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Advocating for Inclusive Mental Health Care through Focused Psychiatry Training

By Dr. Antoine Beayno

From my early days in medical school, I knew that I wanted to become a psychiatrist. My decision was met with mixed opinions from my family and colleagues, as stigma towards this specialty persists. But I’ve always longed to pursue a career in psychiatry and hoped to contribute to fighting the stigma and spreading awareness of mental health and illness. The exceptional approach psychiatry takes in exploring human behavior and the motivations that drive it is fascinating and deeply rewarding. It also provides a unique privilege to not only be part of the patient’s story, but also have a role in achieving a positive shift in their narrative.

I completed my medical education and training in my home country of Lebanon. I was fascinated about all aspects of mental illness, but was particularly interested in the mental health of minority and vulnerable populations, especially sexual and gender minorities. In my home country, I worked closely with the Lebanese Medical Association for Sexual Health (LebMASH), which advocates for the mental and physical health needs of all individuals and LGBTQ+ individuals in particular. I became a partner with LebMASH in 2017 and then became an Executive Board Member in 2019. It has been a mission of mine to advocate for the mental well-being of the LGBTQ+ population, which is exposed to unique stressors due to its minority status, especially in a country like Lebanon, where homosexuality remains illegal and deeply stigmatized. While I felt the work that I did was undoubtedly valuable, many systemic and socio-cultural barriers made pursuing further training opportunities and expanding my experience with this sub-population exceptionally challenging.

NYC during the COVID-19 pandemic.
Boarding the airplane on our way to NYC!

I decided to travel to the United States for additional experience and to expand my clinical, research, and leadership skills. One of the most fascinating prospects in psychiatry is that every single patient is unique and has their own story. As such, I was excited to find myself in the melting pot of cultural diversity offered by the United States. I was delighted to match at my program of choice at The Mount Sinai Hospital in New York City in early 2020. Unfortunately, the spring of 2020 was the first peak of the COVID-19 pandemic in the United States, of which New York City was the epicenter at the time. Simultaneously, the world reacted with global international travel restrictions and embassy closures. In fact, the only international airport in Lebanon, located in Beirut, was closed for many months, and the US embassy in Beirut was subsequently closed, with no appointments for J-1 visa applicants. This period was filled with growing anxiety and uncertainty, with significant concerns that my delay in onboarding to my new position would jeopardize my J-1 physician opportunity. Thankfully, my program was very understanding of the unanticipated circumstances that led to my situation. Additionally, the Exchange Visitor Sponsorship Program (EVSP) was actively working with embassies around the world to help facilitate incoming J-1 physicians’ applications to join their respective training programs. This made me and my fellow incoming J-1 physicians feel validated and not alone. Fortunately, the airport in Beirut successfully opened on July 1, 2020, and I was finally able to obtain my visa appointment and arrive to the United States seven days later.

One of my mentors, Dr. Jacob Appel and myself.

The first few weeks of my training in the United States were exciting, however not without continued trials and tribulations. On August 4, 2020, a massive ammonium nitrate explosion struck the capital city of Beirut in my home country, injuring some friends and family members. The scale of destruction in the city was immense. It was terribly difficult for me to see videos and images of the city, where I grew up and made wonderful memories, in this state of ruin and devastation. My colleagues and supervisors were incredibly supportive and made this potentially intolerable period in my life much more bearable. It is an amazing privilege to be a part of a collaborative multi-disciplinary team, working with talented colleagues and esteemed mentors, especially when everyone ensures your experience is enriching and empathetic.

Colleagues just wanna have fun!
Halloween at work!

During my clinical rotations, I was exposed to wonderful learning opportunities, especially in specialty clinics including HIV Psychiatry and Transgender Medicine. It was a remarkable learning experience to be directly involved in the psychiatric and medical care of LGBTQ+ individuals and contribute to their life journeys. Furthermore, during my Consultation-Liaison Psychiatry inpatient rotation, I had the opportunity to evaluate a transgender woman who was hospitalized on the surgical unit. She shared that she was unfortunately repeatedly misgendered during her hospitalization by multiple members of the care team, which caused intense feelings of frustration and traumatization. This highlighted a crucial fact for me: stigma and discrimination against sexual and gender minorities are a global phenomenon. There is a lot of work yet to be done.

I am entirely grateful for my ongoing training experience as a J-1 physician in the United States, despite the challenges I faced. I can certainly say that the difficulties have proven entirely worthwhile. I am benefiting every single day from countless learning opportunities and valuable clinical exposure. I am additionally very proud to continue to be involved in activities and initiatives for awareness about LGBTQ+ mental health and education about inclusive health care, both in the United States and Lebanon, due to the advantages of virtual video conferencing. I couldn’t be more content!