901 Health: Dr. Altha Stewart on Mental Health

The UTHSC professor was recently elected president of the American Psychiatric Association.

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Memphis magazine sat down with Stewart to discuss her time in Memphis and the biggest psychiatric issues facing the city.

Memphis: Let’s dive right in. Why did you decide to focus on psychiatry?

Dr. Altha Stewart: I like people. I wanted to be in medicine, but I wanted to be in the part of medicine where you could actually work with people and not just focus on their illness. Psychiatry affords me the opportunity to have a strong therapeutic relationship with patients, but also to engage with them in a personal, intimate way around how I can be helpful.

While there is a privatized sector of this field, what made you want to go into public health?

I like to think it’s the family business. Everyone in my family has worked in the public sector, either in government, in public jobs, or in federal positions as civilians.

What was it like growing up for you in Memphis?

I grew up in Memphis in the late 1950s, 1960s. It was kind of an interesting time, a time of transition. I was in the 10th grade when Martin Luther King was assassinated here. I was born into the segregated South, and then grew up in the Civil Rights era up to and including his assassination. I went to a public school, Carver High School, which is now closed. But I graduated from Sacred Heart High School for girls, which is also now closed. I’m the person that if you do the background check on, my high school is closed, my college changed names, my medical school was merged and has a new name. All of the background checks will lead you to believe that I’m making things up.

Now you’re the president of the oldest medical society in America.

That’s right. Quite a jump for a girl who doesn’t have a background. Anyway, after high school, I then went to Christian Brothers when it was still Christian Brothers College, an all-boys school. I was in the first class of girls who were actually admitted to the school in 1970. Shortly after, I think in the 1980s, at some point it became Christian Brothers University with all of the big departments that it’s got now. But that was my beginning.

What was your experience as one of the first female students at the university?

It was wonderful. I think there were about 20 or so women who lived on campus, and I was one of them. We had hundreds of boys as our friends of course, and big brothers. It was an interesting time at the school, because it was the 1970s, and there was a lot of change in town, and some of that change was also being experienced on campus. The guys were really very wonderful to us. Most of them really did think of us as little sisters. I don’t recall there being a lot of relationships between the girls and the boys on campus, but a lot of them adopted us as their little sisters and took real good care of us. All the girls lived on the top floor of what was then the only dorm. There was a nun as the resident advisor. But she couldn’t hear very well, which made for interesting curfew.

How did the administration adapt to having a new type of student body?

I think the Brothers were ready for it. At that point, there were probably more brother professors than laymen professors. They’d made the conscious decision to go coed, I’m sure in part because of financial reasons. But, I don’t remember there being a major problem on campus. It was even back then a diverse student body; we had students who came from all over the world. Back then it was mostly sciences and engineering, with some accounting and I guess what we call the liberal arts. Now, it’s a massive university structure with all kinds of wonderful areas of study. They just gave me an honorary doctorate of sciences when I spoke at the commencement this year.

After attending CBU, can you trace your professional path until you arrived here at UTHSC?

I quickly left Memphis, because as I said, it was the 1970s, and things were still a little turbulent. I went to Philly to medical school. I stayed there on and off for 20 years. Moved around to New York and Detroit, and ran large public mental health systems in those places over the course of the last two or three decades now.

Did you ever think that you’d want to return to Memphis?

No, I actually never imagined returning to Memphis. I came back for family reasons and decided to stay. Then, I got involved with some things in the community around improving mental health and got pulled into working in a community program, and running a federal grant, and then working in the county on special projects. Then I was introduced to this person, the former dean of the College of Medicine, who recruited me to come and start the Center for Health in Justice Involved Youth based on my work over the last seven years.

Tell us about the Center’s mission.

The Center’s mission is to identify and keep at-risk youth out of the juvenile justice system, or if they’re in, to keep them from going deeper and get them out as quickly as possible. We are not a service provider, we do training; we do some specialized service identification is the way we look at it. We know which providers offer which kind of service, and so we help to coordinate and serve as a clearing house for the community around where those services are. We also support the planning and development of much-needed new services. We do a little workforce development in the course of that training. We do a lot of community involvement, community engagement, community education around mental illness, around trauma, around adverse childhood experiences and those things, which are impacting how kids get into the justice system.

Does that tie directly into combatting the school-to-prison pipeline trend?

We’re part of the group that is trying to disrupt that school-to-prison pipeline. We work very closely with Shelby County Schools in the area of truancy, which is sometimes the first step onto the path into the pipeline. We actually work with providers who do screenings at the truancy meetings to identify those kids who have challenges that we aren’t addressing, which are resulting in them getting into trouble in school, which results in them being suspended, expelled, and then getting into more trouble and on the path into the justice system.

I know in the past, mental health has been a taboo subject. Has there has been a strong community response? Are you finding appropriate allies here that really can help with your work?

There’s still significant stigma. What we try to do is break down all of the barriers that we can that contribute to people having those misunderstandings, misconceptions, and sometimes deliberate misrepresentation of the facts. But there’s still an awful lot of stigma, and we spend a fair amount of time here at the Center working directly with folks in the community, especially families of kids who’ve been targeted to go into the system, or who were identified as having problems that will result in them going in the system. We spend a lot of time working with those families in those communities, helping them to understand what the system is and isn’t, what mental health treatment does and does not do, and how to best access the treatment that really addresses your child’s specific need.

What would you say are the biggest mental health concerns facing Memphis?

Inadequate resources, inadequate resources, and then there is inadequate resources. By that, I’m only somewhat facetious, because there are lots of people providing service. They tend to fall in a very traditional pattern. For many of the youth and families who need those services, the traditional model simply does not work. The traditional model is “you know you have a problem, you go ask for help, you get an appointment,” but that’s really not how it works in the community. Most of the time, because of the stigma, people don’t recognize that it’s a mental health problem. In the black community for example, many people see mental illness as a moral, character, or as a personality flaw that you don’t have enough faith, that you’re just lazy and weak, and can snap out of it.

In other communities, it’s considered an embarrassment to the family to seek help. In some communities, people don’t trust the providers of services, because they’ve lived in places where those are the people who help imprisoned people, illegally, and keep people under lock and key because of their beliefs. There are all kinds of things going on in this community alone that contribute to that kind of myth and stereotype about mental illness that keeps people from coming into service.

I imagine being the director of the Center comes with its own set of challenges. What are yourday-to-day duties?

Right now we are not a physical location. One day we will be. There’s a team now that works with us on a variety of projects that we have. We’re recipients of some funding for the Children’s Services Department to disseminate into this community an understanding of how adverse childhood experiences, early childhood trauma impacts children in their development and puts them on a path for out-of-home placement as well as serious illness in their adult life. We have those things and we have a staff that works with that who are based right here in the Center. We have some research under way now, where we’re looking at the prevalence of trauma in kids who are in the juvenile justice system, in detention in that system, because across the country, the data supports the fact that for kids who are in the detention setting, up to 70 percent of them have had at least one episode of serious trauma. Most have had up to four.

When you calculate the kind of trauma and the amount of it, it’s cumulative. These are kids who are almost set up to wind up in negative outcome situations. There is that piece that contributes to my having no typical day. On any given day I might start at the juvenile court in meetings around helping to plan for programs, or training staff, in how to be more trauma informed. I might then be in the community doing a presentation to community folks about what it takes to be a trauma informed community so that we can all be part of the resiliency that our kids need. I might end the day at a meeting at a church helping the clergy understand how they can use their pulpit to help craft a positive message of hope when it comes to seeking treatment. Most people don’t understand that mental illnesses are brain diseases, just like your heart or your lungs or your liver, or any other organ in your body. Your brain can have a disease. That’s what mental illness is.

These are very treatable illnesses, we’ve got wonderful and effective treatments, but we’ve got to get people to understand that they work, and that if they need them, they should not be embarrassed or ashamed of seeking that help.

If the Center gets its own dedicated space, how do you see it expanding from there?

I think the brick and mortar will just be a central core location. We will always do the bulk of our work in the community. That’s what this is all about. One of the things that was most helpful in securing my recruitment here was the notion that the university wanted to phase outward into the community. Taking the best resource that is the brainpower, and the human resource within the walls of this university out into a community that very much needs it is my goal. I don’t ever intend to sit for eight hours a day in an office. We will always be out in the community. It would be nice to have a place where we had an established base to kind of come back to, but if we never had a brick and mortar, we would still be in the community.

You were recently elected president of the American Psychiatric Association, and are now the first African-American president of the organization. What does it mean to be leading this organization that allows you to focus on your passion?

It’s obviously quite an honor. I’m deeply grateful to my colleagues who elected me and entrusted me with leading this organization over the next year. It’s also a tremendous responsibility both because it is the largest psychiatric organization in the world, and the oldest in the United States. We’ve been around longer than the American Medical Association. We preceded them by three years. We are an old, established, very large international organization. We are the voice of psychiatry here and internationally. That’s a tremendous responsibility to shoulder. Being the first African American comes with its own set of challenges, responsibilities, and sense of accomplishment, of course. But there is a lot of responsibility in being president of an association that has over 37,890 members in the United States and abroad. That’s a lot of people looking for something.

Are there plenty of foreign members?

Yes. We have many [around 2,000] international members. But we are a presence around the globe. We partner with people around research and training initiatives, and trading ideas about best practices in terms of services. There are places in the rest of the world that may have only one psychiatrist for every 100,000 of the population. They manage to provide some level of care as best they can. In places in the United States, we’re grossly underserved: the rural areas, the Appalachia area, some parts of the Southwest, certain parts of the Upper Midwest, where there may be limited number of doctors. There are models around the world that we are looking at. We’ve shared the model of assertive community treatment, having people in teams on the street to take care of people, industry, we’ve partnered with people to create those models for them in their areas. Memphis, as you may or may not know, is home to The Crisis Intervention Team Model, where police and mental health professionals work together. That’s now a model that’s international. While it wasn’t a part of the development of APA, certainly psychiatrist members of the APA are aware of CIT, and promote the use of that model to reduce the negative outcomes when police interact with people with mental illness.

As the president, are there any special areas you’d like to focus on, or any new changes you’d like to implement specifically?

Not so much new changes, but my areas of focus over the next year are going to be engaging younger members who are much more tech savvy and social justice-minded around how they can become more involved in the APA and move into leadership positions. Because the future of psychiatry belongs to them. I want to be part of helping them get ready for their future. I want to continue our work on the global scene, and even scale it up if possible. Thinking of models of care that are effectively used in other parts of the country, and how in some parts of our country those are the kinds of models we ought to take a look at, I’d like to take a look at more of those things. Then, because of what’s happening generally in the country around diversity and exclusion, we have a major initiative at the APA around diversity and inclusion, that I’d like to see expanded. Certainly, coming from Memphis, there is a special place in my heart for working on these race relations kinds of things. The APA has taken some tremendous great steps in that direction. I’d like to see more of that happen. I think it would be helpful in general in the country. I think psychiatrists are uniquely positioned to help to either model behaviors that would be helpful, or to help people adapt and deal with the changes that come about when there is a shift in the population make up.

How do you think all of your experience and resources at the APA will help you solve the issues right here at home?

That remains to be seen. Certainly I’m going to use whatever I have available to me on the national scene to help move the needle on some of the issues we have here, and I hope vice versa, some of what I know from having lived in Memphis at the beginning of my life, and now back again, with respect to all of these things. Memphis is big on the global scene also. You can’t be an international organization and not think globally. There is a lot to learn about how you interact with people in different places. There’s a lot of cross cultural understanding right here in Memphis because of the make-up of our population being so diverse. The university I think has a lot to offer in terms of what we do that will impact nationally.

On a more local level, what can the community be doing to help with the stigma against mental health?

I think as we move into the community, having people out there who are champions, who both understand and buy into the notion that mental illnesses are real, but effective treatments are available. Helping to spread that word as credible messengers in the community will be the most help. I think communities being understanding, and supportive of people with mental illness. The average person with mental illness who is hospitalized does not get visits from friends and others. If you go into the hospital because you got appendicitis and you have surgery, your hospital room is filled with balloons, you get flowers when you go home, as soon as you’re able to eat you get a casserole. That’s sort of the picture of “we’re here for you.” For people with mental illness, that is often not the picture. Frequently people don’t want to be around them. They’re isolated; families with children who have these problems are typically the families who can’t come to family gatherings because the kids act out, they can’t have their kid go to someone else’s birthday party because they never know what’s going to happen. No one comes to their party if they throw one, because they don’t want to be around them. These are people, especially the kids, who are very isolated, and who don’t get a chance to have kind of normal social interactions. These are families that are really struggling to be involved and engaged with their support networks, which is why it’s so important that we work with churches and community organizations, because that’s where people go for help. If they’re not afraid of people with mental illness, maybe there’s hope that the rest of the community won’t be afraid either, and will embrace them instead of expel them. It’s going to be a very busy year, we think. The APA will celebrate its 175th anniversary, so there’s a lot going on with us going forward. We’ll have a big annual meeting in San Francisco this year as part of our celebration. In terms of local things, we’re just going to continue to do the work we do here at the Center, continue to spread the word about de-stigmatizing mental illness, and continue to work on improving the kinds of services that people get based on what they need.