Women Leading Mental Health Research

Could you briefly describe the focus of your NIMH-funded research?

NIMH funded my research to investigate why and how youth of color ended up in the emergency department with a mental health crisis. More and more Black, Latinx, Indigenous, and Asian youth are experiencing mental health problems that need immediate help from trained mental health clinicians. Youth of color are also more likely to keep coming back to the emergency department with mental health crises.

One theory is that people who are marginalized have a difficult time trying to get what they need from health systems. I’m exploring with youth, families, and clinicians how problems navigating mental health care, interacting with providers, or making treatment decisions contributed to the rising use of emergency psychiatric care.

Why is the research you’re doing so important?

There’s a very good possibility that costly and traumatic emergency room visits might happen because kids had problems accessing mental health care outside the emergency room. My research is trying to unpack what those problems might have been, so we can figure out new ways to fix them.

How does it feel to know that your actions could make a difference in people’s lives?

Many people need mental health care but have problems getting the care they need when they need it. If my work can help them with that, then my day is made.

Why did you decide to go into mental health research? Was there a specific moment or experience that pushed you toward this career path?

I started studying kids and mental health care because my oldest boy has been diagnosed with autism and ADHD. He was six when he was diagnosed, and that was just about when I was starting to really work on my Ph.D. When I went looking to see what was being done in research on mental health care, I got frustrated because there was very little research on the struggle parents were going through to keep their kids in consistent, timely psychiatric care. So, I dug into it more, and that ended up driving my thesis project.

What struggles have you had to overcome on the way to where you are now professionally?

I had to learn to ask for help from my mentors and my peers. I was scared they’d think I was a bad researcher if I let them know I was struggling. I expected that people would not understand how difficult it is to be a parent and a scientist. But that’s not the case. Research is open to people being parents; it’s open to people being older; it’s open to people having disabilities or going through transitions.

What do you wish you’d known about your career in high school?

I wish I’d studied my languages better. Twenty percent of the US population is Latinx. Many of the kids I’ve interviewed are native Spanish-speaking first, and so are their parents. And it’s hard for non-English speakers to get mental health care because of language barriers. Every day, I practice my Spanish to do the work I need to do.

What advice would you give girls or young women considering a career in mental health research?

A new scientist needs to find a community of researchers they feel comfortable with. They need to find mentors who actually mentor them, or ideally, a research lab; one person is not enough.

I have the great pleasure of working in a field that is mostly female—and it’s magnificent. I’ve worked in heavily intensive male environments like banking and economics. But there’s something about having a research group run by women who support each other that is not to be underestimated.

What was the best advice you ever got in your career?

Just do it.

I, like many other people, have a variant of ADHD. It’s very easy for me to get upset and think that the thing that I’m trying to pursue can’t be pursued. A lot of researchers have mental health problems, like anxiety or depression.

But my mentors said, just do it; just go after it. So, after hesitating for years, I went to grad school.

What is your favorite thing about working in mental health research?

Finding out new stuff and working towards answers to questions that are important are my favorite things. I love exploring and knowing that what my research team uncovers will someday help somebody build something beautiful.

Have you had any successes or breakthroughs you’d like to share?

I’m very excited to keep working on questions about how we provide psychiatric emergency care and what happens to people after they’ve received it. My NIMH project led to some new research on youth of color who are LGBTQ+, on decision-making in a psychiatric emergency environment, and some theoretical work on access to care. Out of the initial findings came a grant through the Initiative on Cities to improve shared decision-making during a psychiatric emergency. This work has also driven several research projects about problems accessing mental health care during the pandemic.

How do those wins feel for you?

I’m really excited. Youth of color and their families told me over and over again that no one was listening to them. This research is helping them be heard.

Is there anything that you’d like to add or anything you feel we may have missed?

To be successful, you need to take good care of yourself.

I come from an immigrant family, where my parents sacrificed a lot for my sister and me. So, when I started working, I thought I had to sacrifice my health to be a success, and that was a mistake, and I wish someone had told me that before I graduated high school.

Self-care comes in two forms. One is just making sure you have a routine that will support your research and goals. Of the generation of researchers before us, many women who had a family were getting up at four o’clock in the morning to do their research. For some women, this is sustainable. But I’m not convinced it’s sustainable for all women. You need to structure your environment to support you. When you’re supported, you can do your best work.

The other form of self-care is community. No one does research by themselves. You need to learn to be part of a team. Find people who understand where you’re coming from and understand your dreams. Having a network that you trust will help you when you get frustrated, when you are down, or when you’re looking for your next research opportunity.

What is the focus of your NIMH-funded research?

My NIMH-funded research focuses on youth suicide prevention, with a particular focus on family and community-level approaches to reducing suicidal ideation and behavior among Latinx and immigrant youth. I also focus more broadly on racial equity in youth suicide prevention. My long-term goal is for this research to inform multi-level interventions integrated across multiple systems serving minoritized youth, from health care systems to schools to communities.

Why is your research important? How does it help people?

Suicide is one of the leading causes of death among adolescents and young adults. Preventing suicide is about saving lives, but it’s also about healing and about creating a better world for the next generation. Young people deserve to live healthy lives in safe and nurturing environments, with hope for the future and the freedom to be their full, authentic selves. They and their families also deserve high-quality mental health and social support services that are culturally responsive and available in their primary language. No one person or team will accomplish these goals in isolation, but I believe that through collaboration and advancing this work at multiple levels, we will move toward a healthier society.

How does it feel to know that your work benefits society?

Without a doubt, the hope that this work will benefit society is a key motivator for me. At the same time, it can feel daunting to try to draw the line from a research project or a program to a larger impact. I’m Puerto Rican, and in Spanish we say, “poniendo mi granito de arena.” Literally, this means “putting in my little grain of sand.” But what it means is that you are making your own individual effort for a greater goal. It acknowledges the enormity of the effort and the importance of each person doing their part. When I think of it that way, it gives me hope for what we can do collectively to make an impact.

Why did you go into mental health research? Did a particular moment or experience that pushed you toward this career path?

There have been a series of moments that I see as key touchstones moving me towards mental health, towards immigrant mental health, towards working with young people, and finally towards a focus on mental health research. My path has been shaped largely by experiences working with youth and families, as well as by grappling with inequities and injustice in the multiple systems in which I’ve worked and trained. Before graduate school, I worked in schools and at nonprofits, including a children’s advocacy center, where I worked with youth who had experienced abuse or witnessed violent crimes. In all these settings, I worked with Spanish-speaking families, particularly with many young Latinas with untreated depression. These experiences solidified my commitment to working with young people who had experienced trauma and supporting families facing complex challenges.

I actually didn’t go to graduate school with the intention of becoming a researcher, but I did have that in mind as one of the roles I might play as a psychologist. I was more focused on clinical training and on the goal of eventually running programs or an agency dedicated to Latinx youth mental health. Once I was in graduate school, I learned that there was still so much work to be done in developing and implementing culturally responsive and evidence-based youth mental health programs. For some conditions, there were no programs at all, and for the programs that existed, there were massive barriers to getting them directly out to communities. I was also inspired by the work of Black, Indigenous, Latinx, and Asian psychologists and researchers who had persevered in addressing these problems despite often having little support for their work. All of that led me to a research career and still motivates me today.

What do you wish you’d known in high school about your career?

I wish I had known that there are so many ways to have a career that involve improving health and well-being. I had no idea what public health was as a field, for example, and I saw research as being something distant from the more applied work of providing services or working directly with people. I wish I had known that there are a range of ways to do research, from basic science in a lab to working primarily with data to qualitative and ethnographic work to implementing programs in clinics and communities. And I wish I’d known that you don’t have to choose just one way to do the work—there are many combinations of activities and interests that can make up a research career, and there are approaches that fit different personalities and goals. I want young people today, especially youth of color, to know that they already have experiences, knowledge, and ideas that we need in the mental health field.

What advice would you give to girls or women considering a career in mental health research?

First, I would say to reflect on what matters to you and what drives you in doing this work. And write that down, so it’s available to you when you’re feeling lost (which we all feel at times). Second, I would say not to accept everything people tell you about yourself, especially if it doesn’t ring true with your understanding of who you are. Early in my career in human services, I was told more than once that I would be more effective if I stopped worrying about all of the systemic problems I couldn’t change. I used to feel troubled by this feedback until I realized that understanding and analyzing systems was one of my strengths. I also realized that creating systemic change was one of the goals driving my interest in this work. So this was not a deficit to be fixed, but rather a skill and an interest to be honed, and it became the foundation of my career today. Third, seek community wherever you go. For me, developing supportive relationships with peers has been essential to managing the stresses of this career, from my earliest jobs to graduate school to now, and these communities have also been where some of my best work has developed.

What is the best advice you received in your career?

It’s hard to narrow down to just one piece of advice. I’ve had family members, mentors, and peers that have influenced me greatly over the years. That said, before I started graduate school, a professor told me to remember that you can’t pause your life for five or six years while you get your Ph.D. She said to make decisions about my career with my full life in mind and not to get attached to one timeline or path. It’s been fifteen years since that conversation, and that advice has helped me immeasurably in keeping the bigger picture in mind and adapting when things have inevitably changed from what I was expecting.

What is your favorite thing about working in mental health research?

My favorite thing about working in mental health research is the collaboration across various mental health disciplines and with children, families, and community leaders. I think that, at its best, this field involves creativity and connection. Ultimately, mental health and wellness impact us all, and there is deep wisdom to be gained from how individuals and communities navigate life and seek healing.

Have you had any successes or breakthroughs you’d like to share? What was that moment like for you?

For a long time, I’ve had varied interests, goals, and professional experiences that didn’t always fit together in the eyes of others, even though they made sense to me. It has felt like a personal breakthrough to increasingly be able to integrate those distinct experiences into specific projects—for example, to collaborate with colleagues on youth suicide prevention research in pediatric primary care, which is the setting where I completed some of my foundational clinical training. Sometimes it takes time for the bigger vision to be made a reality, but it’s uniquely rewarding when you start to see the result.

Why did you pursue a career in mental health research?

The Cherokee women in my life—my mother and late grandmother—have instilled in me the importance of working with and for our people. These messages underscore many of our Cherokee community values, and it is significant they were given by my mother and grandmother, as our tribe’s clan system is matrilineal. Through my own family, community, research, and clinical experiences, I have witnessed the impact mental health and suicide inequities have and the incredible cultural strengths we bring to not only address these inequities but to live well.

What is the focus of your NIMH-funded research?

Many American Indian/Alaska Native (AI/AN) communities, and particularly youth, are disproportionately affected by suicide. AI/AN communities and researchers continue to call for research to promote cultural strengths and protective factors in suicide prevention efforts. Culturally grounded prevention interventions, which place local culture and values at the forefront of intervention design, implementation, and evaluation, hold strong promise to prevent AI/AN youth suicide.

I am grateful to be part of and build upon the decades of mental health and suicide prevention collaborative research conducted by the Johns Hopkins Center for Indigenous Health and the White Mountain Apache Tribe.

The White Mountain Apache Tribe developed a culturally grounded intervention called “Nohwi nalze dayúwéh bee goldoh dolee” which approximately translates to “Let our Apache heritage and culture live on forever and teach the young ones” in English and is also called “The Elders’ Resilience Curriculum.”

White Mountain Apache Elders developed this program with support from the Center for Indigenous Health to create a curriculum and teach youth ages 9-14 about Apache values, culture, traditions, and language. This NIMH-funded community-based participatory research will identify youth strengths-based, protective factors and Elders’ Resilience Curriculum core components that target these factors. It will also develop a theoretical model with White Mountain Apache Tribe community members to understand the intervention’s causal mechanisms and outcomes, develop a culturally adapted assessment battery, and conduct a pilot evaluation of this intervention.  

Why is your research important?

As a first-generation student, I encountered extreme underrepresentation of Indigenous content throughout my education. During my undergraduate studies, I recognized that most of the empirical mental health literature about AI/ANs was deficit-based and focused on Western theories, methods, and frameworks to understand and address mental health inequities, including suicide. Tribal values and community and cultural strengths that are important to me were largely absent from the research. This motivated me to use my education to pursue collaborative research that underscores cultural strengths in mental health promotion and suicide prevention research with our communities.

Together with White Mountain Apache Tribe research partners, we hope to show that the Elders’ Resilience Curriculum can promote youth mental health, identity, and connectedness. We have a long-term goal of scaling this program to other tribes and urban Native communities.

What advice would you give to girls or young women considering a career in mental health research?

Build a support system of mentors and other caring people outside of academia and research who will provide professional guidance, as well as personal guidance and encouragement.  

What was the best advice you ever got in your career?

Stay true to yourself and your values, and keep your family and community in your heart and mind throughout your career.

What is your favorite thing about working in mental health research?

It is truly an honor to work with our Native communities on mental health research and a privilege to have community members share their stories. I enjoy working with our project teams to develop creative ways to disseminate mental health education and research with our communities (through projects like storybooks, videos, and infographics) aligning with community-based participatory research. Finally, I am thrilled when I see an increasing number of Indigenous scholars and researchers – I see us as part of a growing collective centering our communities, cultural strengths, and wellness. 

What struggles have you had to overcome on the way to where you are now professionally?

One struggle that I’ve dealt with is being one of the very few Indigenous scholars and feeling isolated in several academic institutions I’ve attended. I’ve witnessed non-Indigenous researchers question, misunderstand, and devalue Indigenous knowledges, methodologies, and methods. My hope is that we continue to recruit, retain, and support Indigenous scholars on academic research paths to increase not only our physical presence in these spaces, but also to uphold that our Indigenous knowledges, methodologies, and methods are valid.

Have you had any successes or breakthroughs you’d like to share?

I am grateful to my NIMH K01 mentorship team: Drs. Allison Barlow, Novalene Goklish (White Mountain Apache Tribe), Melissa Walls (Bois Forte and Couchiching First Nation Anishinaabe), Mary Cwik, Nancy Whitesell, and Emily Haroz. They provide incredible support and strength, which I strive to pass on to Indigenous scholars whom I have the privilege to mentor. In addition, it is significant that my NIMH K01 mentorship team is all women. In the words of the late Chief Wilma Mankiller (the first woman elected as Cherokee Nation Chief), “It is the women who are responsible for bringing along the next generation to carry the culture forward.”

Why did you decide to go into mental health research? Was there a specific moment or experience that pushed you toward this career path?

I decided to conduct mental health research because, despite all the advances that have been made, there is still so much we don't know. Mental health is linked to all outcomes of life. I believe mental health research can lead to many breakthroughs that can have an impact across the lifespan.

The moment that pushed me toward examining youth suicide and suicidal behavior was when my mother passed away from cancer when I was 14. My mother was my best friend, and that loss took me down a very dark path. I struggled with depression and anxiety and, at my worst, had suicidal thoughts. But I had a family surrounding me who got me the mental health services I needed.

I want to make sure my research matters and can help people, as it helped me, strive for greatness and overcome obstacles that they may face.

Could you briefly describe the main focus of your NIMH-funded research?

The main focus of my NIMH-funded research is discovering early risk factors for suicide and suicidal behavior in high-risk groups of youth. I examine risks such as a family history of suicidal behavior and mental health concerns, neurocognitive functioning (decision-making skills), and emotion regulation and reactivity.

My research focuses on youth between the ages of 6 and 11 years. Some youth have a parental history of suicidal behavior, whereas others have a parental history of mood disorder symptoms (like depression). We plan to follow these youth from early childhood to early adolescence.

Why is the research you’re doing so important?

I hope my research will give us some insight into where and how we can intervene early in a child's life to change their risk trajectory. Young children who have a parental history of suicidal behavior are more likely to engage in suicidal behavior themselves.

I believe that with the proper intervention, we can decrease the odds of youth engaging in these behaviors. We have to understand what risk factors to target and at what age to do so.

What advice would you give to girls or young women considering a career in mental health research?

Never give up! I have seen many obstacles and have faced many challenges in my career and personal life. Still, I believe every challenge and circumstance has made me stronger and given me the fire needed to continue to strive forward. Be thankful for the challenges! They will teach you something both personally and professionally. Also, find a mentor who can help you when you find the challenges overwhelming. We all need a cheerleader in our lives.

What was the best advice you ever got in your career?

Rejection is a part of the career path I have chosen. Everyone will not like the paper you wrote or the grant you submitted for funding. You will have more things rejected than you will have accepted, but that doesn’t mean you can’t learn from those experiences.

From the rejection, I have learned how to present my research in a different light that makes it stand out from the crowd and tells a better story. Take the feedback and try again!

What is your favorite thing about working in mental health research?

My favorite thing about working in mental health research is the impact my research can and does have. I have been blessed to receive NIMH funding and conduct research to hopefully help youth at high risk for suicidal behavior.

I also enjoy mentoring others. I have worked with many research assistants, medical students, and others and always find it a joy to sit down and hear their stories and help them in any way I can to get them to where they want to be. To play a small role in their process is always a joy!

What do you wish you’d known about your career in high school?

I wish I had known that rejection and perseverance are necessary keys to success in the career I have chosen! I also wish I had known that the career I have chosen would have a lot of twists and turns…it is NOT a direct flight in any way, shape, or form.

What struggles have you had to overcome on the way to where you are now professionally?

First, I had to come to peace with--and still do regularly—my mother’s death during my teenage years. It is a hard reality to face and experience, but I remind myself she is looking down on me and is very proud of my accomplishments. This helps me continue to move forward.

Second, I had to overcome the feelings of “less than.” In the research world, actually everywhere in this world, you can be perceived as knowing less because you are a woman of color. I had to first acknowledge that this is not a "me" problem, and then I had to show others I deserve a seat at the table!

Finally, I have struggled with trusting others in the field. I have heard horror stories of “mentors” stealing ideas from their mentees and claiming the idea is their own. I have heard of only certain institutions getting the funding, so you have to collaborate with those institutions to get anywhere in your career. I have listened to many other horror stories, but I refused to allow them to be my story. Trusting others in the field is important, as together, we can drive the science further and make a larger impact. Forming those bonds takes time and energy, but in the end, they are always worth it.

Have you had any successes or breakthroughs you’d like to share?

The successes I am most grateful for are the opportunities I have had to share my research path with others. I’ve had the opportunity to share the bumps and the twist and turns I have faced along the way with postdocs, graduate students, and undergraduate students. It is always an honor to do so, and I hope my story inspires others!

You don’t have to know all the details of where you will end up, but you do have to have a destination in mind, and you have to take that first step! Get up, keep going, and keep dreaming.

Why is your research so important?

Science has the power to transform lives. Science can guide where we invest scarce resources, and science can help us even the playing field. Global science matters locally. The scientific research we do globally harnesses the power of teams across boundaries, letting us apply global lessons to public health challenges right here at home.

My NIMH-funded research helps us challenge systemic inequalities and racism. In the global settings where I work, a history of colonialism and structural racism remain major social and structural determinants of health. I use data on health disparities to prioritize who and where to work and then partner with young people and their communities to develop evidence-based solutions to address their health priorities and ensure that everyone lives healthy and full lives.

Why did you decide to go into mental health research?

I was drawn to mental health research because good mental health is vital to thriving, especially for young people navigating major transitions in their lives. Yet, in many places globally, mental health is ignored, especially in young people. This may be because mental health issues tend to be less visible than physical health issues or because of stigma, cultural context, or underdeveloped health systems. I hope that my research shines a spotlight on how vital good mental health is and can help young people lead their best lives and use their fantastic ideas and energy to better this world.

What advice would you give to girls or young women considering a career in mental health research?

Find an outstanding team of mentors who can support you along your journey. I leaned on my incredible team of mentors to help me navigate professional and personal milestones. Believe in your deep talents and, hopefully, as you advance, you can use your experience to support the next generation of diverse talent. We need people of all backgrounds to help us achieve the vision of health as a human right for all.

What was the best advice you ever got on your career?

Be generous and collaborative; the best science happens when we put our great ideas out there and sharpen them with others.

What is your favorite thing about working in mental health research?

Going into a career in mental health research is exciting. Every day is different, but one thing remains constant. People trust you with the most intimate and personal experiences of their lives. As you conduct research, they invite you into their lives with incredible generosity and trust. That trust is invigorating, and it inspires me to think constantly about how I can sharpen my science and do more and do better.

What do you wish you had known about your career when you were in high school?

I wish I had learned about public health in high school! I had no idea that this was a career path you could pursue. If I had known that I could pursue a career that has such a massive impact on the lives of so many, and that is a form of social justice, I would have jumped in sooner.

Why is your research so important?

Families play a major role in the initiation of care and providing support for people with mental illness. Families are also impacted by positive and negative experiences when seeking treatment and receiving treatment for their loved one; and these experiences impact their engagement. It’s important to study family engagement because it is often linked to clinical and process outcomes during treatment as well as the transition out of coordinated specialty care.

What advice would you give to girls or women considering a career in mental health research?

You will encounter people who are negative or outright unsupportive, and as a woman, particularly a Black woman, you will have to endeavor more. Don’t let anyone diminish your voice or your ideas because your mind and your greatness are needed to propel us all forward.

What is your favorite thing about working in mental health research?

I have the unique opportunity and pleasure of having Black and other racial and ethnic families share their personal experiences and stories with me about seeking and receiving mental health services. They trust me enough to relive and share their experiences with me. Their stories and their trust directly inform the work that I do and inspire me to make sure I do it well. Doing community-engaged research is what makes it meaningful, fun, and impactful.

What do you wish you had known about your career when you were in high school?

I wish I had been exposed to behavioral research and the insights it can offer into mental health and illness in high school. Science and research encompass so many different things beyond a lab and working with a Bunsen burner.