Autumn brings about many things: leaves on the ground, cooler temperatures, and of course, Halloween. But while many look forward to a reprieve from the summer months, the start of the season can introduce new challenges. Seasonal depression—commonly known as seasonal affective disorder (SAD)—is a temporary condition estimated to affect 10 million Americans each year.
Mariana Figueiro, PhD, Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and Director of the Light and Health Research Center at Mount Sinai, explains the effects of SAD and how those who experience it can manage the disorder.
What are the symptoms of seasonal affective disorder, and what causes it?
Symptoms of seasonal affective disorder vary, but in general, it includes feeling down or depressed as well as experiencing a lack of interest and energy. People tend to be sleepier and tend to overeat, especially carbohydrates. And, as with any depressive episode, there could be suicidal thoughts. These depressive symptoms occur at specific times of the year, typically the fall and winter, and there is a full remission at other times of the year, such as the spring and summer.
Unfortunately, the cause of the disorder is still unclear, but there are some competing theories. One is that the start of autumn causes circadian rhythm disruption. Another is that the photoreceptors in the eye are not as sensitive to light, and another is serotonin reuptake dysfunction, which is an imbalance in serotonin levels. But the most prominent theory is that, due to the lack of or delay in getting morning light, the biological clock in the brain is out of phase with your natural light-dark patterns, affecting the timing of the sleep cycle. As such, your biological clock is telling you that it is 6:30 in the morning, but your watch is telling you differently. That mismatch can be the cause of seasonal depression.
Does the disorder only affect people who live in cities with long winters, or are people in warmer climates affected as well?
It tends to mostly affect people who live at higher latitudes, as these areas have less daylight availability in the winter months.
In the United States, higher latitude areas will be the northernmost states such as Alaska, Washington, Michigan, New York, and Maine. In the New York metropolitan area, we have about 15 hours of daylight at the height of summer but only about nine hours in the dead of winter. This contrast is starker in areas that are farther north. Barrow, Alaska—the northernmost city in our northernmost state—has 67 straight days of darkness in the winter.
Within high latitude populations, the prevalence of SAD varies between one and 10 percent. But it can happen at lower latitudes, it’s just less prevalent.
How can I recognize and manage SAD?
If you go to a physician, there are standardized questionnaires—such as the seasonal pattern assessment questionnaire—that you can take. But, in general, if year after year you begin to crave carbohydrates, lose energy, lose interest in things, overeat, and oversleep around October, that’s a good sign that you should seek a formal SAD diagnosis.
Once you consult a physician, they will discuss how you can manage the disorder. There are two common ways to treat SAD. One would be medication—typically an antidepressant or a selective serotonin reuptake inhibitor—that would be prescribed by a physician. The other is non-pharmacological: light therapy. Exposing yourself to light—be it morning, natural, or electric indoor light—will help resynchronize your biological clock so that it matches your local time. You can do this by adding more lights in the home, opening up your windows, and trying to be outside during daybreak. And if you work from home, try to sit facing a window. Making your environment brighter during the day will help get more light to the back of the eye, which is what you want in order to be an effective treatment for seasonal depression.
Has light therapy been used to treat other illnesses?
Yes, it has. The Light and Health Research Center at Mount Sinai has done a number of studies showing that—outside of treating seasonal depression—there is a definite benefit to exposing people to bright days and dim nights. For instance, in a study with Alzheimer’s disease patients, the lighting was changed in their nursing homes and assisted living facilities to simulate bright days and dim nights. The results were a very robust, positive impact on their sleep, mood, and behavior. In other applications, we worked with persons with mild cognitive impairment and sleep disturbance from mild traumatic brain injury to see how light therapy can help. And we have been working with breast cancer and myeloma transplant patients to see if delivering light therapy during a transplant or during chemotherapy will help to minimize fatigue and improve their sleep.
There are various applications. You can even use it to try to get your teenager to go to bed and wake up earlier. The addition of light can have many positive effects on life.
Binge eating disorder is the most common eating disorder in the United States, thought to affect as many as 3 percent of people during their lifetimes. Yet it remains poorly understood.
Now, researchers from the Icahn School of Medicine at Mount Sinai have made important progress with the first genome-wide analysis of binge eating disorder (BED). The study, published in Nature Genetics in August, identified genes that appear to be associated with BED risk. The study also found evidence that iron metabolism may play a role in the disease.
“By applying machine learning to the study of binge eating disorder, we’ve gained important insights into this poorly understood condition, and a new tool for exploring other underdiagnosed diseases,” says Panos Roussos, MD, PhD, Professor of Psychiatry, and Genetics and Genomic Sciences at Icahn Mount Sinai and Director of the Center for Disease Neurogenomics, who is a co-author of the study. “By combining Neuroscience with genomics and big data analysis, we can discover more about how the brain works and ultimately prevent psychiatric disease.”
A Fresh Look at Binge Eating Disorder
Binge eating disorder has significant impacts on a person’s health and well-being. “It can cause substantial distress and impairment in quality of life,” says Trevor Griffen, MD, PhD, a psychiatrist and neuroscientist who collaborated on the recent study while he was a fellow in child and adolescent psychiatry at Mount Sinai. “BED often co-occurs with other psychiatric disorders, such as depression, ADHD, and substance use, and seems to be a nexus of metabolic dysfunction, with associations to conditions like diabetes and high blood pressure.”
Trevor Griffen, MD, PhD
Yet it took a long time for the scientific community to recognize BED as a distinct disorder. It was first included as a new diagnosis when the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2014. As a result, the diagnosis is all but absent in the electronic health records and large biobanks that researchers tap into for large-scale genetic analyses. Luckily, the Mount Sinai team developed a workaround.
“A big part of this study was using machine learning to figure out the people most likely to have BED,” says lead author David Burstein, PhD, a data scientist at Mount Sinai who works in the labs of Dr. Roussos and study co-author Georgios Voloudakis, MD, PhD, Assistant Professor of Psychiatry, and Genetics and Genomic Sciences.
Using electronic health record data from more than 767,000 people through the Million Veterans Project, Dr. Burstein and his colleagues applied machine learning approaches to sift through medical diagnoses, prescription medicines, body mass index (BMI) data, and other factors, looking for patterns that would predict if a person had BED. Applying their model to smaller cohorts of people with diagnosed BED, they showed the approach could meaningfully predict the disorder, even in the absence of a formal diagnosis.
Genes Point to New Binge Eating Disorder Treatments
Applying the machine learning model to some 362,000 people for whom genetic information was available, the researchers zeroed in on several genetic loci that appear to be associated with BED risk. One of the genes implicated in the new study is MCHR2, which is associated with the regulation of appetite in the brain. Two others, LRP11 and APOE, have previously been shown to play a role in cholesterol metabolism.
David Burstein, PhD
Another gene identified in the study, HFE, is involved in iron metabolism. The identification of HFE aligns with recent research suggesting iron metabolism may have an important role in regulating overall metabolism, Dr. Griffen says. In particular, iron overload seems to be associated with binge eating, the team found. Interestingly, iron deficiency has been implicated in pica, a disorder that drives people to eat non-food items such as soil or hair.
“There have been hints that iron is a player in the eating disorder world,” Dr. Burstein says. “This new study is more evidence that the mineral deserves a closer look.”
The findings also point toward new directions for treating BED. So far, treatment has mostly focused on repurposing therapies used for other disorders, such as depression or ADHD.
“This study identifies genes and systems that could serve as potential targets for treatments that finally address the underlying biology of BED,” Dr. Griffen says. “It also continues to build evidence that there are biological and genetic drivers of binge eating behaviors. The more we get that message out there, the more we can decrease stigma associated with binge eating.”
A New Tool for Eating Disorder Research
Dr. Griffen is continuing to collaborate with Dr. Roussos and Dr. Voloudakis to expand on their findings, with plans to develop mouse models and dig deeper into the mechanisms. Ultimately, their goal is to develop new treatments that target the underlying biology of BED.
Meanwhile, the researchers are eager to apply their new computational approach to other diseases such as bulimia nervosa—another common eating disorder for which no genome-wide analysis has ever been done.
“Being able to infer a diagnosis from medical records is really significant, not only for BED but for other eating disorders, which are often extremely underdiagnosed” and therefore challenging to study using electronic health records, Dr. Burstein says.
The approach can also extend the science into populations that have been overlooked in past research. Most research on eating disorders has focused on white females. Using machine learning, researchers can more thoroughly study eating disorders in males and populations with other racial or ethnic backgrounds.
“This is exciting work, with so many potential future directions,” Dr. Burstein says.
Both psychiatric disorders and disorders of the reproductive system are common in women of reproductive age. Often, they co-occur. “There is a lot of overlap between these two disease classes—but very little research into why that is,” says Nina Zaks, MS, Clinical Research Scientist in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
She wanted to learn more about that overlap. Together with Magdalena Janecka, PhD, Assistant Professor, Psychiatry, and Genetics and Genomic Sciences, and other colleagues, she spearheaded a systematic review and meta-analysis to probe the association between mental health and reproductive system disorders in women. Their paper was published in JAMA Network Open in April.
The analysis revealed some interesting patterns—and shone a light on how much more remains to be discovered.
Psychiatric and Reproductive System Disorders: Increased Odds
Nina Zaks, MS
The analysis included 50 qualitative and quantitative studies, each of which explored co-occurring psychiatric diagnoses and reproductive system disorders. The research team cast a wide net, considering a range of psychiatric diagnoses including depression, anxiety, psychosis, and neurodevelopmental disorders such as autism. On the reproductive system side, the team looked into diagnoses such as inflammatory diseases of the female pelvic organs, non-inflammatory disorders of the genital tract, and ovarian dysfunction.
The overlap between the disease classes, they found, is significant. In women with polycystic ovary syndrome (PCOS) and chronic pelvic pain, for instance, the odds of affective disorders were approximately 1.7 to almost four times greater than in women without the disorders. But the team also showed that the overlap between many other psychiatric and reproductive disorders simply has not been studied yet, revealing a considerable gap in knowledge, with potentially serious implications for women’s health.
Overall, the literature shows that women with reproductive system disorders have two to three times the odds of having psychiatric disorders compared to women without those conditions. “We see comorbidity between psychiatric and reproductive disorders everywhere we look,” Dr. Janecka says. “Despite that, there is so much about that comorbidity that has not yet been studied. It’s an urgent research priority to address this.”
Looking for Links in Mental Health and the Reproductive System
What can account for the overlap? Unfortunately, most studies in this area don’t dig into the possible causes, according to the researchers.
Scientists have suggested a number of possible explanations for the association between reproductive system and mental health disorders. For example, stress and quality of life factors associated with mental illness could affect menstrual cycles and reproductive function. Psychiatric medications might interfere with reproductive function. It’s also possible that some underlying genetic causes contribute to both types of disorders.
Though much more research is needed, there are reasons to suspect biological causes for the connection, at least in some cases. “From a mechanism standpoint, it makes sense. Many psychiatric diagnoses present differently between females and males, possibly due to a hormonal component,” Dr. Janecka notes. “Better understanding this connection will provide us with some insight into these mechanisms, while also improving quality of life for patients.”
Polycystic Ovary Syndrome: PCOS and Depression
Magdalena Janecka, PhD
Among the studies that Dr. Janecka’s team analyzed, the largest portion focused on PCOS. Those studies showed that women with PCOS have an increased rate of depression, anxiety disorders, and bipolar disorder.
PCOS is relatively common, affecting as many as 5 to 10 percent of women of reproductive age. The condition is associated with symptoms such as infertility, obesity, acne, and excessive hair growth. One explanation for the increased risk of psychiatric diagnoses in women with PCOS is that those symptoms interfere with quality of life or body satisfaction and self-esteem. However, some emerging evidence suggests that is only part of the story, the researchers found.
The studies suggest that obesity and infertility appear to exacerbate psychiatric symptoms in women with PCOS, but don’t fully explain them. Indeed, genetic factors may play a role in both conditions. In a twin study, for instance, researchers found that the risk of depression was higher not only in people with PCOS, but also in the twin who did not have the syndrome. That implies a possible genetic cause that might increase the risk of both conditions.
Chronic Pelvic Pain
Another subset of the research the team examined focused on chronic pelvic pain. The condition affects one in seven women in the United States. In some cases, the pain can be traced to problems such as endometriosis. But for many women, the cause of their chronic pelvic pain remains elusive.
Unsurprisingly, chronic pelvic pain is associated with significantly higher rates of depression, the researchers found. Physical pain may not be the only explanation, however. “A number of studies showed that women who had chronic pelvic pain had an increased rate of childhood sexual trauma,” Ms. Zaks says. “This might point toward an environmental explanation for the increased rate of psychiatric diagnoses.”
Psychiatric Research at Mount Sinai and Beyond
Learning more about the shared mechanisms might help researchers better understand the development of both psychiatric and reproductive system disorders and could point to new directions for treatment.
The findings also suggest that physicians should do more to screen for and treat co-occurring disorders. “It may be that if you address a patient’s reproductive problems, psychiatric treatments may be more successful,” Dr. Janecka says.
The two researchers plan to continue exploring some of these associations in greater detail, but they hope they won’t be the only ones to dig deeper. “We know this association exists, and we know there’s a gap in the research. The data are there, just waiting to be studied,” Ms. Zaks says.
“One of the main things that struck us is how little is known,” Dr. Janecka adds. “This is just the starting point.”
What do resilient people do when times get tough? Researchers at Mount Sinai, including Dennis Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs of the Mount Sinai Health System, have a long history of exploring that question.
So when the COVID-19 pandemic arrived in New York City early in 2020, Dr. Charney gathered together Mount Sinai experts in trauma and resilience, who recognized almost immediately what lay ahead. They saw that their staff was at risk for stress-related conditions from the mounting crisis—and they didn’t wait to react.
By early that summer, the Center for Stress, Resilience, and Personal Growth (CSRPG) opened its doors, directed by Deborah B. Marin, MD, the George and Marion Blumenthal Professor of Psychiatry. Over its first few years, the Center has become a firmly established resource available to all Mount Sinai staff, faculty, students, and trainees.
When developing the program, the Center’s leadership, including Vanshdeep Sharma, MD, Craig L. Katz, MD, and Jonathan DePierro, PhD, drew on their collective expertise managing the behavioral health impact of the September 11, 2001, attacks in emergency responders.
“We had existing services that predated this Center, but there was a clear need as the pandemic raged on to have an on-the-ground resource led by mental health professionals,” says Dr. DePierro, the Center’s Associate Director and an Associate Professor of Psychiatry at Icahn Mount Sinai.
The Center was designed to provide evidence-based services to increase resilience and support the psychological well-being of the people who make the Health System function. Three years later, it remains a valuable and effective resource for the Mount Sinai community, and a model for other health systems.
Treating Health Care Provider Stress
Dr. DePierro and his colleagues at the Center set out to create a program that would support staff with mental health needs while also offering preventive measures to reduce the risk of stress-related conditions. Their dedicated team includes clinical social workers, psychologists, psychiatrists, and support staff. Together, that team supports the 43,000 people who work within the Mount Sinai system, including health care workers, administrative and support staff, medical students, and trainees.
Jonathan DePierro, PhD
One of the Center’s earliest offerings was an immediate way to connect to support. “Anyone employed at Mount Sinai can call to be evaluated over the phone and referred for behavioral health care as needed,” Dr. DePierro says.
While some in-person services are available, telehealth options are also available for behavioral health services. That makes care more easily accessible for those who need it—and helps them feel more comfortable seeking services in the place where they work. “We take many efforts to ensure we’re protecting confidentiality,” Dr. DePierro adds. The Center’s faculty practice is led by Clinical Director Ashley Doukas, PhD.
While providers at the Center often help people manage work stress and burnout, their concerns don’t have to be job-related. “We started in the midst of the pandemic, but people are presenting with stress from all sorts of things: exhaustion, relationship problems, sleep problems, depression, anxiety,” he adds. “We take care of you first as a person, and second as a health care provider.”
Boosting Resilience Through Prevention
Treatment is only part of the Center’s scope. The Center’s leadership team also drew from the deep well of scientific literature on resilience to develop training materials that would help employees weather the storm of stress.
Based on that science, the team developed a series of resilience training curricula to give people the tools and skills to manage stress in healthy ways. Since 2020, they’ve led almost 400 resilience workshops with the Mount Sinai community. Those workshops are tailored to the needs and cultures of a given group. Nurses, for instance, may have different needs and stressors than hospital security staff or medical students. “One important lesson to take away from this is that there is not a one-sized-fits-all approach,” DePierro says.
The workshops are customized for each population, but they share a common goal: “They provide the tools people need to manage the ups and downs they deal with on a daily basis,” Dr. DePierro says. Scarlett Ho, PhD, Director of Education, is responsible for the ongoing expansion and evolution of the resilience workshops.
Tools that can boost resilience in the face of stress and trauma include:
Social support
Remaining optimistic
Facing fears rather than withdrawing from them
Physical exercise
Having a role model or mentor
Thinking flexibly about challenges
Avoiding negative self-talk
Much of the evidence in support of these strategies is described in detail in the forthcoming third edition of the book Resilience: The Science of Mastering Life’s Greatest Challenges, by Drs. Charney, DePierro, and the late Yale University psychiatrist Steven M. Southwick, MD.
An Investment in Health Care Provider Well-Being
The Center continues to grow and expand its offerings. In 2021, the team shared its resilience training program with the broader New York City community, partnering with faith-based organizations in Harlem, the Bronx, Brooklyn, and Queens.
“In 2022, we trained community health advisors and pastors in nine organizations to teach workshops to their congregations, reaching over 1,000 community members,” Dr. DePierro says. This work built on more than a decade of community-based partnerships fostered by Dr. Marin and health care chaplain Zorina Costello, DMin, Director of Community Engagement for the Center and the Center for Spirituality and Health at Mount Sinai.
In 2022, the Center and Mount Sinai’s Office of Well-Being and Resilience jointly received a $2.1 million Health Workforce Resiliency grant from the Health Resources and Services Administration to further develop the resilience training and tools. In collaboration with partners in digital health, including the Hasso Plattner Institute for Digital Health at Mount Sinai, the Center’s leadership also created an app called Wellness Hub. Available to Mount Sinai’s health care workers, the self-guided digital health platform allows users to screen themselves for stress and provides activities to boost resilience.
Staff of the Center for Stress, Resilience, and Personal Growth at Mount Sinai
The Center’s team is collecting data to evaluate the efficacy of their workshops and the app. So far, feedback has been positive. Surveys from workshop participants suggest that following the training, people feel better prepared to manage stressors from their jobs and their personal lives. “They have a better sense that they can bounce back from life’s challenges,” Dr. DePierro says.
As the team collects more data about program outcomes, they are considering packaging the material for other health systems to use to boost resilience among staff. In the meantime, Dr. DePierro says he’s happy to share his knowledge with other health system leaders who want to take steps to invest in the mental health and well-being of their providers.
“We’re exceptionally lucky that Mount Sinai has had the vision to invest in this resource at a time it was badly needed,” he says. But even as the pandemic eases, that investment is paying dividends, he adds. “We’re baked into the system now, and we’re not going anywhere.”
“We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
By the time students reach New York City’s Judith S. Kaye High School (JSK), multiple systems have failed them. As a public transfer school for students with significant barriers to their education, many of JSK’s students have faced significant adversity.
“All of our students have been disconnected from school at some point and many have experienced some trauma,” says school principal Andrew Brown. Mental health disorders and substance use problems are common, but linking students to traditional mental health services is nearly impossible. “Even for students who are ready to meet with someone, once they leave the building, the obstacles are frequently insurmountable,” Brown says.
Thanks to Mount Sinai’s UPRISE (Use Prevention Recovery Intervention Services & Education) program, students no longer have to leave school to get the care they need. “Rather than trying to get students to come to us, we provide services on-site,” says Rachel Weller, PsyD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and project manager and clinical supervisor for UPRISE.
The partnership, launched just before the COVID-19 pandemic, is helping students address their mental health problems and substance use, often for the first time. “Having access to this high-quality care, within the school building, is a game changer,” Brown says.
Youth Mental Health: An Unmet Need JSK, which serves about 145 students at their Manhattan site, is co-located within the School of Cooperative Technical Education (Coop Tech), a career and technical school that serves about 1,500 students. Students from both schools are offered access to mental health and substance use treatment through the UPRISE program.
UPRISE is an offshoot of the Comprehensive Adolescent Rehabilitation and Education Service (CARES), a program of the Addiction Institute of Mount Sinai that has served adolescents and young adults for more than 20 years. CARES provides a therapeutic high school environment that includes a range of targeted services for youth with complex mental health, substance use, and educational problems. While CARES has seen great success, the need for services among New York City youth remains significant. UPRISE is a new model that shows how mental health services can be integrated into a public school setting.
Both Coop Tech and JSK serve historically marginalized populations who have long been subject to systemic racism and discrimination, says Shilpa R. Taufique, PhD, director of the psychology division for the Mount Sinai Health System and director of CARES. “These students and their families have all had the experience of not being seen or heard, and of having institutions impose what they think is best for them,” she says. “There’s such a deep mistrust of the systems that are supposed to be helping them.”
As a result, students have often struggled for years with mental health problems — even before the COVID-19 pandemic made youth mental health a national crisis. “We see many kids present with PTSD, complex trauma, major depression, anxiety, and difficulty with substance use,” Dr. Weller says. “What’s most striking is the number of students who have a longstanding history of mental health difficulties, yet have never received any type of treatment.”
A New Model of School Mental Health UPRISE aims to give adolescents the tools to help them develop into healthy, functioning young adults. The clinical team is small but mighty: Dr. Weller is on-site in the school most days, along with part-time clinical staff including two postdoctoral fellows and a graduate student extern. They currently provide services for about 30 students, but Weller and her colleagues hope to double that number in early 2023.
UPRISE offers a range of services, including:
Psychoeducation
Individual therapy
Group therapy
Family therapy
Milieu therapy
Substance use treatment
Medication management
In addition to counseling and therapy services, the team helps students connect with prescribing providers via telehealth for medication management. All of these services are billed to students’ insurance companies, making it a model that is both sustainable and replicable, Dr. Taufique says.
Flexible Approaches to Teen Mental Health Plenty of schools have experimented with embedding social workers or mental health providers in school settings. But UPRISE goes further. Before launching the program, the team spent a year learning about the schools and their students’ unique needs. “People make a lot of assumptions about teenagers, especially young people who have been disconnected from school or who are in treatment,” Brown says. “[The UPRISE team] didn’t come in with any expectations about who these kids are.”
That open-minded attitude has led to several innovations. URPISE takes a novel approach to family therapy, incorporating school staff into students’ treatment plans much like parents or other family members might be included. “The school setting is a surrogate family for most of these students. The teachers, guidance counselors, and social workers are very involved in their students’ lives — these are the people students call in the middle of the night if they’re in crisis,” Dr. Taufique says. “We want to highlight the roles they play in students’ lives and also give school staff some therapeutic framework to draw on so they don’t get burned out.”
Clinicians provide services to students in school during the school day, but they also reach out to them in the community. If a student has a phobia of the subway or anxiety about coming to school, for instance, providers might arrange to travel to school with them to provide a form of exposure therapy. “We’re not bound by the traditional therapeutic framework where you meet in an office for a scheduled appointment,” Dr. Weller says. “We literally meet them where they’re at.”
Services Without Stigma In addition to services for patients, UPRISE offers psychoeducation and outreach to the entire school community, such as school-wide presentations on topics related to substance use and mental health. The program is also open for a drop-in hour five days a week, so any student in either school can come in to talk whenever they need. “With the drop-in hour, we discuss things that are going on in students’ lives, provide some psychoeducation, and sometimes link students to services or provide referrals,” Weller says. “We want to make this accessible, even to kids we’re not directly serving.”
At a time when most of the news about teen mental health is bleak, UPRISE is making a positive difference in his students’ lives, Brown says. “We have students who are seeing counselors for the first time. They’re showing up to appointments, connecting with counselors. They’re more connected to school.”
“Students look at this as a tool to help them get better and help them transition into adulthood. There’s no stigma attached to it,” he adds. “It’s just become a part of our community.”
“Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
Stigma remains a big problem for psychiatry. Inpatient psychiatric care, in particular, has long suffered from unfair portrayal. The mere mention of an inpatient psychiatric unit conjures up images of Jack Nicholson in One Flew Over the Cuckoo’s Nest. This stigma is present not only among the public, but also among many doctors and medical providers. “There’s a certain amount of stigma and fear around the idea of being hospitalized in a psychiatric unit, but it’s a very different quality of care and treatment than what is typically portrayed in the media,” says Rajvee Vora, MD, MS, Associate Professor and Vice Chair of Clinical Affairs for the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai.
Forget the stereotypes, Dr. Vora says. The inpatient psychiatric facilities at The Mount Sinai Hospital are bright, welcoming, and beautifully designed, and patients receive high-quality care. “Patients are up and walking around, encouraged to be up and about, attend groups and sessions, and play basketball in our indoor court.”
Above all, hospitalized patients receive a range of evidence-based treatments to help them manage their mental illnesses. “Many patients think that being hospitalized is the worst thing that can happen to them,” Dr. Vora says. “But sometimes it actually ends up being the thing that turns their life around.”
An Interdisciplinary Approach to Inpatient Mental Health In recent years, the field of psychiatry has moved most treatments to outpatient settings. Yet for some patients with severe mental illness and acute psychiatric needs, inpatient care remains critical. In fact, the need for such care has increased recently. “During COVID, many outpatient providers switched to remote services, which aren’t always accessible to people with serious mental illness,” says Danielle Campisi, LCSW, director of social work for the inpatient psychiatry service. “Now we’re seeing a big uptick in the number of patients that had been chronically well-managed, but lost access to care during the pandemic.”
The team at Mount Sinai’s inpatient behavioral health unit treats a variety of psychiatric illnesses, including:
Mood and anxiety disorders
Personality disorders
Psychotic illness
“Treatment isn’t something that happens to the patient. It happens with the patient,” says Dr. Rosenthal.
Patients don’t need to be severely incapacitated to benefit from hospitalization, says Blake Rosenthal, MD, Assistant Professor of Psychiatry and Inpatient Unit Chief at The Mount Sinai Hospital. “Sometimes our patients have developed psychotic symptoms for the first time. They may have a change in their ability to perceive reality or are developing hallucinations,” Dr. Rosenthal says. “They can come in without having a complete decompensation and loss of function, and we’re able to meet those needs really well.”
Cutting-Edge Psychiatric Treatments Inpatient treatments typically include medications and intense psychotherapy, including individual, group, and milieu therapy. As a cutting-edge research institution, Mount Sinai offers access to new and emerging treatments, including interventions such as electroconvulsive therapy (ECT) and esketamine for treatment-resistant depression. Patients also receive additional services such as art therapy, music therapy, dance/movement therapy, and substance abuse counseling. “Inpatient treatment is so much more than medication management,” Dr. Vora says. “The core of the work we do is ‘milieu therapy’ — what being in this environment does for patients.”
Patients are treated by an interdisciplinary team that includes an attending psychiatrist, psychiatric residents, nursing staff, creative arts therapists, assistive staff, and social workers. The team develops a comprehensive treatment plan for each patient, which describes the interventions and services they will receive as well as the plan for transitioning to outpatient care. That transition is important, since patients typically stay in the hospital just a week or two before being discharged to outpatient services or to higher levels of care, such as assertive community treatment (ACT).
Social workers work closely with patients to understand their psychosocial needs, connect them with appropriate services, and teach them about their illnesses. “When patients come in, they’re sometimes resistant to being treated. We do a lot of psychoeducation to improve patients’ understanding of their illness, the potential need for medications, and the importance of outpatient follow-up,” she says.
It’s a collaborative effort, Rosenthal adds. “Treatment isn’t something that happens to the patient. It happens with the patient,” he says.
Inpatient Mental Health at Mount Sinai While Mount Sinai provides access to the latest evidence-based treatments, its biggest asset is the people delivering those therapies, Dr. Rosenthal says. “What really distinguishes Mount Sinai’s inpatient program is our team. Our treatment team almost functions as a single provider,” he says. “It sounds cliché, but everyone on the unit cares deeply about how patients are doing.”
Mount Sinai has leading experts in schizophrenia, depression, and other psychiatric illnesses, who often consult on treatment. The team mentality extends to treating a patient’s non-psychiatric medical conditions as well. The inpatient psychiatry team collaborates closely with other service lines such as OBGYN and neurology to ensure all of a patient’s healthcare needs are met during their inpatient stay.
Most psychiatric inpatients are transferred from the emergency department, but individual cases are considered. Learn more about Mount Sinai’s Inpatient Behavioral Health Services, or contact the inpatient behavioral health admissions coordinator at 212-241-5675.
Binge eating disorder is the most common eating disorder in the United States, thought to affect as many as 3 percent of people during their lifetimes. Yet it remains poorly understood.
What do resilient people do when times get tough? Researchers at Mount Sinai, including Dennis Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs of the Mount Sinai Health System, have a long history of exploring that question.
