By Susan Gallagher
Psychiatry residency alumna Carrie Brown, MD, MPH, credits her first clinical rotation as a Duke University medical student—at John Umstead Hospital, a state-funded psychiatric inpatient facility in Butler, North Carolina—with planting the seed for her future career in psychiatry. “That experience opened up a whole new world for me,” she says. “I was drawn to working with people with psychotic disorders and other serious mental illnesses.”
Brown has always had a passion for science, but as a child, she envisioned a different path: she dreamed of being an astronaut and started college at Princeton with a plan to study astrophysics. Although she found research measuring cosmic background radiation fascinating, she discovered that what she enjoyed most was building relationships with people. This realization prompted her to look for ways to use science to improve people’s lives. She shifted her focus to molecular biology and began to consider a career in medicine.
During medical school, after researching recruitment barriers for minorities in oncology trials, her interests moved toward more clinically focused research. That experience inspired her to pursue Duke’s joint program with the University of North Carolina-Chapel Hill (UNC) to obtain a master’s in public health during her third year of medical school. For her thesis, she analyzed rape crisis programs and domestic violence centers across the state—a project that drew her closer to a future in both psychiatry and public policy.
Brown was attracted to the Duke psychiatry residency because of its strong grounding in internal medicine. It also presented an opportunity to return to John Umstead Hospital, where she spent a year as chief resident. She enjoyed her work there so much that she stayed on for five years after she graduated from residency in 2008. As an attending physician, she trained Duke and UNC psychiatry residents after the merger of John Umstead and Dorothea Dix hospital into Central Regional Hospital and served as the Duke Psychiatry Residency site supervisor.
Although she loved her work at Central Regional Hospital, she wanted to expand her understanding of the treatment of serious mental illness. She took a position with the UNC Center for Excellence in Community Mental Health to help people with serious mental illness thrive in the community. “It was the same patient population I worked with on the inpatient side, but it was incredibly rewarding to help individuals live in their own apartments with wraparound services, rather than being in institutional or correctional settings,” she reflects.
Around that time, Brown also began seeing patients at Central Prison in Raleigh, work she has continued to this day as an associate professor at UNC. One afternoon each week, she works with inmates who have psychotic disorders and who are completing a long-term treatment program, with a goal of transitioning from solitary confinement to the regular prison population.
In addition to her faculty appointment at UNC, Brown joined the North Carolina Department of Health and Human Services (DHHS) in 2018 and was soon after promoted to the Chief Medical Officer for Behavioral Health and Intellectual and Developmental Disabilities in February 2019.
Although this role was a massive career change, Brown says, it was a logical next step for her, given her breadth of experience in health services research, clinical research and both inpatient and outpatient care—as well as her strong interest in shaping systems and public policy. “I’d developed an understanding of how our health system is working or not working from the perspective of how all of these different aspects of care integrate, and I thought, ‘Wouldn’t it be great to try to tackle this at the systems level?’” she says.
Her team at DHHS serves as a shared resource between the Division of Mental Health and the Division of State-Operated Health Care Facilities to provide medical expertise. They also guide the development and implementation of effective, integrated systems of care for people in the state with behavioral health needs and intellectual and developmental disabilities.
Brown has been deeply involved in an expansive transformation of Medicaid in North Carolina that will result in the most significant set of changes in 40 years. She notes that it’s a particularly exciting time for psychiatrists to be at the DHHS because part of the redesign is to fully integrate behavioral health, mental health and physical health services. “Finally, we’re in a place where the head and the body can be reunited at a real systems level,” she quips.
Her current focus on systems may seem like a departure from her background in clinical care, but Brown sees parallels between the two: “People are complex, with different facets to their personality and a mix of strengths and weaknesses—and systems are like that as well,” she reflects. “As physicians, we can support people at an individual level, but also in the systems that we participate in and the systems we develop to build a healthy population. That’s what’s so exciting about the public policy world.”
And besides, according to Brown, departures aren’t such a bad thing. When asked what advice she has for current residents thinking about their future, she says, “I couldn’t have predicted or mapped out my career to date, but as I kept following my passion, new opportunities arose, which has led me to where I’m supposed to be.” She recalls that during residency, she and many of her peers felt that they needed to map out their careers early on. But now—more than a decade into her multifaceted career—she encourages residents and new psychiatrists to keep a curious, open mind and not be afraid to try new things. “There’s so many different ways you can contribute to society and evolve professionally if you continuously stretch yourself in different directions,” she advises.
Reflecting on her own residency, Brown looks back fondly on the camaraderie among her fellow residents, some of whom she has stayed in touch with—including Duke Psychiatry faculty members Seamus Bhatt-Mackin and Damon Tweedy. She’s also grateful for the strong foundation the program gave her in implementing evidence-based practices, the therapy training she received in the Family Studies Program and the breadth of clinical and academic experiences the program affords.
Brown’s roles at UNC and DHHS keep her beyond busy, but when she’s not working on overhauling a health system or providing therapy to inmates, she enjoys spending time with her family, running and traveling. She’s also an assistant consulting professor in Duke Psychiatry & Behavioral Sciences.
Interested in learning more about the North Carolina Medicaid transformation? View Brown’s talk, “NC Medicaid Transformation: Challenges and Opportunities,” which she presented at Duke Psychiatry & Behavioral Sciences Grand Rounds on November 11 during Medical Alumni Weekend.