Spotlight Interview with Dr. Michelle P. Durham

“…Between working locally or globally, at the end of the day, we have to remember that there is a person in front of us.”- Dr. Durham

Location: Boston, USA

Bio: Dr. Michelle P. Durham, MD, MPH, FAPA, DFAACAP is the Vice Chair of Education in the Department of Psychiatry at Boston University Chobanian & Avedisian School of Medicine (BUSM) and Boston Medical Center (BMC). She is a board certified physician specializing in pediatric and adult psychiatry with additional board certification in addiction medicine. Her public health and clinical roles have always been in marginalized communities. She is dedicated to health equity and advocacy for equitable mental health treatment globally and locally. In addition to her clinical practice at BMC, Dr. Durham is the Co-Director of Implementation for Transforming and Expanding Access to Mental Health Care in Urban Pediatrics (TEAM UP) for Children, Associate Director for the BUSM/BMC Global and Local Center for Mental Health Disparities, and Clinical Associate Professor of Psychiatry and Pediatrics at BUSM.

Of all the different roles you play in the Department of Psychiatry, what is your favorite project you are working on?

I don’t necessarily have a singular favorite project I am working on. Ultimately, what I love is mentorship and partnership, meaning there are great folks in our department and outside of our department that we can collaborate with. It’s the getting together to ask, “How can we solve an issue?” That’s what really guides a lot of projects I pursue with the notion of, “How can we do this work better? How do we provide better care? How do we serve marginalized communities? How do we push the envelope? How can we be innovative? How would I want to be treated? How would my family members want to be treated?” Those are my guiding principles. What my answer is really pointing to is that I lead with my mission, vision, and values in everything that I do. With all the projects and teams I’m leading, these questions are in my mind. It’s really a lesson to go with and do what makes your heart tick. All my local and international work shares a common thread. Unfortunately, good mental health care is hard to come by, and it’s even harder to come by as a person of color or of low socioeconomic status. I always ask what can we do to improve that, in all settings?

Why is approaching psychiatry with a global lens important to you?

I hope everybody who is doing global work remembers that at its root, it is really about bi-directional learning. It should not be about us going to another country and telling people what to do and deciding their care model. Quite frankly, we have folks here in the U.S. who are not getting adequate care and we have so much to learn, too. I feel that should really be at the forefront of what folks who want to do work outside of the U.S. think about. The bidirectionality is so important, especially at Boston Medical Center where our patients speak over 150 different languages with our top three being Haitian, Cape Verdean, and Spanish. And so, the interest for me is, “How do I do this work better? What am I missing in my clinic day-to-day when I’m engaging with a patient or their family?” I think about all aspects of who our patients are. Most of the time, a patient’s country of origin, their cultural beliefs, and how they grew up are what guide whether or not they are going to say yes to something, or give you information, or even come in for treatment to begin with.

            The global work I’ve done has dated back to my residency training. Then when I became faculty, I went on my first trip with the Department of Psychiatry’s leadership team to Ethiopia and then Somaliland. That experience was very enriching for me. Since then, I’ve been to many countries in Africa and have done a lot of teaching. When I come in to teach, I always keep in mind to say in all my lectures, “I am letting you know what we do in the U.S., and I would also love to know how is this different or similar to what you have learned.”

I also think that then led to reinvigorating the Africa Global Mental Health Institute (AGMHI), which recently had its conference in Cape Town after a recess during the pandemic. I am always in awe of our colleagues and everything they do with fewer resources than we have here in the U.S. I also think we have a lot to understand and gain. They’re so much more knowledgeable because they had to learn how to expand their knowledge base without the luxuries that we have in the U.S. They are really depended on to do things outside of psychiatry in ways we don’t experience because we have access to other people on the team. We have also practiced the bi-directional piece by having international trainees come to Boston to observe and learn and vice versa where our U.S.-based trainees are able to go abroad to understand different systems and see how things operate. This exposure provides so much additional knowledge to benefit from and utilize in serving our diverse patient population.

You’ve been a key player in the AGMHI - My question to you is what are your hopes for the AGMHI’s future?

I really feel like our collaborators in South Africa and the U.S. are strong partners, but I would love for it to grow beyond that. We want every country on the African continent to also have strong ties, with the AGMHI being a centerpiece to build these connections and relationships for resource sharing. It’s about utilizing the brain trust on the continent and not necessarily needing to have a U.S. partner. The AGMHI is essentially answering the question of, “How do we build the strength within the African continent?” We hope that people will start to look to our AGMHI members on the continent to lead, whether that be through panel discussions, research initiatives, clinical training, etc. We want to emphasize resource sharing because our members have such strong networks.

Can you speak about the importance of addiction psychiatry?

I’d like to start by just thinking about addiction. The media unfortunately tends to only think of the homeless person on the corner as the person with a substance use issue. So, I want to put everyone’s beliefs about that aside because it is 100% inaccurate. People use and misuse drugs every day; people that you’ve seen at work, that are leaders of companies, that have a family, that have a house. Everyday people use and misuse drugs. That population that you see outside of the doors of our emergency room at BMC or on the corner is a very small percent of the population. I just want to lay that out because I think there is this notion that it’s only certain people who use drugs. Most health consequences of drugs come from nicotine and alcohol - which are both legal. Legal drugs have lots of health consequences for folks. Like everything else we do in psychiatry, when it comes to the point when you need psychiatric help, it's because you’re not functioning-at home, at work and/or in your community. This is why I think that every psychiatrist should know how to work with somebody who has a substance use issue. It’s also in our guidebook, the DSM (Diagnostic and Statistical Manual). As a training director, and likely because I trained at BMC, I always made sure it was incorporated into our curriculum. If you graduate from our program, it's because you understand that people come to you as a whole person with many different issues, and one of them may be that they misuse substances. I don’t want to contribute to the field and to healthcare where we silo things. We see a lot of co-occurring issues such as trauma, depression, anxiety, etc., not for everybody, but for a good percentage of the population. We need to be equipped as psychiatrists to understand links between issues to understand how to best approach the root cause. Our goal in psychiatry, whether a child or adult, is trying to get them back to their baseline of being a functioning member of society. There is a lot more to say on this topic, especially in the context of BMC where we serve low-income communities and people of color. This makes it even more challenging because, like anybody, we need you to have a stable living environment, food, etc., because when you don't have those things, it's really hard to focus on your substance use. These are really complex issues that require patience and dedication.

Dr. Durham, the way you speak is so engaging and digestible, especially coming from someone who doesn’t have a clinical background - it’s truly like listening to a TED Talk!

I really do appreciate that. I’ve said this in some talks I gave to medical students a few months ago, but sometimes even I’m confused by some physicians and the point they are trying to get across! Some people do really interesting research, but we have to find a way to communicate properly or else everything is going to stay in this academic environment with just the researchers reading it and not informing the communities you are doing the work to improve. You have to figure out how to translate it, and talk about it, and maybe even do a TED Talk! No one outside of academia is reading an academic paper. I am probably saying something that I led with earlier, but the question comes down to, “What are we doing this for?”  

Any advice to youth interested in a similar career path?

What I will say in general is the path to being a psychiatrist is long so you have to be dedicated. Part of this journey is understanding that not everything has to happen back-to-back or perfectly as to what you expected. I think we all get caught up in this idea of not wasting time and doing everything by the book. If you follow your heart, your intentions, and the things you are dedicated to, then you will find your “correct path.” I also advise you to stay involved in interest groups because it helped me remember what my end goal was. Medical school is difficult, but I always kept activities that were aligned with my interests. Have a good peer network because you rely on them a lot; they know you in a very holistic way and will know how to support you best. Stay consistent with what you believe in and make choices based on that. Stay true to your values.

What do you look forward to exploring in the new year?

I always tell the residents that we, as physicians, have chosen a path of continuous learning - that's sort of innate. It’s no surprise that I am now saying, “I've been in a role for a decade, I know it pretty well, but I want to grow in a different way.” Sometimes, that means you have to go outside of a system to be seen in a different way and to learn something different and to be challenged in a different way. This new year is going to bring a new challenge and new phase in my career. I am really going to be thinking about how to build a system of care when most of my career has been very focused on training and education. I am going to be more clinically focused, still working with the same population but with a different perspective.

Closing Thoughts

The last thing I’ll say is whether working locally or globally, at the end of the day, we have to remember that there is a person in front of us. Whether we are sitting in Ethiopia or in Boston, there's an individual in front of us with potentially different experiences in terms of their family or community. Lumping people all together just because they come from one place, never really works. We need to think about asking the right questions of the person in front of us and being curious about their own experience, not thinking about it as the experience of the person we saw before them. Each person is different, and you have to ask questions and be curious to get an understanding of who they are and how they walk through this life.

Explore TEAM UP for Children online trainings here: Enhance the skillset of the primary care team in core competencies of pediatric behavioral healthcare

 By Joanne Won, December 2022