Good. Thank you. Thank you so much for being here bright and early. We appreciate your attendance, and I'm so honored to be with the panel that we have, not only because of their intellectual firepower, but really what they represent in their own careers and their diverse interests, their diverse life journeys. And as you'll see during the course of the session, backgrounds that really span translational neuroscience, social science, clinical research, and community engagement, even in clinical and education realms. So really a very wide lens looking at advancing diversity, equity, and inclusion in psychiatry research. I think we're all aware that the pipeline into psychiatry research is ever endangered and is precious. The pipeline of investigators from historically underrepresented communities, minoritized communities is even more threatened and more precious. And much of what we talk about today will be about ways of enhancing the welcome to and the support for investigators of minoritized groups into psychiatry research. Equally important is the collaboration that we have with diverse communities in designing and carrying out research that's meaningful to those communities. So that will be another focus this morning when we talk about enhancing diversity in psychiatry research. We mean both the workforce in psychiatry research, but also those who collaborate with us from diverse communities. A number of us are on the APA Council on Research. My name is Jonathan Alpert. I'm member and chair of the APA Council on Research. And as I'll be introducing people, there are other members of the Council on Research here today, as well as colleagues who are not members currently on the Council. But one of the catalysts of today's session that we were asked to put together by Dr. Brandel as one of the presidential sessions was this work product of the Council on Research that was published in April in the American Journal of Psychiatry on structural racism in psychiatric research careers, eradicating barriers to a more diverse workforce. And I'd encourage those of you who have time to take a look at it. It's a very good resource and update really on the landscape that has to do with enhancing a more diverse workforce in psychiatry research. If we look at the challenge and the context that if we look at BIPOC and other historically underrepresented groups, they comprise at least a third of the United States population. But if we look at psychiatry residencies, probably about half are, half of that number, that percentage are represented in psychiatry residencies. If we look at psychiatry faculty within academic medical centers, it's half of that. And if we look at the number who are actually involved in psychiatry research, it would be much less than half of that. So the numbers dwindle progressively when you look at who makes it into psychiatry residencies, who makes it onto psychiatry academic faculties, and then who are those who are able to pursue research careers, not just for a few months or for a year, but for their careers. We know that minoritized investigators are less likely to receive grants from the NIH and other funding agencies, even when they've received other NIH funding earlier on. So if we're thinking about individuals who might have received diversity supplements or K awards, even if we look at those individuals, they are less likely than other individuals to receive NIH and other funding subsequently in their careers, even when controlling for publication record and training history. There are many factors that contribute to that, and some of our discussion today will be about those factors and how to address them. Certainly early in career, a lack of access to knowledge, a lack of experience at early stages of career, significant financial pressures, often lack of generational wealth, that if you think about somebody who elects to do a PGY-5 or 6 postdoctoral research fellowship and the salary that's associated with that, often the assumption is that it will be backstopped if they want to get an apartment or need childcare that it will be backstopped by family resources. And often early career investigators from underrepresented groups don't have generational wealth to rely on, and just the opposite, that often the flow of resources goes in the other direction, that there's a sense of commitment to helping other family members. I remember a mentee not many years ago who was very interested in psychiatry research, very interested in psychiatry as a field, wound up choosing neither research nor psychiatry, but going into clinical neurosurgery. And his explanation, not that he hated neurosurgery, and it wasn't that it was a terrible choice, obviously, there's a need for talented people of underrepresented groups in neurosurgery, but his explanation was that he felt that he was carrying his entire family on his back, and that the only way he could do that was to enter a field that would be more lucrative, and psychiatry was not that field, and particularly psychiatry research was certainly not that field. Also a misalignment of research interests with funding priorities, and I think we'll get to talk a little bit more about when we think about NIH or other funding priorities, and then the interests of investigators who often come from underrepresented groups, that there's a misalignment with funding priorities that's changing gradually, but probably not rapidly enough. Often insufficient institutional and mentoring support at local institutions, and significant social and institutional pressures that often we talk about the minority tax, that if somebody happens to be in a department where they're one of the few individuals from an historically underrepresented group, they're asked to do additional mentoring, to serve on DEI committees, to serve on other search committees and other committees, to be available to patients who want to see people who look like them, and so often they're spread very thin, and there's rarely additional compensation or time afforded for all of those activities. Equal aggressions, and a lack of a sense of belonging. Another mentee I remember who was an MD-PhD, recruited as an assistant professor to another institution on a 10-year track, he was invited by his chair to an institutional gala, dressed up very nicely, was really looking forward in his new institution to attending the gala, and somebody came to him with a crumpled napkin and empty glass, just assuming he was part of the catering staff, and it's the kind of everyday occurrences that Chet Pierce, who was a dear mentor to some of us in this room and thousands of others, referred to as microaggressions and the kinds of things that wear people down and make them feel like they just don't fit, just as this new assistant professor felt that he wasn't sure if he had a path forward after that night, that this might not be a place where he would be viewed as a colleague. And stereotype threat, that the internalization of a sense of maybe not being good enough, and that tends to be reinforced if there are lack of mentors from like backgrounds or a cohort of peers who might have similar backgrounds. So all of these, and we could make the list much longer than this, but all of these are contributing factors to the threatened pipeline of diverse investigators in psychiatry. And on the other side, when we look at who participates in research, and if you look at the demographic table in most psychiatric research, it doesn't reflect the face of the country or the world, and there are a variety of reasons why BIPOC and other minoritized groups are substantially underrepresented in research of biomarkers and new treatments and other psychiatry research. And there are consequences to that. It means that those communities have limited access to promising investigational treatments that might not be available for years. It limits the generalizability of results significantly, and it limits our knowledge about the true feasibility, acceptability, and effectiveness of our interventions among diverse groups and our ability to develop culturally attuned interventions. Basically, it weakens our science in psychiatry if we don't have the kind of diverse representation that looks like the communities that we serve. Many contributing factors here, too, as you know, traditionally well-earned mistrust of medical research and a concern about being exploited in the context of research. Some communities have significant mental health stigma, so it's a barrier to getting mental health care. It's also a barrier to participating in mental health research. Social determinants of health-related barriers, transportation, child care, the kinds of things that are barriers to getting health care are also the barriers to participating in clinical research. And then we've often failed to engage diverse community stakeholders, not simply when we're ready to recruit for our studies, which is easy to do and come out and say, could you put these flyers up in your church or in your community areas, but to engage diverse community stakeholders in the early development of research that might answer questions that are meaningful to community members who we would be inviting to participate. And then going back to the initial challenge, the lack of investigators from diverse backgrounds is a further reason why people might feel less invited and welcomed into research. So the objectives of today's session is to characterize, and we've been talking a little bit about this, the underrepresentation of racial and ethnic minoritized investigators, as well as other key stakeholders and participants in psychiatry research and its impact on our field and research in our field, to recognize the structural factors that have contributed to the underrepresentation of racial and ethnic minoritized investigators, key stakeholders and participants, and to identify current and potential future approaches to advancing diversity, equity, and inclusion. And we'll be talking a little bit about our own experiences in our own institutions and others we know of, and we'd love to brainstorm with you about ideas that you might have. So I'm so pleased to be able to introduce this really stellar, stellar panel. Carolyn Rodriguez, who's co-chair with me, is also a member of the APA Council on Research. She's Professor of Psychiatry and Behavioral Sciences at Stanford and Associate Dean for Academic Affairs. Christina Mangurian, who's also a member of the Council on Research, Professor of Psychiatry, Vice Chair for Diversity and Health Equity in the Department of Psychiatry at UCSF, where she also is Director of the Program for Research on Mental Health Integration among Underserved and Minority Populations. Thank you for welcoming us to your city. Helena Hansen, Professor of Psychiatry, is Interim Chair of the Department of Psychiatry and Biobehavioral Sciences, as well as Interim Director of the Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine, where she's also co-chair of the Research Theme and Translational Social Science and Health Equity, topics she'll be talking more about today, and Associate Director of the Center for Social Medicine. Thank you so much for being here. And then two panelists that we invited, and I'll explain why they were invited at the 11th hour, and both were incredibly generous to join us. Justin Chen, who is Vice Chair for Ambulatory Services, as well as Vice Chair for Health Justice at Weill Cornell Medicine and Psychiatry, and also for much of his career was at Mass General, where he's Executive Director of the MGH Center for Cross-Cultural Student Emotional Wellness. And Olu Ajalur, who is Associate Head for Faculty Development, Director of the Mood and Anxiety Disorders Program, Director of the Clinical Research Corps, Center for Clinical and Translational Science, Director of the Adult Neuroscience Residency Research Track, and Co-Director of the MSTP Program, as well as the University of Illinois Center for Resilience Professor of Psychiatry at the Department of Psychiatry and University of Illinois Chicago. So as you see, quite a breadth of experience that our panelists bring today. And the reason for the 11th hour invitations to our dear colleagues Olu and Justin was related to Ayanna Jordan, who was co-author on, second author on the paper that I mentioned in AJP from the Council on Research, and was here at the meeting and very unfortunately had a family emergency that called her back home, but we're very grateful for her brainstorming with us about this session, and I know that she's thinking very much about all of us this morning, just as we're thinking very much about her. So what is our journey this morning? Part of it is done, the introduction and welcome, and then Dr. Mangurian will be talking about a special program at UCSF that she developed during her tenure there, and we'll go right now, I'll describe it. And then Helena Hansen will be talking about one of the areas that has been relatively under-focused on in terms of research priorities, social science and psychiatry, and then Carolyn Rodriguez, co-chair, will moderate a discussion among all of us, and hopefully those of you who are here this morning will actively participate with us. So this is the journey that we'll be on together this morning, and now I'm very pleased that Dr. Mangurian, who might be better at finding her slides, and I will be... Great, thank you very much. Thank you. Thank you, everyone. Hold on, bear with me for just a second. Let me get this up. And let's see if I can do this. All right. Yes, and I'll have a small update that since I was the Vice Chair for Diversity and Health Equity at UCSF Department of Psychiatry, I'm now the Vice Dean for Faculty and Academic Affairs at UCSF, so now I have a broader lens. And so what I'm delighted to talk to you all about is actually some interrupting actually at the structural level to help improve the lives and improve the capacity for minoritized or other historically excluded faculty to kind of move forward in their careers. And so what I'm going to talk about is give you a little bit of the evidence, because I think that John already did a great job underscoring the why we need to pay attention to this. I'll describe some of the work that I did while I was Vice Chair in the Department of Psychiatry, and then finally describe some work that I'm doing system-wide across the School of Medicine. All right, and this is just more of a disclaimer that the work that I'm going to be talking about today is not my work alone. I've been helped by very many sponsors over the course of my career, many mentors who've really helped me do this, and many mentees and colleagues who've worked alongside with me. So this is not just my work. And what I'm hoping, if you see the little ripples in the bottom, I don't know what stage each of you are in in your careers, but I know that you are likely in very many different places and different positions, and I hope that you take some pearls of what we talk about today and take the ones that fit for you. And I'm hoping that some of what I might bring up or some of what we'll discuss here might inspire you to go and make ripples at your home institution to make things even better. And this is just, I like creating some rocks for policymakers to throw. You'll see them in a little bit. That's what I like doing. I have some disclosures in funding. The only funding that's relevant today is from Genentech, which helped provide some funding for a mid-career program that I built at UCSF. Otherwise, these are funding outside of the work that I'm discussing today. And then I'm going to very briefly shift to framing some of the problem regarding diversity of research faculty and academic medicine as a whole. It also applies to psychiatry. So this is just a little kind of tongue-in-cheek article that a friend of mine, Eleni Linos, wrote a few years ago, where she looked at the top 50 NIH-funded institutions and looked at the chairs. She published this in BMJ's Christmas issue, which is kind of a funny issue, right? And so she looked across in chairs and she realized somebody like me, Christine, who's a woman, might need to grow a mustache because there was a higher prevalence of mustaches among chairs than women. Okay? So that was interesting, right? And it's kind of just highlighting, what is this? It's 13%. Then I worked with an incredible scholar, Reshma Jagsi, who's currently chair at Emory in radiation oncology. And we projected out with Dr. Wheeler, kind of, you know, a lot of people are like, oh, the pipeline. Well, the pipeline for women has been pretty good for a while going into medical school. Well, if we keep doing what we're doing, this slide that you can see here, I'll try to use this fancy thing. You know, this is time, this is years, and this is the proportion of faculty up to 50% who are chairs or deans. The orange and the blue are chairs. Chairs is blue, orange is deans. If we do what we're doing, we'll achieve gender equity and leadership in 50 years. That's thinking. Okay. So we can't do that. That's not okay with me. It's not okay for me to think about my daughter, not that she wants to go into medicine, but if she did, I want her to have as much a chance of getting there. And we know it has nothing to do with people's talent. It has to do with the structural things getting in the way. I want to make sure everybody's aware of several reports by the National Academies of Science, Engineering, and Medicine, as well as the AAMC that has been publishing for years about this, but even more recently, a lot has come out about practices for addressing underrepresentation of women in medicine, of advancing anti-racism diversity and equity in medicine. And then actually the AAMC has a series of really interesting articles about salary equity. And so I think these are worth you perusing. And then I'll highlight some work that I did with Carolyn Rodriguez, which I'll be talking about today, and Regma. These are two women that I talked about before. We had an opportunity to make a commentary in an article that was looking at the dearth of women, basically Latina physicians. And the percent was like 2.4 of all physicians are Latina women, which is different from what it is in the population. And Carolyn and I, you can't tell from my name, but I'm Latina myself as well. And we read this and kind of commented on things. And we kind of aligned with what the National Academies have recommended and kind of got at the how, what are you going to do? And so what we recommended were three things. Increase leadership opportunities for women, and I think women of color specifically, targeting mentorship and sponsorship. Now, not everybody knows the difference between mentorship and sponsorship. Most of you know what mentorship is, right? Does anybody know what sponsorship is? Can I see a couple of, like, we can't, right? So it's the idea of not just, you know, you working one-on-one with somebody, but having somebody in a position of power who talks about you, who provides you with opportunities to get resources or get in the room where it happens, right? And that sponsorship is critical. And so targeting sponsorship, or as the business world calls it, because we're behind in medicine, the business world calls it access to opportunity and access to glamour work, right? Women do a lot of the housework. So do other historically marginalized individuals, right? You talked about the minority tax, all of the committee work, all of these different diversity activities that typically are unpaid. That's what ends up falling on a lot of women and other minoritized individuals. And instead, let's give them more of the glamor work. Okay, and then data, data-driven accountability. So this is where I wanna focus. How do I actually do this? And this is where I'm gonna show a bunch of different ideas for you all to pick up the ones that might fit right for you. And so I gave a talk on this and I had six years in the role as the inaugural Vice Chair for Diversity and Health Equity. And some of the things I did is I focused on data, okay? So I was like, okay, we had 30% of women who were full professors. And so then I said that out of, you know, 30% of all full professors were women. And I said, this should be different because our Department of Psychiatry actually has a lot of women. And so I went and targeted those associate professor women, regardless of series in the department, and made sure that I talked to them and their chiefs about getting them to go up for promotion to make that equal. So I got it increased through a joint effort of a lot of people from 31% to 51%. And this, and so that's notable, right? So you just were looking at the data and then making an intervention based on the data. Now, this was not a huge lift. This was sending an email, a targeted email, to that faculty who could go up and to their chief, but sending that in the right time and encouraging them helped change our numbers. So did the overall women faculty at UCSF, but that's higher for not just because of me. This was an effort to really increase women faculty in the institution. I also started, actually, before I became Vice Chair, I started something called Warm Hearts, which was a group of women at my county hospital. So I started this when I was an assistant professor. I'd gone to the early career leadership symposium for women in the AAMC, and I found that I learned a lot from my peers. So I set up this group of women from cross departments to just meet and talk. We'd often have a leader come in. I had asked for food from our dean. That's all I wanted. This was pre-COVID, clearly. But I was like, if we have food, these busy people will make their way here. They're in the middle of the wards and doing other stuff. So I just had lunch once a month. And I'm telling you, this group has been really, persists to this day. I no longer lead it. It's taken a life of its own. It actually has representation and rotating representation of who's chair, so it's in different departments. And it actually has been able to have a voice, okay? An advocacy voice. So we were able to provide the provost with information when they did some event on women that said, well, from us as a whole and as a group, you're louder than an individual. So as a group, we all say, these are things that we want. And so that's an idea that's a quote-unquote easy thing that you could get started at your organization, these groups. Another thing that we did during COVID under the leadership of Alyssa Appel and others is started these mom pods. So we all know the data around the COVID pandemic and the impact that COVID has had upon the careers of women and other historically excluded individuals during COVID. And we started these groups of women. It was informal, but they kind of had a group where they were able to talk about how hard it is to do their science, how hard it is to do their other scholarly activities while having children at home. I did some, and I did other supports. Again, this is with real help of a wide variety of people. I also had, during my role, started a kind of subgroups during my role as vice chair. I had a group on education. I had a group on communication. I had a group on advancement and promotion. And then I had a group on research, right? And so I made it very clear, let's have actionable goals over the course of the year. I'm not able to pay your group. So you're gonna meet just once every other month. And then the chair's gonna meet with me every other month individually. And we're gonna accomplish some things stepwise because I didn't want to add to their minority tax. So some of the things that they built is they built a URM research mentorship award. So they now give out an award once a year to somebody in our department. Again, that's a way to increase visibility of a historically excluded faculty. We started a gender equity work in progress, and this is actually more gender and racial ethnicity equity within academic medicine. So it's a work group really looking at policies and procedures and trying to uncover things that could be improved in academic medicine. And we've had publications from this. I mentioned the mid-career program. So that was a program that I built with Genentech funding. And it was to support mid-career associate or early full professors to get mentorship as a group with high level senior leaders to help reduce isolation and provide stipend support. So it's kind of like an internal K24. So we give them $75,000 a year, and these are given to people who are exceptional mentors, right? So we're actually paying them for some of their mentorship and giving them discretionary funds to use however they'd like because having those flexible funds is extremely helpful. And this has been, they really love it, and it's been really helpful. This was our first meeting because I got the Genentech funding in, I think we put out the call for applications in February, 2020. So it's a two-year program. So this is our last year together where we were able to meet in person, finally, given everything during COVID. But I was really honored to be able to work on that with Kirsten Bivens-Domingo, who at that point was the Vice Dean for Health Equity at UCSF. She's now the Editor-in-Chief at JAMA, and she's a really extraordinary person. But this program has been, really garnered a lot of attention at the university. And then I worked with Christine Yaffe, who's another really incredible scientist on building out the Doris Duke Fund to Retain Clinical Scientists. So we actually give awards, give dollars to junior faculty who are doing research, who have informal caring responsibilities. And so what I mean by this is not just caring for an infant, but maybe their partner has cancer, maybe their parent has Alzheimer's, maybe their child is very ill. So giving them those opportunities to keep their research moving while they're attending to these issues. I don't think that, John, you got into this data, but there's a lot of data that women and other historically excluded faculty tend to do a lot of informal caregiving, and that bears out in my work, my research. And then we definitely focused on sponsorship. I would sponsor people through our committee to focus on Chancellor's Awards at the institutions, Watson Fellowships, where the money is given out by the School of Medicine, and we sponsored students to go to SNMA. And this is some of the stones. This might hopefully inspire some people. I was interested in family leave, and I was interested in paid family leave. And so, and I was gonna look at it within the Department of Psychiatry. So I was gonna go collect some data. And I knew that doing diversity work, unless you publish, it can be discounted, its value. So I was like, okay, I'm gonna publish on this, and maybe I'll publish it in AJP. So I start collecting the data, and then I run into the Vice Provost for Academic Affairs, and he says, Christina, could you actually do it on all schools of medicine, like the top 10 schools of medicine, our peers? Could you do that? That would actually give me a lot of information. So I did that, and all I did was write an article, very easy, you can count in your hands, you know, how many, it was not any fancy statistical analysis, it was how many of these places had family leave policies, and how long were the family leave policies? And the short answer is, you all know, it was much less than what the pediatricians recommend, of 12 weeks, it was much less than that, it was 8.6. And as you went down in privilege, because I did a series of articles, faculty, residents, staff, each privileged group had less and less number of weeks. And so I'm very proud that UCSF had helped to expand our paid family leave to 12 weeks, but I'm even more proud that the work was used by an advocate in the American Board of Medical Specialties, as well as ACGME, to expand the family leave given to residents up to, and I've still been mad that it's not 12 weeks, but it's six, which seemed like good, but I still want it to be higher. And really, we should be doing this for our staff as well, it's kind of disgusting that we don't, as psychiatry, we actually should be leading this, given the mental health benefits to the mother and child. So I publish a lot. And then this is one of my favorite picture with a couple people who you'll find familiar here, but when I had the pleasure to be chair with Helena on the Council of Minority Mental Health and Health Disparities, I brought together a lot of the leaders doing diversity work across the country, and we published our work, in addition, published our work as being diversity leaders, and what we thought was a real double bind in this role and real challenges, and so we published recommendations that if any of you hold those roles, to be able to move forward and help your institution resource these roles sufficiently so these faculty can do their best to help. And then, do I have time to go through the ARCHES program? I have like 10 more slides, is it okay? So this is the ARCHES program that I built. I don't know how many people knew about the first grant. Has anybody heard of the first grant? So not many, some people have. So this was an NIH initiative. It was the brainchild of Hannah Valentine. It was to bring in cohorts. So they were like, let's recruit cohorts of like 10 people into institutions, and of historically excluded individuals. So we put forward an application with Kirsten and our provost at that time, Dan Lowenstein. UCSF has a long record of doing a lot of really impressive DEI work, and yet we still have evidence that a lot of our faculty don't feel like they belong. And so we tried to have some write this grant. I had the honor of being the director of the program, the core for that program, and so I built out a program to support this. We did not get this grant, but we did get donor fundings, and I was allowed to kind of launch last year the first light program is what we initially called it. Later, we ended up calling it Arches, and that was based on a competition actually within the group community where we could say, come up with a name. We wanted our community to come up with a name. We didn't want to come up with a name. So we got a bunch of ideas of names, and then people voted on it and chose. When you're coming up with an initiative like this, you need to build a strong team. So I was able to build a strong team inside and outside of medicine, across different schools, and had diversity in types of science that people were doing so that I made sure that all different kind of types of science are also recognized. I built what's called a Changemaker Circle. This used to be called the Old Girls Club. They did not like that. They didn't like the New Girls Club either, and so they're the quarterly Changemaker Circle, and what this is is these are senior women of color at the institution who've been in major leadership roles and are able to advise the work that I'm doing here and we're doing together, and I'm just blessed to have this group of just incredible people guiding me, and I specifically was looking for women of color because it was at the intersection of folks who experienced both racism and misogyny. I have a great institutional advisory board, so also know that I have to have the buy-in of the institution, so have that, and was able to have really fantastic ad hoc advisors as well, including Kamara Jones, Ruth Shim, and Monica McElmore who've really helped shape this work. Now, I mentioned the first grant. Now, that was focused on 12 people. We were gonna dump a ton of resources on 12 people, and that was good, and that's what some institutions have done. NYU, Sinai are doing really interesting work bringing folks in and giving them money, but I was worried about those who are already there. What about those of us who are already at the institution, and what about them, and so I took it more as like we should be investing and looking at everybody, so we're actually, our target is URM research faculty across all schools and build activities in response to what they say, so we've done a lot of listening tours and information gathering for them, and so these are the different program components. We have early career quarterly seminar series, so we talked about mentoring and mentoring up and down, understanding advancement and optimizing your CV. These are interactive sessions, and then, of course, I find out, and some of you have seen this, but I find out that some of them didn't even know they had a financial analyst assigned to them, so they didn't know what money, you're like, I was just, I asked that question because I could tell from a question in the group that they didn't know. I said, can you raise your hand if you know that you have a financial analyst and very few did, and I was like, this is not okay. We're gonna have a whole thing on finance, and so we had one on finance. We also have some online resources for the URM faculty to get specific funding that might be available to them at the university. This is the mid-career cohort that I told you about. This year, we have this incredible group of faculty, and actually, the Biohub helped support one of these investigators, and this is just a quote from one of the scholars and just how much they really enjoy it, so I'm trying to think about ways of scaling this. I can't give $75,000 to everybody, but I can figure out ways in building a community to support these mid-career folks, and this is who Ryan and Steve are working on. This is the community building, so we have a listserv, we have a website, we have had socials, we have a landscape of all the community affinity groups are at the organization, and we are starting, we have these peer groups that have started. We do explicit sponsorship through our newsletter where we highlight somebody's work in there, and so people see them, and I pay a lot of attention to who am I highlighting, and so I measure who am I highlighting. Am I highlighting always people from the School of Medicine, because as many of you know, UCSF is a health sciences university, and medicine is like this elephant, and so I make sure, no, we need to make sure we're talking about dentistry and pharmacy and School of Nursing, and we need to make sure we're not just highlighting women, but also men, and not just, you know, different groups, so everybody feels included, including different types of science, and we started Arches Coins, which is basically money for people to go out and socialize with no strings attached. It needs to follow university rules, but if they want to go out to dinner together, me, Helena, and Carolyn want to go out to dinner together, we can go out to dinner together. All we have to do is afterwards take a little selfie and send it in, and that's it. It's low, low cost, and then I'm focusing, I really want to focus on changing the institution itself, and so part of the grant that I had was this change maker component, where people could actually go in and transform the organization, and so I've been working on sponsoring and aligning with existing activities, like anti-racism grants that are given out by the university, and going out, reaching out to those investigators, and helping to amplify their work, and sponsor them by connecting them with other individuals, and these are two of the faculty members who are working on evaluation, which is critical. The mid-career program has already brought in, you know, from the initial investment that we got, 11 million dollars from just the mentors, not even the mentees, and so we're trying to compare that, and there's also been really good evidence of sponsorship by them. So then I'm gonna just do a few slides for you to take home. So my recommendation for everybody here, there's a lot of emphasis on recruitment. I think that should continue, and we don't wanna bring people into the institution that's not going to support them. Okay, people, I'm sure, at their home institutions have seen this happen for their trainees. They try to diversify the trainee population, and then the trainees have difficulty at the institution. So I think there should be flipped and focused on retention. I also think that, and so this is with a focus on retention, improving mentorship and sponsorship at the institution. I think centering efforts around women of color helps lift everybody. So I think that is something of interest. I think offering research support for these caregivers, encouraging peer mentorship is critical. I think use data. Gather as much data as you can and get really granular. So use your scientific skills to look in. Look not just at how many professors are there, how many tenure track professors are there, and what is the difference between URM and non-URM investigators? How many different series? Get granular into this. Start looking at who are the leaders? Do we really, if we're really trying to achieve our goals, do we have people at the top who reflect our population? And we should, including endowed chairs. I've done a series of studies looking at endowed professorships, and it's just the same story every single time, every single specialty. It is not equivalent in terms of gender, and it's hard for us to get the race ethnicity data, but I'm pretty confident that the answer would be similar. And then I would focus on policies. Accountability metrics with the chairs. So at UCSF, the dean, when he meets with the chairs, has to actually, the chairs have to come with, this is what I've done for you lately, and it's got very specific things around what have they done for leadership, what have they done from here, et cetera, to make sure that they're adhering to best practices. Salary transparency. I think paid family leave. I'm starting to bark down the path of elder care. There's a lot of people who are providing a lot of elder care, a lot of our existing faculty who are, and we don't have adequate leave policies for those individuals. And then targeted recruitment for leadership roles. So what I would say is that a lot of the time, many of the people that I've recruited to positions, and most of you know this, but women and other minoritized individuals won't feel like they have the skills to join, to be at that leadership role, whereas there's difference with more privileged groups, well, they'll need, I have 20% of the skills, I think I can do it. A woman will be like, I need 80%, right? So you actually have to go in and target those individuals who you think actually could apply and say to them, I think you'd be great, you should apply. And that's actually an evidence-based strategy to try to diversify your workforce. So you do actually have to do something a little different to counter some of the barriers that people face and some of the stereotype threat. So anyway, that's it, we'll move on to the next one, but thank you. Thank you so much, Christina, that was really awesome. And it's given us a lot of momentum and a lot of food for thought. My recommendation would be for us to proceed with Dr. Hansen's talk. And I know we have a lot of ideas and thoughts that we want to discuss, and we can weave the two areas together during our discussion. Wow, what a hard act to follow. So it's just such an honor and pleasure to be here with both of you, my heroes, really. I don't know how many of you know this because he's so modest as a person, but Jonathan Alpert has really just renovated the social medicine, social psychiatry tradition at Einstein, and I've just been getting nothing but enthusiastic feedback from psychiatrists and trainees in psychiatry of all colors and stripes. So it's just an honor to be here and to benefit from organizing this panel. And Christina Mangurian, I think, her work speaks for itself, what can I say? It's just amazing. Actually, Christina has already delved into, she's really demonstrated a theme of my talk, which is, let me pull up the slides. Really, I'm gonna be delving into the type of research that we do. And I think Christina has illustrated, not only has she vigorously pursued and modeled for the rest of us, how do you really intervene when it comes to representation and research, but she's researched it. She's actually documented it, made it a part of the academic process and the fiber of what we do in research. So she really illustrates that. Let me see if I can, okay. And here, let's see. Oh, it's in the view, I don't know. Yeah, actually, I could use your help with the view. Okay, I'm just updating them. Okay, thank you. And also, I want to say Christine and I are psychically connected because I noticed that we chose the same PowerPoint backdrop for our slides. Okay. So I want to make the pitch that to make real headway on justice, equity, diversity, and inclusion in psychiatry, we do need to look at the type of research that we do. And we are in an era of biopsychiatry and a lot of excitement and focus and investment in molecular technologies to improve mental health. At the same time, we've noticed that we need to attend to social, what we're calling social determinants of health. And they're structural drivers. You know, they're kind of institutional policy drivers. So one thing, if speaking of who we're bringing into psychiatric research, my experience is that social determinants and their structural drivers are of high interest to future and current psychiatrists from marginalized groups because they have lived experience of those structural and social drivers of health inequalities. And they're especially interested in social scholarship underlying the social drivers, what explains the mechanisms. So if you want to get into depth, more rigorous analysis of why it is that we see the patterns that we see, then it's important to turn to a wellspring of theories of methodology of, you know, a very long tradition of focusing on those social phenomena. And it's and what comes out of that is an explanation for things that could otherwise be counterintuitive. So I'll just give you a couple of examples. And I have no disclosures, by the way. I snuck this slide in last minute, realizing that I did not have the obligatory disclosure slide. But this is a slide that I often use when I'm talking with students and trainees. This is the study that came out of then Institute of Medicine, now National Academy of Medicine with the soundbite that you may have heard that the U.S. spends the most per capita on health care of any nation in the world and has the worst health outcomes of any industrialized nation. What explains that, right? That seems a little unusual. And I'll give you a little hint. In the lower left-hand side, they focus on structures. How is, for example, the U.S. structured? We don't build, we don't bake public health into our transportation systems, our food systems, our gun laws, any of that, right? And here's another interesting counterintuitive finding building on the one I just mentioned. This is by two social epidemiologists working out of the U.K., Richard Wilkinson and Kate Pickett. And this is mental health, but they found the same linear relationship between degree of inequality in the society and health outcomes when it came to physical health outcomes. So the more unequal a given nation is, really meaning unequally distributed income is and other resources, the worse the health outcomes. And the really interesting finding here was that the wealthiest people in the most unequal nations, such as the U.S., being the upper right-hand corner extreme, lived shorter lives than the wealthiest people in the more equal countries. So how do you explain that, that inequalities are bad even for the health of the rich? That's an interesting one, right? So these are counterintuitive findings, and what they cry out for is mechanisms. Like we need to understand the social mechanisms explaining those patterns. This slide has to do with social causes. We need to foreground social causes to correct health inequalities. So in this era of a lot of investment in molecular technologies, we must collectively really push back that we also need investment in the social causes for those inequalities. They're equally, if not more important when it comes to spotlighting inequalities. And here are just a couple of examples. Some of you may be involved in the ABCD study that showed that actually investing in anti-poverty programs and income support led to better brain development and outcomes. We intuitively know that, but it just shows where we should be putting our money, right? And then housing as healthcare. That's a concept that many of us have been lobbying for. We can focus all we want on the tertiary care that people who are houseless require at really high levels, and costing the healthcare system a lot of money. What about providing housing? Well, it turns out that's a really great prescription for better outcomes. And we're in a society that is very, our healthcare system is the most profit-oriented of any health system in the industrialized nation. So one thing that we're inundated with is promises of better health, including more health equity through new technologies. New, by the way, patented commercially distributed technologies. So if you start to delve into the social theories that you might need to really examine that claim, you realize per my mentors, Bruce Link and Joe Phelan, sociologists that develop theory of fundamental causes of disease, part of their theory is that despite the claims that we hear, if in a society like ours with very extreme social inequalities, you introduce new technologies for health without addressing those inequalities, you're actually going to widen the gap in health outcomes rather than narrow them. And in my own world of addiction treatment research, you know, recent events bear us out on that. So this is a slide illustrating inequalities in treatment with buprenorphine. So buprenorphine now being gold standard of treatment for opioid use disorder. And 20 years after its FDA approval for office-based maintenance for opioid use disorder, we find that white Americans are three to four times as likely, those with opioid use disorder are three to four times as likely as black Americans to get buprenorphine as treatment for that opioid use disorder. And that might have something to do, it's just one little hint about why we're seeing now 20 plus years into the overdose crisis, not only increasing overdose rates among everyone because we haven't addressed the structural systemic drivers of overdose, we focused on technologies like buprenorphine, but those technologies that are available have focused on middle-class white Americans and we're now seeing that black and Native Americans are the ones dying off at the highest rates of opioid overdose. So I'm just using a couple of examples from my own scholarship. This is a book that I had the great privilege of co-editing with Jonathan Metzl and we got a lot of contributors, many of them from UCSF, but from different academic medical centers across the country to give us their examples of how they're intervening on structural drivers of health, in particular training medical students, residents, and others to do that, to intervene on structural drivers of health. What we're trying to do is answer the question of what do clinicians, clinical practitioners, have to do with social determinants and structural drivers? It can often seem overwhelming, the way that we now, it's a good thing we teach about social determinants, when I was coming along that wasn't even a term in academic medicine, we teach about it, but what we do is we show them these unbelievable inequalities and then leave it up to their imagination, what do you do about it? Well since we're trained to treat individual patients and not think in terms of systems and structures, we're left without any tools, and UCSF researchers actually have shown through studies on this, that that leaves trainees paralyzed. They then feel, oh it's so overwhelming, it's like boiling the ocean, there's nothing I can do about it, and it actually is counterproductive, so we have to give them actual concrete practical things that they can do, and I won't get into too much depth about that because that would take up our whole time together. So now I want to pivot to, apologies if this is coming across as an anthropology professor's lecture, I'm putting on my anthropology professor hat, but what I thought I'd do as an exercise is, because I want to really kind of be as concrete as I can be about how the enormous promise of social science for academic medicine and psychiatric research, so what I want to start by reviewing some terms that probably will sound familiar and give you a little bit of background on where those terms came from, just to kind of excite your imagination about how terms that come out of the social sciences can greatly enhance what we do and give us the tools that we need to pursue inequalities. So this one I think is a more familiar one, structural violence, that's a term that really got popularized in the late 1990s to early 2000s. On the left you see the person who actually coined the term, Johan Galtung, who was a Norwegian sociologist. What he was trying to do is explain how casualties during peacetime, he had been studying death under war conditions, right, that makes intuitive sense, people die in a war, but then he was trying to explain the fact that casualties, particularly among those in on the lower end of the hierarchy across societies, can be equally high in peacetime. Like where does that come from? So he eventually outlined how institutional and policy forces blocking marginalized people from meeting their basic needs caused death, and he labeled this a form of violence. And so this concept really took hold, that we're actually doing violence to people who are suffering from structural oppressions. And on the right you see Paul Farmer, who took this term up and really popularized it in medicine. So that's just one example. Another example, most of, raise your hand if you've heard of participatory action research. Okay, you've probably heard of community-based participatory research, which is very, it's probably the same thing, it's similar. Although participatory action research really, it's a term that came directly out of the work of Paulo Freire, who's featured here. He is a Brazilian educational scholar and philosopher. He authored a very famous canonical book called The Pedagogy of the Oppressed, and he developed an approach to liberation of the lower classes in Brazil, internationally, but he was focused in Brazil on people who lived in the favelas, in a very, very unequal, stratified society, and focused on how education can address the root causes. So participatory action research came out of his philosophy of education, that people who are oppressed, number one, have lived experience that is a form of knowledge. So they should be elevated as having their own intuitive form of knowledge, and they should draw on that knowledge towards self-determination. So it was a theory of liberation, really. But the nuance here is that he also emphasized that people who are oppressed in very hierarchical societies are taught that they are to blame for their own poverty, in many cases, and in psychiatry that takes the form of, for example, self-stigma. You know, people who are blaming themselves for weak character, lack of self-control, and the addiction field that is very pervasive. But what he was saying is that it's actually through this form of liberatory education that you teach people about, or they can educate themselves about, the structural underlying causes of poverty, and therefore get out of that self-stigma, because that is one of the major forms of oppression, is to convince people that they're to blame. And this is a nuance that I think might sometimes get lost in community participatory research, because what he was highlighting is that a part of this process is a certain kind of awareness of the social structure and a transformed self-awareness. And then, okay, you've probably heard of Kimberly Crenshaw's intersectionality, which was referenced by Christina, right? You're talking about the intersections, you're talking about women of color as lifting all boats. Why is that? So legal scholar Kimberly Crenshaw, in the 90s, was active on a number of court cases where she had to argue that, for example, in the case of a black woman that suffered workplace discrimination, that it was really an intersection of her racial identity and her gender identity that led to where she was, because the opposing party in that court case argued that in a workplace, it was an auto manufacturer, that actually, you know, there were just as many black people working on the factory floor as white people, and it turns out these were black men, that there were just as many women working in the front office, you know, in the administration as men, but these were white women. And so Kimberly had to argue for the intersection of racial identity and gender, and then she did other cases having to do, for example, with Latina women in California who couldn't get intimate partner violence services because they may be undocumented, they were Spanish-speaking, and so these intimate partner violence assistance organizations actually would not take them, because they said, we don't have the language facility, we can't help you with your legal problems of immigration status. So, you know, she took on a number of cases that really illustrated the intersection of these different identities and how you have to address all of them together to get the results that you're looking for, multiple sources of marginalization. Standpoint theory, this one might be a little bit outside of active awareness, but it's implicit in a lot of our conversation, and especially in what Christine was talking about, too, that people from marginalized groups actually end up achieving different things and bringing a different kind of knowledge to bear in academia. We do draw on our lived experience to ask different questions, and so what Sandra Harding, who's the philosopher in this image, argued was that we actually get stronger objectivity when we have a diverse research workforce, because the way that we are strongest in our knowledge base is to have critical thinking and inquiry, where we're questioning each other and bringing unanticipated questions to bear on the received wisdom, so we get stronger knowledge from that. She was actually also, I don't know if she was conscious about this, but she was implicitly tapping W.E.B. Du Bois' insights about the double consciousness of black Americans that he wrote about a century before. Sociologist W.E.B. Du Bois talked about how the lived experience of being a black person in the United States gave people implicitly a knowledge of the structures that they had to navigate, so they had to be knowledgeable in a conscious way about social structures that white Americans simply took for granted. And then I'm going to end this series of things with the concept of social capital. So I don't know how many of you have heard of Pierre Bourdieu, who's in this picture. There are a couple different versions of social capital. So Robert Putnam is a U.S. sociologist, so Pierre Bourdieu is a sociologist who was in France for his entire career. There's Robert Putnam, who's an American sociologist, who also used the term social capital. But I turned to Pierre Bourdieu because I think his was a little more fleshed out in terms of his theory of inequalities. And what he wrote about and studied was how was it that our hierarchical social structures reproduced generation after generation, especially in the U.S.? Many of you may know the statistic that actually there's less social mobility in the U.S. than in Western Europe. We think of the U.S., you know, it's pull yourself up by your bootstraps kind of place where anyone, American dream, any enterprising individual can make it, right, regardless of their roots. That's kind of the, that is the narrative we give ourselves, correct? And it turns out that it's actually the exact opposite. That Western European nations that have much more robust social safety net, and for example free education, universalized health care, things like that, have more social mobility. It's easier to move up in terms of social class from generation to generation. So social capital derives from his more comprehensive theory of symbolic capital to explain that there are forms of capital that are passed down in families that aren't only financial capital. In some ways, so social capital is your social network. Who do you know? Cultural capital is the knowledge base that you have, you know, what level of education, for example. There are other forms of capital, but these help to reproduce the social hierarchy from generation to generation. And so I want to show this image just to show a little bit about how the theories of social capital bear on our work in psychiatry. In the upper left-hand corner, this is an article that I cite a lot with my addiction psychiatry colleagues. This sociological study showing that people who live in areas of the U.S. that have been de-industrialized, lots of unemployment, Rust Belt America, they have high measures of social isolation, right? They don't have thick social networks. And the more isolated they are, the higher the overdose rates in those communities. And then in the lower right-hand corner, recovery capital is a term that's starting to catch on in psychiatry. That for people to be successful in their recovery from serious psychiatric conditions or addictions, they need to have a robust support system in community. Now I'm going to pivot to some concepts that I think are going to be ascendant moving forward. Okay, so these are my top contenders for important social concepts. This image is Cedric Robinson, who most people have not heard of in psychiatry. He's beginning to be more known in social sciences, but he was a very modest, quiet man who wrote an incredible tome when he was at UC Santa Barbara, in which he coined the term racial capitalism. He is going back into colonial history, several centuries into colonial history, and explaining how US capitalism in particular was founded on forced labor, slave labor, among indigenous and then African peoples forcibly imported here, then indigenous servants, but also expropriated land, and explaining how capital is extracted from that. So the racial hierarchy in our society is the foundation for the extraction of capital that we see now. What he didn't do quite as much of, because he was writing about this in the 70s and 80s, was to look ahead to, for example, biotechnologies. So if you take all the healthcare industries together, pharma, biotech, health insurance, healthcare itself, we're talking about the single largest sector of our economy, and it's founded on a racial logic. And it's founded on a racial logic not only involving extraction of labor, poorly paid labor, but also on consumer markets. So who is it that, for example, pharmaceutical companies look to first if they want to sell a lot of product at a high price, they're going to look to well-insured white Americans. And so, you know, a lot of the products that are coming down the pike are first marketed towards them. And then there's a whole logic, and I won't get into detail, but this is the subject of my current scholarship, how later in the patent cycle when something is about to go off patent, other markets like publicly insured patients are going to be targeted. But there's a whole racial capitalist logic to our healthcare system, because our healthcare system, just like anything else in our economy, is grounded in racial hierarchy. This is a term that I convinced my dean when I was first recruited to UCLA to add to the title of the job that I took when I first arrived there, which is translational social science. For the kinds of things I'm describing to become more central to the work that we're doing in psychiatry and academic medicine, we need to really, really consciously bring it in. So right now, most academic medical centers have very little relationship to the social science departments at the same institution. They don't really hire social scientists as faculty members to teach, to do research. And so in this era of translational clinical science, which largely takes insights from the laboratory bench to the bedside, you know, my continuous argument, this is the argument I made when I applied to an MD-PhD program at Yale, and I wanted to do a social science for my PhD. I said, we need not, this was 30 years ago, we need not only to take insights from the bench to the bedside, but from community to bedside and back to community. So that's what translational social science is about. That's what I'm trying to capture with that term. And then another term that I hope will start to have more purchase is social technologies. Since we're in a society that is very technophilic, you know, we're looking for technologies to solve our problems, and that's a little problematic often because there's a magic bullet ideology underlying that, that if we just down the pike, you know, this is how pharmaceutical companies, biotech companies sell their product, just one more technology, and we will solve all the problems of our society, right? Well, if we start to look seriously at the social interventions that will solve the problems of our society and start to recognize them as technologies in themselves, then maybe we can do much more in medicine to incorporate those social technologies. And so this is an image from one of my favorite social technologies. I had the privilege of doing a residency program at Bellevue, it was an NYU program at Bellevue, where I spent a lot of time in an addiction clinic that was almost entirely based on art therapy and group therapies. So this is, in the upper left-hand corner is Ruben Lopez, who has given me permission to write about him and quote him at length. I met him in an art therapy group when I was a resident. That art therapy group was the first time that he had the chance to work with paints and with art materials. And he was really, he was 57 when he was first referred there from the Bellevue Men's Shelter across the street, and he took to it. And he stayed in that art studio for as long as the staff would let him stay every day. And he went on to win statewide art competitions and become a recognized quote-unquote outsider artist with outsider meaning not formally trained in art. But he wasn't the only one. The art therapy groups, and there were music therapy groups, yoga, meditation, cooking group in this clinic, it was a really remarkable clinic. But the idea was that creating things together in a group setting hit a lot of boxes. It helped people to feel connected, have a place of belonging. It gave them concrete skills that made them feel competent in a situation where they often had been referred to the clinic feeling very much rejected and helpless. And in the end, for people like Ruben, but many others, it transformed their identity, gave them a different self-narrative. So Ruben now introduces himself as an artist, not as someone who's an addict or a former addict. I'm an artist. So that's a social technology, actually. So the creative arts can be the foundation for a social technology. We also had a filmmaking group. And if I had time, I would love to have shown you some clips from that group. But it's the same thing about group process, transformed identity, and narrative is really important, giving oneself a new narrative. This is the sobriety garden in the same place. And I came to see community gardening as a social technology. Again, bringing people together. There are a number of people who didn't necessarily respond to one-on-one traditional therapy or psychiatric consultations in a private room with a locked door. It was a foreign concept to spill out your guts to a strange person in a room isolated from everyone else. But in a group setting, working the soil, a lot of different kinds of interactions would happen with the therapists, with peers. Peer support was a big theme in this clinic. And there was something very symbolic about planting and cultivating and harvesting. You know, that there was an analogy with one's recovery and one's life. You know, that there were cycles. And this, by the way, this garden grew vegetables that were then used in a cooking group. So people who hadn't cooked for themselves in quite a long time when they arrived at the clinic got into that, into cooking for themselves and feeding themselves. That also very symbolic. Another image from the garden. And then I'll end with the theme of bio-social research. So this is my current fascination and preoccupation that there's so much potential for social scientists to collaborate with life scientists, to better understand how social environments impact the development of the brain and the body and the function of the brain and the body. And so this is just one image. You know, neuroplasticity is a model that life scientists have really grabbed on to very heavily. But I think in psychiatry, we're almost a little behind. We have a mechanical idea about how the brain develops and works that really has historically excluded the social environment. But we are complex organisms. We've evolved in socially complex settings. That's allowed our survival. And so we, by definition, have a biology that responds to social environments. And those can be toxic or they can be regenerative and health-promoting. So on that note, I want to try, let's see. I'm gonna try to show a video, a one-minute video. Let's see if I manage to do this. Because, just a little background. One of the highlights right now of my work at UCLA is collaborating with life science colleagues on a neuroscience and society center that we're building. And the idea is to develop a community participatory neuroscience. So I think by now, community participatory research is a little bit more accepted and understood in mental health research. But it's very rare that laboratory scientists engage in it. And so we're trying to imagine together what would it look like to bring lab scientists into community, in this case, South LA, an area formerly known as South Central LA, an area that's very under-invested and very low-income, very high rates of law enforcement intervention and things like that. So what I'm gonna do is I'm gonna show a video that kind of gives you a visual. We showed this, we put this video together very quickly for our first funder, the Dana Foundation. So the sound is a bit distorted, but I think the images speak for themselves in our quest to develop a community participatory neuroscience. ♪♪♪ -♪♪♪ For a multidisciplinary group of people, including community members who are collaborating with us to do research in academia, who want to reimagine neuroscience, what would it look like if we actually could literally start it with the concerns of communities that historically haven't been well-served by neuroscience? Could we develop a method for doing this differently? And one thing I should have mentioned is that this is a collaboration between UCLA and Charles Drew University in South LA. Which is Charles Drew, a community that sprung up on the heels of the Watts Rebellion, really exclusively, really focused on inequality, not exclusively, but very strongly focused on health equity. So with that, and just as a fun teaser, one of the first pilot projects they took on was looking at low-flying law enforcement helicopters that are otherwise known as quote-unquote ghetto birds because they focus on South and Central LA, very poor neighborhoods. So our neuroscientist colleagues have taken the noise pollution of low-flying helicopters at night, nighttime, which is very prevalent there, and modeled its impact on brain function and development, starting with rodents and moving to fruit flies because the intergenerational effects can be modeled in fruit flies. They reproduce so quickly, and multigenerational trauma is something that they're trying to capture. So I just thought I'd end with that as a little stimulus for imagination about where we could go, and I certainly advocate, along with a growing network of my colleagues, that combined social science and medicine for more joint training in social science and medicine slash psychiatry, as well as really lobbying our research funding organizations, NIH primary among them, to fund more social science in collaboration with other forms of science. Thank you. Thank you. Thank you so much, Helena, that was amazing, and you really took us to places that we didn't expect with that far-ranging and such an insightful talk. It's a pleasure to reintroduce Carolyn Rodriguez, who will moderate our discussion. Wonderful, thank you so much. Another round of applause, amazing. Thank you both. All right, so I thought maybe I would give an opportunity for our new panelists just to, if you wanted to say a few words or just reflections on the talk, things that spoke to you, and then very quickly, we're gonna just transition to questions from the audience and open it up to everybody in the panel so we can get, there's so much food for thought here, so wanted to give you guys an opportunity. Go ahead. I think in light of the time, we should give the time over to the audience, but I just, holy smokes, like this. I'm an avid classical music fan, and I think the thing that it's like watching a soloist, both of you, and I love the interplay. I think what I wrote down was actually thrilling because it's a totally different framework for understanding this, and what you did was give us language and tools, so the complement of the two talks was just incredible. Thank you. Yeah, I just wanna echo Justin's comments. The excellent presentations, I was taking a lot of notes, and I just wanted to highlight a couple things that I've recently sort of interacted with that sort of jive with what you guys were talking about. The first was I did a talk at the American Physiology Summit about the lack of diversity in psychedelic research trials, right? So there's a lot of excitement about psychedelics, but if you look at the studies, especially the high-profile ones, they're very homogenous, mostly white, with people that have had prior positive experiences with these drugs. So does this generalize to the kinds of patients that I see in Chicago at UIC? I don't think so. So I think that's something that needs to be addressed, and I think there are groups working on that. So for example, Jessica Maples Keller and Sierra Carter are working with the Grady Trauma Project to use MDMA in those patients that have suffered from PTSD. So we're making headways in the right direction with that. And then I also wanted to highlight a couple things that are happening at NIMH along those same lines. So Dr. Mangurian, you talked about the importance of data and collecting data, and that's something that's in the forefront of Josh Gordon's mind when he's talking about funding rates across different racial and ethnic groups, and it's something that they're paying very close attention to. Another thing that they're doing is working on improving the diversity of study sections, because that makes a huge impact on who gets funded and the type of projects that get funded. And NIMH, as an institute, I think, they're beginning to look at funding priorities that address some of these structural determinants or social determinants of mental health. I was very pleased to see at the American College of Neuropsychopharmacology, they had a session on the social determinants of mental health. So I think our field is going in the right direction. Thank you, Justin. Thank you, Olu. So we have our first question, and we don't have a mechanism for anonymous questions, but we're amongst friends, so if there's something that you wanna just ask a question, or if you wanna write it down on a paper and just give it to me, I'm happy to read it out for you. So go ahead. Thank you so much. So I'm just checking if there's anyone from my department here, so. Ah. Thank you for this presentation. I really appreciate that, and it's very eye-opening for me. I'm so sorry, could you just say your name and where you're from? Oh, yeah, okay. So we get to know you, too. We get to know you, yeah. Yeah, my name is Can Michel. I'm a third year psychiatric resident at Wash U in St. Louis. Welcome. So again, I really appreciate this panel and presentation. I'm on research track on my residency program, and actually I'm working with Dr. Bartsch with the ABCD study, and I'm really glad she's an expert. It's fantastic. Sometimes I question myself, like what portion of this research translates to the North St. Louis, for example, because most of the St. Louis population are very underserved. There's a big historical structural racism there, segregation, and I find myself sometimes as a trainee who is on research track, you know, this existential crisis, like what portion of this research translates to my patients at the ED, I mean, and I don't know how many times I thought about quitting research track, so I just wonder if you have any recommendation to the trainees who are having this existential crisis, actually, about what they are doing, like how they can maintain their motivation. I think I asked this question to Dr. Mangorian when she virtually attended WashU, I think, research day, but I wanna hear your thoughts as well, other panelists as well. I have a second question, I'm sorry, but if you have any question, please take over. Well, actually, can you pause? Maybe, could we answer the first one? Because I know there's a lot to say, and then please, you know, we'll ask your second question, yeah. Yeah, I mean, I would not give up. As I said, I think things are going in the right direction. I think having more of that participatory type of research allows you to continue the work that you're doing, but having an impact in the communities that you really wanna impact. So I would say that there are mechanisms, there are tools and strategies that have been brought up this morning that I think will allow you to pursue your research interests and have the impact that you're seeking to have. Sure. I think you heard some of my ideas before, but I think it's important for you to have a group of peers that you can talk to and be with. And so having folks who are doing similar science to you, and I love the direction that NIH is going, and them making sure that more underrepresented or racial, minoritized individuals are on study section, the more a minority tax will happen, right? So they'll be asked more and more to serve on the study sections. I wonder whether a radical idea could be, do we start paying people to serve on study sections? Do we start paying certain individuals who are gonna be taxed more, or on different committee service, right? How many committees am I asked to be on? So many, and so are a lot of people here who are minoritized, should that be okay? Should we be monitoring that? How many times are we asking people to do this? And similarly, what kind of science is being funded? I love that NIH is moving forward in trying to diversify who's there making decisions, and are they looking at what types of science? Because right now, as you were just looking at social determinants of health, it's very clear that certain science is funded, and certain science isn't, right? There's discrimination on the type of science. So I think that that also is like a target for us to go move forward, because I couldn't agree more with Obu, that like, we're going in the right direction. I'm just, I'm not a patient person, I guess, that I wanna keep pushing it forward. I have very quickly added personal, so I'm very interested in Asian American mental health, and thinking about ways that the community needs to co-create sort of interventions that are gonna be more understandable, I guess, comprehensible. And when I finished residency in 2013, was going down sort of a K route, and essentially, I think the message I got was there's not gonna be space for this. If you wanna do this work, you need to embed a biomarker, or something that's gonna make it attractive. So I think the shift in the NIH is huge, and so I totally agree with everyone here, just persist, you know, and things go through cycles, and I hope we're moving in a direction that recognizes the limits of, what did you call it, the bio, the bioscience era that we're in. Thank you, and I realize we're getting near to time, so I want you to get to your second question. But just to say, it might go without saying, that NIH is but one of many organizations, and they have a particular viewpoint, but there's Brain and Behavior Research Foundation, there's American Foundation for Suicide Foundation, there's internal grant mechanisms, there's just good old-fashioned, like, you know, writing up, like, this is the gap, and just advocating through your residency, or through your chair, that this is something that needs funding, and just drawing attention to it. So you have many, many avenues. I'm doing that, no worries. So, does anybody have any questions? Going once, going twice, does anybody have? Okay, I don't wanna like, You could defer, wait, wait, somebody has a question. Are you deferring your second question? That's very kind of you, okay. I'm gonna ask the others. Okay, go ahead. I have a couple questions as well. Hi, I'm Brian, I'm at Rising PGY-3, also on a research track, and I was curious, kind of thinking about, when I'm designing my own studies, and starting my own projects, how to recruit, and retain more diverse participants to research. As Olu was saying, in psychedelics, it's not very diverse, and I think that's probably true for most research studies, and I'm curious, what can I focus on or are there any tools that I can use to? Can I just make one humble suggestion? You know, I was talking about participatory action research, which these days is referred to as community-based participatory research. That's an approach that can be used for a lot of different kinds of studies, including laboratory studies. The more people who are affected directly participate in designing research questions, conducting the research, the more invested they are, and the more trusting they are of the research team, because the research team consists of them. And also, there's, if you take a look at a larger entity from the Department of Psychiatry, like the School of Medicine, sometimes they're really invested, for example, in cancer. Cancer gets a lot of funding for clinical trial research, so I would connect with the School of Medicine and clinical research entities, because they're working out those things on a sort of across-institution level, and sometimes they'll even have an office where they've tried out a lot of different things that can give you advice for free. So don't neglect just looking within the institution about this question, which is very important. And I would say, bravo, bravo for asking the question and for seeking this out. I think that's the first step, right? Having an interest in being inclusive. Yeah, and I'd agree with that statement, and something, one of the best practices is also thinking about paying the community members who are participating with you in that work. Is there time for another question? Okay, last one, and then all the questions, you can come back up. We'll be here for a while. Go ahead. Yeah, my name is Victor. I'm a medical student from Brazil, and I have a question about one of the topics that was mentioned. It's about the systemic issues that we have in society, and how can doctors actually deal with them? Because this point was raised during the presentation, but I don't know what can we do. For example, last semester I was working with people in social vulnerability situations in Rio, some part of them living in the streets, and the feeling that I was having while listening to their stories is that I could not actually help, like maybe the major problems they were having. And so my question is, what can we do? And what have we done? So I'm gonna try to be brief. Those of you who know me know that I spend a lot of time on this topic. It turns out that there's a strong social medicine tradition in Brazil from which I draw in my work here. I and my colleagues are calling our particular approach structural competency, but there are many other ways that it's emerged under different labels in different places. But for example, with really big policy issues that you see affecting your patients, we as practitioners and physicians in particular don't speak up often enough to policy makers. And it turns out we have a certain kind of gravitas. When we talk about a policy like a housing policy or drug law as a health policy, it's gonna affect the health of our nation, the policy makers listen with a special ear. And so that's just one example of the myriad ways that we could be weighing in a lot more often. We could be speaking to people in sectors like housing sector, in my field, drug law enforcement. So there's so many things we could be doing to act at those kind of structural policy institutional levels. All right, thank you all. We appreciate it. And we'll be here for a little bit. So just come up. Thank you.

psychiatry research

diversity

equity

inclusion

underrepresentation

mentorship

minority tax

career advancement

academic medicine

social determinants

interdisciplinary collaboration

health disparities

institutional policy reform