I completed my undergraduate, medical school, and residency training at the University of Washington in Seattle. I am board certified in family medicine and psychiatry with subspecialty training in addiction medicine. My clinical interests include inpatient and outpatient psychiatric consultation to primary care providers, mood disorders in pregnant and postpartum mothers, and clinical service in underserved communities.
My clinical service and research focuses on the interaction of mental and physical illness, especially in patients with chronic pain. Much of my research in recent decades has focused on the risks of treating chronic pain with opioids. I have developed educational programs and outcome tracking tools to assist with opioid treatment of chronic pain. I have published a book about patient empowerment in chronic disease care, The Patient as Agent of Health and Health Care (Oxford, 2017). I have another book written with Jane Ballantyne forthcoming, The Right to Pain Relief and other deep roots of the opioid epidemic (Oxford, 2022).
My primary clinical interest and expertise is in the evaluation and treatment of women with mental health issues during pregnancy and postpartum, as well as women’s mental health throughout the life cycle, including premenstrual and menopause-related psychiatric symptoms. In addition, I am interested and experienced in evaluation and treatment of anxiety disorders and depression.
My primary interests are in diagnostic evaluation, psychiatric methods, psychosomatic medicine, fatigue syndromes, pain disorders, abnormal illness behaviors, and human temperament and personality. I have conducted research jointly with colleagues at the University of Washington and the University of Washington Twin Registry on chronic widespread pain, depression and related phenomena.
Personal Statement
My career goal is to give suicidal clients and their clinicians the best chance to succeed. I have been working in the area of health services, treatment development, and clinical trials research to prevent suicide for over 30 years. My graduate training was in community/clinical psychology and focused on achieving clinical ends through prevention and other systemic interventions in socio-culturally diverse populations. I have brought these perspectives into health services research. I have developed or adapted interventions to improve care and clinician willingness to work with suicidal patients including Caring Contacts, Dialectical Behavior Therapy (DBT), Collaborative Assessment and Management of Suicidality (CAMS), and Preventing Addiction Related Suicide (PARS). I have developed an adaptation of DBT Next Steps, a program to assist psychiatrically disabled individuals find and maintain living wage employment. My research has been funded by NIMH, NIDA, the Department of Defense, American Foundation for Suicide Prevention, and the State of Washington.
I am the director of the Center for Suicide Prevention and Recovery (CSPAR) whose mission is to promote the recovery of suicidal individuals and the effectiveness and well-being the clinicians and families who care for them by conducting rigorous and ecologically valid research, developing innovative interventions, improving policies, systems and environments of care, and providing expert training and consultation. CSPAR faculty and staff seek a deep understanding of the cultures and settings in which we work that leads to meaningful and effective interventions ready for implementation.
I also direct the Suicide Care Research Center, an NIMH P50 funded research center focused on using Human Centered Design and MOST optimization methodology to improve the care of adolescents and young adults (age 13-30 years) in outpatient medical settings. We are conducting one fully powered trial, three R34s, and 4 pilot studies within UW Medicine and Seattle Children’s hospital to develop innovative interventions to support primary care, Collaborative Care, and specialty medical clinics care for patients experiencing suicidal thoughts and behavior. The center supports effort of over 20 faculty and 16 staff as well as 11 emerging and advanced collaborating scholars and funds 2 annual pilot grants (each $100,000 over two years).
In addition to clinical research, I founded the Society for Implementation Research Collaboration (SIRC) focused on disseminating and implementing innovative, evidence-based interventions in the systems that need them. Beyond my research, I directed the Harborview Dialectical Behavior Therapy program at Harborview Medical Center 1996-2019, co-lead the UWAnnual Comprehensive DBT Training Program and Suicide Care in Healthcare Systems: We Can Do Better Serving our Patients and Caring for our Clinicians, both of which meet the Washington State requirement for suicide prevention training. I have a long history of training and mentoring junior faculty, post-doctoral scholars, psychiatry residents, pre-doctoral psychology interns, undergraduate students, and post-baccalaureate trainees. I provide psychotherapy and consultation at the UWMC Outpatient Psychiatry Clinic.
| I am a Seattle native who has spent my entire academic career at the University of Washington School of Medicine. I joined the faculty of the UW Department of Psychiatry and Behavioral Sciences in 1977 and was based at the Seattle VA Puget Sound Health Care System. I joined the Seattle-American Lake Geriatric Research, Education and Clinical Center (GRECC) in 1977 as a clinical investigator and later served as GRECC Director from 1987-1998. In 1998, I was appointed Chair of the Department of Psychiatry and Behavioral Sciences and held this position until February, 2014. I am certified by the American Board of Psychiatry and Neurology with Added Qualifications in Geriatric Psychiatry and am listed in America’s Top Doctors and Best Doctors in America. I am recipient of the 2005 American Academy of Child & Adolescent Psychiatry, Robert Cancro Academic Leadership Award: Best Chair. I have conducted extensive research on the treatment of depression in patients with heart disease and stroke and has published more than 140 scientific publications. I am active in community efforts to improve the quality of care for the seriously mentally ill and with my faculty colleagues am implementing regionally, nationally, and internationally innovative and highly effective models of care that integrate mental health care into primary care settings. I am working with medical schools and the health ministries in Vietnam and Cambodia to strengthen psychiatric education, expand the mental health workforce, and develop delivery systems for psychiatric care in those countries. |
