Issue 1 | VolUme 4 | spring 2016 The GW Psychiatrist The Newsletter of the George Washington University Department of Psychiatry and Behavioral Sciences GLOBAL MENTAL HEALTH P. 3 RESIDENCY 2016 P. 6 FIVE TRIMESTERS CLINIC P. 8 3 The Chair’s Column: Why Global Mental Health? 4 International Perspectives in Psychosomatic Medicine 5 From the Program Director 6 From the Associate Program Director: On Core Values and Recruitment 6 Reflections on the Residency Fellowship in Health Policy 7 Updates from Children’s National Health System 7 World Handball Champion? Sam Goodman, M.D., Emeritus Professor of Psychiatry 8 Five Trimesters Clinic: Notes on the 2nd Biennial Perinatal Mental Health Conference 9 Great Expectations: The Intern Perspective 9 Kudos & Congrats 10 Emotionally Focused Therapy 11 Changing Faces of Leadership in Psychiatry 11 Sanity and Survival: Grand Rounds Summary ThaNk yoU, WrITerS aND reaDerS! Editor: Jason Emejuru, MD Contributors: Victoria Anderson, Trevor Forde | Advisor: Lori Kels, MD, MPH Senior Marketing Manager: Sean Liphard Design: Kelly Sullivan DeParTmeNT of PSychIaTry aND BehaVIoral ScIeNceS 2120 L Street, NW, Suite 600 | Washington, DC 20037 202.741.2888 | gwdocs.com/psychiatry The Chair’s Column: Why Global Mental Health? treated patients in clinics for immigrants and refugees, and conducted asylum eval- uations for political refugees in our Human Rights Clinic. By 2015, the global mental health track had enabled GW psychiatry residents to train in 10 countries and to publish a number of journal articles. However, our global mental health curriculum provided all our psychiatry residents with expertise as applicable in the U.S., as in low income countries. First, skill sets for global mental health were the same as those needed for urban, multicul- tural populations in the U.S. Global mental health training was ideal preparation for future community psychiatrists. Second, global mental health required clinicians to learn how to address suffering from sources other than psychiatric illnesses. Addressing social suffering from demoralization, grief, loss of dignity, and violations of human James Griffith, MD GWUHP had collapsed in the economic rights was essential in low income countries Leon M. Yochelson Professor and Chair upheaval of the Clinton health care reform. but also important in the U.S. Third, global The GWU psychiatry residency lost its na- mental health required a clinician to engage he American College of Psychi- tional identity. Making global mental health families and communities as units of treat- atrists awarded its 24th Annual a new centerpiece for the GW psychiatry ment, not just individual patients. In many Award for Creativity in Psychiatric residency made sense for three reasons: (1) low income countries a person was more a Education to our GW Global Mental Washington held the nation’s most mul- family member than an individual. Skills for HealthT Program for its teaching innovations ticultural patient populations with over a family-centered care were needed through- in psychiatric education. The American hundred languages represented in school out our U.S. healthcare system. Fourth, College of Psychiatrists noted that the GW systems of Washington and its suburbs the practice of global mental health relied global mental health program has matured (USA Today, September 24, 1997); (2) a upon building resilience, not just treating since its creation in 1998 into a national dozen full-time and clinical faculty members psychopathology. Drawing upon patients’ model for teaching global mental health were leading figures in cultural psychiatry, spiritualities and other cultural practices as in psychiatry residency education as a trauma treatment, ethnopharmacology, sources of resilience was vital for promot- four-year curriculum of didactic seminars, torture-survivor rehabilitation, and human ing mental health in low income countries, supervised clinical training, research, and rights advocacy; (3) our physical proximity but of similar importance in the U.S. Global mental health and human rights advocacy. to NIMH and international NGO’s provided mental health has been a good fit for the Why has global mental health achieved unique resources for global mental health natural strengths of our department. It also such prominence at GW? This question can (Griffith, 2014). The other answer came has extended the reach of our humanistic be answered in two different ways. The first from an ethical commitment to further commitment into the wider world. The is historical. In the late 1990’s the GW psy- mental health for those who stood outside training that our residents have gained has chiatry residency found itself without a mis- mainstream America — a commitment to outfitted them well for psychiatric careers sion. Through the 1980’s and early 1990’s, leave no one behind. at home. After 17 years, our Global Mental GW psychiatry was organized around the Health Program has shown how the global This commitment included within its George Washington University Health Plan is also local for Psychiatry. (GWUHP), the nation’s first, most success- scope those who lived in low- and mid- ful, and longest lasting health maintenance dle-income countries, in zones of armed organization created to train residents from conflict, and as immigrants and refugees in References our country. In 1998 the GW Department of (1) Clemens NA, MacKenzie KR, Griffith JL, & Mar- all medical specialties by credentialing them kowitz JC: Psychotherapy by psychiatrists in a man- as HMO providers (Clemons et al, 2001). Psychiatry began providing the psychiatric aged care environment: Must it be an oxymoron?: A In 1994, the U.S. News and World Report component of mental health services at Forum from the APA Commission on Psychotherapy ranked George Washington University Northern Virginia Family Services, whose by Psychiatrists J Psychother Pract Res 10:53-62, 2001. Medical Center as third in the nation as a multilingual psychosocial programs included medical school organized around primary a Program for Survivors of Torture and (2) Griffith, JL. Marie Rohde interview with James L. Severe Trauma funded by the U.S. Office of Griffith, MD: Global mental health, one refugee at a training. During this era, GW psychiatry res- time. Health Progress 95(2):54-59, 2014. idents provided mental health services for Refugee Resettlement. GW psychiatry res- 90,000 GWUHP subscribers in downtown idents studied cultural psychiatry, learned (3) “Educators challenged by diversity’s demands,” Washington. By the late 1990’s, however, therapies for posttraumatic symptoms, USA Today, September 24, 1997. gw PSychIaTrist | SPrING 2016 3 International Perspectives in Psychosomatic Medicine psychiatry became increasingly popular in the General Health Questionnaire (GHQ) the 60s and 70s led by charismatic leaders to designate a patient as having a “minor” such as Thomas Hackett, Morton Reiser, psychiatric disorder such as anxiety, depres- Eugene Meyer and James Strain. These sion or somatization. Easy to score, the GHQ psychiatrists, along with others at UCLA, has been translated into many languages and Rochester, focused primarily on the and used internationally. Over the past 20 severely medically ill with particular interest years, consultation liaison psychiatry has in hemodialysis; cardiovascular disease and made significant advances as a specialty in cancer. The concept of biopsychosocial was the United Kingdom, although there is no popularized by George Engel, who was an formal certification process as in the U.S. In internist and psychoanalyst, not a psychi- the U.K., psychosomaticists’ work is similar atrist. His “New Medical Model” was a to the United States, especially with a reaction to his observations that physicians focus on the somatizing patient. Australian were solely focused upon organic pathol- psychiatry has had a strong psychosomatic ogy rather than also considering the life group who have trained in both the U.S. setting in which they developed and coped and U.K. and regularly contribute to the with their illness. Sadly, his work has been literature. In the U.S., the Patient Health Thomas Wise, MD forgotten by many physicians, but psycho- Questionnaire (PHQ) developed by Kurt somatic medicine continues to keep his Kroenke is similar in its goals at the GHQ . or psychosomatic medicine, the approaches alive. Over the past decade it It is a simple method of screening patients subspecialty of psychiatry that inte- has become apparent that health utilization to identify those with depression who are grates our field with other medical is dramatically augmented by comorbid in need of psychiatric assessment and care. specialties has a global presence in psychiatric. This has led to psychosomatic The GHQ screens for both anxiety and Fwhich our own program at Fairfax has been medicine working in primary care settings. depression. actively involved. Concurrently, the target of such interven- tions has shifted from the individual to a Publications from our Fairfax program For three decades, the Psychosomatic population based approach. have reported results from GHQ screening program at Inova has been actively involved of primary care patients in respect to health in psychosomatic organizations both in In Europe and the United Kingdom, care costs and diagnostic attention for both North America and Internationally. Cur- there has been a different developmental anxiety and depression. Other reports from rently, Dr. Catherine Crone is president of