Honoring Black History Month: Q&A With Dr. Stephanie Le Melle

Stephanie Le Melle, MD, Columbia’s Director of Public Psychiatry Education, runs the Public Psychiatry Fellowship where she’s training the next generation of psychiatrists devoted to the recovery of people with serious mental illness. She grew up in a politically and socially active family and had a sense of public duty from an early age. Dr. Le Melle shares that Black History Month reminds her of all the racial trauma her predecessors endured caused by centuries of discrimination and violence. “They had to deal with injustice and physical brutality, yet they still tried, they continued to pave the way for me to be where I am now,” says Dr. Le Melle. None of us got here by ourselves, whether we’re a minority or not, there were people who had to work hard to get to where they were to allow us to follow in their footsteps. “And so, for me, Black History Month is the celebration of that passage from one generation to the next and the steps I can take to pave the way for the next generation."

Tell us about your work.

I’m the director of Public Psychiatry Education for Columbia’s Psychiatry Department. I also run the Public Psychiatry Fellowship Program, a one-year, post-doctoral fellowship for 10 fellows a year. Our fellows receive didactic training and supervision twice a week and work the remaining three days as part-time attending psychiatrists in public behavioral health programs throughout the city. Typically, the fellows work with people who have serious mental illness and complex needs in the shelter system, psychiatric emergency rooms, crisis centers, at Rikers Island, and on Assertive Community Treatment (ACT) teams, crisis centers—essentially in any community behavioral health program that serves this population.

I am also the course director for the community psychiatry curriculum for our residents. We have a didactic curriculum across all four years of residency training, which is primarily focused on acute care and on a private practice model of care. Residents, therefore, see people in the emergency room or inpatient settings when people are at their worst. While they don’t get much exposure to how people actually live when they are well in the community, we try to provide this exposure for them.

Why community psychiatry? Why the Public Psychiatry Fellowship?

I’ve been interested in social justice, civil rights, and civil liberties since I was young. I grew up with a sense of my civic duty to be a good citizen, take care of others, and to provide for underserved populations.  

However, growing up I wasn’t exposed to the field of psychiatry. I didn’t know anyone who had even gone to a psychiatrist, so it just wasn’t on my radar. But in medical school I was drawn to people who had serious mental illness and spent time in the “back wards of the hospital,” where I would sit and talk with patients. The more I learned from people who had serious mental illness, the more I realized how marginalized they were. I realized that although their symptoms were being treated, the other conditions of their lives were not being addressed, that even my peers, other medical students, residents and attendings, were not giving people the same sort of attention or consideration they gave other patients. I also saw firsthand that people served in the publicly funded systems of care are poor and people of color are over-represented in the public sector health care system. 

I also had some terrific mentors along the way, one of whom was Merrill Rotter MD, the Director of Law and Psychiatry at Einstein – Bronx Psychiatric Center, who at the time, was starting the very first mobile crisis team and CPEP program in NYC at Elmhurst hospital. As a med student, I did an elective with him and that solidified my commitment to psychiatry. Working with Merrill and seeing how he worked with clients, how he helped to develop a system of care for clients who had complex needs, and how important continuity of care was for these clients, led me to community psychiatry. This was my first exposure to recovery-oriented systems-based practice.

What was your experience like working at the Washington Heights Clinic when it began to be viewed as “Cutting-Edge Community Psychiatry”?

Washington Heights was designed intentionally by our first Director, Chris Beels MD, and then by Francine Cournos MD, to be a community program that was client centered and where each member of the multidisciplinary team was recognized and respected for their expertise. It also was patient-centered care and recovery-oriented care based on what individuals needed, including providing continuity of care from inpatient to outpatient care, to CPEP, all the while addressing their social determinants of health in a culturally informed way. Our outpatient staff knew our inpatient staff, we had recovery oriented multidisciplinary teams that communicated regularly with each other across these services.

The perception that mental illness “is not a crime” is gaining traction. What are your thoughts about healthcare being First Responders rather than police?

While 988 is a good starting point, what we really need is crisis systems of care. Right now, we have emergency rooms, inpatient units, and the criminal justice system, but we really need to have a spectrum of collaborating services and preventive services. We also need to address police brutality against people with mental illness and people of color. Police are not clinicians and should only be involved in mental health emergency responses under very specific conditions.

Do planning grants going to the State level with bills being introduced in Congress make sense to you?

Grant funded programs like the Support and Connect Center, through Project Renewal, are working to address the need for “a spectrum of services” for people in crisis by serving as diversion sites for police to “drop off ” people who need assistance, social services, and peer support but are not acute enough to require emergency care. These programs have overnight beds where people can stay for several days, get services, treatment and avoid having to go to an emergency room or end up in the criminal justice system. Clients can actually get their needs met and remain in the community. Grants are a good starting point and programs also need other sustainable funding stream to grow like billable services.

Given that it’s Black History Month, how should we be thinking about race and change? 

Addressing racism is not a minority issue, but instead a majority issue. Minorities have been trying to address these issues for years and it has had some impact. The fact that I’m sitting here talking to you as an associate professor at Columbia University and running a program in our department I think speaks for itself. However, the fact that we have no African American full professors in our department also speaks for itself. So why is that? Why do these disparities and inequalities exist? There’s a long history to this, but I think we should focus on what can we do about it now.

How can Columbia psychiatry improve its track record in increasing diversity in the field?

I think it has to be from the bottom up and the top down. We can start with our trainees by helping them to be reflective of their own biases and stigma and how that impacts the way they interact with each other and also with the clients we care for. Like in our emergency room, when we’re doing an evaluation, but not just in an emergency room—in any clinical evaluation—we put down “African American female.” Why is that even relevant? It’s just a female who needs care. 

Part of education is exposing people to what they don’t know, so there’s all sorts of knowledge that needs to be gained, and I think that the Office of Equity, Diversity and Inclusion (OEDI) will help with some of these educational goals. It should not be that this office alone is responsible for change. Departmental culture change needs to be supported by our administration. Everybody needs to be involved, and once we are more aware of our own bias and the structural racism that exists even in our departmental structures, we can begin to look at the data and address these issues.