Dr. Daniel Knoepflmacher (Host): Hello and welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I speak with experts in various aspects of psychiatry, psychotherapy, neuroscientific research, and other important topics on the mind.

As we celebrate Pride Month in June, we're turning our focus today to LGBTQ+ mental health and one unique program designed to address the needs of the LGBTQ+ community, the Weill Cornell Wellness Qlinic. As I mentioned that name, I should point out that in this case, the word clinic is spelled with a Q, as in Q-L-I-N-I-C. This unique program was designed to address significant gaps in the community.

Members of the LGBTQ+ community experience higher rates of mental illness and face unique barriers to accessing care. Factors include societal stigma, discrimination, and a common mistrust of medical providers due to prior negative experiences. Medical training has only recently integrated teaching about the specific needs of the LGBTQ+ population, making it all the more difficult to find mental health care sensitive to the needs of sexual and gender minorities. That is where the Wellness Qlinic comes in. It provides free care for folks in the community who might struggle to find treatment elsewhere. And it provides crucial education and clinical experience for medical students, psychiatry residents, and psychology trainees.

Today, I'll be discussing LGBTQ+ affirming mental health care with three individuals who have been instrumental in the Wellness Qlinic. It's a pleasure to welcome Constance Zhou, who is a Weill Cornell Medicine MD-PhD student interested in Psychiatry. They were one of the co founders of the Wellness Qlinic and served as the clinical executive director from 2019 through 2024. Hi, Connie.

Connie Zhou: Hi. Thanks for having me here.

Dr. Daniel Knoeplfmacher: It's great to see you. I've always seen you at the clinic, but it's nice to have you on the podcast. And next, we're joined by Dr. Jessica Spellun, who is a Clinical Assistant Professor of Psychiatry at Weill Cornell Medicine. She helped found the Wellness Qlinic as a senior resident and later became one of the clinic's faculty directors. Great to have you here today, Jess.

Dr. Jessica Spellun: Great to be here.

Dr. Daniel Knoeplfmacher: Thank you. And finally, I want to welcome Dr. Christopher Ceccolini, who is an Assistant Professor of Psychology and Clinical Psychiatry at Weill Cornell Medicine. He's the Director of Research and one of the faculty advisors in the Wellness Qlinic. Thank you for joining us, Chris.

Dr. Christopher Ceccolini: Thank you for having me on tier today. It's a pleasure.

Dr. Daniel Knoeplfmacher: Well, this is great. I'm excited to have you guys here and I want to jump right in. and the first thing I want to talk about with each of you is to give our audience a chance to learn a little bit more about who you are and specifically how you became interested in mental health generally, and LGBTQ+ mental health specifically. So, I'll start in the order I just went. Connie, can you tell us about yourself and how you developed these interests?

Connie Zhou: So, I think my interest in mental health specifically in the LGBTQ community started before I came to med school. I think in college, having friends in the community, and myself being LGBTQ, I think I had a lot of personal experiences with mental health and seeing friends of mine struggle with mental health and not knowing where to go or what to do. In college, I also had the privilege of volunteering with a suicide hotline where many of my patients were also LGBTQ. And I think that solidified my interest. And so when I came to medical school, I was already pretty certain that this was my interest.

Dr. Daniel Knoeplfmacher: So, you came to medical school as an MD-PhD student. Were you thinking Psychiatry as you came in?

Connie Zhou: Yes, absolutely.

Dr. Daniel Knoeplfmacher: And what was in just a minute on your research as a PhD student?

Connie Zhou: Right now, my research focuses on the role of astrocytes in neurodegeneration. But looking forward, I want to focus on kind of the mechanism underlying some neuropsychiatric diseases.

Dr. Daniel Knoeplfmacher: Great. Well, thank you, Connie. And I'm going to ask you, Jess, the same question. Tell us about how you got here.

Dr. Jessica Spellun: Similar to Connie, I also applied to medical school knowing that I wanted to be a psychiatrist. I come from a family with multiple doctors and thought that I was never going into medicine, wanted nothing to do with it, was going to be a comparative literature major in undergrad, really loved learning about the world and other cultures around the world through stories. I took an abnormal psychology class, and just thought the brain was the coolest thing ever, and had to figure out, "Does this mean I'm going to be a doctor? Does this mean I should be a therapist?" And I decided to do both. And similar again to Connie, the interest in LGBTQ+ mental health specifically does come from my own personal experience coming out to myself as a gay woman later in life, right before medical school, and already being interested in the mind and the stories that we tell ourselves and just really fascinated by the fact that I could keep something from myself for so long, that was so true, and wanted to both understand that better and also help trainees to think about that and was also feeling very aware of the fact that, in clinical spaces with patients, I was drawing on my own limited experiences about sexuality and gender and wanted to be a part of building something into the curriculum that could speak to that, I guess, address that. And I guess I'm jumping ahead of myself a little bit. Anytime I think about that year in residency, it kind of goes to the next stage of then I met Connie and Matt, but I'll hold off on that part.

Dr. Daniel Knoeplfmacher: We'll talk about the actual birth of the clinic. Yeah. That's what you're alluding to there, which you were instrumental in starting. And I listened to that and it's about you bringing your identity, your interest, and culture and all of that to being a clinician. That story just makes so much sense. This is where you ended up. And I would ask you the same, Chris. So, tell us about how you ended up in this position and with these interests.

Dr. Christopher Ceccolini: I feel at least that my pathway into Clinical Psychology and this work with LGBTQ+ mental health was a little non-traditional compared to some of my own colleagues. I would say that my interest in mental health broadly actually began in my early 20s, right after I graduated college. So, I was a very traditional liberal arts major at Wesleyan University where I majored in religious studies. And when people would say, "Why do you want to do that?" I'd say, "Well, it's just really cool. And I like the classes." And of course, what that led to was graduating college with very little idea of what I wanted to be doing with my life, which at the time I ended up selecting to do a year with AmeriCorps. I didn't get a choice where I would get placed actually. So, I was actually placed in Louisville, Kentucky in a counseling center. And in the South, sometimes university counseling or mental health counseling can include faith counseling, which I didn't expect at the time. At the time, I was somebody who had lived mostly in New York and Connecticut and wasn't used to this way of being. And I was so struck when I started doing that work, seeing so many young people that would come into this counseling center, struggling to integrate their faith and their sexual orientation, or their emerging gender identity.

And I remember speaking to folks who were working in more of the mental health sphere at the time, and they felt really that that was just the way things were, that there were people who were of faith, and there were people who had this sexual orientation. Maybe you could try to mitigate those two, but that was a longstanding journey that really wasn't going to happen.

And so, I, being a stubborn person, wanted to understand more about that intersection of mental health, at the time, faith, but also just emerging identity, LGBTQ identity. So, I pursued my master's degree pretty soon after that at Teachers College, Columbia University, where I really got involved in a laboratory, research lab, where we conducted research on stigma and mental health, and that just solidified my interests. That's when I knew that's what I wanted to be doing. I went on to complete my PhD in Counseling Psychology up at Boston College. And I specifically for that degree chose a research mentor who was looking in his research at LGBTQ mental health through a positive psychology lens. Because for me, I was personally getting a little tired of the language that I would see so often around disparities and illness. And really, in the clinical work that I was hoping to do as a psychologist and eventually my future research, I was hoping to really focus on strengths and expanding access to care and well-being as opposed to just focusing on disparities. And I think that's really reflective of what I wanted in my career.

Dr. Daniel Knoeplfmacher: Well, thank you all. And this indicates what each of you brought to the table in your work in the Wellness Qlinic. But before we talk about the Wellness Qlinic, I want to take a step back and expand on some of the stuff that I talked about in the introduction about the specific challenges and risks that are faced by members of the LGBTQ+ community, especially when it comes to mental health. So, I'm wondering, Chris, maybe, could you expand on that for us?

Dr. Christopher Ceccolini: Absolutely. And I think it's really important to preface any reply to that kind of question with the context for those disparities. And those disparities do exist. Let's not get us wrong on that. But it's not that there's inherently anything wrong with folks in the LGBTQ community. Rather, it's the developmental experiences of so many queer folks in the United States and around the world that set us up for those disparities to emerge in adolescence and adulthood. So, what are we talking about when we say that? Stigma, prejudice, discrimination from family and friends, experiences of heteronormativity or cisnormativity. And just to define that, that's sort of this assumption that to be heterosexual or cisgender is to be normal, and that to be gay, trans, that's abnormal. That's what that means. And all of these things that we're talking about really fall under this bigger umbrella of this idea of minority stress, which is all of these things working together that make life just that much harder for folks in the LGBTQ+ community.

And generally, we like to say that in mental health, if we have a sense of harmony with the world around us, that's a healthy life. But deprivation of that experience is the source of that minority stress. And it can even foster these negative feelings inside of us, right? That's often what we call internalized homophobia, internalized transphobia, the internalization of the world's negative views of us.

The example that I actually will draw from my own life for this, an example is that if my father, when I'm a young child, walks in on me singing Broadway musicals in my bedroom, and says to me that that's bad because that means I'm probably gay, well then maybe I start to dislike myself for liking those Broadway musicals in the first place. And then, maybe I try to avoid other people who I see in the world being similar to me, the other people who like musical theater. I stay away maybe from something that gives me a great amount of joy. I mean, in my case, to draw on that example, I had been doing child theater when that instant occurred. I stopped doing musical productions for about four or five years. So, I say that as a sort of a tamer example of something, but it's something that can really affect one's development, as one emerges as an adolescent, as a young queer person, a gay person, a trans person into adulthood.

But now that we have the groundwork for all those disparities faced by the community, let's name some of these disparities. So, queer folks are more than twice as likely as heterosexual and cisgender folks to have a mental health disorder in their lifetime. They are 2.5 times more likely to experience depression, anxiety, and substance use compared with heterosexual and cisgender individuals. And, you know, you hear this so often, the rate of suicide attempts is four times greater for us in the LGBTQ+ community. These are very serious disparities. And while I don't personally take an approach to focus only on risks and disparities, these are important factors to keep in mind. And really, it's these disparities, I think, and I don't want to speak for either Connie or Jess, that really led to folks wanting to put something together here at Weill Cornell Medicine that directly addressed the needs of the queer community in New York City in the Tri-State area.

Dr. Daniel Knoeplfmacher: And with all of those disparities that you're describing, we know that these individuals will experience stigma in the care that they will get in the medical community and seeking mental health care. So, I'm wondering, if you had anything to add to that, the piece on the medical side where there's gaps in terms of what these individuals can get for their care.

Dr. Christopher Ceccolini: Something I would add is that often when I meet LGBTQ individuals in therapeutic spaces, clinical spaces, they are often quite concerned or hopeful, but I'm aware of the unique stressors that they face in the world, and we've already reviewed those. And I think it can be really difficult in these spaces when you encounter a provider who maybe they want to help you on paper, but if they don't know all of those unique things that I've gone through in my childhood, adolescence, emerging adulthood, a lot of the world telling me that I shouldn't be who I am, I am bad for being who I am, I don't know, my confidence in the care that I'm going to receive is a lot lower, it's diminished, and maybe I'm less inclined to return for future care and seek any sort of medical support or specifically mental health support.

Dr. Daniel Knoeplfmacher: And that's where medical education comes in, because there's a gap in that knowledge being taught. There was, I'm hoping that gap has closed. But Connie, let me ask you about that. So as a medical student, did you feel that you were getting sufficient education in this area?

Connie Zhou: I think that LGBTQ topics in curricula have expanded in the last probably decade or so. But even so, they mostly focus on topics like STI prevention or risks for cancer, other types of like primary care or like medicine-related issues. And not a lot of time in medical education is dedicated to mental health disparities and what treating that would look like, I think.

Dr. Daniel Knoeplfmacher: And that's where the Wellness Qlinic comes in, is helping to provide that mental health care. How did it get started? How was the education you were getting? How did this process begin that we now have this clinic at Weill Cornell?

Connie Zhou: Yeah. So, the Inception story is actually very close to my heart. So, one of my dear friends, Matt Wickersham, who was also in the same MD-PhD entering class as I was in 2017. We were two first years. I think we were getting a beer after class at like a bar nearby. And we both realized we had this interest coming into medical school, specifically about LGBTQ mental health. And Weill Cornell already has this wonderful infrastructure for student-run clinics such as the Weill Cornell Community Clinic and the Weill Cornell Clinic for Human Rights, but we realized that there wasn't any clinic that was sort of focused on LGBTQ mental health. And when we looked broader, beyond Weill Cornell into New York City, Columbia has the Q Clinic, which focuses on LGBTQ primary care, and STI testing. And so, we thought that this would be a great opportunity to build something that we were both passionate about that would really serve to fill this gap.

Dr. Daniel Knoeplfmacher: And Jess, at that point you were a senior resident. Tell us about how you got involved and then how you got involved after that, after you graduated.

Dr. Jessica Spellun: Yeah, I can't talk about this part of the story without also mentioning Dr. Jess Zonana, a mentor of mine and a former faculty member of Weill Cornell Psychiatry Department, who was incredibly instrumental in helping Connie and Matthew to navigate the systems within the institution and build the clinic. And so, I was already thinking about the questions that I had mentioned earlier, kind of how to frame my own understanding about the development of human sexuality and gender and bringing that into the therapy space and found my way to Dr. Zonana, who connected me with Connie and Matthew and I was so inspired by their enthusiasm and the ambition behind this idea. And it felt so right, it felt so needed, and it felt like the right moment at the right time as far as all of the cultural changes that have happened since 2017, 2018, heading into today.

And so, it was a fun intellectual project too. How do we empower students to be the clinical providers while also giving them the opportunity to learn more and teach more about providing, welcoming, affirming, inclusive care for this population? How much psychiatry do they need to know? How much of the affirming care do they need to know? How do we build this thing? And so, that was really how I became involved, is in trying to bridge the education gaps, both originally for the medical students and ultimately for Psychiatry residents and Psychology trainees who later were folded into the mix after doors opened, and also to support faculty in their continued learning in this area in order to be good supervisors. And it just became so clear from the start that there was a clinical need and an education need and a research need as well. And that's how we arrived at our three-pillar mission of providing free, accessible access to care for adult members of the LGBTQ+ community in New York City, in advancing the education and training in LGBTQ+ affirming mental health care topics in the medical school and Psychology and Psychiatry training programs, and to do our part as a small program in contributing to the growing need for more research in this area. What are the needs of this community? Are we meeting them? How do we meet them, et cetera?

Dr. Daniel Knoeplfmacher: Well, let's talk about all three of those and go individually. So, I'm going to start with the clinical services. Maybe, Connie, could you tell us what is being done in the clinic?

Connie Zhou: So, we offer a variety of services, including everything from new patient intakes to ongoing medication management and psychopharmacology. We also offer individual psychotherapy for patients with a resident. Usually, these are time-limited 10 session psychotherapy sessions. And we also offer a unique DBT-based group therapy module, which is entirely led by medical students under the supervision of a social worker. And throughout all of these services, most of our patients actually do engage in multiple modalities of treatment, and we have a very high retention rate, which indicates hopefully to us that there's a high degree of satisfaction. And interestingly, a lot of our patients who come to us are actually seeking mental health care for the very first time, which sort of goes into what Dr. Ceccolini was saying earlier in terms of maybe people not having access to affirming care or having reservations about seeking mental health care. I think that the promise of a clinic that's LGBTQ specific and designed with that intentionality to it has been appealing for our patients.

Dr. Daniel Knoeplfmacher: Can you tell us a little bit about the patients, not identifying information, but just more age range, backgrounds, some of the diversity of the population you're serving, and we are in New York City.

Connie Zhou: Yeah. We have an incredibly diverse and lovely patient population. I'd say that primarily our patients are in their 20s or 30s, of course, with exceptions. This is probably primarily because a lot of our early marketing was focused on social media, so Facebook, Instagram, that's really where we recruit a lot of our patients. Although over time, this has changed and we get a lot more referrals from providers within Cornell or outside of Cornell. I think one third of our patient population is actually uninsured with two-thirds having insurance, but having either high co-pays that they would have to pay at other clinics or even like younger people who are on their parents' insurance and are hesitant about using that insurance for mental health care. I'd say that our patients are also very racially diverse. And over half of our patients identify as transgender, gender non-conforming, or non-binary. And of course, all of our patients identify as LGBTQ.

Dr. Daniel Knoeplfmacher: That's a real cross-section of the community, and you're providing really important clinical care there. And that really connects to education as well. I know that the residents in our program, which I'm the training director of, they have their first outpatient therapy experience in this clinic, which is early in residency and is a really nice, unique experience, and are also, I can tell you, quite often interested in getting direct clinical experience working with LGBTQ individuals. So, there's real educational value in the clinical piece, but there's also education before you do the educational piece. And Jess, I wanted to ask you about that, including the clinical piece. But can you tell us about these components and experiences for medical students, residents, and psychology trainees?

Dr. Jessica Spellun: So over time, this has certainly grown and evolved and, for the medical students, is now an online module that they complete in order to become volunteers, whether they're doing clinical volunteering, staffing the front desk or serving on the student board. All volunteers are required to complete this educational model that covers topics such as the disparities and potential risk factors that Chris outlined. We also make sure to include topics related to resilience and psychological strengths as well, teaching more about the developmental trajectory of sexuality and gender, talking about some of the safety assessment that is important for future providers to understand and be listening for related to the potential higher rates of substance use, unsafe sexual practices, and how to talk to patients about the ways that they keep themselves safe or might benefit from further education and support in how to keep themselves safer. And we also have students complete a module on that is specific to the transgender, gender non-conforming population and options for social and medical transition so that they're entering this space informed, both about the experience of individuals and to be able to inform them about options, if that's something that the person presenting for care needs.

And it's also important to mention that one of the things that we really emphasize is not making assumptions, and that LGBTQ people are accessing mental health treatment for the same reasons as everybody else, distress, anxiety, depression, difficulties with their boss, difficulties in relationships. And it's not always going to be relevant to do a complete history of someone's sexual behaviors, how they've come to identify as far as sexuality and gender. And sometimes it might be, and that there's an art to that and an art to meeting people where they're at. I think that's the biggest thing that I would want students and residents and trainees to be taking away from this, and to be humble in the fact that we can't know everything and that our patients are the experts of their own experience and to be curious to learn more. It's probably beyond the scope to go into all of the detail. The residents get very similar introductory overviews, meant to match their level of learning and so do the psychology trainees, not quite as didactic-focused for the older, more advanced trainees.

Connie Zhou: In parallel to what you said, Dr. K, about the residents, what's really interesting about our care model is also that, for most of our medical student volunteers, these are actually first and second-year medical students. So, this is often one of their first clinical exposures as well. And part of what makes our program exciting for medical students is that they have this kind of early opportunity while they're mostly doing classwork and sitting in a lecture hall to actually meet patients and to ask patients about their life histories and to practice doing differential diagnoses. And I think that that helps build a lot of confidence for them as they go into their clerkships later on, whether or not they go into Psychiatry.

Of course, we do have some program lifers who started out as medical students and are now some of your residents. But I think, for all of our students who've gone through us, we've overwhelmingly had positive experiences from them in terms of integrating what they've learned about LGBTQ mental health and the LGBTQ community in general into their care practices going forward.

I'd also say that, since its inception and since the opening of our clinic in March of 2019, over 200 medical students have volunteered in our clinic in some capacity, either on the student board or as volunteers. I myself, in a very non-nepotistic way, I'd say, also had the privilege of volunteering in the clinic and saw my first patient there as well under Dr. Jess Zonana, and absolutely loved that.

Dr. Daniel Knoeplfmacher: Well, thank you, as a training director, because you are giving great exposure to Psychiatry very early on in medical school. And we've been able to have a lot of those former medical students as our residents, which has just been such a gift. And to go back to what you were saying, Jess, I mean, I think that point about the humanistic focus, like obviously we're talking about a specific population, but always remembering the common humanity at the core, which is you know a big part of the humility is something that all of us need to always hold onto and is important as a psychiatrist to really, and a doctor frankly, to learn early on.

Dr. Jessica Spellun: I would add too, since we're talking about folks in the clinical encounter early on in their training, I don't want to be defensive about this because we are very proud of the clinical care that we provide, we have studied it. We know that there have been positive patient outcomes. There are ongoing studies in process to ensure that we are actually delivering what we think we are delivering. But it has come up along the way as we've presented this model, whether it's an ethical issue to be having early trainees working with a population that might have more mental health needs. And so, I just wanted to speak to that, as far as the fact that a student-run clinic is an essential established evidence-based model for addressing the needs of, in particular, disenfranchised communities within healthcare systems, and that we are also trying to connect with people who might not be able to access care elsewhere. And at the end of the day, some thoughtful, humanistic, good care is better than no care, we think, and we're studying. So, I just wanted to add that note.

Dr. Daniel Knoeplfmacher: Thank you for adding that, and I want to get to the studying in a moment with Chris. But before, just to build off what you just said, I mean, certainly Connie mentioned these other existing clinics that are great models, which are serving marginalized populations already within Weill Cornell. So, I'm wondering, specifically, we know the care is good and we're going to talk more about the research reporting that, but can you speak for a moment about the support that I happen to be one of the volunteers, but that you and Jess Zonana, and then lots of other faculty and senior psychiatrists were involved in supporting this care. Can you talk a little bit about how that fits in as well?

Dr. Jessica Spellun: So, we wanted to make sure that we were following the traditional medical model of training and that everybody had the appropriate supervisory support on the student side and on the trainee side. And so, there is always a faculty supervisor for all shifts of the clinic. All patient care is run by them during every shift. The residents who are serving as therapists and Psychology trainees who are serving as therapists have a separate therapy supervisor, which would be the same as with any other therapy case in training, in addition to having other supervision opportunities built into the structure of the training program for psychopharmacology as well.

The faculty volunteers who supervise have all undergone their own training in affirming and inclusive mental health care for this population and to gain further background in informing themselves about the lived experiences of the LGBTQ+ community.

Dr. Daniel Knoeplfmacher: This is a real grassroots effort. And that includes the research too, which I want to turn to. Chris, can you talk to us about what studies you guys have been doing as part of this?

Dr. Christopher Ceccolini: One thing that drew me to the Wellness Qlinic when I was completing my postdoctoral fellowship here at Cornell before I transitioned into being one of the faculty advisors last year was the opportunity to understand patient outcomes and volunteer outcomes. And so, as Jess has already alluded to, the clinic is really interested in understanding what is the evidence base for what we're doing? Are we just throwing things at the wall and seeing what sticks? Or is there method to the madness, I guess? And it turns out there is. But to speak to that, there's ongoing studies of patient outcomes at the Wellness Qlinic. We're ever revising that. So, as volunteers come and go, and they do come and go over the years, different volunteers raise different research questions. They may be interested in whether providers feel that they are providing affirming care versus whether patients feel that they are receiving affirming care for their identities. Studying whether those are in concert with one another or if there's disparities there and studying what we can do to improve affirming care, just understanding clinically what the makeup of participants in the clinic are in terms of demographics, but also in terms of depression, anxiety, substance use. What are we seeing on those fronts?

And then, from the perspective of volunteers, we're about to actually have published study in Academic Psychiatry just looking at the DBT programming that Connie alluded to, how did engaging in DBT programming as an early medical student affect your professional trajectory? Did it change your interest? Did you go from not wanting to pursue Psychiatry as an area of specialty is to saying, "You know what? I think Psychiatry residency and a career there is what's for me." These are really intriguing questions that I think we get to look at in the Wellness Qlinic actively.

And on the horizon, you know, we're looking toward integrating with other departments at Weill Cornell Medicine, specifically digital mental health, and seeing if there's a way to integrate a mental health app, the Maya app, which I know has been spoken about on this podcast in the past, but seeing if that's something that can also supplement care that we are providing at the Wellness Qlinic to ensure that we're doing everything we can to provide access to care to a population that often faces so many barriers.

And I know we've talked about this in the past, Connie, that there's a very long wait list for psychotherapy. And so, thinking about ways in the research and interventions we provide about how do we shorten that? How do we make it so that just because you're on the waitlist doesn't mean you're just sort of sitting around waiting for access to care? What can we do either with mental health apps or just with the nature of the interventions we're already providing to increase that access to care?

Dr. Daniel Knoeplfmacher: So, an effort at quality improvement of the care.

Dr. Christopher Ceccolini: Yes.

Dr. Daniel Knoeplfmacher: Well, you spoke about future directions. I'm wondering in general from all of you, what future directions do you see for the Wellness Qlinic?

Dr. Christopher Ceccolini: I think what I would say is something that I came to this role being very passionate about that was cultivated in my own graduate training was dissemination of work. It's not enough, I think, to do good clinical work in one place. It's to disseminate it also. It's part of our responsibility in Academic Medicine to make sure that, you know, if what we're doing is evidence-based and it's effective, then we should be sharing that with the wider world. So, something I'm passionate about in the work I've been doing with these students and these volunteers is really focusing on dissemination and engagement in broader research structures and just getting involved in the larger academic community.

So, what that has looked like is not only responding with enthusiasm when a volunteer comes as I have a research question. I love that. I think that's great. But to then have a meeting that says, "Okay, what does it actually look like to carry that idea thoroughly from something like an IRB application to selecting measures to considering all the ethical dilemmas we're going to have to navigate in that IRB process and then to effective data collection? And then, after we look at it all, what do we want to do with it?" Right? So, I'm always scanning for the next conference, the next publication that we can put out there, because it's really important to make sure that our work isn't happening in a vacuum. And then beyond that, ultimately, what can be the goal of that? Raising grant money and hoping that, ultimately, we can expand these efforts beyond the walls, or maybe the Zoom walls of Weill Cornell Medicine, and making sure that we're reaching the widest population possible in a way that's ethical, safe, and also effective for the needs of the community in New York city.

Dr. Daniel Knoeplfmacher: Well, you're describing wonderful mentorship. So, thank you for all of that. What about, Connie and Jess, what other future directions for the clinic?

Connie Zhou: I think that for all student-run clinics, not just ours, the biggest challenge is always sustainability, and how we can make sure that with each generation of enthusiastic students, that a new generation can take the helm and bring in their new ideas. As you mentioned, I've been in this role for a long time, and I was finally able to turn my hat over to some younger students who are bright eyed and bushy tailed this spring, Karolina Sadowska and Courtney Lee, who are going to be running the ship. And I'm excited to see what new ideas they bring to the table. And I hope that the Wellness Qlinic can live on for many, many generations and continue to impact a lot of people.

Dr. Daniel Knoeplfmacher: Wow. Yeah. Well, can I ask you, before we turn to Jess, one other future question? What are you thinking career wise? You're entering the end of your training. What's ahead for you?

Connie Zhou: Hopefully, I'm going to be finishing my PhD this year in Dr. Anna Orr's lab, and completing my last two years of medical school. I'm definitely interested in continuing on the Psychiatry track. I think I want to continue to integrate research in clinical care. A lot of my current interest clinically is PTSD in the Wellness Qlinic population and in the LGBTQ population in general, and how that intersects with people's lived experiences of trauma and their own history and how that kind of manifests in their life and how they learn to cope with that.

Dr. Daniel Knoeplfmacher: Well, we're eager to welcome you to the field of Psychiatry. We really already have, frankly. So Jess, what other things future-oriented are you thinking about in terms of the clinic?

Dr. Jessica Spellun: I think along the same lines, to continue to sustain for future generations and to have the infrastructure to grow and incorporate all of these new ideas. I think some of that is probably at some point going to come down to funding and grants that Chris is alluding to. And continuing to acknowledge that at the end of the day, this is an operation run on volunteerism and people devoting additional time out of their day. And it has been such a rewarding clinical experience to participate in and a truly rewarding professional development opportunity to be able to mentor so many wonderful medical students wherever they land in their future training. Happy to have as many as possible in Psychiatry, of course, but it takes time, and how do we continue to support all those involved to be able to continue to devote their time and their efforts.

Dr. Daniel Knoeplfmacher: Well, thank you also for the tremendous mentorship, and thank you to all three of you. I want to ask one last question, thinking about how to support the community. We often will end the podcast by thinking about useful resources that could be for folks who might be seeking LGBTQ-affirming mental health care. It could be for clinicians serving those individuals helping those individuals. I would ask this about New York city and around the whole country, if possible. What resources are out there that can help?

Dr. Christopher Ceccolini: There's a few resources in at least the New York City community, that are reliably affirming. That includes the Lesbian, Gay, Bisexual, and Transgender Community Center, as well as Callen-Lorde Community Health Center. They're a phenomenal resource in the Tri-State area for those of the LGBTQ community who need access to affirming care. They don't just do mental health care, they also do primary care. So, it's a comprehensive healthcare provider.

On a national level, I always think about things like the LGBT National Help Center, as well as The Trevor Project, as resources for those struggling with crisis in the LGBTQ community. And then, I always just say things like 988, the National Suicide Hotline. And then of course, if there's ever an acute psychiatric emergency, 911.

Dr. Jessica Spellun: Trans Lifeline as well. And for folks who are interested in learning more as far as their own clinical training, the Association for Gay and Lesbian Psychiatrists that is always looking to rename themselves, but can be found at aglp.com has a great online curriculum posted. There is also lgbthealtheducation.org that gives resources on setting up an affirming space as well as some of the other topics that we've mentioned today.

Dr. Daniel Knoeplfmacher: Connie, what about for people interested in the Wellness Qlinic itself?

Connie Zhou: We're always happy when people reach out, and we love to hear from people. Whether it's people who are interested in volunteering, donating, learning more about us, we're available on Instagram as well as our website, which will be posted.

Dr. Daniel Knoeplfmacher: Yes, it will. And all donations and volunteering and everything is very appreciated. Well, listen guys, I was very excited about having all three of you on. This is the first time we've ever had three people at once as guests on the podcast. And this is a great opportunity to do that. So Connie, Jess, Chris, absolute pleasure to have you here today.

I have to say, I'm inspired by the work that all three of you have done in all of these areas. And I say that as someone who has had experience in the Wellness Qlinic and has worked with trainees who have been learning in the Wellness Qlinic. It is just such a gem in our institution. And really, I know firsthand how valuable this is for patients, for trainees, and for our community. So, thank you for all the important work you've done at the clinic and for joining me today here.

Dr. Christopher Ceccolini: Thank you.

Dr. Jessica Spellun: Thank you for having us.

Connie Zhou: Thank you so much.

Dr. Daniel Knoeplfmacher: Thank you. And thank you to all who listened to this episode of On The Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. Our podcast is available on all major audio streaming platforms. That includes Spotify, Apple Podcasts, and iHeartRadio. If you like what you heard today, tell your friends, give us a rating, and subscribe so you can stay up to date on all of our latest episodes with great guests like I had today. So, come back soon and listen to our next episode. Thank you.

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