Tag: Mental Health

2026 Tarrant County Medical Society President Cheryl L. Hurd, MD

Feature Article

By Allison Howard Hunter

This article was originally published in the January/February 2026 issue of  Tarrant County Physician.

Dr. Cheryl Hurd, a psychiatrist committed to both clinical care and medical education, believes that organized medicine is the foundation that supports every other part of medical practice. But she’ll be the first to admit that she didn’t realize its importance early on.

“I was a student member of TMA, but I never did anything,” she says. The same was true during her residency in Arizona. But after years of participation, Dr. Hurd’s advice for medical students and residents is simple: Don’t just join—get involved.

When she returned to Texas and entered private practice, it was as the only psychiatrist in her medical group. Feeling alone, she rejoined TMA and immediately found connection in colleagues, committees, and a whole psychiatry track of support she didn’t know she was missing. “The camaraderie was huge,” she says. “I finally didn’t feel like the only one.”

Dr. Hurd’s involvement in organized medicine also offered practical benefits: TMLT insurance, CME funding, and—most importantly—the chance to advocate. Advocacy, she says, is what allows physicians to push back against excessive regulation, protect physician-led teams, and fight for the future of the profession.

She’s candid about the challenges physicians face. “Healthcare is regulated more than almost any other industry,” she says. Yet advocacy has delivered real wins: tort reform, increased medical education funding, and—critically for her field—expanded mental health funding in Texas even during budget-cut years.
“That’s why advocacy matters,” she says. “It protects us, it protects our patients, and it keeps our profession alive.”

And, as she found, those who advocate for you also have your back at the toughest of times, sometimes in ways that are less obvious than legislative wins. In 2020, when physicians were on the front lines of the COVID-19 pandemic and PPE was scarce, putting healthcare professionals at greater risk, Dr. Hurd was surprised to receive a box from TCMS.

“I opened it up and it was five hundred N-95 masks,” she says. “Just this whole box of N-95s. And then there was an email. It was from TCMS, saying, ‘Hey, we’re trying to help you.’ And they sent it to every single member; they sent every member a box because they wanted to protect us.”

Dr. Hurd credits that support as the reason she got even more involved, leading to her serving as our 2026 TCMS president. She saw in TCMS a reflection of her own ideals—a mission to care for patients, physicians, and the physician-patient relationship.

But it is the physicians like Dr. Hurd who give our medical society its heart, inform its values, and guide its vision.

“Dr. Hurd is the intelligent and compassionate doctor that you would wish to take care of your dearest loved ones,” says Helene Alphonso, DO, a friend and mentee of Dr. Hurd. “As a mentor, she nurtures lifelong learning at every level of medical education. She advocates for her patients and fellow physicians with countless hours and innovative solutions. . . . We can’t wait to see how her leadership in the Tarrant County Medical Society will shape the future.”

Though Dr. Hurd is now passionate about all things medicine, growing up, she did not want to be a doctor—or a teacher or a dancer or even a veterinarian (though she does have a major love for animals). No—at six years old, Dr. Hurd was determined that she was going to be a lawyer. She held on to this dream all the way through college, where she earned both a bachelor’s and a master’s degree in English from SMU, still convinced that law school was her next step.

It was during those years of study that Dr. Hurd met her husband, Howard. They had a good plan: he would go to medical school, and she would go to law school. Still, she decided to defer for a year because his education was taking him to Houston, while Dr. Hurd’s was taking her to Austin. As newlyweds, this separation was hardly appealing, and with law school only taking three years against medical school’s four, the choice was easy for her to make.

Dr. Hurd had planned to work in editing or proofreading for the year, but with a competitive job market and no connections in a new city, she had a frustrating lack of success. One day, she asked her husband if she could join him for his classes to give her something to focus on aside from the unfriendly job market, so he brought her along. She was immediately enthralled.

“A couple of weeks into his school, and I’m sitting there in the classroom taking more notes than he is,” Dr. Hurd says, laughing. “And I just thought, ‘Wow—this is fascinating. Why did I never study this?’”

Quickly, her decision was made—medicine was her future. In a short time, a passion grew into something she knew would sustain her in the years ahead.
Dr. Hurd and her husband were both accepted to Texas Tech’s School of Medicine, so they made the move to Lubbock. A couple of years later, Howard matched to a general surgery residency in Temple, Texas, so she transferred to A&M College of Medicine to complete her clinical rotations. When she graduated in 1998, she began her psychiatry internship at Good Samaritan Regional Medical Center in Phoenix, Arizona. Her training was unique—a joint internal medicine and psychiatry program that allowed her to combine the specialties that most interested her.

After her internship and four years of residency, Dr. Hurd was more than ready to begin practicing as a fully qualified psychiatrist. She and her husband knew they wanted to come back to Texas—the question was simply where they would land. Having their friends and family here was a huge draw for the young couple, but they were also motivated by positive legislation for medicine.

“With tort reform in 2003—that’s when I graduated residency—I was thinking it would really be nice to not have escalating malpractice costs,” Dr. Hurd says. “They’d still get money if I actually did something wrong, but the goal was that all the frivolous lawsuits would go away. And by and large, they have.”

They settled in Brownwood, Texas, where Dr. Hurd set up a psychiatry solo-practice collaborating with a larger organization of specialists. She was the only psychiatrist in the area, and she also consulted at the county hospital. At first this kept Dr. Hurd quite busy, but her practice slowed down after the financial crash of 2008. Soon she moved to Fort Worth, where she joined UNT Health Science Center and UNT Health, although her clinical assignment was at JPS. She later transitioned to Acclaim Physician Group when it was formed, and she stayed there until 2022. Throughout that time, her role grew from serving as the consult medical director to being the psychiatry program director and vice chair of education.

Though she was involved in education through TCOM and JPS, she maintained an active full-time practice. However, when she began serving as TCU Burnett School of Medicine’s psychiatry clerkship director, she stepped back from her role at JPS and joined Connections Wellness in a part-time role.

“At Connections Wellness, I still have a clinical job where I see patients and precept students,” says Dr. Hurd. “And then I had my role as psychiatry clerkship director. I do the behavioral health year-one lectures, clinical skills, and things like that. So, I’m all things psychiatry at the School of Medicine.”

Though Dr. Hurd treasures her role within medical education, she did not seek it in the early days of her career. When opportunities first arose in education, she turned them down in favor of focusing on her clinical practice.

“I thought, ‘No, I’m just going to go out and save the world one patient at a time,’” she remembers. “‘I’ll do clinic and just be a doctor, be a practicing physician. That’s what I was trained for.’ When I started at JPS, I just thought I’d be a psych consultant like I was at the county hospital down in Brownwood. So, I show up, do my orientation, and they’re like, ‘Here’s your team.’

“I went, ‘Team? What team?’ I had a resident, I had an intern, I had students. I just tried to base my precepting on some of the best preceptors I’ve had in my training. So that’s how I got involved and learned that I really loved it.”

Much like her discovery of medicine, Dr. Hurd considers this unexpected assignment another act of serendipity—one that was to her benefit, as it was (and is) for the many residents and medical students who have been under her tutelage.

Her colleague, Debra Atkisson, MD, has seen Dr. Hurd make a big impact both in education and practice throughout her career.

“I have known her for more than fifteen years and have observed her dedication to her patients and the medical students and residents she has taught,” says Dr. Atkisson. “She has provided our community and the state of Texas with outstanding education about psychiatry. . . . We are very fortunate to have Dr. Hurd serve as our president for Tarrant County Medical Society.”

Dr. Hurd has had variety in the roles she has held throughout her career, but they have all hinged on one overarching goal: supporting mental health for physicians and patients alike. This has involved making petitions both to TMA and the Texas Medical Board, being involved in mental health legislation through First Tuesdays, and serving on councils and boards supporting mental health—including TMA’s Physician Health and Wellness Committee, where Dr. Hurd served for the maximum nine-year term, including two years as vice chair and two years as chair.

Though progress has been made in mental health support and treatment, she sees that much more lies ahead.

“I want to continue to work on reducing the stigma and also try and get more involvement in the community itself to support and encourage and grow mental health access.”

But the problem goes beyond the average patients—physicians struggle greatly when it comes to accessing mental health.

“We’re the last ones to go seek help,” she says. “There used to be punishment for physicians with their licensure when they were under treatment. So, they didn’t seek treatment, or they felt like they couldn’t be honest about treatment. And there’s been a huge effort to flip that narrative and get physicians to understand it’s actually okay to get treatment, and this is thanks to both the TMA and the Texas Society of Psychiatric Physicians, after much work and many, many years.”

As she begins her term as TCMS president, Dr. Hurd does so with the goal of continuing this mission.

“One of my goals is to get the community more informed of opportunities for mental health support,” she says. “We are also trying to work on increasing access and bringing more behavioral health and mental health programs to the area.”

Those who know her believe Dr. Hurd will thrive in this role and ably utilize the opportunities it provides.

“I knew of her leadership at the Texas Medical Association, where she served on the Physician Health and Wellness Committee,” says Angela Self, MD, who has been friends with Dr. Hurd for many years. “She works tirelessly for her patients and for the practice of medicine. . . . She sacrifices many hours volunteering, advocating for the improvement of healthcare for physicians and patients across the country.”

As Dr. Hurd looks toward the future, she does so remembering the many physicians who have impacted her career. Carol Nati, MD, was a great mentor for Dr. Hurd, especially during her time at JPS. Dr. Atkisson encouraged her to get involved with TCU’s School of Medicine and Connections Wellness, and Greg Phillips, MD, helped give Dr. Hurd the drive she needed to get more involved with TCMS. Dr. Hurd credits these physicians—alongside many others, and her ever-supportive family— for helping her become the doctor she is today.

Though medicine always keeps her busy, Dr. Hurd loves spending time with her husband; their two children, Dawna and Perry; and their dogs (they always have several, and there is usually a rescue in the mix). If she has a spare moment, you’ll probably find her reading a book—all genres are welcome!—or joining in a multiplayer computer game that her husband got her involved in years ago. She’s now the only one in her family that plays, but through it, she has developed a network of friends spanning the globe.

“It’s kind of fun to have long-term friendships that are not based on just your circle,” says Dr. Hurd. “It gets us out of our comfort zones in those boxes we live in, where we only do things with people who are pretty much like us.”
Dr. Hurd is eager to widen her scope of friends and colleagues even further in the year ahead as she partners with physicians and other change-makers to make a difference for medicine in Tarrant County and beyond.

“I’m excited to see what we accomplish for medicine in 2026,” she says. “There’s a lot of work to be done!”

What We Carry: Reflections of Tomorrow’s Physicians

TCOM Student Article

By Jean Nie, OMS-II

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

While weaving through the Oculus in New York City, I found myself drawn to a small storefront with walls covered in handwritten notes. The space, The Strangers Project, invited passersby to pause and read the anonymous stories of others—fragments of lives laid bare in ink. I wandered slowly, absorbing confessions of heartbreak, illness, hope, loss, and quiet resilience. As I read, I was reminded that every person is carrying something—often invisible, often unspoken—and how unjust it is to reduce a person to a single narrative, a surface impression, when human beings are anything but simple. Despite the many ways we might differ, I felt a deep familiarity with their words. Suddenly, in a city that often feels vast and indifferent, the room felt like a heartbeat—small, warm, and profoundly human.

Fast forward to my first year of medical school. That experience stuck with me, and I found myself trying to recreate a version of that space—this time in the halls of my own school. I organized a “reflection wall” for SOMA, a student-led advocacy organization, not knowing how it would be received. Nevertheless, I wanted this reflection wall to serve as a space for medical students to share their feelings and thoughts in the midst of a seemingly never-ending study session. Over the course of the day, I watched as students came in, some in waves, some peeping their heads in out of curiosity. Some students I knew, others I had only smiled at in passing. But gradually, the wall became filled with notes. Some were long, taking up the entire allotted half page, while others left short yet equally impactful single liners. The vision for this wall was to provide a space for students to pause in the middle of the relentless pace, to process what we often suppress, and to speak without needing a response—only to be heard.

There were papers written with bubbly letters that matched bubbly attitudes. Several students wrote about the moment they knew they wanted to enter medicine: a family member that was saved, a compassionate healthcare worker who made an exception to hospital policy so a patient could say goodbye to a loved one, and personal anecdotes of healthcare saving the writer. These stories echoed familiar themes of wanting to make a difference, to help people feel seen, to be a source of hope during dreary times. Many mentioned that despite the difficult journey, they are reminded of the privilege it is to be in this position, and by expressing gratitude, they are able to see the light at the end of the tunnel, even during the late nights.

But alongside the gratitude, the wall became a fuller picture. Many of the students were tired—beyond tired. Not just from studying, but from what feels like a constant negotiation between who they are and who this profession demands them to be. There were reflections that whispered of burnout and others that screamed of it. There were fears that ran deeper than fatigue—fears that this profession might not deliver on its promise of fulfillment and that a patient’s care would be determined by billing codes and insurance coverage rather than sound clinical judgment. Some reflections expressed fear of the future as well as scars from the past, especially moments where the healthcare system abandoned them or a family member physically or fiscally.

But the pain extended beyond the personal. Threaded through many reflections was a sense of despair about the system itself. Students wrote about the deep inequities they had witnessed: how wealth shapes not only who becomes a doctor but who gets to see one. How poverty, often the root of illness, remains beyond the reach of prescriptions. How medicine tends to treat symptoms while the structural causes—housing, food insecurity, systemic injustice—go untouched. One note captured a particularly painful irony: that even physicians, trained to heal others, often struggle to care for themselves.
I stood in front of the wall in silence, letting each emotion resonate with a part of me that’s felt it before. Like those notes in the Oculus storefront, the ones we wrote were acts of vulnerability—honest, unfiltered moments that revealed the beating heart beneath the white coat. That tension between inspiration and injury felt like the core of the wall. I realized that in creating this space for my classmates, I found myself reconnecting with the essence of why I chose medicine: to confront, to share, and to bear witness to the human experience alongside others. Because at its core, medicine is not just a discipline of diagnoses and treatments—it is a deeply human endeavor. It asks us not only to learn but to listen. Not only to act but to bear witness. Science may guide our hands, but it is our humanity that allows us to truly heal.

The fears expressed by my peers are real, and some will undoubtedly come to pass, if they haven’t already. But within the fatigue and frustration, I felt a reprieve. It’s in these moments of reflection, both quiet and collective, that I find the thread connecting all of us—not just as students or future physicians but as human beings. If we can protect that thread and create space for our own humanity as fiercely as we do for our patients’, then perhaps we won’t merely endure this profession; we’ll have a hand in reshaping it.

Project Access Tarrant County

Salud en Tus Manos:
Medication
Management

By Kathryn Keaton

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

On July 16, Project Access Tarrant County (PATC) held its second Salud en Tus Manos class. For those unfamiliar with it, Salud en Tus Manos (“Health in Your Hands”) is a new initiative under PATC that addresses the social drivers of health (SDOH) faced by many of our patients. These classes, provided through Texas Health Community Hope as part of our Community Impact Grant, are designed for patients with diabetes and/or hypertension who live in one of five priority ZIP codes: 76010, 76011, 76104, 76105, and 76119.

The July class, “Managing Your Medications,” guided participants through the entire prescription process—from the doctor’s visit where a medication is prescribed to understanding labels, following directions, and knowing how to request refills.

Why This Curriculum Matters
Medication adherence is a challenge nationwide, especially for chronic conditions like diabetes and hypertension. When compounded by SDOH such as language barriers, limited formal education, or financial insecurity, the consequences can be severe.

In fall of 2024, PATC saw this firsthand. A 39-year-old woman had waited more than a year for gynecological surgery. When she finally received a surgery date, her pre-op testing revealed dangerously uncontrolled diabetes. Records showed she had not returned to her primary care provider since her initial PATC referral, and she admitted she skipped follow-ups because she “felt fine.” Without those visits, she never received medication refills. Her surgery was canceled, delaying treatment another five months. Though she eventually had a successful procedure, her experience underscores the importance of consistent care and medication compliance—the very issues Salud en Tus Manos seeks to address.

Who We Reached
Our July participants were foreign born with a median age of 45. All had lived in the United States for at least 18 years. The highest level of formal education completed was eighth grade, with 75 percent of the attendees’ education taking place outside the United States. Every participant had hypertension, and half also managed diabetes. All reported attending medical appointments every three to six months.

While all participants felt “extremely confident” in understanding their medications, half believed they could take prescriptions however they wished as long as the medication was prescribed, and all believed they could not receive their medications in their preferred language.

Encouragingly, the post-survey showed significant improvement: 100 percent of participants correctly recognized the importance of taking medication exactly as prescribed.

Hands-On Learning
The class combined instruction with interactive activities. Participants identified warning labels, practiced interpreting dosage and timing instructions, and learned when and how to request refills—not only for their chronic condition medications but for all prescriptions.
Like our first class in March, participant satisfaction scores reflected both engagement and impact. The curriculum is clearly filling an important knowledge gap and helping patients feel more confident in managing their health.

Looking Ahead
Medication management is a crucial step toward improving long-term health outcomes, and Salud en Tus Manos is proving to be a meaningful resource for patients navigating barriers to care. With every class, PATC and its partners continue working toward healthier futures for our community.
Our first class, “How to Communicate with Your Doctor,” gave patients the tools to ask questions and advocate for themselves during medical visits. This September, we will be offering that class again—this time with two sessions, one in English and one in Spanish. The program will continue to grow. The next planned class, “Food as Medicine,” specifically requested by half of past Salud en Tus Manos attendees, will explore how nutrition choices can support patients in managing chronic conditions and improving their overall well-being. Together, these classes are building a foundation for healthier lives—one step, one conversation, and one patient at a time.

The Poison, the Clouds, and the Clearing: Mindfulness in Medicine

BY SETU SHIROYA, MS-II TCU , WITH NEHA SOOGOOR, MS-II TCU; EDITED BY JAYESH SHARMA, MS-II TCU

Breathe in. Breathe out.

It is my first day in the clinic. My heart is racing in my white coat that I have little confidence wearing. My anxiety skyrockets, as do my feelings of not belonging.

What if my attending doesn’t like me? What if I make a mistake? What if my patient starts crying? How do I do a lung auscultation again? What does losartan do?

I can’t remember. I can’t think.

Breathe in. Breathe out.

I have been studying the whole day, my career-defining board exam is in one week, my head is throbbing, my eyelids are drooping. I am clicking through flashcards but nothing sticks. The days are merging into one; someone asked me for the day of the week, and I came up blank.

Breathe in. Breathe out. Breathe in. Breathe out.

Only one year into medical school, and everything feels like a dream. I’ve made it so far, yet the future seems so daunting. I love my life but also fear it at the same time. I want to keep going. I’m excited, but I’m nervous. Where am I in my life? Do I even belong here? Am I the only one thinking this?

Breathe in. Breathe out.

I say it to myself over and over again—my thoughts have been spiraling for days. I need to breathe. I need to calm down.

Breathe in. Breathe out.

I do belong here. I’ve made it so far in this journey; the hard work, the endless hours were not in vain. There is so much more to go and I remind myself that I am excited. I just need to take it one step at a time.

Breathe in. Breathe out.

I am going to be present for patients. I will be a doctor. One step at a time.

Breathe in. Breathe out.

The rampaging thoughts settle, my mind clears, and I open my eyes.

It’s going to be okay.

The morning alarm rings, and my first thought is always the same: “Can I sleep for five more minutes and not think about the long day ahead?” I have stressful exams to take and sometimes dread the workload awaiting me. It feels like the only quiet time I get is in the morning, when I am drinking coffee, working out, or just embracing the quietness. I try to find time to relax, but burnout feels like it is always looming over my shoulder. However, mindfulness and meditation have helped me reorient myself and develop a healthy way to process these feelings.

What does it truly mean to be mindful? To me, mindfulness is staying grounded to what is in the present moment. It can be easy to think of the past or try to anticipate the future. However, the only inevitability we hold is this present moment. Not a second before, not a second after.

How can we practice this? Mindfulness comes in many forms; some find relief in running or weightlifting, making it a point to have a constant regimen at the gym. Others find it through meditation, focusing on breathing and relaxing the mind. These share one commonality: a mental space we create where we stop thinking about the past or trying to anticipate the future, focusing instead on what is present within and around us. There isn’t one answer to seeking mindfulness; the greatest difficulty lies in knowing where to begin.

As medical students and future doctors we are expected to quickly calm ourselves after these stressful moments and proceed. Sadhguru, a guru who is the founder of the Isha Foundation, states: “Fear, anger, resentment, and stress are poisons you create in your mind. If you take charge of your mind, you can create a chemistry of blissfulness”.1 It is especially easy in a hectic and high-paced environment or period of life to get lost in our thoughts about the stressors we experience. Our thoughts are like clouds. We can either let them pass, or we can dive into them. Taking control of our mind to let the clouds pass, helping our mind become still and focus on the present, is difficult.

This is where meditation techniques can help train our mind. Meditation techniques often involve bringing awareness to a single action or sound. For example, they can be used to bring awareness to your breathing or the repetition of a few words. One method I use is called “4-7- 8 breathing.” Close your eyes. Breathe in for four seconds through your nose. Hold your breath for seven seconds. Breathe out for eight seconds through your mouth. As you inhale, stay aware of how the air flows through your body, from the tip of your nose to your navel. As you exhale, follow the air out from your navel to your mouth. Repeat this about two to three times.

At TCU Burnett School of Medicine, our Meditation and Mindfulness Student Interest Group aims to educate medical students about techniques such as 4-7-8 breathing and help them stay engaged in healthy mindful practices to avoid burnout. Our goal is to cultivate a supportive student community dedicated to mindfulness, fostering connection through monthly meditation sessions, inspiring physician guest speakers, and meaningful community volunteering.

It is going to be okay.

My mother always told me, “Take it one step at a time, one day at a time.” As medical students, we’re often exposed to patients and situations that can take an emotional toll on our mental well-being; times such as witnessing a patient’s death or delivering a life-shattering diagnosis. Before we can process what we’ve witnessed, we’re often thrown back into a fast-paced environment without a moment to rest. In such a high intensity life, grounding ourselves with activities that bring comfort and ease becomes crucial to our mental well-being. My hope is that we future physicians can practice mindfulness early, so that we can be present for our patients. In turn, we can help our patients be mindful as we work together throughout our most difficult moments to maintain healthy behaviors.

References:

1. Sadhguru Quotes – Fear, anger, resentment, and stress are poisons you create. If you take charge, you can create a chemistry of blissfulness within yourself. Accessed February 13, 2025. https://isha.sadhguru.org/en/wisdom/quotes/date/december-06-2021

Beyond Treatment:

Project Access and Social Determinants of Health

By Kathryn Keaton

IN 1885, ELEVEN YOUNG NUNS WITH LITTLE TO NO medical experience arrived in “bawdy” Fort Worth via horse-drawn carriage. Their charge was to staff the Missouri Pacific Infirmary. While their initial task was to tend to injured and ill railroad workers, by 1889, The Incarnate Word Order had purchased land and built a hospital that became known as St. Joseph Infirmary.1 In 1923, after a boy died from lack of medical treatment at a different local hospital, Mother Superior proclaimed that both those with means and without would have equal treatment at St. Joseph – including Black patients – when many other hospitals did not.2 During the Depression, Fort Worthians lined up for food distributed by the nuns. Renamed St. Joseph Hospital in 1966, the sisters continued staffing St. Joseph Hospital, working alongside Fort Worthʼs physicians, many of whom still have core memories of the sisters and the care provided until its closure in 2004.3

These sisters never heard the term “Social Determinants of Health,” but in Fort Worth, the nuns were pioneers of the practice. The Office of Disease Prevention and Health Promotion defines Social Determinants of Health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of-life outcomes and risks.”4 The World Health Organizationʼs more simple definition is “non-medical factors that influence health outcomes.”5 These issues vary greatly and are different for every community and individual,
but they each fall into one of five categories: economic stability, education access and quality, healthcare access and quality, neighborhood and environment, and social and community context.6

There is no one list of what these categories include, but the factors account for 50 to 70 percent of all health outcomes.7 The Nova Institute for Health of People Places and Planet claims that “A personʼs health . . . is determined far more by their zip code than by genetics or their family history.”8 This fact is sobering considering that Fort Worthʼs 76104, home of the Hospital District,
has the lowest life expectancy in the state, first reported by UT Southwestern in 2019.9

Equitable access to timely healthcare is certainly among the SDOH that Project Access Tarrant County addresses, but since the beginning, PATC has striven to go much deeper than only access to specialty and surgical care.

The two factors most impacting SDOH for many low-income, uninsured Tarrant County patients are healthcare access and financial stability. These are inextricably linked, particularly for noncitizens who rely on their health to maintain employment and upon their continued employment for their health. Even among American citizens, the uninsured percentage of the Tarrant County (and all of Texas) population is 20 percent, double the national average; however, the percentage among Tarrant County Hispanics or Latinos is over 28.10

Healthcare access, the primary SDOH that PATC addresses, has a direct link to financial stability, especially when our intervention leads to continued or regained employment. In addition, PATC strives to identify other social determinants our patients face and address and/or refer to the best of our ability.

Primary Care
In addition to the growing number of JPS neighborhood clinics, Tarrant County is home to a vital network of free, low-cost, or sliding scale clinics that provide essential primary care to the underinsured or uninsured population. These clinics are geographically scattered across the county, including locations in Fort Worth, Arlington, Mansfield, Grapevine, Crowley, and others. Most of these are community- or church-based clinics, but Tarrant County is also home to one federally qualified health clinic (with three locations) and an optometry clinic that is based on a sliding scale model but also takes private insurance.


While most PATC referrals come from these clinics (including JPS), we also receive referrals from our volunteer physicians, emergency departments, and
the general public. The patients that come from places other than a primary care setting are more likely to have untreated (and sometimes undiagnosed) medical conditions. At least 28 percent of all active and pending PATC patients have diabetes and/or hypertension. Among Tarrant County Hispanics and Latinos, who comprise about 90 percent of all PATC patients, heart disease is the second leading cause of death, followed by diabetes at number six. In 2020, 30 percent of adults whose annual income was below $50,000 had not had a routine check-up in the past year. Because they lack basic primary care, they may not understand the importance of preventative medical care, or they may have other SDOH barriers. Others are simply unaware of what resources are
available to them.

“Ray” recently met with PATC Case Manager Karla Aguilar. Referred by a PATC volunteer ophthalmologist who specializes in retina diseases, Ray has severe diabetic retinopathy requiring surgery. He told Karla he could barely see to work and relied on his wife to drive him everywhere. While simultaneously working on the paperwork needed for Rayʼs enrollment and surgery, Karla asked about the primary care Ray has been receiving. The answer was “none.” She helped him choose from PATCʼs partner clinics and made a direct referral. She seized the opportunity to educate him on the importance of primary care,
especially with a chronic disease like diabetes. Ray seemed unaware that untreated diabetes can lead to serious health conditions, including a recurrence of his retina disease. Further into the discussion, Karla discovered that Rayʼs wife and their children, ages 12 and seven, were also without a primary care home. PATC referred the patientʼs wife to the same clinic as Ray and, since their children are citizens, referred them to a social service agency that can help them apply for Medicaid.

Healthcare Literacy
Ray needed a primary care physician, but the underlying problem was not understanding its importance. Formal education isnʼt the only factor in understanding oneʼs own healthcare. Language, culture, and knowledge of resources also impact this SDOH. PATC caseworkers frequently educate patients on what many would consider common knowledge. They also empower patients to ask questions and understand their own health.

“Sandra” called former PATC Case Manager Diana Bonilla to complain about her PATC volunteer physician. “Heʼs not treating me correctly,” she vented. “I want a different doctor.” After some investigating, Diana learned that the patient was not asking any questions of the doctor (who, of note, is very well known in his field) – and the patient admitted that she felt that, as a charity patient, she did not have the “right” to ask questions about her own health. After a long conversation, Diana encouraged the patient to take written notes of what she didnʼt understand about her care and questions she had about her condition. After Sandraʼs next appointment with the same doctor, she called Diana back. She excitedly told Diana that her questions were patiently answered, she understood her diagnosis and the prescribed course of treatment, and she was thrilled to complete her care with this same physician. Healthcare literacy and patient empowerment likely prevented a patient from discontinuing her medical care. In this case, a delay of care would have had a devastating impact on her health and her familyʼs wellbeing.

Another PATC patient, “Enrique,” was enrolled in PATC for heart issues, but he also had a severe psychiatric diagnosis. His mother was his caregiver. She was often sad about her sonʼs mental health diagnoses, and, apparently as a coping mechanism, she told Diana that she had started sampling her sonʼs medication. “I want to see how it makes him feel.” Taking a deep breath (and quickly Googling), Diana explained to her that not only would his medication
not make her “feel” the same way as it made Enrique feel but was also very dangerous. She read off a list of possible outcomes of taking a medication that was not prescribed to her by her doctor.

PATC also provides practical solutions to common SDOH, such as interpretation and transportation barriers. The 2022 Tarrant County Public Health Community Health Assessment reports that almost 6 percent of all Tarrant households have limited English proficiency; however, among Spanish-speaking households, that number is over 20 percent. Many non-English-speaking patients have adult family or friends they prefer to take with them for interpretation, but PATC has provided interpreters for close to one thousand medical appointments. Spanish is the main language requested, but we have also received referrals for patients who speak Arabic, Burundi, Farsi, French, Hindi, Korean, Mandarin, Mandigo, Nepalese, Persian, Portuguese, Swahili, Tanghulu, Urdu, Vietnamese, and Wolof. We provide in-person interpreters whenever possible; however, for some less common languages, we employ a national phone-based service.

Healthy People 2030’s social determinants of health. 4

Transportation is another potential barrier to care, especially in Tarrant County, where most municipalities have no public transit. While Arlington does have a rideshare program, it is the largest city in the United States with no public transportation. The cities that do have mass transit are limited and they usually donʼt cross city lines. Fortunately, most PATC patients have access to transportation. PATC can provide private rides for the ones who do not.

Vulnerable Communities
Immigrants and people of color are among the most vulnerable communities in Tarrant County. Because the Tarrant County Commissionerʼs Court disallows
undocumented individuals from enrolling in JPS Connection,11 the countyʼs indigent program, existing SDOH barriers are exacerbated. PATC excludes those
enrolled in JPS Connection 11, so most of our patients are the undocumented, a segment PATC has dubbed the “never served” when it comes to specialty and surgical healthcare. Eighty-five percent of PATC patients are Hispanic who speak Spanish only. The remaining 15 percent are mostly undocumented patients of non-Hispanic origin. Covering racial inequality in the United States down to our own community would take years of Tarrant County Physician magazines, and the Robert Wood Johnson Foundationʼs report “What Can the Health Care Sector Do to Advance Health Equity?” gives an in-depth summary of the problems and roads to solutions for some of the factors.

One of the guiding principles of this report states,
Pursuing health equity entails striving to improve everyone’s health while focusing particularly on those with worse health and fewer resources to improve their health. Equity is not the same as equality; those with the greatest needs and least resources require more, not equal, effort and resources to equalize opportunities.12

Conclusion
Project Access excels at providing medical treatment, and this is, of course, why the program was created. We also enjoy showcasing the medical care provided. What we have not done as well is communicate the depth of services we offer to make sure that our patients not only have access to medical services, but that we also address the issues that have prevented the care in the first place. We are not a wide program, but we are deep. PATC will never be able to fix the global issues of inequality, poverty, and education; but we can (and do) address the issues facing our individual patients that impact their access to and understanding of their own care. Hopefully, they will possess more knowledge and tools for the next time they face a healthcare crisis.


References:

  1. Steve Martin, “Goodbye St. Joseph Hospital.” Tarrant County Physician, 90, no. 8 (August 2012): 8-9, 16.
  2. Regrettably, Black patients were confined to the St. Joseph basement, as were Black physicians. Riley Ransom, Sr., MD, opened the 20-bed Booker T. Washington Hospital, later known as the Fort Worth Negro Hospital and then the Ethel Ransom Memorial Hospital, in 1914. “1115 E. Terrell Ave: Tarrant County Black Historical & Genealogical Society,” TCBHGS, accessed March 2024, https://www.tarrantcountyblackhistory.org/1115-e-terrell-ave#:~:text=Booker%20T.,by%20the%20American%20 Medical%20Association.
  3. Texas State Historical Association, “St. Joseph Hospital,” Texas State Historical Association, accessed March 2024, https://www.tshaonline.org/handbook/entries/st-joseph-hospital.
  4. “Social Determinants of Health,” Social Determinants of Health – Healthy People 2030, accessed March 2024, https://health.gov/healthypeople/priority areas/social-determinants-health.
  5. “Social Determinants of Health,” World Health Organization, accessed March 2024, https://www.who.int/health-topics/social-determinants-of health#tab=tab_1.
  6. “Social Determinants of Health,” Social Determinants of Health – Healthy People 2030, accessed March 2024, https://health.gov/healthypeople/priority-areas/social-determinants-health.
  7. Karen Hacker et al., “Social Determinants of Health—an Approach Taken at CDC,” Journal of Public Health Management and Practice 28, no. 6 (September 8, 2022): 589–94, https://doi.org/10.1097/phh.0000000000001626.
  8. “Social Determinants,” Nova Institute for Health, April 14,2022, https://novainstituteforhealth.org/focus-areas/social-determinants/.
  9. “New Interactive Map First to Show Life Expectancy of Texans by ZIP Code, Race, and Gender,” UT Southwestern Medical Center, accessed March 2024, https://www.utsouthwestern.edu/newsroom/articles/year-2019/life-expectancy-texas-zipcode.html.
  10. “Tarrant, Texas,” County Health Rankings & Roadmaps, accessed March 2024, https://www.countyhealthrankings.org/health-data/texas/tarrant?year=2024.
  11. Alexis Allison, “Want a Say in How JPS Operates? Hereʼs How to Get Involved,” Fort Worth Report, February 18, 2023, https://fortworthreport.org/2023/02/18/want-a-say-in-how-jps-operates heres-how-to-get-involved/.
  12. “What Can the Health Care Sector Do to Advance Health Equity?” RWJF, accessed March 2024, https://www.rwjf.org/en/insights/our-research/2019/11/what-can-the-health-care-sector-do-to-advance-health-equity.html


STUDENT ARTICLE: ADVOCACY FOR PATIENTS’ MENTAL HEALTH

by AIYANA PONCE, OMS-II

This article was originally published in the March/April issue of the Tarrant County Physician.

HISTORICALLY, STIGMA AGAINST MENTAL HEALTH, ACCESS to care, and discrimination contribute to worsened health outcomes. This is especially true for certain racial or ethnic groups such as those made up of Black and Hispanic individuals, as there are culturally negative views on mental health symptoms and/or treatment, a fear of mistrust of the medical community due to historical discrimination or mistreatments, or lack of access to mental health services.

To help address this, the Lay Mental Health Advocates (LMHA) program was created. This free, virtual training program is designed to teach laypersons the fundamentals needed to advocate for someone who is dealing with mental illness. LMHA focuses on teaching mental health advocacy by understanding how social determinants worse mental health and play key roles in overall health outcomes for marginalized communities. The social determinants of health are defined by the U.S. Department of Health and Human Services as “the conditions in the environments where people are born, love, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

LMHA began as a volunteer project during my time as a research trainee at the National Institute of Allergy and Infectious Diseases before beginning medical school. In addition to conducting experiments in a traditional laboratory setting, I was a fellow of the National Institutes of Health Academy. This program allowed me to meet other trainee scientists equally as passionate about patient advocacy. Ultimately, the goal of this program was to implement a volunteer project that addresses health disparities in the local community.

We saw a need for interventional programs to fill the mental health gap that is particularly prevalent among marginalized communities. Our program consists of a weekly online workshop led by psychiatry residents or attendings from Duke University Hospital and local community leaders. they include interactive role-playing advocacy practice, case study reviews, and other informative components. Our eight-week-long program was modeled after the Johns Hopkins Medicine Lay Health Advocate Program and the Mental Health Allyship Program. Through LMHA, advocates can identify several different mental health conditions, gain a greater understanding of the factors that exacerbate health disparities, understand how to provide effective emotional support, and gain confidence in the role they can play in the lives of their community members by BEING mental health advocates.

The pilot program took place during Spring of 2021, and we had 100 participants whose ages ranged from 18-58. We are now on track to our third workshop series, with participants from across the county. In addition to that, we are currently expanding our team, working on our non-profit application, and establishing a volunteer program to work with the Duke Behavioral Health Inpatient Unit.

Watching this program grow beyond anything my team had imagined has been very rewarding. I wanted to share this journey with those of you reading to encourage you to continue advocating for yourself, your patients, and your community. If you ever see a problem that needs to be addressed or a gap that needs to be filled, just go for it- you never know what may come of it.

References:

1. https://www.psychiatry.org/patients-families/stigma-and-discrimination

2.https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020–08964-3#ref-CR28

3 . https://health.choc.org/understanding-the-role-of-cultural-stigma-on-seeking-mental-health-services/

4.https://health.gov/healthypeople/priority-areas/social-determinants-health



It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.


On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide.  He was a remarkable person whose work touched so many lives—he was always willing to help others.  He is greatly missed by all who knew him.     

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.  

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.  

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.1  

As terrible as this sounds, there is hope.  Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress.  However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in.  We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.  

The truth is, being a physician is hard.  We train for many years to be able to do the work that we do.  We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves.  We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.  

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues.  It is okay to tell someone when you are struggling and to seek out help when you need it.  A psychiatrist friend puts it best—“Everyone needs a therapist.  I have one.”  At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well.  If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help.  We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support.  It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness.  All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient.  Why should mental health be any different?  Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.  

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends.  We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

References
1John Matheson, “Physician Suicide.”  American College of Emergency Physicians. Accessed August 3, 2022. 

https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide/#:~:text=Each%20year%20in%20the%20U.S.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
emotionalppe.org
The Project connects healthcare workers in need with licensed mental health professionals who can help.

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