Sharely Fred Torres, MD, with her grandfather in Puerto Rico.
The racial and ethnic disparity in mental health care is a critical issue facing psychiatry—and health care as a whole. Lack of access, a dearth of racially and ethnically diverse providers, and increased need across the board due to ripple effects from COVID-19 have intensified the need for minority providers. The Substance Abuse and Mental Health Services Administration (SAMHSA) launched the APA SAMHSA Minority Fellowship Program to address this. Sharely Fred Torres, MD, a rising second-year resident at The Mount Sinai Hospital, was just awarded this year-long fellowship, which begins in October 2021.
“One reason I knew I wanted to go into psychiatry is that there are so few minority providers, which is not a problem that is unique to psychiatry,” she said. The Mount Sinai Hospital is at the border of two socioeconomically distinct neighborhoods of East Harlem and the Upper East Side, so the inpatient psychiatry unit sees very diverse patient populations. “In my medical training at Mount Sinai, I would say that more than 50 percent of my encounters are in Spanish. I feel really lucky that I can talk to many of my patients in their native language as a bilingual person. They’re much more comfortable with a doctor they can relate to, and more likely to be honest about topics they would otherwise keep hidden.”
The path to psychiatry
Dr. Fred Torres was born and raised in Puerto Rico, and has been interested in pursuing a career in psychiatry since she was young.
“I realized that working in medicine could allow me to work with all kinds of populations and help people in the most fundamental way possible, which is their health,” she said. Regarding her interest in psychology, she said, “I really liked thinking about what drives people’s behaviors and decisions. It applied to so many interactions I’d had.” Dr. Fred Torres’s psychology course at Harvard was taught by Professor Dan Gilbert, who inspired her to pursue psychology as her college major with an emphasis on social and cognitive neuroscience. She joined Harvard Medical School’s Family Van program, which provided disadvantaged neighborhoods in Boston with preventative health screenings such as blood pressure, cholesterol, and blood sugar levels, as well as medications.
“I loved the medical aspects, like learning how to take someone’s blood pressure, but I also loved listening to their stories,” she said. “When the patients spoke about loss and trauma, it really became clear that the lack of access to mental health services was a huge problem in this community.” It was during these years that she also realized that many of her college peers were navigating emotional stressors in school. “I noticed mental health issues affect everyone. But not everyone seeks care.” This led her to join Harvard’s Student Mental Health Liaisons program to advocate for mental health services for college students. She worked with the director of Harvard University Health Services to ensure that freshman orientation at Harvard featured workshops on mental health services so that freshmen had the information early on, rather than waiting for a crisis to seek help.
In medical school, she became one of the first students at the Icahn School of Medicine at Mount Sinai to be accepted to the Primary Care Scholars Program launched in 2015. Through this four-year scholarship for students interested in providing primary care to underserved communities, she provided longitudinal care for patients in a variety of primary care settings. Her medical school tenure was five years, because she took a scholarly year to research under the mentorship of Adriana Feder, MD, and Mercedes Perez-Rodriguez, MD, PhD. “That year really grounded my interest in psychiatry,” she said.
Research and APA SAMHSA Minority Fellowship Program
Dr. Fred Torres is grateful that she is able to take advantage of the APA SAMHSA Minority Fellowship Program for psychiatry residents who are committed to addressing mental health disparities through a scholarly project. She plans to research cultural components that shape post-trauma trajectories within the World Trade Center (WTC) first-responder cohort that Dr. Feder has been studying for many years as the associate director for research at the WTC Mental Health Program.
“When Hurricane Maria hit Puerto Rico in 2017, I was in the beginning of my scholarly research year. Being directly impacted by that experience made me realize I wanted to shift my learning to focus on trauma-based research,” she said. “I saw how in the face of trauma, despite much loss and hardship, there was also a sense of support growing in the community in Puerto Rico with people at home coming together to support one another through this shared experience. I was proud and inspired by my community.” Dr. Feder let her know that she could learn about trauma by working with the WTC cohort, a unique population affected by the same traumatic event, in which there is a significant Hispanic population as well.
Dr. Fred Torres wants to explore culturally unique resilience factors within this group. “In much of the Hispanic community, no one talks about anxiety or depression,” she said. “Instead, there is a tendency to go to church and pray when faced with life stressors.” She hypothesizes that depending on the individual, the religious factor and other culturally specific variables can serve both as a barrier to and enhancement of resilience, strength, and meaning after a traumatic incident.
Via qualitative individual interviews during her fellowship, she plans to compare the Hispanic WTC cohort to other minority and non-minority counterparts to identify culturally specific factors that contribute (or detract) to resilience. She hopes the findings from her fellowship research are ultimately incorporated into culturally sensitive therapy for trauma. The Mount Sinai Hospital’s psychiatry residency allows time for research projects in the second year, and Dr. Fred Torres’s mentors, Dr. Feder and Dr. Perez-Rodriguez, will guide her in her scholastic work.
Career plans
Once she finishes residency, Dr. Fred Torres hopes to focus on outpatient therapy for many psychiatric conditions such as personality disorders, depression, anxiety, and trauma. “I like the idea of longitudinal, years-long relationships with patients,” she said.
After residency, she hopes to continue to pursue research and academic interests in order to better inform the care she provides patients. “In this career, you can help anybody,” she said. “There’s nobody who doesn’t need health care. I feel privileged to be in a position to help someone on such a fundamental level. But within the field of psychiatry, we face unique challenges to providing care. Our practices are not as clear-cut—you can’t draw someone’s blood and with a biomarker determine that they have depression or anxiety, in the same manner that you can measure someone’s cholesterol level for example. We rely on the psychiatric interview. I enjoy this challenge of working with patients through that subjective space together.”
Furthermore, as she did in medical school and her residency with the Admissions Committees, Dr. Fred Torres hopes to continue efforts to ensure the diversity of the medical field by recruiting diverse medical trainees and increasing academic support for students who are underrepresented and/or disadvantaged in medicine.