Q & A: Shelly F. Greenfield, MD, MPH, Chief of the Division of Women’s Mental Health

In September 2013, McLean launched the Division of Women’s Mental Health with Shelly F. Greenfield, MD, MPH, as its chief. We recently sat down with Dr. Greenfield to talk about the division’s roots, goals, and projects.

Horizons: What was the genesis of the Division of Women’s Mental Health?
Dr. Greenfield: The division began through what we called the Women’s Mental Health Initiative, which emerged from McLean’s strategic planning process in 2006. We convened the leadership of various clinical and research programs across the hospital that focus on the mental health of girls and women. From our many discussions, it became clear that McLean had tremendous strength in clinical programs serving girls and women and that these programs would greatly benefit through expanded opportunities to collaborate. Yet, we needed a more formal mechanism to foster that collaboration.

Several things helped inform our work and thinking. One of the most exciting was a scientific symposium we held at McLean in fall 2012 to bring together local and national experts in the field of women’s mental health. In April 2013, we hosted a visiting scholar, renowned women’s mental health researcher and clinician Donna Stewart, MD, from the University of Toronto, who advised our steering committee.

After much work by both leadership and staff over 18 months, we had an excellent framework and were ready to launch a division dedicated to serving the mental health needs of girls and women and to advancing women’s mental health through clinical care, research, and training.

Horizons: Viewing women’s mental health as a distinct field is a relatively new phenomenon. Why is McLean taking this approach?
Dr. Greenfield: McLean is responding to a shift in focus of the medical field toward recognizing the unique health needs of women. Historically, medical research and clinical trials were conducted primarily with male subjects. Beginning in the 1990s, the National Institutes of Health played a large role in making sure that women (and minorities) were included in research studies. These studies have revealed that many diseases do indeed have certain sex and gender specific characteristics, etiologies, and treatments, so McLean has taken new, innovative approaches to treating women and girls.

Horizons: How is McLean unique in the ways it serves women and girls?
Dr. Greenfield: McLean has a number of specialized programs serving the needs of girls and women. They include 3East, a continuum of programs for girls and young women who exhibit impulsive and self-endangering behaviors; the Gunderson Residence, serving women with borderline personality disorder and other complex issues; the Klarman Eating Disorders Center; and the Hill Center for women with histories of trauma, mood, and anxiety disorders, and borderline personality disorder. We also have two programs that disproportionately serve women: the Gunderson Outpatient Program for people with borderline personality disorder and an inpatient unit in the Dissociative Disorders and Trauma Program.

McLean researchers have conducted landmark research studies on borderline personality disorder (the work of John G. Gunderson, MD, and Mary Zanarini, EdD), women and addiction (my own research), and newer investigations into dissociative identity disorder and post-traumatic stress disorder (Milissa Kaufman, MD, PhD).

Horizons: What role has philanthropy played in the formation of the division?
Dr. Greenfield: Our programs focusing on women and girls have a long history of philanthropic support. But we could not have launched the Women’s Mental Health Initiative or created this division without the tremendous generosity of an anonymous family over many years. Philanthropy also has enabled us to recruit an exciting young researcher, Kristin Javaras, DPhil, PhD, who will be joining us in March 2015. Dr. Javaras’s research will focus on binge eating and obesity, as well as borderline personality disorder, conditions that disproportionately affect women.

Horizons: What are some of the most important issues around women’s mental health today?
Dr. Greenfield: We are seeking to understand the etiology, or causes, of disorders that are more prevalent in women and girls and how to prevent them. These illnesses include major depressive disorders, stress-related disorders, such as PTSD, and eating disorders, all of which are often further complicated by co-occurring substance use. We know that the lifetime course of these disorders often differs by gender. Investigating those gender differences is essential for advancing our understanding and informing better treatments.

Horizons: How will the division address these challenges?
Dr. Greenfield: Foremost by increasing collaboration across clinical, research, and training programs to provide cutting-edge, evidence-based clinical treatment for girls and women. McLean can also play a significant role in disseminating knowledge so that girls and women everywhere have access to gender-responsive care. Currently, we are looking at best practices for caring for females with co-occurring disorders, as well as how to share treatment practices throughout and beyond McLean.

We are also implementing our new evidence-based Women’s Recovery Group in our alcohol and drug misuse treatment program and will soon launch it in other units that treat women with substance use disorders, such as our eating disorders program.

Additionally, we are providing a first-ever clinical training experience for a mental health fellow who is focusing on reproductive health issues at Brigham and Women’s Hospital. Finally, we are advancing research in eating disorders and borderline personality disorder through our new recruit, Dr. Javaras.