This limited podcast series is brought to you by APA's Women Psychiatrists Caucus and hosted by Anjali Gupta, MD, President of APA's Women Psychiatrists Caucus. Dr.Gupta is an Assistant Professor in the Department of Psychiatry at the Georgetown University School of Medicine. She has led a number of wellness and equity initiatives at Georgetown and was selected to be a Gender+Justice Initiative Faculty Fellow for her research on The Experiences of Women in Medicine. She is active with APA's Committee on Women's Mental Health and is Chair of the AMWA Literary Committee. In this series, Dr. Gupta will interview women psychiatrists across the country who lead in a variety of ways. These conversations will uncover insights from guests' journeys in psychiatry on a range of topics, including work-life integration, mentorship, gender equity, and more.

In this episode, Dr. Gupta is joined by Dr. Dionne Hart. Dr. Hart is board-certified in Psychiatry and Addiction Medicine. She is an adjunct assistant professor of psychiatry at the Mayo Clinic Alix School of Medicine and was recently elected to the APA BOT as the Area 4 Trustee.

Transcript for Audio

Dr. Dionne Hart (00:00): Seek ways to be successful, even when somebody tells you no the first time, to keep looking for someone who may say maybe, or give you a no, but then tell you what you have to do in order to get a yes. Just keep trying, and knock down the barriers you need to, but sometimes grab a friend, and see if they can help you knock it down.

Dr. Anjali Gupta (00:27): Welcome to the Women in Psychiatry Podcast, by the American Psychiatric Association's Women Psychiatrists Caucus. I am Dr. Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewing women psychiatrists across the country who lead in a variety of ways, so that we can hear their stories and learn from their insights. I'm looking forward to being here today with Dr. Dionne Hart. Thank you for joining us today.

Dr. Dionne Hart (00:57): Thank you for the invitation.

Dr. Anjali Gupta (01:00): Dr. Hart, just going back many years, what inspired you to go into psychiatry?

Dr. Dionne Hart (01:07): Growing up, I was in a blended family. My father's first wife was diagnosed with schizophrenia early in their marriage, but after they had kids, and it changed, of course, the trajectory of their family. She was hospitalized for a very long time, so she didn't have the opportunity to be physically present for my older siblings. I knew how that diagnosis changed their lives, but also, as a Black woman, and this was in the 60s, she was misdiagnosed, I believe, because her symptoms occurred right after she gave birth. I think if she had been diagnosed today, she would've been diagnosed with a postpartum psychosis, or maybe a major depression with psychosis, but we'll never know. Certainly, the idea of a misdiagnosis, the idea of how mental health could change a family for forever, was always something in my mind, so when I went to college, I studied psychology. I was a social worker, and then eventually found my way back into medicine with the intention of becoming a psychiatrist. That was always my goal.

Dr. Anjali Gupta (02:48): At what age did you have an understanding of some of these pieces about mental health, and some of what was happening?

Dr. Dionne Hart (03:00): It was very gradual. From a very young age, because it was such a big age gap between my dad's first family and me, 20 plus years, I grew up with my dad, "You're going to be the doctor, you're going be," because all the things that he wanted them to do, they chose different routes. It's like, "Okay, you're going to do all these things." Medicine was always like, "Okay, this is something I should be thinking about very strongly," but I think this mystery of who she was really wasn't clear to me growing up. We would go visit her in hospitals when we went to see my grandparents, so I knew that she was important enough for us to incorporate her into our family visits, but I didn't quite know who she was.

(03:56): She would cling to me so tight when I saw her, and it wasn't until years later that I realized, she thought I was the baby she left behind, and she would get really sad when I left. She always sent gifts that she made, or things that she bought, and then suddenly, for some reason, we stopped visiting. She was always somebody that I was curious about, but not until I was older did I start to put the pieces together, and carefully try to ask my older siblings about her, but naturally so, they were pretty guarded, and not wanting to talk about it. I think some of it was, they didn't know, but also, what would that mean if they had to say that their mom had a mental illness?

(04:59): It was one of these secrets that was open, but also very closed. I think that happens a lot in Black families, particularly, the stigma of saying that you have a loved one who has mental health struggles. I'm going to over rise the discussion about, you should know your family history, because you're going to be an adult, and have your own children, or just because mental health is health, and it should just be something that is generally talked about, but it wasn't. Throughout my life there's been pieces where I've been more curious about it. Even last year, I asked my oldest sibling, who is almost 80 now, about her mom, and she had very little details, but was very open to talking about it. That's changed, and I was grateful for that, but she just didn't have more information.

Dr. Anjali Gupta (06:12): Well, thank you for sharing that personal story, and the complexity for a child, like you mentioned, the stigma, and then also piecing together the perceptions as a child. You went into psychiatry and came out of residency. What was your first job out of residency?

Dr. Dionne Hart (06:39): I had an obligation to National Health Service Corps, because when I went into medical school, I went in as a single mom with three kids. Money was difficult, and trying to figure out how to finance medical school and also take care of my kids, I elected to do National Health Service Corps. When I went out of residency, I had essentially one choice that was close enough to my home, where my kids wouldn't have to be disrupted in the middle of high school. I worked in a secured medical center which was part of the Department of Justice Bureau of Prisons. That was my first position at a residency. I always moonlighted during residency just for that same reason, to try to supplement my income, but that was my first full-time position. I'm still there.

Dr. Anjali Gupta (07:46): How was that? That was probably so different. Had you had exposure during residency? How was that for you?

Dr. Dionne Hart (07:56): The year before I became a third year, the policy changed. Before that, all the residents had to do one outpatient day during their third year, every week, at the Federal Medical Center. It was incorporated as part of the community psychiatry education. When I became a third year, that stopped, so I elected in my fourth year to do a month there, because I knew there was a possibility that I would end up in a correctional facility as a part of my National Health Service Corps service obligation, but also, because I realized that those were many of the patients that, after they were healthy enough, recovered enough to go to a state facility. These were the same kind of patients at a federal medical center that we saw, and then we transferred.

(09:04): I was very curious about patients who were living with severe mental illness, so I elected to be there for a month, and it was very different. Obviously, Mayo has an amazing system, and I am taking that aside from the healthcare piece, but the actual system of Mayo is amazing. People anticipating things that you will need as a physician are there before you even ask, almost. I went to a system where nobody was asking, there was no anticipation, and even after you asked, it might not be available. It was a big transition, but after I got used to the systems piece, I realized the healthcare actually was very much the same. The majority of psychiatrists and general physicians at that time were Mayo-clinic trained, so the patient-first mentality was present, and had been weaved in from the inception of the medical center, because the first associate warden of medical was a Mayo graduate.

Dr. Anjali Gupta (10:19): Wow.

Dr. Dionne Hart (10:22): It was, and it still is a place where I feel I can make a difference, where I can help patients with some of the most severe mental illness that I've ever seen, but also, make a difference by just seeing people, and recognizing how much healing comes from people being treated with humanity out there first, and thinking about what led you to be in that institution second. I've tried to maintain that. Of course, I only had a three-year obligation, and I've been there for 17 years.

Dr. Anjali Gupta (11:06): I was going to ask you how your career unfolded from there, and it sounds like your career blossomed there.

Dr. Dionne Hart (11:14): Yeah. I enjoy working with the patients, and as a woman of color, to work in a correctional facility, I realized even my presence made a difference for the people who did not have a severe mental illness. For the people who are overrepresented in corrections, just seeing a Black woman professional was something that helped them feel safer. Oftentimes, people would know my name and I had never seen them before, but just would say hello, and just very respectful, and just pleased that I was there. I realized how much of a difference I can make just by being present, but also, advocating for people with different experiences than the majority of the administrators who have come and gone, and just trying to talk about some of the needs that may not be immediately obvious, or known, or understood, and really trying to advocate for those patients. It has become my professional career. It certainly wasn't something I thought of when I went in. I thought I'd do my three years and then move on, but I am pleased I stayed for the patients.

Dr. Anjali Gupta (12:44): It sounds like they're lucky to have you.

Dr. Dionne Hart (12:47): I hope so.

Dr. Anjali Gupta (12:48): Dr. Hart, through this journey, tell us a little bit about mentorship, peer support. How has that been for you?

Dr. Dionne Hart (12:58): Well, especially because I work in a non-traditional setting for healthcare workers and physicians, there's been challenges. People talk about outside influences impacting healthcare, the political determinants of health, and insurance, and all those things that people think of is not penetrating into correctional facilities, and it does. There's a lot of external factors that come into taking care of patients. I report to people who are not healthcare providers, and they have a lot of influence over my day-to-day work. It's been very important for me to have strong mentorship outside of the institution, to help me stay grounded, to help me continue to manage the stressors associated with working in that setting, the trauma that I experience vicariously through my patients, and also, my own personal experiences. I have been so grateful, because many of the people that I've met in medical organizations like the APA and AMA have been there to Zoom, to text, email, have a face-to-face to help me stay mindful of my purpose as a physician, and my purpose in that setting.

(14:50): I think it has been an exceptional gift for me to have mentors. It is not just people who are senior, it's been people who are at the same career point, but also, sometimes medical students and residents. I remember just last year, when I was on an APA committee, I was sitting next to a medical student. I asked him about a task, and he said, "Dr. Hart, I'm a little overwhelmed, so that's a future me problem."

(15:22): I was like, "What?" For a minute, I was just taken aback. And then I thought about it, and I'm like, "Good for you, exercising self-advocacy and saying, "I'm overwhelmed at this moment. I can't commit to that." I use that often, and I will say shout out to Brandon, because he really helped me. Just that little tidbit, he was advocating for himself, but it also helped me. It's like, "Okay, you are right. We don't have to take on everything at this moment. We can say, that's for the future." I just think that mentorship, and people giving you good advice comes from all directions of people, people who are retiring, people who are peers, people who are still building their careers, and it's just such a gift.

Dr. Anjali Gupta (16:21): I love that. What an important tidbit, that as long as you are open to receiving it, it might come from all directions, and all different places you might not even expect.

Dr. Dionne Hart (16:35): Definitely.

Dr. Anjali Gupta (16:37): What advice do you have for women who might be looking for mentorship?

Dr. Dionne Hart (16:41): I think what you said is very important, being open to it. I think we often think about mentors coming from people who are advanced, or have a similar path, but it just doesn't have to be that way. Many times I have mentors who come in and help me with a particular problem, and it's not that we decided to part ways, or we're not in touch. They were mentors that I needed for that moment, and then you decide, okay, there's a way to move forward, or somebody else needs them at that moment, and you don't have the same long-term mentorship that you might have with others.

(17:35): I think being open to the fact that you might have the need for several mentors at different stages, that it might not always be long-term, and that it might come from an unexpected source, I think it's very helpful. I just would always advise people to listen, and be mindful of the lessons that somebody else can teach you. It doesn't have to be someone who looks like you, it doesn't have to always be a woman, but I think the diversity of the experiences that I have been blessed to benefit from is something that I think has shaped who I am, not just as a physician but as a person.

Dr. Anjali Gupta (18:33): Thank you. Such important, important messages. You mentioned professional societies. Talk to me a little bit about that. How did you get involved? How did you find those mentors through those societies? What were ways that you were-

Dr. Dionne Hart (18:53): I was involved in the Student National Medical Association as a medical student, and then, when I transitioned to Mayo, it was the first time I'd ever lived outside of Chicago. I've been a single mom for a long time, but I was a single mom with family nearby, so coming to Minnesota, I was without any support. Initially, I just didn't add another thing, but senior year, I had the opportunity to get involved in the Minnesota Medical Association, and the Minnesota Psychiatric Society, and it was just stopping by, feeling out. When I wasn't selected to be chief resident, I was upset, and then I said, "Okay, you have a day where you can feel bad for yourself, and then you have to figure out what you want to do." That's when I really started to get more involved in medical associations.

(19:57): Of course, I realized how much I enjoy policymaking, and going to those meetings, and even the wordsmithing, I just love it. Advocacy and work within those medical organizations, especially the benefit of being around people from different specialties that I don't think I would've gotten just anywhere else, I think that really influenced me. What started off as a loss and a disappointment has really taken me into the trajectory of being very actively involved in multiple medical associations, and just being so grateful for those meetings, and those opportunities to be around my peers. AMA's nerd prom is what we call it every year, when we get together for the president's ball, and it's just so much fun to be around people who get you.

Dr. Anjali Gupta (21:05): It sounds like you move in a number of directions. Any tips for women on work-life balance, time management, how to move in all those different directions?

Dr. Dionne Hart (21:21): I would say I'm still a work in progress when it comes to time management and that balance, but I will say one thing, too. I think that I poured everything into my professional life that was available outside, from helping my children to get to a good place in their lives, and making sure they were educated and all those things. All the energy I had left went into building my professional life, and I never really thought about life after my kids left, because they were my life balance in the work-life balance. When they became adults and started to have their own lives, it was like, "Where's that life part now?"

(22:19): I think that I would say for people to leave a little bit for themselves. I got so used to saying no to people that a lot of time went by, 17 years, before I realized, I haven't been on a date, because I was just so immersed in building my kids up, building my career that I'd never thought about other things. I would say, leave a bit for yourself, but also, when it's important to say no sometimes, but don't say no by default. I just realized, I said no to a lot of opportunities in my personal life that could have been very meaningful to me later on, but I was just so focused on all these things that I thought I had to do that I just didn't plan for the other part.

Dr. Anjali Gupta (23:25): Okay. What have been some of the leadership positions you have enjoyed, and why?

Dr. Dionne Hart (23:36): I think the leadership positions that I have enjoyed were the ones that really didn't feel like work. I think that we take on some committee roles because maybe nobody else volunteers, or you get [inaudible 00:23:53], or you feel like you have to do these things to build up. The ones that have been the most significant, to me were ones where it felt like I was building something. It was very interactive, and engaging. I would say right now, I am the chair of the general sessions for the scientific planning committee for the APA annual meeting, and I never realized how much work goes into planning those meetings, because I just would show up and choose what course I want. And then, when I'm sitting in that room, I'm like, "Oh my goodness, this is a lot of work."

(24:38): But then, we all started talking and planning about what learners would experience, and just trying to build this program, and it was a lot of work, but it just became a lot of fun. I think that's a really good example of taking on these roles, and trying to manage the responsibilities, but also, realizing what the purpose is. If you are on any kind of committee, or any kind of leadership role, where it just feels awful, like you're burdened by just putting it on your calendar, I would say step back, and let somebody else fill that void, somebody who would enjoy that work, and find something for you. Stop checking boxes. Take on leadership roles, take on responsibilities that are meaningful for you in your career.

Dr. Anjali Gupta (25:37): What has been one leadership role that has perhaps been most challenging, and why?

Dr. Dionne Hart (25:45): I currently have an administrative position at my full-time position. I never wanted to be an administrator, I just enjoy taking care of patients. I took this role, or sought it, as a means to try to have some kind of control over my patients, my caseload, trying to take care of myself. I am serving a purpose in doing so, but it's definitely the most challenging, because it's a place where I have to sit and be uncomfortable, because it doesn't give me that joy. I don't feel like that same type of camaraderie like I do in the medical organizations, where I feel like we're all working for the same purpose. It feels like a lot of tug-of-war. It is sometimes very stressful to be in the room where it happens, because you have to hear about all the things that are happening in that room.

(26:49): I think that has been the most challenging. I stay present, and I do my best because I know that I'm representing the interests of patients and people who not only are not in the room, but don't have a voice. It's probably the one exception to the rule about things that I take on because they serve a purpose for me and feel like this is where I need to be to make a difference. I think I'm there, I do try to make a difference. I don't always feel that my voice is unmuted, but I have to be there, because there isn't a person to step in who can do it right now. That's a challenge, and it's my challenge for the next couple of years.

Dr. Anjali Gupta (27:40): Shifting a little bit to leadership in academia, such as program directors, department chairs, what are ways they can support underrepresented medicine, psychiatry residents and faculty?

Dr. Dionne Hart (27:55): Right now, I still identify as a community psychiatrist, but I have an adjunct role at Mayo Clinic. I do a lot of teaching about health disparities, about correctional medicine and correctional psychiatry, and I have been very supported from Mayo Clinic's leadership in order to bring that experience to the trainees. What I have found is a gap, is that adjunct faculty members have the same expectations for promotion as people who are full-time faculty, and it's just really unrealistic.

(28:40): Our community experience, our community work, our clinical experience does not receive the same level of appreciation and understanding when we're talking about academic promotion. I am definitely one of those women who is finding it difficult to break that ceiling for associate professor, and I know a lot of people have talked about, that is the biggest barrier. I think part of the ways that people could support all women, but particularly women who have minoritized backgrounds and identities, we tend to do more community and clinical work than lots of academic work, so having the same recognition of what that means when people are talking about promotion, I think would be a tremendous way where we could be supported.

Dr. Anjali Gupta (29:39): Yeah, that's super interesting, because the other pieces sometimes in academia, such as service, mentorship, some of those areas that provide faculty meaning are sometimes the ones that aren't recognized within those structures. That sounds like a really important recommendation in terms of faculty. What about residents? Are there things that we could be thinking about to support our residents?

Dr. Dionne Hart (30:14): I have taken, in some ways, the adjunct title to be the person that you go to when you don't want to just talk about your traditional residency responsibilities, and was like, "Okay, bring me all the stuff that you feel like, if you said it within the bubble of the academic institution, that somebody might not understand, or they might judge you for. Tell me all of those other things." I really try to use that as a true supplement to their education, to be a true, in some ways, rebel against the system. "Tell me all the things that you wish you could do if you didn't have those barriers, if you weren't so worried about being a resident and then becoming a fellow, and then doing all these things so you didn't ruffle any feathers. What would you want to do? What is the struggle you have with the institution?"

(31:27): I think that has been helpful to the trainees, to have somebody who they can call who's outside the system, but also has experience with the system, to guide them, and support them in their ambitions. I think that's been helpful. I would also recommend any resident medical student, think about what is not present in your team of mentors, your team of consultants, or attending, sorry, Mayo-ism, and what would you want to add to that? Seek that from the outside. Go on LinkedIn, Doximity, and think about your interests, and try to find someone, and fill that gap. I hope that I continue to be that person for my trainees, so that they can always feel that there's somebody to help them, and if I can't help them, to find somebody who can.

Dr. Anjali Gupta (32:31): Yeah, you just mentioned a couple of really important nuggets to unpack. One was just to build a group of mentors. Sometimes, I think for residents, they get assigned to a mentor or two, but to really think about building a group, and they might gain different insights from different people. And then, the other part, just working to find that, and again, professional societies such as APA, social media, there are so many different ways now that they could access mentors even beyond their institution. Having mentors within academia and outside of academia could give them different experiences to draw from. I wanted to give you a couple of minutes to see if there's any other thoughts, or any closing ideas you'd like to share with us. It's been such a wonderful half hour, and I've really enjoyed listening to your journey in medicine.

Dr. Dionne Hart (33:39): Well, thank you. Again, thank you so much for the opportunity. I think that what I would like to stress, and I am at probably at the age where I do a lot of, "When we were in," but I think it's important to know, when I started in medicine, I felt like there were places that I couldn't go. There were places where women had not had opportunities, or women had to think about balancing childcare and all of these other responsibilities that male physicians, they just didn't. One time, a peer gave me advice that still resonates with me, and helps me today, and that, was never accept no from someone who doesn't have the power to say yes. Somebody tells you no, and they never had the authority to authorize what you're trying to do, say thank you for your time, and then move on.

(34:51): I think we sometimes look for the person who may, in some ways, confirm for us that we shouldn't try, or give us that out. I think it's unconscious, but it's because we get so many messages from other people saying that we shouldn't be in some circles, or we shouldn't do some things. I would just say, number one, follow your passions, but also, seek ways to be successful, even when somebody tells you no the first time. Keep looking for someone who may say maybe, or give you a no, but then tell you what you have to do in order to get a yes. Just keep trying, and knock down the barriers you need to, but sometimes grab a friend, and see if they can help you knock it down. We are really restrained by the things that we see as impossible because somebody hasn't enlightened us about it, but sometimes, it's just ignoring the self-doubt, and just moving forward.

Dr. Anjali Gupta (36:02): So many pearls of wisdom. It's been, truly a joy. Thank you so much Dr. Hart for being here with us today.

Dr. Dionne Hart (36:10): Thank you so much again for this opportunity, and I look forward to more conversations with you and anyone who listens.

Dr. Anjali Gupta (36:18): Thank you.

Speaker 3 (36:20): The views and opinions expressed in this podcast are those of the individual speakers only, and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only, and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.