“We can’t always prevent psychosis. But the earlier someone gets treatment, the greater the likelihood that they’ll recover and do better in the long term.”
A college student often hears her name in the wind. A teenager starts to believe they have a special relationship with God. Another is worried that strangers are watching him. Yet they all retain insight and skepticism about the strange beliefs and perceptions they’re experiencing. They wonder: Is it just a trick of my mind?
These symptoms may indicate clinical high risk for psychosis (attenuated psychosis syndrome). In addition to suspiciousness, grandiose thoughts, and perceptual disturbances in what they see and hear, people at clinical high risk often experience social withdrawal, worsening performance in school, anxiety, and suicidal ideation. About 20% will develop psychosis within two years.
The symptoms of clinical high risk often develop in adolescence or early adulthood, and they are, unsurprisingly, alarming. “We see a lot of functional impairment and suffering in these individuals. They’re often afraid, and their families are often afraid,” says Cheryl Corcoran, MD, associate professor of psychiatry at Icahn School of Medicine at Mount Sinai and co-director of Mount Sinai’s Psychosis Risk Program. She and her colleagues are there to help.
“The goal is to catch people early to provide treatment,” says Shaynna Herrera, PhD, a clinical psychologist and instructor of psychiatry and project director at the Psychosis Risk Program. “Through education and cognitive behavioral therapy, we help them learn about the symptoms and how to manage them. We can’t always prevent psychosis. But the earlier someone gets treatment, the greater the likelihood that they’ll recover and do better in the long term.”
Interventions for Attenuated Psychosis Syndrome The Psychosis Risk Program works with teenagers and young adults at clinical high risk for psychosis, providing evaluation, treatment, and psychoeducation to reduce the risk of psychosis and help patients manage symptoms.
For patients with high clinical risk, anti-psychotic medications aren’t recommended as a first-line therapy (though patients may take medications to address comorbid anxiety or depression). The Psychosis Risk Program offers a variety of interventions to help patients and their families. These include a structured five-session psychoeducation program that educates patients and family members about psychosis risk, called BEGIN: Brief Educational Guide for Individuals in Need. The program also offers cognitive-behavioral therapy for psychosis (CBT), which aims to decrease symptoms, provide coping skills, and prevent the development of full psychosis.
This type of CBT is adapted for people with clinical high risk, and research has shown that it can delay the progression to psychosis for at least four years, says clinical psychologist Yulia Landa, PsyD, MS, assistant professor of psychiatry, Director of Cognitive Behavioral Therapy for the Treatment and Prevention of Psychosis research and clinical program, and co-director of the Psychosis Risk Program. “We will need much longer longitudinal studies to know if CBT can really prevent psychosis, but we can delay it, and maybe prevent it,” she says.
Because most patients are adolescents and young adults who still live at home with parents, the Psychosis Risk Program also provides family-based programs. “Our group- and family-based CBT teaches family members how to interact with their loved ones who are beginning to experience psychotic-like symptoms and learn how to support them in using CBT skills at home,” Dr. Landa says.
Schizophrenia and Psychosis Research In addition to clinical work, the Psychosis Risk Program is active in research, from mechanistic studies of biomarkers to research that evaluates diagnostic and clinical services. One recent project aims to improve early identification of patients at clinical high risk. “[Attenuated psychosis syndrome] is a newer concept, and not all clinicians recognize there is this population of people at clinical high risk who don’t meet the criteria for a psychotic disorder,” says Rachel Jespersen, LMSW, a clinical social worker and coordinator of the CBT for the Treatment and Prevention of Psychosis research and clinical program. “What’s more, these are types of symptoms people don’t spontaneously disclose, so it can be difficult to identify patients at clinical high risk.”
To improve identification, she and her colleagues recently conducted a pilot screening program in Mount Sinai’s outpatient clinics. They asked providers to use a brief screening tool for all patients between 12 and 30. Those who screened positive received further evaluation, and patients identified as clinical high risk were referred to the program for symptom monitoring and adjunctive treatment. The screening pilot identified 3.5 times as many patients at clinical high risk of psychosis compared to the standard referral model, Dr. Landa says.
She and her colleagues are also evaluating interventions such as CBT-based programs for individuals, groups, and families. “Eventually we want to establish solid interventions that could be disseminated across Mount Sinai and integrated into community practice,” Dr. Landa says.
Meanwhile, Dr. Corcoran and colleagues are actively involved in research to better understand biomarkers for schizophrenia. The Accelerating Medicines Partnership: Schizophrenia, spearheaded by the National Institutes of Mental Health, is collecting information on biomarkers such as MRI and EEG data, cognition, fluid biomarkers such as inflammatory and genetic markers, daily diary studies and biosensors that may predict behavioral patterns, even subtle patterns of language and facial expression that could predict the transition to psychosis. Mount Sinai is one of the study’s data processing centers, responsible for collecting and analyzing data from across the consortium. “We’ve identified a number of biomarkers that are predictive of psychosis,” Dr. Corcoran says. “We want to understand how they relate to each other, to better understand the causes of psychosis and ultimately to develop new pharmacological treatments.”
In addition, one of Dr. Corcoran’s abiding research interests involves collaborating with physicists, engineers, and computer scientists to use artificial intelligence to analyze speech, language, and face expression. Language disturbance (particularly complexity and coherence) is common in psychotic disorders, and often appears at the initial onset of symptoms. Using natural language processing, Dr. Corcoran and her collaborators were able to predict psychosis onset in clinically high risk patients with an 83% accuracy rate—that is, more accurate that clinician predictions. The implications of this field of study can potentially help prevent psychosis by initiating the development of treatments that address the problems with cognition that are at the root of language disturbance. Her team has focused on this as a biomarker for mechanistic studies (several currently in recruitment), and are working to include this “natural language processing” approach for services as well.
Patient Care at the Psychosis Risk Program Running throughout all clinical and research efforts at the Psychosis Risk Program is a commitment to the well-being of patients, whose symptoms are often misunderstood and stigmatized. “We have been contributing to research on stigma and interventions to reduce stigma,” Dr. Herrera says. “And we’re committed to involving patients and their families in our work. We conduct qualitative interviews and get their feedback so that we adjust our practices and make sure that they are meeting peoples’ needs.”
The program staff also takes time in caring for patients with a challenging and frightening diagnosis. “In mental health care, there’s often not enough time to provide psychoeducation and do lengthy feedback sessions” where the evaluating therapist sits down with the patient and their family members to discuss the diagnosis, Dr. Herrera says. “One thing that makes Mount Sinai stand out is that we take our time to do thorough assessments, give feedback and write detailed reports so that families and clinicians have the information they need to seek care.”
Schizophrenia and psychosis remain challenging conditions, for the people affected and for their clinicians. But Mount Sinai’s Psychosis Risk Program is providing hope and health to the young people at clinical high risk. Learn more about their services and research, including language-based studies, at www.mountsinai.org/psychosis-risk.
Growing up is never easy, and adolescence has often been a difficult time for kids. But the ongoing pandemic has made life even more difficult, especially combined with the always growing influence of social media.
Nearly one in three adolescents will experience some form of anxiety disorder, according to the National Institutes of Health. Kids who are uniquely vulnerable include lesbian, gay, bisexual, transgender, Black, and female students.
Experts say there are steps families can take to address these issues, especially when it comes to use of social media.
Findings regarding the impacts of social media on adolescent health are nuanced and sometimes in conflict, though many clinicians and researchers agree that there are some adolescents who are more vulnerable to the effects of screen time than others. Families can intervene by monitoring for possible problems and helping kids determine how much they should use social media, how to balance that with other activities, and the drawbacks of taking away the smartphone entirely.
Stacey Lurie, PhD
“The good news is that parents can play a positive role and help their kids navigate screen use and social media,” says Stacey Lurie, PhD, a psychologist at the Mount Sinai Adolescent Health Center, who, along with her team, see more than 25 young patients each week. She is also the Director of the Center’s Psychology Training Program, which trains the next generation of psychologists in comprehensive mental healthcare for adolescents.
The Center is one of the leading centers of adolescent health care, training, and research in the United States. Mount Sinai experts report a significant uptick in teen anxiety, stress, and depression among the adolescents and young adults they treat. The uptick emerged during the pandemic and is consistent with a nationwide pattern described by the Centers for Disease Control and Prevention, which found that between 2009 and 2019, the experience of sadness or hopelessness among high school students had increased by 40 percent.
Many kids were struggling with virtual learning at home instead of in class due to the pandemic. Even as they began returning to the classroom, the experience of the pandemic had left a mark, which will be something experts will watch as kids prepare to return to school in the fall.
“As kids returned to in-person instruction, they have been experiencing social anxiety,” says Dr. Lurie. “The shift to a virtual environment was challenging. Shifting back was tough to handle all at once. Additionally, we are seeing more students struggling with attention difficulties, brought on in part by the virtual training model and the short-term feelings of reward brought on by social media apps and gaming apps.”
A key aspect of mental health care, says Dr. Lurie, involves getting families to come together to address screen use in a productive and collaborative fashion. Dr. Lurie works closely with families to address this. It’s all part of a process she calls “media planning.”
“The reality is that most young children these days have smart phones and it’s a whole new territory for parents,” says Dr. Lurie. The Pew Research Center reported in 2018 that 45 percent of teens say they are online almost constantly, up from 24 percent of teens in 2014-2015; they similarly reported that a majority of parents, 71 percent, are concerned that their child might spend too much time in front of screens.
Here are some of Dr. Lurie’s suggestions for parents:
Kids are experiencing greater anxiety and depression these days. Keep an eye out for signs your child is not acting like themselves and keep the lines of communication open so you can help.
Parents need to find the right balance for screen time. This is no small task, but it does help to bear in mind the new role of smartphones in kids’ lives today as lifelines to their entire community. Parents should have a conversation with their children. Finding a middle ground is key—so is being collaborative, and not controlling. For example, taking a phone away as a form of discipline for poor performance in school, or something else the parent is not happy about, is not recommended. Parents can set new limits if they think their child is going overboard with screen time, but taking the phone away is akin to removing that lifeline.
Families need to come together and decide on their goals; there needs to be agreement on how much screen time is okay.
Recognize that kids, like adults, see everyone on social media seeming to have the time of their lives. Help them to understand that’s not always true. Parents can help their children become informed critics of what they are seeing on social media.
Parents need to be good models on screen time. So, for example, if the family has agreed that phones will not be a part of the family dinner, then parents should refrain from phone use at this time.
“Many family members don’t know much about firearms,” Dr. Goodman says. “We’re trying to empower those individuals, who can make a difference if we give them the knowledge, tools, and skills.”
Each day, approximately 17 veterans die by suicide, according to the 2020 National Veteran Suicide Prevention Annual Report. Of those lives lost, 68% die from a self-inflicted firearm injury. Clinician-researchers at the Mount Sinai Health System are working to lower that number, through a new initiative that aims to help concerned family members speak to veterans about safely storing firearms and reducing the risk of self-harm.
The project is led by Marianne Goodman, MD, Professor of Psychiatry at Icahn School of Medicine at Mount Sinai and acting director of the Mental Illness Research, Education and Clinical Centers (MIRECC) at the James J. Peters VA Medical Center in the Bronx, a program affiliated with Mount Sinai, along with New York Governor’s Challenge team members.
The MIRECC is a national network of 10 research hubs within the Veteran Integrated Service Network. “The MIRECC is basically a research think tank within the VA,” Dr. Goodman says. “We take a bench-to-bedside approach, conducting genetic and neuroscience research, through clinical trials, and into services research.” Each MIRECC site has its own research focus. At the James J. Peters VA Medical Center and its academic affiliate, Mount Sinai, the program’s faculty and fellows conduct research and outreach focused on severe mental illness and suicide prevention.
Empowering Veterans’ Loved Ones Dr. Goodman’s latest effort is a website, WorriedAboutAVeteran.org, directed towards the loved ones of service members. The website grew out of the New York State Governor’s Challenge to Prevent Suicide among Service Members, Veterans and Families, with funding support from the New York State Health Foundation. Their working group, including team members from the Veteran Integrated Services Network (VISN) 2 Center of Excellence in Suicide Prevention and New York State Office of Mental Health and Counseling on Lethal Means (CALM) consultants, met for close to two years before launching the site in the spring of 2022.
Though the premise is simple, the site addresses an important unmet need, says Dr. Goodman, an expert in suicide safety planning interventions. “A lot of instructions have been developed to help clinicians counsel patients about firearm safety. But there’s nothing directed toward the families who are living with a veteran and their firearms,” she says. She hopes the site will be a resource for families, and a tool that clinicians can share with patients and their families.
The website shares information on the safe storage of firearms, how to limit access to firearms during times of distress, how to start conversations with loved ones about suicide and safety, and resources for seeking help and support. Much of the site’s content is based on the stories of other veterans and their family members who have been in similar situations. “Many family members don’t know much about firearms,” Dr. Goodman says. “We’re trying to empower those individuals, who can make a difference if we give them the knowledge, tools, and skills.”
Even when family members are concerned that a veteran might be having suicidal thoughts, raising the topic of firearm safety can be challenging. “Discussing safe storage of firearms can be a thorny subject. Veterans often associate their firearms with rights, values, and personal service experiences,” says Robert Lane, PhD, a clinical psychologist and MIRECC postdoctoral fellow. “What makes our site unique is focusing on the significant people in a veteran’s life and helping them facilitate conversations about practices that can increase the safety of a veteran and a veteran’s family during a time of heightened risk, while being mindful of these rights, values, and service experiences.”
These conversations do not necessarily have to result in a veteran giving up access to firearms, Dr. Lane adds. “They’re about considering the safe storage options that are most effective for that Veteran’s lifestyle and needs and the veteran’s family.”
Before developing the website, Dr. Goodman and her colleagues conducted interviews with family members of veterans, including family members who have lost a vet to suicide. “We found that they don’t want to hear statistics or see a presentation about the research. They want to connect with others who they feel understand them,” Dr. Goodman says.
Their finished product is based on the experiences and suggestions of real people in close relationships with veterans, including tips on starting a conversation about firearm safety or when and why to call a crisis line when you’re worried about a loved one.
The website is specific to New York, with links to resources such as counseling centers within the state. However, the team hopes to expand it nationally so that it can be used by families of veterans anywhere in the U.S., connecting people to local resources and services as needed.
One message they hope to send is that suicide prevention isn’t just for families of veterans with a history of mental illness. “In an emotional crisis, people can be at heightened risk of self-harm whether or not they meet diagnostic criteria for prior or current mental illness,” Dr. Lane says. “Our focus is about overall safety and applying that focus to all veterans and their families.”
Through efforts such as this website, the MIRECC team also hopes to normalize conversations around suicide prevention. “We want this to be like any other public health conversation, like conversations about the risks of smoking or diabetes,” Dr. Lane says. “If we can take away the mental health stigma surrounding these conversations, we can save veterans’ lives.”
Student providers are trained in CBT and psychodynamic therapy, which has been shown to be an effective treatment for anxiety, depression, and other mental health concerns.
In the East Harlem neighborhood of New York City, residents without access to health insurance are receiving free outpatient mental health care, thanks to an innovative project at the Icahn School of Medicine at Mount Sinai. Part of Mount Sinai’s East Harlem Health Outreach Partnership (EHHOP), the student-run clinic offers no-cost, evidence-based mental and behavioral health treatments to patients in need.
Mount Sinai experts created the program from scratch more than a decade ago to meet the needs of the local population. “There was no model for this,” said Craig Katz, MD, Clinical Professor of Psychiatry, Medical Education, and System Design and Global Health at the Icahn School of Medicine and Faculty Director of EHHOP’s mental health clinic.
In 2021, the clinic served 75 patients, treating them on an outpatient basis for conditions such as anxiety, depression, and alcohol use disorder. Patients, medical students, and psychiatric residents are all benefiting from the program. As the clinic grows, it also serves as a model for other student-run health clinics to follow as they address the mental health needs of uninsured and underinsured communities.
Providing Mental Health Services for the Uninsured EHHOP was launched in 2004 as a student-run free primary care clinic for uninsured adults in East Harlem. It has grown to incorporate a variety of services including women’s health, ophthalmology, and cardiology. The free mental health clinic was founded in 2009.
Patients are first enrolled in EHHOP primary care services. If they are identified as having a mental health condition not readily managed in primary care, they are referred for a consult at the mental health clinic. Trained medical student volunteers provide medication management as well as psychotherapy. The student providers also help connect patients to the on-site pharmacy, social workers, and an emerging alcohol use disorder buddy program, as needed. The majority of patients speak Spanish as their first language, and services are offered in Spanish, either by fluent medical students or through medical interpreters.
Overseeing the services are senior residents, who review each case and treatment plan with student providers. Patients are seen at least once a month, while those receiving psychotherapy and those who recently began medications have more frequent visits, either in person or through telehealth.
Early on, Dr. Katz and his colleagues made a decision to offer psychotherapy, even though it requires a greater time investment than psychiatric medications alone. “EHHOP is committed to offering care that is on par with the care patients with insurance would receive, to the best of our ability,” he said. “Research shows that for conditions like depression, medication plus psychotherapy tends to convey a more robust and lasting recovery, and our goal is to offer psychotherapy to any patient that wants it.”
Dr. Katz is also the founder and director of Mount Sinai’s Program in Global Mental Health, and he drew on practices from global mental health to train medical student volunteers in the principles of cognitive behavioral therapy (CBT). “Early on we wanted to offer individual therapy but didn’t have the person power. But global health research shows us that non-specialists can be trained to provide specific forms of psychotherapy,” he said.
Student providers are trained in CBT, in part because it’s manualized and relatively easy to train, said Cassandra Pruitt, a fourth-year medical student at the Icahn School of Medicine and a student provider active with the free mental health clinic. “There’s also a lot of excellent data about the efficacy of CBT for treating anxiety and depression, which are things we often encounter in EHHOP,” she said. Recently, the program began training student volunteers in psychodynamic therapy as well, an additional modality that’s been shown to be an effective treatment for anxiety disorders, depression, and other mental health concerns.
Evidence-Based Mental Health Services The EHHOP free mental health clinic is an evidence-based program. Mental health clinic staff and volunteers collect data to monitor patient progress and ensure that the program improves outcomes. At each visit, student providers measure the magnitude of patients’ depression and anxiety symptoms using the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) scale.
In a paper pending publication, co-lead authors Alexandra Saali and Samuel K. Powell, both medical students and clinic volunteers, and colleagues found that the clinical service performance of the free mental health clinic was similar on most measures to outcomes for patients with Medicaid or private insurance. While HMOs in New York state had higher rates of acute-phase antidepressant medication management, the authors found no differences in performance in continuation-phase antidepressant management. What’s more, the free mental health clinic outperformed New York state commercial and Medicaid plans on optimal provider contacts for depression and follow-up care after emergency visits related to alcohol or drug use.
Outcomes data shows that patients in the free clinic get better with treatment. In addition to improvements in mental health symptoms, they also report improvements in various psychosocial domains, such as handling social situations, dealing with problems, and accomplishing goals. Patients also report high satisfaction with their clinic sessions.
Student volunteers, too, gain a lot from the program. “In a hierarchical structure like the medical school system, it’s incredible to have a place where we can be autonomous, and receive training in these psychotherapy modalities,” said Ms. Saali. “This has been such a rewarding experience. It’s a way to give back to the community by establishing long-term relationships with patients and serving people who otherwise couldn’t receive care.”
A Model for Free Clinics Building on its successes, the free mental health clinic is launching new projects, including a CBT for diabetes program in which students trained in diabetes-specific didactics help patients with disease management, medication adherence, problem-solving skills, and managing the stress of a chronic illness. The program is also partnering with the humanitarian aid organization International Rescue Committee to provide EHHOP student providers to offer CBT sessions to Afghan refugees and asylum-seekers.
Meanwhile, Dr. Katz and other clinic contributors hope the free mental health clinic will serve as a model for other student-run free clinics to follow in offering mental health treatment to patients.
“The intention is for the design of our clinic, and the tools we use to measure outcomes, to be adopted among the hundreds of other student-run free clinics in the country,” said Ms. Saali, who brings experience to this effort as a former health care consultant with McKinsey & Company, the management consulting firm. “We also have an EHHOP consulting group that works with other programs interested in beginning or ramping up their student-run free clinics.”
The program is currently grant-funded, but it’s a relatively low-cost program since it relies largely on volunteers. “With the exception of medications, we’re extremely low-budget, and that’s because everybody gets something out of this: Patients get care they would otherwise not have gotten. Students get an opportunity to be primary mental health clinicians. And residents have a chance to play a supervisory role,” Dr. Katz said. “It’s a perpetual motion machine fueled by energy and need, and everybody is happy.”
Craig Katz, MD, is Clinical Professor of Psychiatry, Medical Education, and System Design and Global Health at the Icahn School of Medicine at Mount Sinai and Faculty Director of EHHOP’s mental health clinic.
Samuel K. Powell is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
Alexandra Saali is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
Cassandra Pruitt is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
Some stress is part of everyone’s life. But there are times when the daily demands of the job or school, the complications of home life, the pressure of living in the New York metropolitan area, and the state of the world, especially with the ongoing pandemic, can combine to leave you feeling physically and emotionally overwhelmed. In these moments, you may notice your heart rate rising or your breathing becoming heavier, or find you are lacking energy or a sense of enthusiasm or confidence.
You know you need to do something. But what?
Jacqueline Hargrove, PhD
In this Q&A, Jacqueline Hargrove, PhD, a licensed clinical psychologist and Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, says you can start by separating “stressors,” those things like work, planning a wedding, or having a child, from stress, which is your body’s response to these stressors. Once you do that, she offers five tips on how to improve your mindset and increase your flexibility so you can begin to improve how you manage stress and get unstuck from cycles of chronic stress even while the stressors of life persist.
Get physical
The best way to deal with the stress is to do things that are physical. That helps breakdown those hormones that increase our heart rate and our breathing and get us ready for action. This can be a whole host of different things. Anything that literally just gets your heart rate going, or breathing deeply is fair game. Physical activity helps your body reach a calmer state. A lot of folks may not like going to the gym or going for a run. So you can do a Zumba class at home, or yoga. Or just focus on deep breathing or breathing exercises.
Alternatively, you can connect with other people and soak up some physical affection. If you’ve ever come home from work and been greeted warmly by your partner, or even a pet, you know how that can be comforting and stress reducing. Even laughing and crying can be helpful, as many may know from having a good cry or experiencing a deep belly laugh. Afterwards, you feel better, because it’s a physical process and helps us actually release some of that stress and tension that can stay stuck in our bodies.
Figure out what you can control and what you can’t
A lot of the stressors are out of our control. So it’s important to understand if something that is stressing you out is something you have some control over, and can problem solve, or not. If there is something, even a small thing, that you can do and is in your control that will help reduce or eliminate the stressor then absolutely do it. However, if it’s something that’s more chronic or something that you don’t necessarily have control over, try to see what meaning you can gain from the experience. Many of life’s most important transitions, such as that first job or first child, come with stress. But often it is the positive meaning we tend to associate with these events that can help us mitigate the stress associated with them. However, let’s say you may be facing a situation at work that’s challenging. Or in a relationship where you feel your needs aren’t being met. Sometimes just shifting our expectations can actually reduce stress because then we aren’t fighting with what we are expecting of other people or things we can’t control. Overall, it’s important to remember that stress, not chronic stress, is a part of life and learning to roll with and make meaning of these challenges is part of the journey.
Take stock of your environment and surroundings. It’s not necessarily all on you
Try to contextualize your stress. What I mean by that is, sometimes we can think we have a personal failing because we’re so stressed out. But if we just take a minute to step back, we realize there’s so much going on in our lives. Being in a global pandemic right now is stressful, being a parent right now is an added level of stress. Navigating your life as a person of color or an immigrant or a member of the LGBTQ community has its own stress due to discrimination or systemic barriers that are unjustly imposed on these communities. There are so many ways in which our identities can contribute to the stress that we experience. In this way, it can help to acknowledge how our identities and the environment we are in play a role in the day-to-day stress we experience. This can help us not be so self critical and can also help us identify ways to manage that stress and find empowering ways to deal with the stressors.
Redefine productivity
In the United States, there is a common narrative that centers around always needing to be productive, and that is a culture that is ripe for stress. Productivity can simply mean intentionally working toward a meaningful goal. So let’s say your goal is mental health and well-being, then rest can be a really productive thing that you’re doing in line with that goal. Making time for yourself can therefore be productive. Also, capitalize on idle time. This can include choosing to not do anything during those five minutes in between meetings. Or if you take public transit during your commute, maybe intentionally getting off one stop earlier and extending your walk home. Finding time when you don’t need to be engaging with your day-to-day stressors can be really important.
Learn to say no
Learn to say no to things and learn to set boundaries. A lot of our stress can come from sometimes feeling like we have to say yes, or put more and more on our plate, when it actually isn’t in our own best interest. So if you’re saying yes to things, and you have the ability to say no, you can ask yourself: Is this benefitting me? Does engaging in this activity help me feel energized and excited? Or does it end up making me feel depleted and resentful? Take time to listen to your body, set some boundaries, and find some time to relax and restore.
Sidney Hankerson, MD, MBA, holds two new leadership roles at the Icahn School of Medicine at Mount Sinai: Vice Chair for Community Engagement for the Department of Psychiatry, as well as Director of Mental Health Equity Research for the Institute for Health Equity Research (IHER) in the Department of Population Health Science and Policy.
Mount Sinai’s Department of Psychiatry is pleased to welcome Sidney Hankerson, MD, MBA, to our faculty. Dr. Hankerson holds two leadership roles at the Icahn School of Medicine at Mount Sinai: Vice Chair for Community Engagement for the Department of Psychiatry, as well as Director of Mental Health Equity Research for the Institute for Health Equity Research (IHER) in the Department of Population Health Science and Policy.
Dr. Hankerson has received several prestigious awards, including the American Psychiatric Association’s Nancy C.A. Roeske, MD, Certificate of Recognition for Excellence in Medical Student Education, and he was chosen as a 2021 Emerging Leader in Health and Medicine by the National Academy of Medicine. Last year, New York City Mayor Bill de Blasio appointed him Chair of the Community Services Board of the New York City Department of Health and Mental Hygiene. In that role, he identified two priorities. The first is addressing behavioral health care needs in children and adolescents, given the rise in suicide attempts—particularly in Black and Latinx youth. The second is addressing the workforce shortage to meet the increased demand for mental health care. “Figuring out how we address the shortage and demand for these vulnerable populations is crucial,” he said. “Ideally, we can bring in early-stage clinicians and researchers to be on the ground and develop new models of care and engagement and delivery models.”
At Mount Sinai, Dr. Hankerson’s primary focus is in reducing racial and ethnic disparities in mental health treatment, particularly depression. “My overall charge is to really integrate principles of community-based participatory research—partnering with community organizations, and working in lockstep with community members to develop, implement, and test culturally relevant mental health interventions,” he said. To that end, he has launched an initiative in Harlem that trains church members as community health workers to screen for depression and provide brief evidence-based counseling. He plans to build on this to create a model for church-affiliated mental health clinics that can be replicated through New York City, as well as nationwide.
“Mount Sinai’s clinical infrastructure and IHER’s expertise in engaging communities of color will be invaluable in working toward that objective,” he said. “I think it will be a very nice fit, both clinically, because Mount Sinai serves many patients who call Harlem home, and because our churches are among the most trusted institutions in the African American community and have long been natural havens for mental health support.”
Dr. Hankerson believes his most important job is to listen and learn from the faculty. “It’s a priority for me to learn and identify the wonderful things Mount Sinai is already doing in the community, and to try to expand it to give it a bigger platform as well as to identify opportunities that are yet untapped,” he said. “One of the things that’s so exciting and novel about Mount Sinai is the DEI Committee within Psychiatry. To have such a robust committee dedicated to DEI is really phenomenal, so I am really excited to work with them.”
Craig Katz, MD, is Clinical Professor of Psychiatry, Medical Education, and System Design and Global Health at the Icahn School of Medicine at Mount Sinai and Faculty Director of EHHOP’s mental health clinic. 
Samuel K. Powell is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
Alexandra Saali is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
Cassandra Pruitt is a medical student at the Icahn School of Medicine at Mount Sinai and a volunteer in the EHHOP clinic.
