Medical Educator

May is National Mental Health Month, so it seemed a good time to talk with Annelle Primm '76, M.D., about her work in community psychiatry and mental-health education. Primm currently serves as vice-president of the American Association of Community Psychiatrists and is an associate professor at Johns Hopkins Medical School. "When people hear that I'm director of the community psychiatry program at Hopkins, they often think it's a misnomer," she says. "They don't associate an academic institution with community work. But my colleagues and I are really proud of what the program has been doing in urban Baltimore for more than 30 years. The psychiatric residents here work in our program, so they get an opportunity to leave the ivory tower, to go out into the surrounding community and make home visits—a unique training experience for them."

Psychiatrist Annelle Primm

Although Primm as a pre-med student steeped herself in science, one of the courses she enjoyed most at Harvard was in anthropology. "In a way, my choice of psychiatry is an amalgamation of the biological sciences with my interest in different cultures and societies," she says. "In community psychiatry, you look beyond the single doctor-patient relationship to mental health in a whole group or environment. Severe untreated depression, for example, can lead to substance abuse and then HIV/AIDS or incarceration. I've begun to think about treating depression as a way of interrupting a kind of vicious cycle, both medically and socially. So many people in jails and prisons across the country have substance abuse and mental-health problems that have been overlooked. We've got to change that, and providing mental-health education—to personnel throughout the criminal justice system, for instance—is one of the steps we hope can make a difference."

Her efforts to educate nonprofessionals led her to an unusual medium—videotape. "Over the years," she explains, "I became quite alarmed by the number of people I encountered in my work who had difficulty understanding the whole concept of depression as an illness. I noticed that this was a particular challenge among African Americans, who often look at depression in a spiritual context. They might blame themselves for not having stronger faith, or say, 'Well, if I'm depressed, I'll just put it in the Lord's hands.' Meanwhile people were quite ill and going without needed treatment." When she couldn't find literature on depression that suited her patients' particular needs and outlook, Primm hit on the idea of making a videotape and enlisted the help of a producer she had met as a guest on a local cable television show. "I felt so strongly about it that I was ready to spend my own money," she recalls, "but fortunately I found funding. I was able to recruit African-American patients of mine to speak about their own experience with the illness, and a pastor who addressed some of the spiritual concerns." She reports that focus groups of African Americans who have seen the film, Black and Blue, talk about how much they identify with the people with depression on screen, and people of other ethnic backgrounds have also said they found the film helpful.

Since making Black and Blue in 1999, Primm has produced another videotape, Gray and Blue, which she shows to senior citizens during sessions that include medical screenings for depression. She has learned to keep her videos short ("People who are really depressed don't want to watch anything that goes on and on," she notes wryly) and she is planning more films on other forms of mental illness. "As a scientist, it was fun for me to engage in the creative process of telling a story and crafting a message in film," she reports. "It was almost magical how the filmmaker helped me translate my ideas. Allowing people with the illness to deliver the message from the heart was so much more powerful than having it come from the mouth of a mental-health professional."

That experience, Primm says, has taught her that cultural tailoring of health-education material is valuable and is most effective in audiovisual media where the audience's connection with familiar themes and people who look like them is immediate. "Many people," she explains, "are not able to read at the level at which health-education literature is written. Videotape eliminates those barriers. It is an ideal medium for transmitting health information—it is universally accessible. "