New psychiatry chair dreams big to place mental health front and center

Seth Himelhoch, MD, MPH, the new Chair of the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago, didn’t always think he would be a psychiatrist. In fact, his early career plans took him in a very different direction. As an undergraduate student at Brandeis University, he studied English and American literature. “I realized in my junior or senior year that as much as I love poetry, I was never going to be a person who could be a professor of literature. I just didn't have what it took to be that creative.”

He also enjoyed science, so he decided to take the leap to medical school, enrolling at the University of Michigan. He leaned on his liberal arts background to break up the grind of medical school, forming a reading group to share his love of literature with his mostly pre-med classmates.

It was during this time in medical school, in the early 1990s, that Himelhoch found his calling. By 1994, HIV had become the leading cause of death for Americans between the ages of 25 and 44. “It was the epidemic of my generation,” he said, and he resolved to help. “I wanted to be part of the group of people who were going to try to find ways to help people with HIV get medical treatment with dignity and respect,” he said.

Facing a disease that was still elusive and terrifying at the time, he decided he didn’t want to limit himself by specializing in treating a specific disease or part of the body. “Psychiatry offered a holistic approach to the caring of a person, and to me, that was really important,” he said.

Thirty years later, that decision seems prescient. Psychiatry is going through a renaissance, spurred by a groundswell of changing cultural attitudes to destigmatize conditions such as anxiety, depression, and substance abuse. Following the collective trauma of the COVID-19 pandemic, Himelhoch steps in to lead the Department of Psychiatry and Behavioral Neuroscience just as the demand for mental health care has never been higher. It’s an opportunity, he says, to place mental health care front and center.

“Behavioral health, or mental health, has always been sidelined because of those adjectives before the word health. It makes it sound like we're doing something different than other people who work in healthcare,” he said. “One of the single best things that we can do as a community is to lead the way in thinking about mental health as simply health. Once that occurs, then the community of clinicians, and the community of people who seek care, can begin to see all health care as holistic.”

Integrating behavioral health care everywhere

Himelhoch joins the department as its first permanent chair since 2016. Daniel Yohanna, MD, Associate Professor of Psychiatry and Behavioral Neuroscience, served as Interim Chair during the intervening years. He guided the department through rapid expansion, adding more research faculty, clinical providers, and students, and extended its services beyond UChicago’s Hyde Park campus to new locations in the health system, such as Ingalls Memorial Hospital. Appointments for psychiatric services increased by almost 30% over the past three years, owing largely to increased demand through the pandemic.

Before coming to UChicago, Himelhoch served on the faculty at the University of California, San Francisco, the University of Maryland, and the University of Kentucky, where he had been the Chair of its Department of Psychiatry since 2018. Yohanna said that makes him the right person to lead the department into this new era of prominence for psychiatry, because he has already been a part of the evolution of the field in several institutions both similar to, and different from, UChicago.

“Seth always struck me from the beginning as a very patient, thoughtful, moral man with a great deal of integrity, and that's very important for our department,” Yohanna said. “He’s seen and heard it all, so he’s realistic about working to improve and grow the system. I think he'll continue to carry on the added value we've already developed for the department to the rest of the institution.”

The first order of business to meet this demand for holistic care is to integrate psychiatric services into other types of care. Instead of primary care providers and specialists referring patients to a therapist and wishing them luck, Himelhoch believes in addressing mental health needs up front, along with the rest of a patient’s care. Psychiatrists should be part of the patient’s regular care team, embedded within specialty clinics and working side by side with other physicians. For example, someone with type 1 diabetes would meet with a psychiatrist who specializes in endocrinology to help manage the daily stresses of managing blood glucose levels.

Much of this work is already underway at UChicago, with programs that integrate behavioral health screenings into primary care, provide support for cancer patients, evaluate candidates for organ transplants, and assist victims of gun violence treated at the trauma center. The goal is to not just refer these patients to the right behavioral health specialist, but to have that provider close the loop and work with the rest of the care team, advising on how the patient’s mental health needs impact the rest of their treatment.

“That creates a community of learning about behavioral health issues so that primary care providers and other specialists can feel comfortable asking the right questions. They know that they can refer patients if they need to and have it all integrated into one site,” Himelhoch said.

Dreaming big

Himelhoch also brings a research program to UChicago that began during his time working with HIV patients at the University of Maryland. In the early 2000s, research began to show that people with HIV who smoked were dying at a much higher rate than those who didn’t smoke. By that time, antiretroviral drugs were turning HIV into a chronic condition that could be managed instead of a death sentence, but smoking almost canceled out any benefits from the HIV medications.

Researchers believe that HIVs impact on the immune system makes typical smoking-related illnesses like lung disease or cardiovascular disease even more lethal. Himelhoch saw the emerging evidence that a behavioral health intervention—getting people to stop smoking—could have a clear benefit for HIV patients. He and his colleagues embarked on a series of studies for smoking cessation in patients with HIV, including a recent randomized controlled clinical trial in Nairobi, Kenya, showing that a combination of behavioral therapy and medication doubled the number of people who stopped smoking.

At the University of Kentucky, Himelhoch continued research on smoking cessation. He leads one of seven federal Tobacco Centers of Regulatory Science, which informs the Food and Drug Administration on how to regulate tobacco use by understanding the unique smoking habits of a population. While the work in Lexington focused on rural areas, Himelhoch plans to adapt their work to urban areas like the South Side of Chicago, which has high smoking rates as well.

Improving tobacco regulation, researching ways to help people with HIV stop smoking, and integrating behavioral health care throughout a growing health system feel like a tall order for an erstwhile literary scholar turned psychiatrist. But it all fits into Himelhoch’s drive to find where he can make the biggest contribution to help the most people possible.

“I'm a firm believer in dreaming big, and that having big ideas often leads to really interesting and impactful solutions,” he said. “A big part of that is to help other people feel comfortable dreaming big too, aspiring for really big things, and trying to understand what's possible. Then we can provide the right resources so we can get there and hold ourselves accountable to those dreams.”