Session 3: NIMH 75th Anniversary Event 2: Amplifying Voices and Building Bridges: Toward a More Inclusive Future

Transcript

Session 3: Cultivating Inclusion in the Mental Health Research Workforce and Keynote Address and Closing
 

JANET CLARK: I am Janet Clark.  I am the director of Fellowship Training for the Intramural Research Program.  And we are located on the Bethesda campus of NIH.  I'm very much focused on those conducting the NIMH-supported research and ways to build and maintain a vibrant and inclusive research community.

This session will consider how NIMH can help develop a workforce that better represents the full spectrum of our population. Additionally, we will discuss the challenges people face as they try to make it in science and talk about what can be done to address those challenges.  The panel for this session includes researchers from across the spectrum of NIMH-supported science, who are at different career stages and took different paths.  First is Dr. Gina Poe, who is a professor and Lorre Scholars chair in the Department of Integrative Biology and Physiology, the Department of Psychiatry and Biobehavioral Sciences, and the Department of Neurobiology at the University of California, Los Angeles. Dr. Poe directs local and national programs to increase diversity in the neurosciences and other science, technology, engineering, and mathematics fields, or STEM fields.

Dr. Cynthia Rogers is the Blanche F. Ittleson professor of psychiatry and pediatrics, the vice chair of Child and Adolescent Psychiatry, and the director of the Division of Child and Adolescent Psychiatry at Washington University in St. Louis.  Dr. Rogers is an academic child psychiatrist.  And her clinical work centers on addressing the impact of social determinants of health to reduce the development of psychiatric disorders in perinatal and child populations.  Next is Dr. Fátima Sancheznieto, an associate researcher at the Institute for Clinical and Translational Research at the University of Wisconsin, Madison School of Medicine, and Public Health.  Dr. Sancheznieto brings the perspective of someone who studies STEM training environments and programs and the ways in which they can be improved to support and develop the next generation of scientists.

And last but not least, Dr. César Escobar-Viera is an assistant professor of psychiatry and director of the Program for Internet Delivered Interventions on LGBTQA+ Mental Health, or PRIDE iM in the Department of Psychiatry at the University of Pittsburgh School of Medicine.  Dr. Escobar-Viera's research focuses on leveraging social media and consumer information technology to improve both mental health outcomes and access to mental health services for minority individuals.  For this session on Cultivating Inclusion in Mental Health Research Workforce, we will have an informal format with each speaker providing brief introductory presentations to discuss their career path, and their vision or philosophy around research, training, and career development.  These presentations will then be followed by a roundtable discussion for which I will moderate.  First, I would like to welcome Dr. Gina Pope.

GINA POE: I want to thank everyone who invited me here. I've been -- I'm so honored to be here. I'm so glad to be here just to meet the other speakers and the audience members.  You guys are formidable, and I've learned already so much from you.  So, my talk -- let's see -- how do I navigate this? How do I navigate the [laughs] -- the --

Oh, this thing.  Okay.  Thank you. The big green arrow.  Got it.  Okay.

All right.  So, the first piece of news is not so good.  Over the past 10 years, we really haven't budged the way it looks in academia.  This is life science professors of all ranks at all universities in the United States. And really, the numbers of Black and Hispanic professors really haven't changed over the last 10 years.  And, in fact, I saw a report that said if we -- all the efforts that universities are making continues the way we've been, it'll take 100 -- more than 100 years to make the professors look like the students look.

It just is not going to work.  I don't have that long.  And so, we really have to do something else.  All right.  So -- and I think one of the major blocking points is really bachelor's -- high school -- used to be high school.  So, this is in 2010 in dark blue, in 2022 in purple.  The numbers -- or the percent of the population who completed high school or more.

And as you can see, the third column over is Hispanic and the second column is Black.  So, Black people have not done badly in terms of finishing high school.  But when you talk about bachelor's degrees, both Black and Hispanics are falling behind their White counterparts, which is the ones to the far right.  And when you talk about master's degree or more, it's about the same profile.  So, there's drop offs at every level, but really that bachelor's degree is where we're really failing our population.

So, how are we going to increase the numbers of people in research if they're not finishing bachelor's degrees?  And so, that's something we should consider.  This is me in the middle.  You can see I'm one of about 44 people.  And this is the very first research conference I ever attended. And it was funded by the NIMH, and it was a basic sleep research I had with in the laboratory of Barry Sterman [spelled phonetically], who had been an early sleep researcher.

And I was just there to make some money while I was waiting to apply to medical school, and I found out how fun research was. This was pretty much -- these 44 people -- pretty much the entire field of sleep research at that time, 1988. And as you might be able to see, I'm the only Black person in the group.  There are three from -- three Latinos, most of them from Latin America.

There are three people who are Asian.  And there are -- let's see -- some from India -- three from India, but the rest are white.  And it really hasn't changed that much since then.  I am now one of three in the United States that do basic sleep research, who are African American.  Dr. Ketema Paul who's at UCLA.

Marishka Brown trained in it, but now she's a program director at the National Center on Sleep Disorders Research.  She's amazing.  And I asked her, could this be right?  Are we the three?  And she said, "Well, let me think [laughs]."  She hasn't gotten back to me, so she hasn't -- I don't think found anyone else.

There's in Germany, Lisa Marshall.  In Israel, we have Ilana Hairston.  And the other newest member is Lauren Whitehurst at the University of Kentucky.  And that's pretty much [laughs] it.  So, it really hasn't changed that much, but at least we haven't lost ground, at least that's true.  But really, how do we increase it?

It's really not rocket science.  It's pretty much -- the basic thing I'm going to talk to you about today is about being welcoming and thankful and excited to open your arms to other groups.  It's really just follow your heart.  Once you have that attitude in your heart, everything else will follow.

So, let's go through.  So, mental health research is actually doing a little better than sleep research.  Thanks to the NIMH's 20-plus years support of the program called SPINES at the Marine Biological Laboratory, which I've been part of for the last 10 years.  And so, now, we have about 600 people that can meet together at the Society for Neuroscience that went through the SPINES program since 1988.  It's been -- it was the first few -- 10 years was funded in another way, but the NIMH has been funding it since then.

And I've been director of it for the last seven years.  I just turned over directorship to two other people.  But this is just one of the classes.  And this is the first two directors, sort of in the back middle, the older people there.  That's Jim Townsel and Joe Martinez.  And they are the ones who started the program.

And it's -- every year trains about 20 people -- 20 graduate students from backgrounds that are underrepresented in neuroscience -- and specifically trying to get people in mental health research. So, mental health is not doing as badly as some other fields, but it's still not fantastic.  So, here's Joe Martinez and Jim Townsel, who both recently passed away in the past couple of years.  And now, Gerry Downes to the right is leading it, and together with Stephanie Correa, who is also a UCLA professor.

So, what are the barriers?  Well [laughs], you know, we say welcome to research, but we erect barriers to research.  And really, it's fundamentally based on a culture of exclusivity.  You know, we are so great and nobody else can be as good as us. You have to earn your way into our ranks.  And really, we form unnecessary barriers to this entry.

We do things like in college grading on a curve, which is basically changing the way you grade as the semester moves on, or the term moves on.  It's really unfair.  Raising the bar midway as people progress through postdocs to try and go into a faculty position, or in faculty.  You can change the bar as things go along.

And I've been part of faculty promotions committees where I've heard the bar being raised higher and higher and higher every year, when we are saying to ourselves and to each other that, in fact, we value other things besides just nature papers or science papers.  You know, we value other things like community research. But, in fact, you know, we're not putting our money where our mouths are and not promoting, so that's an unnecessary thing.  We're not giving guidelines to our professors or our students.  We're not following our own stated guidelines.  All of these things amount to unfair treatment.

So, it's really not like -- you know?  And so -- and in the past, important contributions have been overlooked.  And so, our community doesn't see what they could be and could do.  It's just really until the movies "Hidden Figures" and "Something the Lord Made;" and finally, acknowledging Dr. Solomon Carter Fuller's first -- who is the first African American neurologist that we finally start to see in the media what is going on.  I didn't know.

When I was in college, I didn't see anybody who looked like me who would be professors and doing research.  So, I didn't even think of it as an undergraduate. I didn't even think of it.  I just joined a research lab to make a little bit of money and pay the rent.  So, you know, really, follow the principles of a building owner or something.

Create a welcoming [laughs] space.  Put structures in place to ensure that voices are heard, success is likely.  Invite people, support them, be fair, provide those resources that are needed.  Consider the disparate needs of different people.  It's not where -- not all cut out of the same cookie cutter.  We all have different needs so listen to them and consider them.

Be self-critical when you're looking at your own record.  Say, you know, why don't I have more people in my lab, or why aren't there more professors in my department?  Be self-critical, what -- how have I failed people in the past?  And then celebrate people's contributions, promote them, and thank them.  Just be welcoming.

So, I was going to go through what different students need or trainees need at different points.  I don't know if I have that much time to go through all of these points so I'm just going to make my slides available if you want them.  It's pretty simple things like, you know, giving high school students specific jobs, et cetera.  What undergrads need?  Money. Don't just rely on free labor in your lab, pay people [laughs].  It really -- it makes it really unfair.  Otherwise -- and trust some to carry on a project.  Give them a first authorship if they deserve it.  My goodness, you know, let them have that.  It really makes a difference.

And then grad students, they need different things. They're in your lab a long time. And so, different needs for different students, but everybody needs money and support [laughs].  They need your time.  They need you to listen to them because they can tell you what they need. They're adults.

So, they need practice talking, writing papers, looking over grants.  Give them those opportunities.  And they will need, in the future, your help with their career promotions every step of the way, so be there for them.  Introduce them to your colleagues.  Give them chances to network.  Bring them to conferences.  Don't just dump them at conferences but introduce them to people.  Give them prompt responses to their questions. Give them guidance on the skills they need to develop.

And then postdocs, you know, they have more independence still.  Give them the respect that they need, and the independence they need.  Don't just make them slaves in your laboratory, but, you know, treat them as your colleagues.  So, anyway, I'm not going to go over every one of these points again.

But even early career faculty, this is UCLA, some early career faculty people I really love.  And I'm so glad they're there.  One of the things that early career faculty need -- and one of the things I really needed -- was a peer group to -- I could confide in and feel comfortable confiding in about the troubles I was going through, or the troubles I was seeing ahead. And then hearing that same thing from other people so I didn't feel so alone or inadequate.  Because everybody struggles with various issues, and hearing how my colleagues struggle with issues that I haven't even seen yet, helped me when I had to get to them, deal with them, and know how to deal with them. That was really, really key.

All right.  So, one of the things we need is how to manage funds.  You know, how to manage people and politics?  And honestly, I was 10 years into a faculty position before I really knew who was who and what did -- who did what in a university.  And we need to really just tell people.  You know, who has what power?  I didn't even realize I would have a boss until I was about four years into it.

I said, "Oh, no."  Yeah.  So, there's very specific things that faculty need to really make it.  We all need peer mentors; people who see you, know you, can promote you, advise you, read the drafts of your papers and your grants, share their experiences, invite you to speak at their universities; et cetera. And we all really need a sense of community and a sense of belonging.

And if you can't get it at your institution, you need to be able to have the peer mentoring all over the country and find it in other ways.  This is a picture of the students and faculty at the SPINES program every summer, three intensive weeks.  Let people know they belong.  You know, give them a place at the table, tell them they belong there, and invite them in. All right.  So, just the same things, have somebody in your life who can celebrate you and the things that you do.  People who can accept you for who you are, and what you uniquely bring, because each person does bring something unique.  And these are the nevers.  I don't even want to go through them.  They're so painful, but it happens all the time.  It's shocking to see, you know, people picking favorites, punishing behaviors and findings they don't like, et cetera, spreading gossip.  I won't go through all of that.  I'll let you look at the slides.  But do support, appreciate, encourage, back up, be open, be clear, promote, show people how, and guide them.  This is one of the SPINES' trainees that I'm with here.

Life is long.  The world is small.  You never know what's going to happen to people.  Your mentees may be your colleagues pretty quickly.  And your colleagues might be your bosses.  Tracy Johnson is now my dean.  She was my colleague before.  So, you know, just use the golden rule, treat people like you would like to be treated.  Be kind to one another.

Live and learn and hang in there, that's one of the things I tried to tell my graduate students.  We're all in an elevator together, and that's really kind of the analogy, right [laughs]?  This is my lab in an elevator.  We're all in it together.  Hang in there.

There are resources, and we're going to hear about some of them pretty quickly like NRMN.  And have a growth mindset.  If you might not be where you want to be right now, but you can get there, keep your mind open.  So, that is, I think, pretty much -- you know, I didn't start out wanting to be a scientist or a professor.  I never saw anybody that I knew doing it.

This is my stereotype of what a professor was, or a scientist was.  And the professor was, you know, overworked and underpaid.  But through good mentoring [laughs] and through the example that people gave me that I got through the backdoor, I saw that, you know, there were people that could be -- that could be like me in this profession.  And it was heartening to see.

So, I want to thank the NIMH for their 20-plus years of support through R01s -- because REM Sleep and Memory is my field -- and other grants that have been granted to me, and then grants that have been granted like, for example, to the SPINES program that have enabled me to continue the work.  And this is my laboratory right now.  I'm hoping -- I have two Black women in my lab.  And hopefully, if they stay in sleep research, we will increase from three to five.

Yeah.  All right. So, thank you so much.  I appreciate your time.

CYNTHIA ROGERS: All right.  Hello, everyone.  I'm Cynthia Rogers.  And I want to thank Dr. Gordon and the NIMH for asking me to come and talk a little bit today.  And I was given the instruction to sort of talk about my journey, what sort of challenges I've faced, and how the mentoring that I've received and I've been involved and has led to more diversity in psychiatric research.  So, that is my charge today, and I will try to do that.

All right.  So, I thought just even starting in with some definitions of inclusion that I think are really important.  One of the things that I read and really sort of internalized about inclusion is that it's a process.  It's not an end.  It's more a verb than a noun.

How do we actually intentionally make people feel welcome, right?  And so, if we don't do that, that's how I feel like we lose a lot of folks along the way. We can do a really great job recruiting folks, but we don't retain them because we're lacking this intentional process of making people feel at home.  So, to talk about my own journey, it has been paved with both challenges, but also with opportunities.  And I want to talk a little bit about both.  If you cannot tell from my accent -- which my husband says you should be able to tell readily -- I am from the great Commonwealth of Kentucky, where I grew up.  We say we're born and bred, just so you understand that we raise horses as well.

And I went to maybe the fifth best public high school -- if we're being generous -- in Louisville, Kentucky, and, you know, received what I feel like was a great education, but was often the only Black student in the room.  Definitely, the only Black female.  So, that's just kind of how my life started and continued pretty much throughout high school.  College, I was fortunate to go to what we consider to be the best college in the country. No one else agrees with us, but that's how we feel about it.

And after that experience there -- you know, majoring in psychology, realizing that my lifelong dream of going into medicine was indeed what I wanted to do and I wanted to focus on mental health -- I then went to -- was able through connections through my adviser -- who was really lovely, but a White male because I had no professors that were Black females throughout college -- recommended me to somebody, another White male at UCSF, and was able to do research with them.  And then went on to medical school at WashU, which is where I am still and apparently will maybe die there.  I don't know, but WashU has a way of grabbing people and holding you really tightly, which is a good thing.  And I'll explain why.  So, I did my residency there in psychiatry, and also my child psychiatry fellowship. Some of that was due to a boy because he had to get a PhD along with his MD so we could never move together.  So -- but I was fortunate to get really great training.  And then I stayed and continued to stay.  I got a T30 -- I was on T32.  I did my postdoc, join the clinical faculty.  Eventually, I got a K23 or career development award, and then got an R01.  And I've had some subsequent R01s since then.

So, I've been successful throughout my career, but I've faced along the way, you know, bias sort of continue -- and the thing about the kind of bias that you faced sometimes as a minoritized person in academia is it's not always super overt.  It's often these just little things that dig at you as you go along.  No one ever expects you to be the most knowledgeable person on a particular subject, or the fact that you have to prove yourself to a degree that maybe other people don't.  And, you know, as I was reflecting on my career for this talk, you realize over time it does take a little bit of a toll on you to have to do that all the time.

Some people walk into a room with the expectation that they're knowledgeable, or that they are going to know, you know, exactly what it is that they're talking about.  And then there are those of us that walk into a room and people assume we don't, and so we have to prove it to them.  And so, that does take -- that does take a toll.  And I think that those are some of the things that I think we don't always talk about in terms of bias, and that's occurred throughout my career.

And then I've had a real lack of URiM mentors. So, I have not had -- particularly on the research side of things -- a Black female mentor ever in my area.  I do neuroimaging research.  I do longitudinal research.  And that just has not occurred across the time of my career thus far. But that has motivated me, and I'll explain that in a moment.

And then as I moved on, even as being a faculty member in my department, which I consider to be one of the great departments of psychiatry in the country, and we've been fortunate to have really fantastic chairs, but I have been the only female faculty member that is Black the entire time I've been there.  And so, just this January, we hired another female faculty member that's Black. She's a PhD, so I remain the only female physician that's Black that's on faculty in our department.  And we're working on it diligently, but it does -- you know, you notice these things.  And I did ask -- we have a new chair, and I did ask him, "Do you know I'm the only Black female faculty?"  He's like, "Yes, I know."  I said, "Okay.  Just checking."

So, that's something we can focus on with your chair back, and you can sort of work on this now.  And just at the medical school, in general, there just aren't that many of us, particularly that are physicians.  And so, that -- looking for your people, your cohort, it can be challenging when you're in that setting.  So, these have been the challenges I faced.

So, now, we'll talk about the opportunities, though, along the way.  If I can -- if I can get this to work -- oh, I'm going the wrong direction.  That's okay.  All right.  So, when I was in California, I had never heard of Washington University.  I realized this is publicized, and so it's probably not a good thing for me to say, but I really had never heard of it.

And I got like a brochure in the mail or something while I was thinking about medical schools.  And I was like, "Oh, this is a good medical school."  And it's close to home, but not too close because, you know, you got to be far enough away that they're not seeing you all the time but close enough you can get to them when you need to.  And so, I thought, "Well, let me check it out," and really fell in love with it.  And while I haven't had any real Black female mentors, I did have one Black male mentor, Dr. Will Ross.  He's a nephrologist.  He doesn't do research.  But what he does do is his best to recruit underrepresented minority students to WashU. And I was fortunate to receive a scholarship, which made it really easy not to go back to Harvard when I was able to go to WashU for med school without having to pay tuition.

And then as a resident and as a fellow, there were these other institutional programs that helped me find a cohort. They may not have been in psychiatry, but other residents and fellows at the medical center, who are also facing the same challenges.  And so, that is what promotes inclusion, right?  So, that is -- these are some of the things that sustained me against some of the challenges that I faced.

And then I was able to -- through our Faculty Affairs Department -- receive, as part of a startup package, some funding for the Faculty Diversity Scholars Program at WashU.  And that came also with a cohort of other junior faculty from other departments that we would meet with frequently.  And so, I'm highlighting these things not as just like a commercial for WashU -- because I think I've also told you some of the downsides -- but also because I think showing that, you know, it's not easy to recruit 20 underrepresented minority faculty in any particular specialty all at once.  Like, that's really hard.

The first grants are fantastic.  Although WashU tried multiple times, and we didn't get it, but I'm not taking it personally.  It's because our dean said he's still committed.  So, bringing those cohorts in, that is great, but you can't always do it like this.  So, you need other things to sustain your people that are there, while you're trying to work on building the workforce.  And these really did help sustain me in the setting of a lot of challenges.

And so, I went on to start a clinical service that serves pregnant and postpartum folks that are mostly under-resourced and from minoritized communities in St. Louis, which is primarily Black.  I run a research center.  I co-run a really large imaging lab, and two years ago decided that wasn't enough.  So, I took on being a division director of Child Psychiatry at Washington University.

So, I've been very successful in this career path. And I'm very fortunate I've had a lot of wonderful sponsors and mentors along the way, even if they weren't from underrepresented groups.  But these other ways of making me feel included when I'm frequently the only [one] were really important to my success.  So, I have felt a very strong responsibility to pay this forward because I want as much as possible other folks not to feel the same way that I felt across their career, a feeling sort of lonely and always being the only.

And so, I've been able to benefit -- been able to do that through some programs that have existed at WashU.  So, there are a lot of faces on this slide.  But if you start to the far -- your far left, those are undergraduates who were part of the ENDURE Program, which is part of the NIH blueprint for -- on neuroscience.  And so, I've been able to mentor them across multiple summers.  And one of them who, you know, came back for another year and another summer, and research projects that were around mental health.

And, you know, I think that's been really -- you know, mentoring is the best part of my job.  I do all these other things that people, you know, focus on, but that's the part I love.  Whenever anybody asked, "What is the part of your job you love?"  Mentoring. Like, I don't miss mentoring -- my mentoring meetings.  I don't miss my grad student postdoc meetings.  Those are the things where I get the most energy, the most joy.

So, mentoring these folks had been really important to me.  One of them is at medical school at Harvard right now, the other one is applying to medical school, and the other one is applying to some postdoc med school programs. And then the next group, the middle, these are all first-year med -- or they're between their first and second year of medical school at Meharry and Nashville.  And they have -- there's a program -- joint partnership between Meharry and WashU to provide research for the top 10 percent of their students.

So, I have been, again, fortunate that they have chosen my lab.  And I've mentored all the folks that you see on the screen over the course of various summers.  Some of them are psychiatry residents, pediatric residents, now OB-GYN residents. And so, I'd like to think it helps them just even a modicum along their way to feel like they too could be successful in academia.

And then the next group of folks are my current postdocs and grad students.  Now, these are not the only postdocs and grad students I have, but these are the ones that are from minoritized backgrounds.  And two of them are neonatology fellows.  So, I'm very promiscuous in who I will mentor.  It doesn't --

You don't have to be a psychiatrist.  Like, I will mentor you in whatever field you're in.  And then one is a PhD graduate student in neuroscience.  And the other has benefited from another really fantastic NIH program, which I only learned about when she contacted me, so that's an issue right there.  I don't know if it's my fault that I don't know about the program, or if it's the NIH's fault that I don't know about the program, but it's the D-SPAN Program, which is -- I don't remember what every single word stands for, but it's basically for -- to increase diversity among predocs and postdocs.  So, it's an F99/K00 grant.  So, it starts during graduate school, and then gives you four years of postdoc support. So, now that I know about it, that graduate student underneath her will be applying [laughs] for it as well, but a fantastic program.

And then on the far end of the screen is a sampling of our lab members.  And so, these are folks that work directly with our participants.  And we feel it's really important that the folks that engage with our participants look like our participants and can relate to them.  And so, although we do not -- obviously, for legal reasons -- put out a job posting that says you must be x, y, or z, we say you have to feel comfortable and enjoy working with populations from diverse backgrounds.

And so, I don't know if it's that or if it's me or if it's the fact that we do research that focuses on health inequities, that brings these folks to our lab.  But we've been really fortunate to mentor them, and many of them were -- one just found out she's going to -- getting her PhD in psychology.  She's a graduate student there.  Many of them go on -- after they leave us -- to be part of the research workforce.

So, while it is a lot to ask if individual, you know, faculty to take on mentoring lots of people, I do -- and I'm not saying it's anybody else's responsibility, but as an individual who lacked that, I feel it's really important that I provide that.  And the more that I provide that, the more of us exist and then the more mentors there are available for other students in the future. So, fingers crossed, this will be sort of an exponential tree of mentors available.  But as the previous speaker, Dr. Poe, pointed out -- oops, too far too aggressive with the green button.  Okay. Pipeline programs are really important. And I agree, you know, starting that sort of high school to college timepoint that ENDURE provides is really important.  That's where we can lose a lot of kids who don't see themselves.  So, going to -- we go to high schools and talk about our careers in St. Louis so that they see what's possible.  I think that's very -- obviously very important.

Funding for those programs is really important, and that's where NIMH can be really helpful.  And then, you know, continuing and potentially expanding research that affects minoritized populations.  I'm really hopeful that nobody that is on my study section is in this room right now or watching this video, but they were upset that we had a research project that was focused on African American women.  And I was like, "Huh, like, I really thought [laughs] that's what NIH wanted."  So, we have to figure that piece out too, right?

Are we interested in research that is going to focus on minoritized populations that haven't been included in research previously in health disparities research, or not?  And if we are, maybe we need to make that more known, but I think that's important.  If you want to increase more of the workforce, they have to know that the problems that face their communities are considered important to the NIH.  And then funding for graduate and postdoctoral trainees, obviously, is very important.  We have to figure out sort of a collective from the NIH, as well as the universities, what are we going to do about graduate and postdoc salaries because they aren't livable?  Like, I'm fortunate to be in St. Louis where at least like the cost of living is low. Another reason why the WashU is lifer, apparently.

But it's -- even there, it's not really enough. And as investigators, there's not much we can do, right?  So, if the NIH doesn't provide the funding, and then the university doesn't want to provide the funding, like we don't have the funding to -- you know, to increase and make it more livable.  So, that's something that we really have to reckon with.  And then doing things like this, where you make your investigators visible to the public for the work that they do, I think is really important.  We're at a time where people are worried that folks like me got here by accident or happenstance or because somebody gave me something nobody else got or that I didn't earn being here.  So, I think making what we do visible is really important for a host of reasons, including encouraging the next generation.  So, with that, I will end and take questions as part of the panel.  Thank you.

FÁTIMA SANCHEZNIETO: Thank you so much, again, for the invitation.  It truly is a pleasure to be here.  I'm not an NIMH researcher.  I'm a child of NHLBI and NIGMS, so I was very pleasantly surprised to be invited.  And then I started to hear the talks, and words like epistemic injustice came up, and nothing about us without us.  And, you know, ask the people that you're working with, and I was like, "Oh, these are -- like, this is the research that I do."  Except the research that I do is on graduate students and postdocs.

So, when people come and tell me, "Well, what does the research say so that I can develop a program that is better for the grad students and the postdocs?"  The first thing I say to them is, we'll have you talk to your grad students and your postdocs about what it is that they need and what it is that they want.  So, there's a lot of cool alignment with the work that I do.  So, again, thank you for having me.  Oh, we don't need two title slides.

Sorry about that.  These are the folks that I worked with.  NRMN was mentioned.  I'm also at the University of Wisconsin with the Center for the Improvement of Mentored Experiences in Research, and up until recently, Future of Research, which I'll also touch briefly on.  So, I usually start not just with the land acknowledgement, but as has been spoken of, as well the questions that are asked.  Who is asking those questions?  What is considered rigorous and not rigorous research?  The traditions that are amplified over others, and the intentionality of settler colonialism and the fact that it is an ongoing project that we can push back against is something that I find really important to highlight, especially because I come from the University of Wisconsin, which was a land-grant university that continues to benefit from land that has not been returned.

And that is an important thing to consider as part of our history and the work that we do.  And this isn't just happening here in the U.S., but all over the world. And again, it's -- because it is an ongoing project, settler colonialism is something that we can all play a role towards mitigating.  This isn't part of my grad research.  But as I mentioned, I'm part of NHLBI, and I was studying blood stem cells when this paper came out from the Zon Lab.

It's a beautiful animation about zebrafish's hematopoietic stem cell development.  So, if you come with me for like two minutes, I will take you down the road of blood stem cell development.  And what actually happens is hematopoietic stem cells, which are highlighted there in green, they bud from the development aorta.  And the endothelium actually buds and then they turn into hematopoietic stem and progenitor cells.  They go to -- in the zebrafish in particular -- what is known as the caudal hematopoietic tissue.  And it is really in their niche in the caudal hematopoietic tissue that they are programmed into being stem cells.

Why do I talk about this here?  It's because while I was doing research on how an environment of a stem cell allows them to reach their fullest potential, I became incredibly interested as a graduate student as to how the graduate training environments that I was a part of were not really priming us for success and to reach our fullest potential.  And you can see, it's not just endothelial cells, that gray cell is actually a stromal cell.  So, there is an importance in the environment that shapes us into who we want to be. And that became the theme for me, not with blood stem cells, but with grad students and postdocs.  That became the more interesting question for me to ask.

And so, thankfully, folks at CIMER, Dr. Angela Byars-Winston and Dr. Chris Pfund, believed in me, took me in as a postdoc at the University of Wisconsin-Madison, where I started to learn the social science of the way that we train grad students and postdocs.  So, this is a paper that was published quite some time ago now by Rick McGee [spelled phonetically] and his colleagues.  Someone mentioned him earlier to me.  But a recent paper just came out of Vanderbilt with a very similar graphic.  And it just goes to show you, like, how much our minds changed during grad school about what it is that we want to do.

And it's not just during grad school.  The Vanderbilt paper actually looks at after grad school. And you can see there's a lot of trajectory change from the minute you start to the minute you end.  And so, my challenge to you is when we talk about the failure of the system to train a grad student or a postdoc, the question is for what?

Because if we are talking about for faculty positions, and we do want to see greater representation in that group, then yes, the way that we are training is a failure.  But if people are leaving to go on to career trajectories that they find fulfilling, satisfying, inclusive, and inviting, then that is a part of what the system is doing and is designed to do.  And I don't say that to mean that we shouldn't strive for inclusion, but I mean that to say when someone like me goes through a program like the Gilliam Program that's meant to increase representation in the academies and the only "measure of success" is that I become faculty, and I decide that I don't want to become faculty, that puts a really big burden on me as someone who is "now leaving" the system or has become a failure or a metric of failure for a program.  And the Gilliam has actually changed course and modified that due to input from us grad students and who were going through the program.

So, I'm going to talk very, very briefly.  I show this figure all the time because this is really the work that I do.  I focus on research, but my research and advocacy inform each other all the time, as do the interventions that I helped develop and then research as well.  And I'll talk really briefly about Future of Research, and then talk about sort of the work that I do with interventions with NRMN and CIMER before I wrap up.  So, that's sort of how my work sets.  And I also do some work with interventions in forming advocacy.  What that mostly looks like is work that I'm doing right now with you all, or a lot of times grad students and postdocs will ask me to come do workshops for them.

So, this was the Future of Research when we first started out.  I actually wasn't a part of the group back then.  And we continued growing, and we actually diversified.  As you can see, this was a very uniform group in Boston of postdocs, but the idea was to do research by postdocs, about postdocs, and for postdocs.  And then we expand it to grad students as well.

One of our most well-known research that came out of this work was Dr. Gary McDowell, who was the executive director for a while. You can see him wearing a red shirt there.  He actually called every public university in the U.S. with a freedom -- with FOIA requests, asking what it was that they were paying their postdocs, because no one had thought to ask what are postdocs getting paid across the U.S.  A lot of times people didn't even know what a postdoc was in the offices that he was calling to ask for that information.

So, we did a lot of advocacy work.  I always put this one down there because that's in addition to -- so, we want to champion, engage, and empower early career researchers with resources so that they can advocate for themselves.  But we also want to point out that the responsibility is really in those in positions of power to drive that change.  It's thanks to Future of Research that -- gosh, seven years ago now.  2016 when the grant selection index conversation was happening, I was able to advocate for graduate students to Dr. Larry Tabak and Dr. Francis Collins in conversations that maybe didn't make Larry very happy.

But again, when he was asking us -- I mean, it goes back to these conversations.  I would say to him, "Larry, you've lost -- the NIH has lost the trust of the early career researchers.  We don't believe that you have our best interests at heart.  And it's your job to regain that trust and to tell us that this is actually careers that, you know, are pursuable for us and that we can get these grants, because right now, we don't see that happening for us." So, that was some of the work we did with Future of Research.

There was other advocacy work.  We've all gone different ways.  I've been the president for five years now.  And we finally decided to shut down the organization, given that the landscape has been changing with regards to early career researcher advocacy, primarily on the unionization front, which we're actually very happy to see.

This is sort of other groups that are doing this work. As I mentioned, there's the large unionization front, which is fantastic, with Higher Ed Labor United sort of bringing folks together and amplifying those voices.  But those of you from Science Twitter -- whether you're still on there or not -- will recognize some of these as groups.  There's the X in, you know, or Black in X Movement that's huge.  There are Vanguard STEM, Yale Ciencia, 500 Queer Scientists, 2030 base out of New York, PhD Balance.

This is not an exhaustive list.  There are a lot of us -- as early career researchers -- out there trying to push for better training environments for ourselves.  And I think the main sort of takeaway is listen to us.  And not just listen to us but work with us to develop these training environments and make them better places for us.

On the research side of things, and what I've been able to do sort of from a creative academic scientist space, I'll mention briefly again so that we can get to this piece.  We work a lot with mentorship.  Mentorship was just mentioned.  Those two scientists that I spoke about earlier -- Dr. Angela Byars-Winston and Chris Pfund -- were part of this consensus study by the National Academies, where they looked at the literature across, you know, decades and really put together a report on what it was to be an effective mentor in STEM. Fantastic report.  Highly recommended.

You don't have to read all 300 pages.  The summary is a really good summary there.  But the definition is one we always go back to. And what it talks about is that it's a working alliance of individuals working together, and that you're providing career and psychosocial support.  And I think that's part -- that part -- particularly in the STEM fields -- tends to scare some of the professors a little bit is that psychosocial piece.

We're not asking you to be your mentees' therapists, right?  Even if you are a licensed psychologist, that's not necessarily your role as a mentor, but having some level of capacity for providing that psychosocial support is instrumental.  And there is research that shows that actually improves outcomes across dimensions. This is part of what I was talking about.

So, you know, professors sometimes don't see the -- or mentors in general.  Faculty as mentors, they don't view psychosocial functions as part of that mentorship role.  Maybe some of them don't believe the realities that some trainees experience. This is like you're inviting us to the table and we're talking, but then you tell us, "Oh, that doesn't happen here."  That's what Future of Research was doing.  It's like, "Well, here's the data.  It actually does happen here."  But then when it came to make changes, then it's, you know, actually listening to us on the changes that we're asking for.

I was really happy to hear about livable wages because that is one of the main points of stressors we know about today. You know, we -- as STEM scientists, we sometimes see ourselves as immune to bias or stereotypes, which we know is absolutely not true.  And then sometimes it's, "Oh, I don't see color or culture in my lab.  I treat everyone equally," when we know that actually creates a lot of issues for people coming into the lab who don't necessarily share that "neutral" or what is expected to be a neutral culture within academic STEM because they don't fit that mold.

On the trainees side, and this is actually where, you know, there's some overlap with the work that you all do, we know that grad training environments are contributing to burnout and mental health problems in grad students and postdocs.  I haven't seen this data yet on junior faculty, but I suspect that some of the issues are similar, especially because the data on medical school residents and medical school faculty has been done and shows similar things.  We know that about one-third of science students experienced depression.  There's data not just from that one.  You know, there's data that's coming out of Europe and different universities here in the U.S.  From as far back as 2016, when I was a grad student, there was already data I could look at.

And this part perhaps is the more important one. And that is, we want faculty to normalize struggle and failure, to validate our competency and potential, and to have open discussions about what those dynamics are like.  Recognize that there are power imbalances, that there are power struggles, that sometimes what you want out of your career doesn't align with what I want out of my career, or that your experience and your career doesn't necessarily align with mine.  This is one of the interventions that I helped to shift over into the materials that we fully published.

So, on this side, you've got entering mentoring, which is an evidence-based, validated workshop.  Some of you have experienced it before.  That was developed by my mentors.  And then this mentoring up approach takes the managing up, and puts it into the context of these competencies.  So, we teach postdocs, grad students, and junior faculty how to advocate for themselves within their mentorship relationships.

I also -- I know I mentioned this briefly because, again, the mental health piece ties into this.  There's a fostering well-being module and component that was -- that I helped develop for entering mentoring as well.  I don't know why that one popped up at the end [laughs], but that's another one of the ones that goes with entering mentoring.  So, there are tools out there to better train people on how to be mentors within the academy.

What it is -- what mentoring up doesn't do is release the advisor or mentor of the responsibility of the mentoring relationship or ignore very real power dynamics or dysfunctions that can occur.  So, what I want you all to take away from this is when you work to empower populations -- in this case, grad students and postdocs -- that doesn't necessarily mean that you're also releasing people in power from the responsibility of doing some, if not most, of that work in order to move towards those changes.  This is a closing thought for the ECRs.  We don't hear this enough.  So, whether you're virtual or whether you are here, your needs absolutely have value, and you are worth an environment that caters to your needs and sees you as a whole human being.

I had a conversation -- well, I've had many conversations with many colleagues, but one in particular stood out.  Someone who was ready to be a professor in her institution looking at me and saying to me -- as, you know, in her case, she's a Black woman in academia -- "It's never going to be the environment that I deserve," and that just kind of stuck with me.  And this is why we do the work that we do over on my team.  I invite you all to see yourselves as part of that work as well.

We can all transform environments, but it takes risking some of our positionality and it takes moving towards some interventions that aren't necessarily seen, given the climate, as legal or constitutional or insert, you know, variable here.  Because it really is, as was mentioned, if we don't do this work, if we just go with the status quo, it's 100-plus years, if not more.  That's Dr. Kenny Gibbs' data from over at NIGMS until we see parity. So, with that, I'll close out. And I will leave questions for the roundtable.  Thank you.

CÉSAR ESCOBAR-VIERA: Hi, everybody.  Let me find the green arrow first.

Here it is.  Okay.  So, well, thank you for having me here.  I'm really honored to join this group of speakers.  I don't even know what I did to be here, but I'm grateful.  And like my predecessors here, I was tasked with describing a little bit of my path in research so far and the things that worked for me and the things that I kind of identified that could be attended to in the future by the powers that'd be.

And so, initially, my path started in South America.  I'm an immigrant.  I came to the United States in 2009, with a Fulbright Scholarship at the time where I was already working psychiatrist in my home country in Paraguay.  And I was working in the psychiatric reform and found out that I was feeling very helpless with the tools that I had in my medical education to collaborate in a way that seemed meaningful to me in something so huge that seem a psychiatric reform.

Ruth is no longer here?  No.  Oh, yeah. The pictures you showed with psychiatric hospitals in the 50s in the U.S. were the same pictures I was living day-to-day in 2006, 2007 in my home country.  So, we were working on those -- on that thing.  And I felt, like I said, helpless.  So, I applied to this scholarship.  I want to learn more on how to do things in terms of improving mental health services.

So, I came to Florida, where I earned an MPH.  And along that path, there was an opportunity to continue into a PhD in Health Services Research.  I was very unsure on what to do at that point.  I had a family back home.  A boyfriend also waiting for me back home in Paraguay.  Do I stay?  "Should I Stay or Should I Go," The Clash song.  And ended up staying, brought the boyfriend.  He's now a husband, don't worry about him.

And in 2016, after completing a PhD, I came -- I went to Pittsburgh for postdoc training.  And during that time -- during that time, I thought, "Okay, what do I have to do as an immigrant to be able to get an NIH grant."  This was 2016.  I had but one choice, the K99/R00, which I applied to and got funded by NIMHD at that time.  And that was my path.

And I was very fortunate, but there are so many bright people who don't have that option.  I think maybe from 2016 until now, maybe some other NIH funding options for immigrants who are on a student visa might be available -- or trainees might be available at this time.  But when I applied, it was the K99 or nothing.  And -- well, I got it, fortunately.  And that's how my path continued.

And then the time came to think about my faculty position.  Where would I be?  My PhD was in health service -- is in health services research, so more geared towards public health.  And one of the things that seemed like an opportunity at the time was staying a bit because the kind of work that I was doing -- that I'm doing is -- seem of interest for the School of Medicine, the Department of Psychiatry.

I ended up applying to a position in the Department of Psychiatry.  Mind you I thought when I left Paraguay, when I started my PhD in public health, I thought this is going to be my path moving forward, public health, because I'm very interested in public health.  And my research -- I'm not here to talk about a lot of my research today -- but is -- as -- is with a public health framework.

And -- but then when I applied to this position, I did because it seemed like a potential opportunity.  But it was very intimidating because it was already back to the School of Medicine, back to the Department of Psychiatry.  Not that I'm not familiar, I'm a trained psychiatrist. But in the back of my mind, I thought that my path was leading me towards public health.  But no, [laughs] it took me back to medicine.  It took me back to psychiatry.

And it was a little intimidating in the sense that, will I fit in a Department of Psychiatry that is very successful? Because, you know, it was a -- in a way, a privilege because it's a very successful psychiatry department.  But very successful in everything that is related to biomedical type of research.  And my research is nothing but -- nothing close to biomedical.  I work with health equity, developing and testing interventions that seek to improve mental well-being.

So, my outcomes are not necessarily the hard clinical outcomes that NIMH is usually looking for.  So -- but wrong again.  [laughs] I -- being part of the center that I'm currently part of, we are actually funded right now by NIMH, developing and testing an intervention to improve outcomes among youth who have been victims of cyber-bullying -- online victimization.

So, one thing that I learned over these first years in my faculty position is -- and my path so far is that a lot of times, one thing that --one thing is that the path is very sad.  Or that you are sad on a very clear and maybe narrow path, or at least that was my experience.  But as you move through the years of education and the years of working in different environments, there's -- so, there are opportunities that open here and there.  And that's also very interesting to see how those things contribute in shaping our path.

But when I was considering this working or coming back to the school of medicine and psychiatry, there were attractive things about it.  Being, like I said earlier, in a successful -- already successful place -- established place if you will, I would have some sort of uniqueness in the department because of my focus on health equity and marginalized populations.  There might be a potential of being a sought-after collaborator because of that uniqueness potentially.

But there were also a lot of challenges that came to mind at that point.  The uniqueness again and the actual likelihood of finding collaborators that would be interested in similar areas or health equity.  A potential focus of the department in things that already made that department successful.  Which, again, things related to biomedical research, which is not necessarily what I'm focusing on.  And the actual likelihood of being able to network with other health equity researchers.

So, those were all things that seemed like a challenge to me before accepting that offer.  And one thing that I learned over these past four years -- I started my appointment as assistant professor in 2020, in September -- is that a lot of the departmental initiatives can actually help health equity scientists making it.

So, turns out to be, I was part of a sort of an initiative in the department of trying to increase the -- this area of research in the Department of Psychiatry.  And a number of things -- positive things, good things, at least in -- to me, again, in my experience, happened.  And I wanted to share just a couple of them because I happen to be part of those things.  And those things helped me find that sense of belonging that my predecessors were talking about.  And I think that was like very accurate to say.

Because participating in these things -- in these initiatives made me feel empowered.  Imagine that I identify myself as a sort of an intersecting identities between immigrant, Hispanic, member of a queer community, finding a sense of belonging is important.

So, this is one of the -- those initiatives that I'm part of in the department.  There's this biannual DEI survey that -- it started happening a few years ago.  And I'm part of the committee that put together this survey.  And the objectives as you see there, assess the cultural climate, and identify DEI priorities for the next couple of years in the department. And the target population is everyone in the department and just faculty members.

Our department has about 250 faculty members. And all staffs and all trainees are also part of the survey.  So, that has been incredibly enriching for me to help shape this type of instrument that the department is disseminating to all of us.  And another initiative that we have is a research -- we call it research equity and community health group, which is like our little group of health equity scientists.

And we have -- the department put a little amount of funding in order to provide us with some infrastructure, some staff time. So, we can start working on supporting health equity research within the department, and also, networking across departments in the school of medicine and the other schools as well.  And those bullet points are some of the things that we're involved with.

And this all includes creating resources for other researchers in the department who are interested in working in or incorporating health equity in their projects.  Creating resources such as how to partner with communities or what aspects of health equity should be included in grants and other things.

And I just want to spend some time in this slide where things that -- all this path helped me identify over time is that it might be important.  And this is why I said earlier to -- for the powers that be to incentivize institutions, departments even more to increase health equity research within their ranks. Not only with specific FOAs, but maybe embed health equity requirements across FOAs.

Very recently, I was part of a grant review panel -- NIDA, where they required -- actually, it was part of their requirements to have a community health collaborative as part of the grant.  Man, that was great to see because every single proposal had to have a community research collaborative.  I would like to see that a lot more because I think that's a way in which we can actually partner with communities from beginning to end of our research projects.  And with that, I will stop and thank you -- oh, sorry.  And thank you very much for listening.

JANET CLARK: I want to start by thanking you all so much for sharing your paths.  And for all of the contributions to mentoring the next generation of biomedical scientists. It's a really important job.  And it looks like you all have a passion for it, which I appreciate.  I want to start by asking a question, going back to the psychosocial part of mentoring diversity.

So, I talk to a lot of trainees at NIH and in the mentoring programs in a variety of societies.  And I worry about, you know, increasing diversity, recruiting diversity, but not changing the culture and not bringing the psychosocial part into that.  But I also understand that there are a number of mentors that are having a hard time wrapping their heads around how to do that if it's not natural to them.  Can you provide some guidance or advice to people who really want to do their part, but are having a difficult time?

FATIMA SANCHEZNIETO: Yeah.  I mean, I think the biggest thing that we say is that these skills can be learned, right?  So, you don't need to be an excellent or super expert, right?  You can take trainings as the first place to start. But even having a community of practice within other faculty members or folks at your institution, you know, to discuss and have conversations, what's working, what's not.  I'll also say faculty more and more are being asked to do more.

And so, the question becomes, at what point do we start to value the mentoring work that other people are doing, right? There's a big faculty staff sort of dichotomy or sort of power imbalance in a lot of universities.  When do we start to recognize other folks who mentor grad students, postdocs, and other folks who can be part of that mentoring collective?  Beronda Montgomery and Joi-Lynn Mondisa talk about ecosystems -- mentoring ecosystems as part of like, how are we all, you know, playing a role in that?  I don't know if others have --

GINA POE: I wanted to echo what you said, which is, I encourage all of my mentees to have a mentoring team with diverse people who have different skills.  Because I think maybe I'm okay at the psychosocial, but I know that there are a lot of people who are really bad at it, even in their own lives, in their own families.

JANET CLARK: Sure.

GINA POE: They're just no good.  They just don't have that skill.  They have lots of other great skills, but not that one.  And so, I think it really does take a diversity of mentors to get any one person through.  And it's okay.  No one person can do everything.

CYNTHIA ROGERS: I don't think I have a ton to add.  I'd like to think that I'm good at the psychosocial.  Otherwise, I'm just bad at my job in general as a psychiatrist.

But I do think that it is important, as was just said, to have a variety of mentors for different things.  There are folks who I serve as, you know, mainly their research mentor.  There are folks that I serve more as a career advising mentor, but not so much the research mentor.  And then, yeah, making yourself available for folks who need to come and just talk to somebody about what is it like to be in this environment?  How do you recommend I get through these different challenging situations?  How did you do it?

And maybe you only meet with that person once a quarter, once every six months, but just so that they know that they have that. Because, yeah, the truth is that not every -- that is not everyone's skillset.  And sometimes, people can do more harm than good if they don't know how to support people.  And so, you know -- but what is incumbent upon them is hopefully, they have some of that insight and have some colleagues they might be able to refer their trainees to that could be helpful in that area.

CESAR ESCOBAR-VIERA: I think the only thing I would add is that it's so important to remember one of the things that my colleagues said about mentoring being bidirectional.  And just keep that, you know, in the -- among your very first thoughts when starting a mentor-mentee relationship.  And open yourself to learn from them and their experiences and their skills.  Because they might as well be equipped with skill sets that you as a mentor do not have.

JANET CLARK: Thank you.

AUDIENCE PARTICIPANT: Related to those questions, I was wondering about how you think about dealing with researchers that don't think they need mentoring training or don't want it.  And also, the institution's role.  I think there was some talk early on about, you know, like the institutions value these things, but they're not really supporting or recognizing them.  So, you know, I'm sure there's a lot you can say.

FATIMA SANCHEZNIETO: Yeah.  I mean, we get a lot of comments about the folks who need our training the most are the ones who don't think they need it or don't want to come to our training.  I think we're -- when we talk about negative mentoring experiences, it's really a spectrum of folks being negligent in their role as mentor, all the way to more egregious behaviors like harassment, bullying, you know, those kinds of things.

I think the two things are different in how you address them.  For the folks who don't necessarily want to come, one of the things that we found is, again, this sort of community of practice with colleagues that -- because that really is what our workshops are.  They've facilitated discussions on case studies where other people are bringing in their experience of what has and hasn't worked for them.

And so, really, talking to them about, this isn't you coming to learn.  I mean, in some ways it is, but we're also interested to hear from you what has and hasn't worked.  Because, I mean, peer pressure is really, you know, something that's a powerful thing. And I always talk about communities of accountability.  That very much comes from Black feminist thought.

And really, what does it mean to create a culture where being negligent and/or abusing or harassing of your mentees is just not fostered and/or rewarded in a particular culture or subculture of a department institution.  You know, all of STEM.  And I think really that's the question that we get to ask ourselves, is how do we build that collectively, right?

GINA POE: Yeah.  I want to also contribute to this.  Yes, thank you.  I think one of the things that we are doing at UCLA is inviting those who are stars at it and those that need it the most.  And inviting them to the table equally and giving them a really nice experience and having everybody equally consider their own culture.  Like that name -- where did my name come from exercise that we did.

Because a lot of people, especially from cultures that are the majority, don't realize that they have a culture even.  And so, they say, "I'm culture blind." But they don't know that, you know, they're swimming in water, right?  You know, that whole thing.  So, you have to say, "How's the water?"  "What water?"

So, I think that really helps people to come to it personally and honestly to realize from the onset that they also have a culture and everybody has a culture.  And we -- things we need to take into account when we deal with one another.  Yeah. But you don't tell people, "Oh, you need to come because you really need it."

You say, "Oh, you're a thought leader in the university, and we need your input," or something like that.

CYNTHIA ROGERS: I will say that I do think it's important that -- is it on?

GINA POE: Hello.

JANET CLARK: There we go.

CYNTHIA ROGERS: Okay.  There we go. I do think it's important that mentoring is, as we said previously, valued by the institution.  But also, that inappropriate or ineffective mentoring is also accountable by the institution.

FATIMA SANCHEZNIETO: Yes.

CYNTHIA ROGERS: So, that we don't let it just continue to perpetuate.  It's one of those things where everybody's like, "Oh, that -- they're not very good."  And everybody's whispering about it, but no one's doing anything about it.

FATIMA SANCHEZNIETO: Yes.

CYNTHIA ROGERS: And so, I think that that is something that we need to foster in all of the academic environments.

JANET CLARK: There's a question online.

GINA POE: I also want to just say, thank you, Ashley, for all of your great work for spines.

She's our program officer.

MODERATOR: This is a virtual question from our audience online. As an independent researcher, what's the best way to connect and find meaningful mentors?

CYNTHIA ROGERS: You -- if you yourself, are already an independent investigator?  I think for me, I -- just speaking personally, I think conferences where I meet other individuals and start talking.  And -- or see someone who's giving a talk, who's doing work that I really admire.  And then connecting with them and, you know, just saying, can -- you know, can I call on you or meet with you or discuss things?

I think you have to be somewhat proactive once you're an independent investigator to seek out the people with whom you can see you can learn from.  And that you can --that you have a -- will have -- likely have a connection with. But I find the scientific meetings and -- or when we invite speakers to come to give grand rounds, and there's something that really speaks to me in the work that they're doing.  Or something about their career that either I want to emulate or learn from, that those are the folks that I seek out.

And I still have, and probably until the day I die, will have mentors.  Because [laughs] I think it's such a valuable relationship to foster.  And so, I have some in -- within my own institution.  I have some at external institutions, you know, that can be very invaluable.

GINA POE: But it's really hard to do that.  And so, I just want to say that one of the things -- at my former university, I was invited into a group of women who were across the -- you know, from assistant professors who -- you know, emeritus professor.

And every month, we just met and each had 10 minutes to talk about something that's on our minds.  And it just -- it was so valuable.  And I was invited to that, and I fell into it.  And this -- it was just like a garden where I could bloom.  So, I suggest that universities and departments foster that.  It was across departments also within the school, and that really helped.

CESAR ESCOBAR-VIERA: I -- oh.  I would also say that reaching out to mid-career faculty might be a very good.  But some of them might be even at their mid-career K, and that they might be really open to get new mentees.  And of course, it's important that there is an alignment of research interest.

Of course, it's potentially more important to have a great feedback -- a great rapport with the individual.  But I think taking that first step at a conference or shooting an email expressing interest in a 30-minute Zoom or another way of connecting is a great first step.

FATIMA SANCHEZNIETO: Yeah.  I'll add to both of what you added.  And, Cesar, to bring up what you commented to us earlier.  The online communities can also be a huge help. I'm on Everyday Science, Twitter. And I know I mentioned it.  But it was such a great place for me to make connections.  Particularly because for a lot of folks who are disabled and/or neurodiverse, the traditional "networking" can feel inaccessible particularly at conferences.

So, finding your people online masted on as an alternative.  I'm trying to find whether that and LinkedIn sort of fill the niche.  Blue Sky is coming up.  So -- but really, don't underestimate, even as Cesar mentioned, an email.  I tell folks if you're not -- so, for me, formulas work well sometimes for social interactions.  And if you're not sure with the cold email, just -- I mean, make it a bullet point. This is my name.  I call it the Inigo Montoya method, for those of you who have seen "Princess Bride".

This is my name.  This is how I'm connected to you.  This is the expectation I have for this meeting.  And if you make it specific, people are more open to connecting. So, a 30-minute zoom is a lot less intimidating to say yes to than will you be my mentor?

Oh my gosh, what does that mean?  Right?

So, that's my tip with that.

AUDIENCE PARTICIPANT: Yeah.  Thank you so much for those great presentations.  I just have a question for you that is kind of a two-way question.  So, non-linear careers are very common in groups like people that look like me, right? And I was thinking about your idea of certain systems thinking that there is only one direction or -- and if that direction doesn't work, it's a failure.

So, what advice would you give to those trainees or early career researchers that didn't have the linear career of going successful grad school, successful postdocs, successful faculty position. And how to overcome those non-linearities due to external factors or internal factors to their own person? And what advice would you give to all of us in the field in order to deal with those non-linear careers in a better way?  Because the field can be very unforgiving to those non-linearities.  Thank you.

GINA POE: Well, I'd say exhort one another to not apply those linear path criteria for people.  When you see someone applying for grad school, don't discount them because they did five years as an artist.  You know, still think about their whole career path.

So, from the reviewer standpoint, have an open, broad mind.  And I think we really need to hold each other to that standard.  If we want diversity in our field, we need to value the diverse backgrounds that people have when they come to us.  Because in fact, it is valuable.  We know it's valuable.  So, we've got to value it and prize it.  Yeah.

CYNTHIA ROGERS: I also think one thing that could be helpful is if --

GINA POE: Yeah.

CYNTHIA ROGERS: Okay.  [laughs] One thing that could be helpful would be maybe some flexibility on some of the rules around some of the grant mechanisms.  We had an amazing -- or we do, she's still there -- amazing faculty member who took time off and, you know, was an editor of a journal for a while and things like that.  And then decided to come back into academia.  But because it had been so many years since her PhD, she couldn't apply for some of the typical career development awards and, you know, could only apply to a K99.  But she didn't really want to leave.

You know, so there -- so, I do hope that there can be built in more flexibility in some of the grant mechanisms that exist that could allow for folks from diverse backgrounds.  Or people who take those kind of breaks, you know, or circuitous paths within -- to get back to academia to be allowed to apply for different type of mechanisms.

FATIMA SANCHEZNIETO: From an individual -- so, we heard from the sort of the systemic.  From an individual perspective, I think some radical self-honesty and self-love is so important.  I spend so much of my life being told collectively, right, not individual. I mean, some people did [laughs]. But just the message being, your needs don't matter.  You have to conform to a certain -- and academia certainly did that.

And being radically self-honest with yourself about what it is that you want and that you need and that you value.  And realizing that if those things don't align with what academia is asking of you is not a failure on your part, but a failure on the system to hold you is so, so, so important.  Because it doesn't make the grief process of leaving a particular path that you had desired easier necessarily.  But it gives you the tools to deal with that grief effectively and find support networks to show you that your value isn't tied to any measure of success by any sort of, you know, career path.

Sometimes you realize that the things that you value are going to come outside of what you do for a job, and your job is going to pay the bills, right?  And you're going to keep those two things separate.  My partner decided that after a master's degree.  And I so value that they bring that perspective to my life.

And so, I think just really finding people who see you for who you are and can reflect that value and love.  So that when it's difficult because it feels like you're not meeting benchmarks of success, it doesn't become a failure on your individual part.  But rather that the system is not fitting what it is that you want or need or value out of your life and career.

JANET CLARK: Thank you so much.  Oh, go ahead.

CESAR ESCOBAR-VIERA: Just along the same lines, it's just important, I think, to see the non-linear path as a true asset that one has and that gives you uniqueness.  And just let them know how unique you are now based on that non-linear path that you follow.  That might be what they're waiting to hear or to see.  And, you know, show them that might be the way of moving forward.

JANET CLARK: And actually, most of us have a non-linear path.

It's not linear for most of us.  So, thank you for sharing so much, and thank you for your talks.  It was fantastic to have you here today.

SHELLI AVENEVOLI: Good afternoon, everyone.  So, I'm Shelli Avenevoli.  I'm the deputy director here at NIMH.  And it's really my privilege to welcome our last speaker of the day, Dr. Altha Stewart.  First, I just want to say, it's been a really fantastic day.  And I just want to thank all of you for sharing your time -- especially the speakers -- sharing your time, sharing your engaging presentations. But most importantly, your insights that kind of teach us about how we can do better in the future.  So, we'll take those to heart.

So, Dr. Altha Stewart is a leader and a pioneer in her field in psychiatry.  Serving as senior associate dean for community health engagement and as an associate professor of psychiatry in the College of Medicine at the University of Tennessee Health Science Center in Memphis.  Dr. Stewart works to improve the health of all residents by reducing health disparities impacting community members.

Dr. Stewart has developed over a dozen community-based prevention and intervention services and research programs.  She led public mental health systems in New York and Michigan and Pennsylvania before returning to Memphis to develop the center and train the next generation of psychiatrists at UT Health Science Center.

Dr. Stewart made history when she became the first African American elected president of the American Psychiatric Association in the organization's 175-year history.  There, she has taken a leading role on issues of diversity and inclusion in medicine.  And how discrimination and implicit bias affect physiological, psychological, and physical health.  It is my great pleasure to present Dr. Altha Stewart.

ALTHA STEWART: Okay.  There's more than five people, I'm happy.

It's the end of a glorious day.  I don't know about you all, but I am just geeked up.

The presentations have been phenomenal.  The conversation, the discussion, the networking, the eye contact, has been phenomenal.

Just passing people as I was walking through the lobby area at lunchtime and just smiling.  I don't even know who you are, but I smile.

And to be here, even as the closer, gives me great pleasure.  And I want to start off by thanking Dr. Gordon, obviously, for extending the invitation.  For the tremendous team of logistics and planners and other people who put up with my inability to be timely in responding.

And insisting that I was not going to use slides. I thought that since I was initially going to be an opening speaker, and my dear friend, Dr. Shim, had some kind of travel issue.

And I wound up being the closing speaker.  I thought by the end of the day, if you are like me, you've had enough of watching the screen.

It would be nice to just engage another part of your brain.  That part that hears and feels and thinks and smiles.  Because the news, while it may not be the best that I'm going to share with you, you won't have to see it reflected on a screen.

You can make up your imaginary idea of what it is I'm talking about and go from there.  I also want to thank a few people for helping to make today.  Because in the spirit of full disclosure, I am not an NIMH researcher.  I have fought very hard to stay out of academia most of my career.  I have prided myself on not being identified in a certain way.  And until about eight or nine years ago, when I was seduced by the dark side of academia I had made tremendous progress along a career path.  Now, eight, nine years later, I am committed to the academy.  I have engaged in research, [laughs] and I am actively recruiting and training people to do the same.

So, see, things can change in life when you least expect it.  The other people I want to thank in the audience are people that I've known for a while and consider to be family.  I've already mentioned Dr. Shim, who messed up the schedule.

You knew it was coming.

Dr. Hankerson, who I met as a young man, eager and enthusiastic and energetic to be a psychiatrist who has come so far in a relatively short time, and who I'm so proud of.  Every time I see him present, I feel like a mom, you know, wanting to jump up and say, "That's my boy.  That's my boy."

And then I want to finally thank all of you for staying through this entire day and being here at the end of the day.  I'm going to do my best.  And I should also, by way of full disclosure, remind you all that I am a southerner.  And I wanted to be an actress until my mother met Ben's mother and Carlos's mother and decided that her child was not going to go into acting but would become a doctor.

I am convinced that if our three mothers got together, there would be no problem with disparities or equity research.

I think they could solve it in an afternoon and feed us.

Just my thoughts.  The final disclosure is I'm the youngest in the family.  I never met a rule that I liked, or a microphone that I didn't.

So, now, you know all that you need to know about me.  And I'm going to try to do what I call a framing.  Because when I was told that I would be the closing speaker, I thought, as I said, that rather than show slides, I would talk.  And there is a universal pattern today.  I don't know if you've all recognized it.  The rule of threes.  Most people have gotten up and talked about three areas they want to focus on. I am not going to break that rule. My story of threes includes a history.

And if you will turn to page eight of this tremendous NIMH anniversary booklet, you will see some of the history that I'm going to talk about.  The second area I want to talk about has to do with how a single moment can create the spark of change that results in a sustained ability to move along a path that we desire movement in.  And then the third is to actually talk a little bit about the research issues and funding opportunities if we are going to seriously address health inequity and health disparities.

So, when I thought about the theme for today and selected as my title, a Black psychiatrist perspective on inclusion then, now, and the future, I said to myself, "Self, this is not the time to do a personal disclosure kind of talk.  This is the time to really expose people to the kinds of things that could make in them the spark of change that we'd all like to see in the system."

But then I get here and everybody has a personal story.  So, I kind rethought that notion and decided that the way to tell the history section, at least, is to weave in and out the story of my own life.  And the intersection of my life with the history of the relationship of Black psychiatrist to NIMH.  And I know you think that is a stretch.  It could be a screenplay and made into a major motion picture if you -- if I think about it.

But the reality is, when I began working on this presentation, the first thing I did was look at some materials that I had received from a colleague when I worked in New York in the 80s named Dr. Beth Davis.  And Dr. Davis had a propensity to minimize her accomplishments.  When I met her, she was director of psychiatry at Harlem Hospital.

She was on several boards and committees in the health and mental health arena.  And what she never disclosed to me when I met her was that she was a part of that group that worked through 1968 and '69 to create the agenda that they brought to NIMH to demand some changes to benefit Blacks with mental illness.

And some other things that they wanted, but that she was a part of that group.  Now, true to form, as in much of the Civil Rights era, women in those groups, while they were considered vital to the work, were really critical to the chronicling of what was being done.  They were the secretaries if you will.  And so, she kept meticulous notes.  Dr. Davis had copies -- carbon copies.  And I mean, real paper with carbon paper, carbon copies.

Some of you have never seen carbon paper. Raise your hand.  If you have no idea what carbon paper really is, raise your hand.  Please, be honest.  Okay.

Okay.  You know the electronic CC on an email.  I'm talking about the original carbon copy.

Okay?  In addition, in the box of archival material from '68 and '69 -- and remember, we're in the Civil Rights period.  We are working as a group.  These psychiatrists -- Black psychiatrists were working on two fronts separately. One was the front of approaching NIMH and other federal agencies to demand that some monies be spent in furtherance of working towards better services, better training, and better research. You saw that in 1946 or 1950 I trained in Philadelphia.

I still have the key ring -- we call it a jailer's key ring.  The big thing that is like a bracelet.  I have that where we went into the wards, with the skeleton key.  I have a brick from Byberry.  All of us who worked there through the bitter end, before they closed it, were given a brick to remember the hospital.  Many is the time I've wanted to use that brick for things other than memory, but I digress.  But this was what those Black psychiatrists on page eight -- those were only a couple of them -- were fighting for.  And so, on a separate front, not only were they assailing NIMH.  But they were assailing the American Psychiatric Association because of the way it treated Black members.

Remember, this was a time when federal funds could be used to build hospitals that practiced segregation.  This was a time when members could refuse to provide services to patients who were Black.  And the organization would not move against them.  Would not say it was unconstitutional, unethical, unmedical.  They would not do any of that stuff.

So, here's a group of maybe a dozen Black psychiatrists who decide to fight, not one, but two major organizations at the same time.  The work that began, that is described in the booklet, in 1968, was running concurrently with the work that was going on to fight the APA.  So, Dr. Davis has this box.  It's got letters.  It's got telegrams.  I don't know -- has everyone in here ever seen a telegram?

There's one in the lobby area where we had lunch on that bulletin board.  It's an actual telegram where you wrote something on a piece of paper.  Some guy, mostly, in the telegraph office -- Western Union was the big deal -- transmitted that using a tapping wire thingy. And on the other end, somebody received a message.  And somebody at that end wrote it out and gave it to him and said, "Dr. Stewart sent you this from New York."  And you're in Los Angeles.

So, she gave me a box with all of these papers. I have letters that are part of the presentation from Dr. Chester Pierce to the -- I think he was the second director. Stan Yolles, I think, was the second NIMH director -- advising him that he would not meet with the group from NIMH alone.  Recognizing that to meet alone was going to be the challenge of a lifetime.  Because once they had the meeting, all the Black problems would be solved.  All they needed to do was meet.

And so, he wanted the committee of people to be part of that.  And Dr. Yolles said, "Well, you know, you've talked to some people, but you haven't talked to me.  And until you talk to me, nothing can be resolved."  Chet was not satisfied.  And for anyone who actually knew Dr. Pierce -- it took me about five years to call him by his first name, Chet.  Well, Chester, but we shortened it to Chet.  Because he was such a big presence at that point.

And I had no idea all that he had done.  I just knew that he was Chester Pierce, professor at Harvard, consultant at Sesame Street, and the guy who did something with people's survival in the Antarctic.  And he has a mountain range named after him.  It's kind of like Solomon Carter Fuller.  You don't know about him until somebody tells you about him.

But Chet and Jim Comer and Hugh Butts and some others, who I came to know when I worked in New York, in the Dinkins administration in what was then the separate office of mental health for New York City before they consolidated.  All of these people I got to know early in my career in like the mid-80s and had no idea the full breadth of what they had done to get me to where I was.  It was because of people like them that things began to change.  We didn't know that history.

As a young resident, an early career psychiatrist, I knew some people had fought with the APA in 1969.  I knew they had barged into a board meeting.  And then suddenly, we had a committee of Black psychiatrists and a consultant observer, I think was the position on the board of directors.  I had no idea that the work that they had done in '68 and '69 had actually converged with my own life path.

Because in '68, when Dr. King was assassinated -- excuse me -- this group was meeting in New York to plan for the meeting in 1969 in May at the APA to make their demands.  In 1968, I was in my dining room, working on homework probably, when the news came out that Dr. King had been assassinated.

The group of Black psychiatrists had their planning meeting in New York City that evening, sponsored apparently by Joe English, which I didn't know until I started reading these letters.  Who was -- I think he was director of another agency that ultimately became part of NIMH or was the predecessor organization to NIMH.

But this group was meeting to plan their strategy for how they were going to make this double assault, NIMH on this hand, APA on this hand.  And it was only a dozen or so of them at the time.  And that night, King was assassinated, they put out a statement that became a press release about how time sensitive this now is.  That the lethality of the racism in America had taken one of the most moderate people out.

And that if that could happen to a moderate, they had to begin work, and quickly, on making sure that the mental health and wellbeing of Blacks in America was much better handled and protected.  And served using the -- at the time, I think they estimated $400 million budget at NIMH.  None of which was going to community-based practices or community-based participatory research or any of that stuff.

And so, when I thought about the fact that at the same time, I am a high school student sitting at my dining room table doing homework, there's a group of people that I would ultimately meet, know, and work with some of them, working on my behalf.  And my mother hadn't decided yet that I was going to medical school.

Go figure.  That convergence leads me to believe that there's a universal truth that things happen for a reason, even when you are, as Dr. Shim showed us this morning from Bell Hooks, living on the radical edge.  And at that time, for me as a little Black girl in Memphis, it was very clear, life was dangerous.

Life was very dangerous.  I've already told you, I'm the baby in the family.  You can tell, I don't know how to not talk.  I pretty much have reached an age where I can say anything I want and dare anyone to challenge me.

I am the proverbial Black woman who gets away with anything now.

And I'm liking this new identity.  But here we are at NIMH at 75.  And in reflecting on my own life, I see the convergence of incidents that ultimately resulted in the work that that group did, both at NIMH and at APA.  Leading to me having opportunities and experiences that I might never have had otherwise.  And so, you know, when I thought about it, I said, well, I met all of these guys and Beth in New York.

I met Joe English there, who turned out to be a good mentor, a great friend, a fellow Catholic.  And a guy that could tell a good joke, I mean, a really good joke, and enjoy it himself.  I met -- I never met Stan Yolles.  I wish I had now because the picture painted of him about his response to these constant back and forth interactions, which suggest that there was a lot rancor.

But my suspicion is that a lot of that, at least on the part of Chester Pierce, was for effect.  He understood the dynamic -- the interracial dynamic well enough to understand the offensive move to make to generate a response that got him the reaction and the action that he wanted in the end.  And I have to say in reading the letters and his chapter in racism and mental health, that is unfortunately now out of print.  And in a couple of articles that he wrote on the whole experience of 1969.

And then a paper on what he described as offensive mechanisms likening it to how an offensive coach in football, for example, which he played at Harvard, organizes, and trains his offense to make sure that at the end of the day, whatever offense they use is successful no matter what defense is mounted.  And I have to tell you, reading that paper, "Offensive Mechanisms", I am not a big sports fan, but reading that paper actually made me want to watch a football game.

Just to kind of imagine how he thought about this stuff, put it in psychological terms, turned it around as a strategy, and used it on the NIMH and the APA.  So, I -- nothing but love for Chet Pierce.  And I think the other important thing out of that time period is in another key player.  In that whole scenario, the NIMH piece, as well as the APA piece was Alvin Poussaint.

And we know Alvin Poussaint, many of us, as the only Black psychiatrist ever known and seen in a Black household.  He was in Jet and Ebony all the time.  He was the only person who looked like me who talked about mental health.  Not so much mental illness, but mental health.  The importance of psychological wellbeing and what racism was doing to the psyche of Black people.

Alvin Poussaint was a man.  And no household that I ever went into growing up didn't have a copy of Ebony or Jet where he didn't have an article.  He was prolific as a writer in the publications that mattered in the Black community, as well as his proliferation of articles in the academic world.  And Alvin, throughout this entire process, kept insisting that people write.  That they work on writing.  That they publish things -- scientific, scholarly things. Not everybody agreed with him because it was the Civil Rights period.

And there was a lot of desire to -- I think the word we -- some of us used earlier today -- have an all-out revolution.  If they won't change, let's just, you know, trash the system and start all over.  The group of '69, as we now call them fondly, really were young turks in the true spirit of that word.

You know, we think of the psychiatrist who returned from World War II and flipped psychiatry on its head.  We think of them as young turks.  But really, I think of young turks as the people like Poussaint and Pierce and Comer and Butts.  And Hiawatha Harris in Los Angeles.  And Al Cannon and Charlie Pinderhughes, the -- probably one of the best-known psychoanalysts who happens to be Black.  And Charles Prudhomme and Charlie Wilkinson.

These were men who were elevated at the academic level, professor and so on.  Two or three of them were chairs of departments at a time when that was a real rarity.  And the others were high enough in their profession that just by participating in this kind of activity, they were jeopardizing their day job as it was. But it was worth it for them, which really encourages some of us to fight the good fight, as I like to think of it.

But when I met Beth and she gave me this material, I had no idea what a gold mine I had.  And it wasn't until probably about 10 years later that I began looking through it. And even then, I didn't recognize the significance of it because I hadn't put all the pieces together of what was going on.  So, fast forward to the end of this history.  I'm working in New York.  I'm working for Billy Jones, who was then commissioner of mental health in the Dinkins administration.  I'm meeting all these wonderful people.

And I have, you know, interactions with people like Chet Pierce and Hugh Butts and others.  And I become part of the APA working my way up from a fellowship.  Not a SAMHSA minority fellowship, but a fellowship -- a legitimate fellowship offered by the APA in leadership and committee work and other things.  And find myself in the, I think now, enviable position of having to make a decision about what I'm going to do.

So, I ran for secretary in one and felt like I got enough votes that maybe I could stand for another national office.  And began hearing the stories of how those people in '69 had fought for us to have a whole elevated level of Black psychiatrists in the APA.  And how it was my responsibility to be willing to take the plunge and do these things. And like a good baby girl from a southern family, I thought, why not?  And ran and won, as you heard.  And it was a phenomenal experience.

And every day of that presidential year, I had to thank Chet and Comer and Poussaint.  And I remember talking to Jim Comer and he said, "This is what we were talking about.  This is why we did what we did.  We needed somebody to finally rise to this level to demonstrate it can be done and we can do it."

As you've heard from others today, I think you said the sense that I don't deserve to be here because I haven't worked hard enough or don't deserve it.  Or only got it because someone said I should get it but I didn't really work for it. Let me tell you, you don't get to be president of the APA without working for it.  So, I give myself full credit for putting in the work that brought the prize, if you will.  And for thanking those guys for their hard work to set the stage for this.

So, their work in '69 -- '68 and '69 resulted in 1970 with me coming to the end of the history story.  Because at that point, NIMH had resigned itself to the fact that they weren't going to go away.  And they began negotiating and created what became the first minority center at the institute, which has evolved over the years into so many other things for which we are very grateful, Dr. Gordon.

Because the commitment that began then has -- even though there've been some stops and starts over the years, has continued. And actually been accelerated over the last eight years now to the point where maybe we can trust that a new administration is not going to tear everything apart and start all over.

So, that part ends the history piece.  My life converged with the history of 1969 for NIMH.  I had no idea that my mother and your mother and Carlos's mother were working against me. But I got to say in the end, it worked out for all of us, I think.

The second piece has to do with that single incident that can happen that leads to so many other things.  Well, the single incident was the culmination of all of those negotiations with the first center for Minority Group Mental Health.  It was directed by a gentleman named Dr. James Ralph, who gave regular reports to the Committee of Black Psychiatrists that was established at the APA.  Gave regular reports to the Black Psychiatrists of America, which was that independent organization that was formed by that group of '69.

So, there were all of these groupings that cropped up after all of the revolution that resulted in some change at the national level and the organizational level.  And also, we believe, in looking at the timeline, resulted in what became the first -- and I want to get this right -- the first convening on this topic of a major federal organization through the secretary of health education and welfare, Heckler.  And it became the report of the Secretary's Task Force on Black and Minority Health by Secretary Heckler, released in 1984.

Now, it took a few years to convene and work and write.  But it happened, we believe, as a direct result of the work done by these gentlemen and women to change the system.  And we've talked a lot today about fundamental change in the system is the only way to make sustained change.  Comer and Pierce understood, from a psychodynamic standpoint, that there are two conditions that suppress the racist impulse of many in America -- particularly many in white America and foster a more humane and just society.

The first is strategic and instrumental actions that support institutional anti-racism.  And the second is people being driven by moral principles, conscience, and passion for social justice, fairness, and respect for humanity.  If you can move the needle on either one, you've got a pretty good chance of promoting at least some kind of progressive change.

But social justice, racial change really is a harder nut to crack, as they say.  And it can be uneven and starts and stops as it progresses.  So that if one person who is behind it leaves and is no longer there, other people who don't really believe in it and aren't committed can stop it on a dime.  So, the plan of Comer and Pierce, who understood this, was using the offensive mechanisms that Pierce had studied so well.

Their desire, their strategy, their goal was to make this a moral obligation on the part of the federal government.  They persisted.  They pursued.  They harangued.  They wrote letters.  They brought in every civil rights leader, every Black Congress person.  This was before there was a Congressional Black Caucus. And they took credit for actually creating the Congressional Black Caucus by forcing people to talk to each other and realize they needed to join forces just like the psychiatrists had.

And so, they used the argument that the federal government has a moral obligation to its citizens, including its Black citizens, to spend the money necessary to protect their health and wellbeing. Particularly in the mental health area. And they pushed and prodded and poked that bear until they got the commitment.  Not just to have the Minority Center and to fund that, but to also persist with creating the Minority Fellowship Program a few years later.

Following up with that was the creation of this national convening to specifically look at the mental health of Black people. Now, I can't say with certainty that had there never been a center for minority group health, there would never have been an office of -- for disparities, research, and workforce diversity. Or a minority mental health and mental health disparities research program.

But I can, I think, say for certain that planting that seed all those years ago, somebody within NIMH said, "This is not going to go away.  There is validity to what is being done."  And with the pressure from outside, particularly the political pressure, since we all report to somebody, that political pressure helped make the goals of that minority center more important than standing tall and firm against change.

So, I'd say that that ambitious agenda that Chet and crew came up with in the late 60s paid off by the 80s.  And under leadership, including the current leadership here, I was honored last weekend to be at a conference and heard Dr. Borba get asked a question about, well, what happened?  The name of this place.  Is it still in -- is that office still functioning?  And do they still do work?

And I was so pleased when she responded, "Names change.  Commitment remains the same."  And it was -- her response was much more detailed.  I don't want you to think she just blew them off, but that's what I heard.

The name may have changed several times; I think was the response.  But the work that we are doing in that office, whatever the name is, is evidence of the continued commitment on the part of NIMH.  And that meant that what started -- again, what started in '69 as an idea of a few people to make a change has continued to grow and blossom like the cherry blossoms are here in D.C.  And that this convening that resulted in a report then set the stage for the stuff we're talking about now.

The disparities were identified.  The inequities were established.  There is a benchmark that we can start with.  And since then, we've had report after report confirming what we know.  And now, we have institutions looking for ways to support changing those things. And we're almost at 40 years out from the Heckler report.  Actually, I guess this is 40 years from the report, if it was 1984.

And we hear today about the ATs of community engagement.  We hear about the Compass program.  We hear about engaging with people who have the experience and the knowledge and the awareness to understand what communities need, what they're willing to work on and how to work with them.  Not how to take a program in, drop it there, do some evaluations, and leave.

We actually have blueprints for how to do this work and a defined agenda for the work that needs to be done.  I actually put some data in here.  But I think I'm going to skip that and go directly to the third and final thing that I wanted to cover today.  Because I think I'm supposed to be done at 4:15 p.m., right?

So, the final thing is the critical issues of work that we still need to do.  That stuff about in the future.  And we've made some tremendous progress.  There are things that have happened in the last decade that many of us would never have imagined.  And I have to believe that Chet is up there smiling, saying, "Finally, you got it done.  Finally."  And I'd like to think that he's happy about it.

But in truth, there's still a lot of the same issues that we've had for the last couple of decades.  People still think this is just a pipeline issue.  There just aren't enough people interested. There just aren't enough people qualified.  There just aren't enough people who I want to work with.  You know, I like working with people like me.  I want to replicate myself.  And really, there's no one that I know who would fit, if you know what I mean.

And having [laughs] gone over to the dark side, I've actually been in rooms where people have expressed these concerns when we have talked about people that we might want to include in these things -- in these research activities.  And I know there's been a lot of work done.  The notice of interest and diversity describing NIH's position, their compelling interest, and their desire to move the needle on this goes without saying is an important step.

But there are a couple of other things that I want to mention out of the -- out of my perspective that I think bear at least discussion after this.  We've heard a lot about training.  And training upstream so that the people who engage in this work in the future actually understand what community engagement is.

You know, community engagement is not hosting a health fair, getting people out, passing out some literature.  Oh, and by the way, if you are interested in being part of a clinical trial, we have something coming up and we've got a gift card for you.

I tell people at my institution all the time, "I don't know about you people, but when I go into the Kroger, people remember they saw me at a program or saw me on TV.  Or remember my voice from an interview on the radio and they say, 'You are that lady."  I said, "Now, you guys" -- and I really should say you white guys.  But I say, "You guys get to go into the grocery store.  You're anonymous.  No one knows you and they never assault you."

And I don't mean that in a physical assault way. I have to stop sometimes and explain something to somebody who heard that much and elaborated it to this much and feels like the university has turned its back.  Or the university can't be trusted.  And I'm put in the unenviable position of explaining that the university is not some big bad thing that you can't trust.  And please give us another chance and all of that.

So, if we don't educate the people who are going out there to engage with our communities, then we're going to keep having people like me have to explain away the challenges that they are -- that are being raised in this work.  And by training people, we're also mentoring them so that they can be elevated to positions of leadership where they can perform and feel like they're doing a good job.

I've had so many people say they'd like to study X, Y, and Z.  Well, that's not a major problem in Memphis.  And I understand you have a scientific interest in it.  But first of all, recruiting people to participate is going to be a challenge.

Secondly, the way you talk to me, if you talk to them like that, nobody's going to want to participate.  And thirdly, why are you interested in that when we have so many other things in town that should be studied?  Couldn't you be interested in something that is relevant to the people you want to work with in the community for once?

So, I encourage people to look at the unique and distinctive health features in the area where you live and figure out how to work that into a research interest as best you can.  And if you can't, either live in a different area or change your mind.

I think we have to be intentional.  We've talked a lot today about the changes needed in our internal structure.  We have to be intentional about that.  We have to be like Chet Pierce, a dog with a bone and not give in to, not yet, we can't do that.  Institutions are going to have to change.

We had a conversation at lunch today about the role of F&A in supporting institutions and how that dries up when there are fewer and fewer grants.  And if more communities get engaged in doing the research that matters, the only research that's going to be left is that very high-level bench research that for many of the faculty that I know is not going to pay their salary.  It's not going to get them to postdoc and will not be enough to satisfy the institution that they're carrying their weight by the amount of F&A that they provide.

I don't know what yours is.  For 26 percent off of every contract that I have -- every grant that I have, 26 percent right off the top takes away from service dollars. And I don't do basic science research. I do community-based, participatory research, service interventions, practices, and strategies for increasing education and communities around health and mental health.

So, every dollar I lose to F&A that I can't put into service means I'm helping fewer and fewer people.  And I don't really like that.  But, you know, that's the way the institution is structured. So, we've got to be intentional about changing the way we operate internally.  And that means people like me have got to keep raising a fuss because I'm old enough and senior enough and don't mind if they do and say things that they think they can get away with to me.  Because I can do and say it back because I'm an old, Black woman who gets away with stuff.  And then we have to use this framework.  I love Dr. Dumont ATs.  I've got a guy in Memphis who started as the director of a small nonprofit that I contracted with to work with me on a system of care program.  And really worked with him on becoming a natural community support for that SAMHSA-funded grant.  He has leveraged that to build his organization.

We no longer even have to contract with him because he can get his own contracts and grants.  But he is now an elected official.  He is the second in command in line for leadership at our county commission. Now, he went from being a nonprofit -- director of a nonprofit to being chairman or president pro tem of our county commission in about five -- less than five years actually.

So, it is that kind of community engagement where we empower and entrust responsibility to organizations in the community who have the trust of the community but are still willing to work with groups like institutions in the academic world.  My last recommendation may be a bit more controversial.  Because since I'm not a researcher, I'm not wed to the notion that a randomized controlled trial is the only gold standard for establishing evidence.

I am not wed to that notion.  I'm not against it because I've seen the evidence that it actually can work in communities.  But I'm part of a group out of SAMHSA looking at how we can better evaluate community-defined programs that are effective and work them into the evidence arena.  Because that's where communities want to start; with what they know works. They'll trust what we know and tell them works after they've been able to show us, they're not stupid.

They've been handling things before we dropped into the community with a few dollars and a big idea.  And if we can get to the point where this kind of work is valued by institutions -- people have said this already today.  If we can get to that point and begin to see this as a path to leadership, a path to elevation and promotion.  A path to sustained career in academia and academic research then, we will have achieved the ultimate goal of Chester Pierce and Jim Comer and the others back in 1969.

I'm going to end with two quotes.  One is from a dear friend, now dead, Carl Bell, a Chicago psychiatrist, who taught me early in my career this mantra.  Risk factors are not predictive factors due to protective factors.  Working in the community, we can identify those things that are considered protective factors, enhance, expand, incorporate them into our work.  Because a child born -- as we heard earlier, a child born where the evidence suggests they have criminal behaviors in their blood, in their DNA, may be at risk.

But that does not mean that at the end of the day, they're going to turn into a criminal because there are things in the community that can be the risk factors.  So, remember, risk factors are not predictive factors due to protective factors.  And identify ways to incorporate into research, building protective factors.

The last one is a paraphrasing of something that Chet wrote in an article that I have mentioned before.  His perspective, as I would say on inclusion, then, now, and in the future that I happily adopt is, "We're not where we started. We're doing much better than we were.

But we've still got work to do to quench the thirst of many Blacks in America who see that we have still not achieved the goal set back in those early days with that early group in '69.  To rectify the importance of servicing better the mental health needs of the Black community."  I'm going to end there.  And thank you for your attention, your time, and being here.

Can you take a question or two?

ALTHA STEWART: Yes, yes, yes.

JOSHUA GORDON: All right.  If you have to leave, leave.  But Dr. Stewart's going to take a question or two before we close.  We'll just come up to the microphones.  A long day then.

ALTHA STEWART: Yeah, looks like.  Looks like we've worn them out.

JOSHUA GORDON: All right.  We'll go ahead and close.

ALTHA STEWART: Thank you.

JOSHUA GORDON: Thank you very much, Dr. Stewart.

MODERATOR: We've got one.

JOSHUA GORDON: Oh, wait, we have a question.

ALTHA STEWART: Yeah.

AUDIENCE PARTICIPANT: Now, I was just sitting there, just, I have to ask.  I can't help myself.  So, you have all this, this box that you received.  Are you working on a monograph of some sort of all these writings? That's number one.  And then number two, I was just sitting there thinking I could see a screenplay, a musical.

I could see it.

ALTHA STEWART: Well, thank you.  First, I wasn't thinking about writing it until I started preparing and realized the significance of this story.  And that so many people don't know all of the history.  I knew about '69 and walking into the APA board of trustees meeting, making demands.  It was in the New York Times.

But I didn't know the time points there around the assassination of King, there being in a planning meeting.  There having a renewed, invigorated commitment to change because they had killed the most moderate person in the world just because he was Black and making some change.  And I think the commitment for me became real at that point.

So, very likely -- two things.  Very likely, I'm working with someone at the BPA -- since this was original material from some planning meetings that resulted in the establishment.  I'm working with them to see if we can find a place to archive it that would pay the respect that I think it needs.  Like, the Schaumburg or the Howard University Library, somewhere at an HBCU, somewhere -- you know, right now, I don't think we have enough for the National Museum of African American History and Culture.

But I don't know.  Maybe a small exhibit there that included Solomon Carter Fuller, the '69, and the progress since then would be something attractive.  But yeah, I am thinking of writing something to capture. Because Chet did some of that work in racism and mental health when he talked about the formation.

But reading the letters and the parallel work at working with NIMH and the APA at the same time while these folks had full-time day jobs in academic settings and private practices.  I think it's worthy.  Now, the second thing about the screenplay, I would love -- I would love it if someone would adapt it.  And I would even play a minor role.

Thank you.

JOSHUA GORDON: Thank you, Dr. Stewart, for an inspiring and fascinating presentation.  Slides are no.  We used to call everything but academia, the dark side.

So, I too moved to the dark side when I came here. I'm going back to the dark side, I suppose.

NIMH is going to host additional activities throughout the year to commemorate the 75th anniversary, which includes one final symposium that will take place on Friday, September 20th.  I'll look forward to being a guest from the dark side at that meeting.

We are also sharing stories, discoveries, and inspiration on our website and various documents, including the 75th anniversary booklet that Dr. Stewart referred to.  So, subscribe to email updates on the NIMH website.  Follow us on social media to stay up to date.  I want to give a special thank you to the speakers and moderators who contributed to today's presentations and discussions.

And to the NIMH staff and our logistical contractors who did a -- really, an incredible job of planning for this event and making it happen.  Especially Jamie Driscoll, the chairperson of the committee that put today's session together.  As well as Phyllis Ampofo and Megan Kinnane, who chair a very large and wonderful group of NIMH staff from all parts of our institute, who've been working on the 75th anniversary celebration for now well over a year and a half.

I want to say a very special farewell.  This is going to be my last 75th anniversary event that I preside over.  Again, it's bittersweet that this will be my final -- these are my final months of NIMH director.  I have one piece of news that most of you know.  And that is the -- that picture of NIMH directors that you saw is going to get a tiny bit more diverse.

As Dr. Shelli Avenevoli, the deputy director throughout my tenure here, will be assuming the position of interim director of NIMH.  Meaning for the first time, we will have a female leader of this institute, if only for the interim period.

With that, I'll give you maybe thematically relevant permission to visit the cherry blossoms and enjoy the rest of the evening here.  Thank you again for coming.