during COVID.
36:26Were higher those concerns were
36:30higher among underrepresented
36:31groups working in the hospital
36:34in the Medical Center?
36:38When we think about the
36:40impact over the past year.
36:42There's a temptation to think that that.
36:45There was a period of time when
36:47things were stressful at the
36:48beginning and that that passed.
36:50But in reality, when you look at.
36:54The percentage of people
36:56who completed the survey,
36:58who reported fairly often or very often
37:03feeling stressed in a variety of ways.
37:06You see that the stress levels have been
37:09pretty consistent all through the year.
37:11Not feeling confident about ability
37:13to work and manage your family.
37:16High levels of exposure to death.
37:19Feeling out of control.
37:22Feeling guilty or ashamed and that feeling
37:25like they wanted to blame others for
37:28the experiences that they were having.
37:35When asked about the levels of particular
37:37symptoms that they experienced,
37:39what you see over the year is that these
37:42levels of symptoms remain high as well.
37:45And what people are reporting are increases
37:49relative to the pre COVID period and
37:53not just the absolute level of symptoms,
37:55but people who feel more tired and exhausted.
38:00You can see that those feelings
38:04remain high throughout.
38:05A number of stress related symptoms,
38:07such as sleeping difficulties,
38:10irritability, anxiety.
38:11Having difficulty focusing those symptoms
38:14are present in half or even over half of
38:20the people who completed the questionnaires.
38:24And feelings that.
38:27Of feeling cut off from other people down.
38:33Racing or slowed thoughts.
38:34In other words,
38:36symptoms that we would associate more
38:39commonly with clinical depression or
38:41even post traumatic stress disorder.
38:43These were present in somewhere
38:45between one out of five.
38:47To almost 4540% of of people,
38:51and those the rates of those symptoms
38:54remained high over the years.
38:56So, so we've been a very stressed community.
39:02And we've.
39:04Struggled over a variety of
39:07of issues and as you heard,
39:10a number a group came together.
39:13There's not time to go over
39:15the entire task force.
39:17But from the Department of Psychiatry,
39:19from the hospital,
39:21from internal medicine,
39:23from the Dean's Office Child Study Center.
39:27But to try to develop support services.
39:30And led by Jack Teves,
39:32who can let her program of town halls.
39:37And Sambol who Co letter program of
39:401 to 1 support.
39:43Ariana for a Hoo Hoo.
39:48Lead drop Inns and huddles for intensive
39:51care unit and other units in the hospital.
39:55Barbara Bell in the domains who
39:57let her program to support new
40:00clinical teams in the hospital.
40:05And other services that were provided a
40:09safety net was created to try to help.
40:13The system manage the terrible
40:17stress of the pandemic.
40:19Ann and I want to particularly thank
40:22almost 200 volunteers from our department,
40:25ranging from residents to faculty,
40:30to Fellows, volunteer faculty.
40:32All parts of the department who contributed
40:35and volunteered their time to support
40:37others during this difficult time.
40:42Another aspect of this year that has
40:44been so difficult has been all the
40:46people that we lost as a department.
40:49Bob Nelson died in in in June, run Doom,
40:54and died last at the end of January.
40:58Last year, Kathy Carroll also died
41:02after a very brief illness. Uhm?
41:06And at all of these people at the
41:10peak of their karere, Nancy Suchman,
41:13who whose work with addicted mothers
41:17was really extremely important.
41:21I'm all of these people died at the
41:24peak of their product tivity and impact.
41:27And they had so much more to give.
41:30And yet we lost them quite suddenly.
41:35This year we also lost done
41:37Quinlan after a long illness.
41:40Run Casey important supervisor at
41:43HCC and Bob Ross, who had been.
41:48A member of our residency program.
41:51We lost a number of alumni, including people.
41:56Who? We're teachers in our department.
42:02Cynthia Russell. Jerry Schmidt.
42:05Tony Vanderpump, Vanderpoel,
42:07who had a secondary appointment in
42:10our department. Sandy Schreiber.
42:12Robert Stern in alumni.
42:16Andrews Slavian target nisenson.
42:19I'm so.
42:20As people were felt losses
42:24in their personal families,
42:27our department family suffered
42:28a number of losses this year.
42:33As you heard in the statements that
42:36this was also a year when we discovered
42:39our resilience in our capacity.
42:41We had psychiatry, residents and faculty
42:44volunteering support our medical
42:46colleagues and medical services.
42:49Remarkably, we were able to transform
42:52our ambulatory care to virtual formats.
42:55Faculty, staff and trainees
42:58volunteered to support others.
43:01The education and research
43:03missions continued despite the
43:06enormous challenges that we faced.
43:09Our resident medical students
43:12residents were very active in both
43:15in the medical school and in our
43:18apartment in highlighting our legacy
43:21of racism and the impact of racism.
43:24Our department. Her.
43:28Came together with a very broad effort.
43:33The Anti Racism taskforce,
43:35which I'll talk about a little
43:38bit more in a bit.
43:39Our residents and faculty were in
43:42some cases providing support to our
43:44surrounding community in a variety of ways.
43:47Our staff.
43:49Came together with projects in
43:52apps to promote the status of
43:55staff in our department.
43:58And the Women's Health conference
44:01organized by by Stephanie Gilsenan.
44:04Sophia Nouri had over 1000 attendees
44:07this year, a remarkable accomplishment.
44:10In some ways.
44:13This year her.
44:15Has brought out in many cases the best of us.
44:21I particularly want to thank Cindy
44:24Cousteau for her leadership Co leadership
44:27of the Anti Racism Task force.
44:30This is a test for us that has
44:32around 70 participants from all
44:35aspects of our department.
44:37It is organized through a steering
44:41committee that works closely
44:43with subcommittees focused on all
44:46dimensions of our department work.
44:49Our clinical work with the
44:51Center Clinical Subcommittee,
44:52led by looming Lee, is meaning.
44:55But Racasan,
44:56Deborah bond.
44:57Our interactions with the community
44:59is a subcommittee led by Co.
45:02Led by Mike Sarniak and Michelle Silva.
45:05The Education Committee Co.
45:08Led by Amber Childs and Christian Wilkins,
45:12the Faculty Development Committee Co,
45:14led by Niyati and Sambol.
45:16The research committee led by
45:19shrill Bellamy and Rena bachata
45:21in the Staff Subcommittee Co.
45:24Led by Cole Peterson and Cream and Robertson,
45:27who we just.
45:29Or presentation this has been
45:32an important central remarkable
45:35initiative for our department and one
45:38that I hope will enable us to move
45:41forward not only in the short run.
45:43But in an ongoing way to make the
45:48department the kind of community that
45:51we can all feel good about being a part of.
45:57And so we're tired.
45:59We're hurting or fragmented.
46:01We long to come together.
46:04We're strong, we're resilient.
46:07We're making a difference.
46:10And we remain a community of compassion,
46:14excellence and impact.
46:18So let's talk a little
46:20bit about the department.
46:21We remain the second largest
46:23department in the medical
46:25school with 243 ladder faculty.
46:2872% of our latter faculty are
46:31Caucasian or identify as Caucasian,
46:33and 52.7% of our department is female,
46:37making us. I believe the only.
46:39Department in the medical school.
46:43That has a higher percentage of female
46:45relative to male faculty members.
46:5049.4% of our faculty either
46:52have the MD or MD PhD degrees.
46:56An 50.6% of our faculty? How are PHD's?
47:01They could be psychologist in our scientists,
47:03other kinds of scientists.
47:06In terms of the tracks of our department.
47:10About 60% of our department are
47:13either in the clinician track or
47:16the clinician educator track.
47:18With about 18.5% in the
47:21clinician scholar track,
47:22which is higher than most
47:24departments in the medical school,
47:2611% in the investigator track
47:28and 7% in the traditional track.
47:33As you probably know,
47:34where the number one NIH grant
47:37supported department in the country
47:39with $110 million in NIH grants,
47:43that makes us also the second
47:46largest department in the medical
47:49school with regards to funding.
47:52The Department of Internal Medicine,
47:54which is about twice our size,
47:56has about $130 million in NIH grants.
48:01We also have significant funding
48:03from foundations from the VA
48:05and the Department of Defense.
48:07As you heard, we were rated the number one
48:10psychiatry program in the country by U.S.
48:13news and World Report.
48:15And I want to particularly acknowledge
48:18Bob Rohrbough in his leadership
48:21of our educational programs,
48:24but really also recognize that
48:27this is been a department wide.
48:30Effort from the recruitment of new
48:34groups of outstanding psychiatry
48:36residents every year from with
48:40residents involved and faculty involved.
48:44The. And we have also.
48:47The excellence of our department
48:49in training is also reflected in
48:51the percentage of Yale medical
48:53students going into psychiatry.
48:55About 10% of the class,
48:57including two who were extremely pleased,
49:01will be joining our psychiatry residency.
49:04Our clinical programs in all
49:07of our our settings are are.
49:11Outstanding, we were rated Yale,
49:14New Haven Psychiatric Hospital was
49:16rated 10 in the country by U.S.
49:18news and World Report.
49:20We enjoy a remarkably collaborative
49:22and productive relationship with Yale,
49:25New Haven Hospital.
49:27Similarly,
49:27us very special collaboration with
49:30the Department of Mental Health and
49:32Addiction Services with regards to our
49:35work at CMHC and with the Department
49:37of Veterans Affairs and the VA.
49:39With our work at the VA.
49:41We are the safety net programs
49:43through CMH C and from for VA for
49:46the state of Connecticut and Yale,
49:49New Haven and we're also national
49:52national referral source such as
49:54the work for treatment resistant
49:56mood disorders in the Interventional
49:58Psychiatry program at Yale,
50:01New Haven,
50:01and a novel collaboration with Silver
50:04Hill Hospital for impaired executives.
50:09This is the department,
50:10the budget of the Department of Psychiatry.
50:13It's about not including the state
50:16budget and not including the VA
50:19budget or our department budget
50:21is almost $150 million a year.
50:2560% of our budget is related
50:28to our research activities.
50:30And nearly 40% of our budget is
50:33associated with our clinical work,
50:35excluding CMH in the VA and
50:39some of the budget.
50:40Other budget is related to administrative
50:45and educational activities.
50:47As you can see from this graph,
50:49our department revenues have
50:51increased during the pandemic,
50:53despite the transition to virtual services.
50:57Anne,
50:58but you should know that the
51:02department net revenues relative
51:04to the expanding costs of the
51:08reflecting the growth of our programs
51:10so that the net revenues to the
51:12department have decreased a bit.
51:13We believe there rebounding,
51:17but we like the hospital like
51:21the medical school are a little
51:24bit challenged economically as
51:26a result of the COVID year.
51:29I mentioned that we are a number
51:31one in the country in NIH support,
51:33and I thought it would be useful
51:35to show what what this has looked
51:37like over the past 10 years.
51:39So that over the past ten years we've
51:42been there, Yale and the University
51:45of Pittsburgh have been neck and
51:47neck in terms of leadership in
51:49NIH grant support in the country.
51:52And we continue to be, you know,
51:55relatively close with the University
51:56of Pittsburgh, but but but we.
52:02Not only remain number one,
52:05not only because we have
52:07more funding than ever,
52:09but also because our increase our
52:12funding has increased more between
52:152019 and 20 than any point in
52:18the history of our department.
52:21And as a result of gap is opened up
52:23between Yale and Pittsburgh and and the
52:26other leading department's in the country.
52:30One of the reasons for this
52:32jump has been a remarkable new
52:34initiative led by Scott Woods.
52:36There his Co investigator Co
52:39principal investigators are Kerry
52:41Bearden at UCLA and John Kane at
52:43the Soccer School of Medicine.
52:46And what you see is that this
52:48is a really important national.
52:50In fact,
52:51international initiative to understand
52:54how people develop schizophrenia from
52:57at risk states an number of people at
53:01Yale are involved in this initiative.
53:04This is also been a transformative year.
53:07For the field of PTSD research due to
53:11discoveries made by Yale scientists.
53:14Using data from the million veteran program,
53:17a group of geneticists led by Joe Calentar,
53:20and Yale and Mary Steen at UCSD,
53:23found the first genome wide,
53:24significant results.
53:25In other words,
53:27the first implicating the first
53:29genes in the heritable risk for
53:32post traumatic stress disorder and
53:34using a national PTSD brain bank
53:37which has emerged from the National
53:40Center for PTSD in which we are
53:44participants in our department.
53:47And the first molecular and
53:49cellular biology of post traumatic
53:52stress disorder emerged as well.
53:55This work is led by a new faculty
53:58member match.
53:59Urgente will join the latter faculty
54:02in July and of course reflects the
54:05legacy of the contributions of Ron Duman.
54:10Over the year we had some faculty
54:13members move away or announced
54:15that they were going to leave,
54:17and three that I mentioned here, Kim Yonkers,
54:20leaving to become Chair of Psychiatry
54:22at the University of Massachusetts.
54:25Alex Kwan, who will be leaving
54:27in a year to take an important
54:29position at Cornell and Megan Smith,
54:32who is leaving you to take a position
54:35with the Connecticut Hospital Association.
54:39Another exciting development though
54:41at Yale has been the emergence
54:44of the Wu Tsai Institute.
54:46We don't really know how
54:48much money was donated.
54:49We're pretty sure it's
54:50a fair piece of change,
54:52but it's it's going to fund work to
54:55try to understand the neural basis
54:58of human cognition and to think about
55:01ways to to advance cognitive function.
55:04It's led by Nick Turk Brown from
55:06the Department of Psychology,
55:08but is a forum for bringing together.
55:12All the neuroscience related work at
55:15Yale and to link it to computational
55:18work and to engineering in new ways,
55:21I think will be extremely exciting.
55:26The some of the work will be related
55:28to human cognition and behavior,
55:30some of it related to neuro
55:33development and plasticity,
55:34and part of it will be related to
55:37neural computation and machine
55:39intelligence and centers focused on
55:42each of these areas will emerge a
55:45number of faculty in the department
55:48are working with this. At various levels.
55:53And and some will be working in
55:57the space of the of the new.
56:01Institute, including Philip Corlett,
56:03George Dragoj, Monica Jadi.
56:07And others.
56:10And we're really thrilled that we have
56:14this opportunity to come together in a.
56:19Organized interdisciplinary effort.
56:24To really advance our understanding of the
56:26neuroscience of cognition and behavior,
56:28I think this will be an enormous
56:31opportunity for faculty in our department.
56:33This is also been a year of
56:36extraordinary firsts for our department.
56:39This year's Indy Cristo was the first
56:42African American female professor
56:45in our department's history,
56:46and one of very few in the medical school,
56:50so we're really extremely proud of Cindy
56:54for her accomplishments and proud.
56:58That this.
57:01Step is finally accomplished for
57:04our department and we believe
57:07that many others will follow the
57:11path that Cindy has paved.
57:14I'm also extremely pleased to
57:17announce that that in July,
57:21niad E will be the first endowed
57:24Professor African American endowed
57:26professor in the department.
57:27He will be the Albert Ekent
57:30associate professor of psychiatry,
57:32and he will be assuming an important
57:34role in the Deans office as
57:37director of Scientific Scientists.
57:39Diversity inclusion for the medical school.
57:42So two very proud moments.
57:46For our department this year.
57:50This year a number of people
57:53have stepped up to two.
57:57To fill in gaps that were vacated
58:00by the deaths of of our friends
58:02and colleagues. Marina pochoda.
58:06I stepped up as the director of the
58:09Abraham Ribicoff Research Laboratories,
58:11as she has already been the deputy chair
58:15for basic research in our department.
58:18This year, Chris Pittenger stepped
58:19up as the director of the Clinical
58:22Neuroscience Research Unit.
58:24He is promoted to professor this year
58:28and therefore is promoted to deputy
58:32chair for Translational Research.
58:34And in July he also will assume
58:37the Elizabeth mirrors.
58:38And how is Jamison Professorship
58:42of Psychiatry?
58:43I'm also thrilled that Mark
58:46Atenza is our new.
58:49Director of the Division of
58:51Substance Abuse Research.
58:53Mark is.
58:56Will be assuming the role that
58:59Stephanie O'Malley has led for many
59:02years and we thank Stephanie for
59:04her contributions in that role.
59:08This is also a year where our
59:11department alumni in a variety of
59:14ways have have provided leadership.
59:16Ellie Mccance Katz, who was a fellow
59:19and faculty member in our department.
59:20As you probably know,
59:22was an assistant secretary for
59:24mental Health and Addiction,
59:26a substance abuse for HHS.
59:31When she stepped down mean a visa lingam
59:34who was a resident and fellow and
59:38faculty member in our department and is
59:41a captain in the Public health service,
59:44stepped in and served as the
59:47interim director of SAMHSA.
59:49And as many of you know,
59:52we're very thrilled that
59:54Miriam Delphine Rittman,
59:56also a faculty member in our
59:59department fellow and faculty member,
01:00:02has been proposed by President
01:00:05Biden to be the next head of Samsa
01:00:10and her hearings for this role will
01:00:13be coming up in the near future.
01:00:16So we're we're thrilled.
01:00:19That Miriam will, will we hope,
01:00:22leads SAMHSA into the future.
01:00:25It's also been a year when we've
01:00:27recruited extraordinary faculty.
01:00:28I'd like to highlight the
01:00:30recruitment of Kristen Brennan,
01:00:32who has come and set up her
01:00:34laboratory under very adverse
01:00:35conditions and hit the ground running,
01:00:38establishing of a number of
01:00:40collaborations here at Yale,
01:00:41Chris,
01:00:42and is very known well known to
01:00:44the neuro scientists in that
01:00:47apartment and in the field.
01:00:49Because of her discovery really
01:00:53creating the first cells derived.
01:00:56The nerve cells derived from.
01:01:00In pluripotent stem cells that
01:01:01can be obtained from the blood,
01:01:04she obtained those tissues
01:01:06from blood from people,
01:01:08schizophrenia and drive nerve cells
01:01:10from those cells which provide
01:01:13a new way to study the biology
01:01:15and the genetics of schizophrenia
01:01:17and other psychiatric disorders,
01:01:20and she's developing a program
01:01:22to not only study the biology,
01:01:25but also to screen novel therapeutics.
01:01:29For schizophrenia, using the nerve,
01:01:32collecting the stem cells,
01:01:35making nerve cells from them and
01:01:38then testing the efficacy of various
01:01:41kinds of treatments that can normalize
01:01:45the abnormalities in these cells.
01:01:48And Christians also able to collect.
01:01:53Stem cells from people without
01:01:55schizophrenia and selectively introduce
01:01:58into those cells the mutations associated
01:02:01with the risk for schizophrenia
01:02:03and and then look gene by gene.
01:02:06How those how those the impact of
01:02:08the genetic risk creates biology that
01:02:11might be treated by novel treatment.
01:02:13So this is a very exciting new part of
01:02:16our department o'll research portfolio.
01:02:18We're thrilled to have Kristen
01:02:21in our department as well.
01:02:23Also pleased to announce 2 new endowed
01:02:27lectures one by that are both came
01:02:30through the good auspices of of Byram.
01:02:33Karasu,
01:02:34who is an alumnus of our department,
01:02:37the long Standing chair of
01:02:40Psychiatry at Albert Einstein,
01:02:42where he was also distinguished Professor
01:02:45Emeritus now and Dorothy and Marty Silverman,
01:02:48Professor Emeritus.
01:02:49Is endowed two lectures.
01:02:52The first has already taken place where David
01:02:56Ross interviewed Irvin Yalom a wonderful,
01:02:59wonderful lecture and that is
01:03:04related to one lecture focused on
01:03:07psychosocial aspects of psychiatry
01:03:09psychotherapy in the humanities and
01:03:11a second lecture which will be on
01:03:15which is devoted to leadership and
01:03:18the speaker. Inaugural speaker
01:03:19for that lecture will be Mary
01:03:21Gentile who is a well known.
01:03:25Expert in leadership.
01:03:26She's on in the Business School
01:03:28at the University of Virginia,
01:03:30and she's going to be talking
01:03:32about how organizations can
01:03:33give voice to values and how
01:03:35leadership plays a role in that.
01:03:40I'm not sure.
01:03:42I know you know you're good.
01:03:44But I'm not sure you know, as a community,
01:03:47how truly exceptional you are.
01:03:49And what I'd like to do in the next.
01:03:52Bed is just review the incredible
01:03:57array of accomplishments.
01:03:59That are faculty trainees and staff.
01:04:03Have been engaged in or received
01:04:06over the years, and so this is just.
01:04:10From this year this academic year.
01:04:14Anne. I think you'll be as
01:04:19impressed as I am to appreciate.
01:04:22How everyone nearly everyone in
01:04:25our community has contributed.
01:04:31In in each in their own unique
01:04:33ways to making us a community of
01:04:37outstanding accomplishment and impact.
01:04:51Again, another group of accomplishments.
01:04:54I'd like to highlight Cindy's crew Cindy
01:04:57Cousteau's selection as an Elam fellow,
01:05:00this is a very high honor for for women,
01:05:06leaders and. Congratulations to her on that.
01:05:20Again, an incredible array of honors
01:05:24and awards and accomplishments among
01:05:27our faculty, all just from this year.
01:05:43Again, more accomplishments,
01:05:46more honors, more more,
01:05:50more accomplishments.
01:05:53This is really a truly we are truly.
01:05:58Blessed to have such wonderful colleagues.
01:06:01To have such outstanding.
01:06:05Trainees to have such exceptional mentors.
01:06:10Uhm? It is the IT is the.
01:06:15It is the one of the most impressive
01:06:20aspects of of what we do. So.
01:06:23This has been a terrible year.
01:06:29Despite all that we've been through.
01:06:32We remain a Community of excellence,
01:06:34innovation, and impact.
01:06:38And we become we as a community become better
01:06:41as everyone is well welcomed and respected.
01:06:45Everyone contributes. Everyone has access.
01:06:50Everyone is paid fairly.
01:06:52And whereas we hold ourselves to
01:06:55the highest possible standards.
01:06:58For. For professionalism.
01:07:02We we hope that we are.
01:07:06We know we are on a growing. Process.
01:07:09We have been through the beginnings
01:07:14of transformation o'll change.
01:07:17We hope to work on all aspects of our
01:07:20mission to make them more diverse,
01:07:22more inclusive.
01:07:25More welcoming more equitable.
01:07:29Uhm? Ann, I want to thank.
01:07:33Everyone on the call.
01:07:35For joining me in this important journey.
01:07:41So. That is. That is the.
01:07:52The presentation this year.
01:07:57I'm now just getting to the chat.
01:08:00I apologize for not being able
01:08:02to look look at it before but.
01:08:05But again, want to thank the folks who
01:08:08made those incredible videos that started
01:08:10us off today and reminded us of who we
01:08:14are and what we're doing. And again.
01:08:17I thank all of you for listening and
01:08:20for your contributions during this
01:08:23important and challenging year. So.
01:08:32I think that's it.
01:08:35Thank you all. Take care.
01:08:37Take care everyone.