Eliot’s psychiatrists on trust, teamwork, and what it really means to treat the whole person
Mental Health Awareness Month 2026 | Featuring insights from Dr. Alana Nagle, MD, Chief Medical Officer; Dr. Sarah Herold, MD, Metro North PACT; Dr. Eden Evins, MD, MPH, Concord Outpatient Clinic; and Dr. Hannah Larsen, MD, PACT Teams
When most people hear the word psychiatrist, a particular image tends to form: a patient stretched out on a leather couch, a silent figure taking notes just out of view, and somewhere in the exchange, an inevitable question: “So, how does that make you feel?” It is a caricature that has outlasted its origins – and one that the psychiatrists at Eliot Community Human Services are quietly, consistently rewriting.
In conversations hosted during Mental Health Awareness Month, four of Eliot’s psychiatrists sat down to talk candidly about what their work actually looks like on the ground. What emerged was a portrait of psychiatry that is relational, collaborative, and deeply grounded in the complexity of community mental health.
The Relationship Is Everything
All four psychiatrists returned, again and again, to a single foundational idea: before any clinical tool can work – before a diagnosis has meaning, before a medication can help – there has to be trust.
For Dr. Herold, that trust starts at the first appointment, with a deliberate acknowledgment that patients often arrive carrying previous experiences with psychiatrists and other mental health providers, some of them painful. She described asking patients early on about what has and hasn’t worked before – creating space to address fear, stigma, or even the memory of a difficult psychiatric hold before anything else. “Trust is so important in that relationship,” she said. “Whatever we can do to facilitate that, we try to do.”
Dr. Nagle, whose training in child psychiatry shaped her approach to adults as well, described a specific philosophy she brings to every first meeting: positioning herself not as the expert, but as a collaborator. She tells patients explicitly: “I am not the expert on you or your child. You are the expert on your body and your experience.” She added that acknowledging the weight of institutional mistrust — which runs deep in many of the communities Eliot serves — is not a concession, but a clinical strategy.
“I say I’m most useful to you as an expert in making clinical recommendations — and ultimately, it’s up to you to do what you think is best with those recommendations. I have no interest in trying to convince you to do something that you don’t want to do. I haven’t walked in your shoes.”
— Dr. Nagle
Dr. Evins, who practices in Eliot’s Concord clinic, echoed this orientation. “The only thing we have is our alliance, the relationship and the trust,” she said. Even when patients arrive expecting nothing more than a script renewal, she finds ways to slow the encounter down, to connect before transacting. That alliance, she emphasized, is not a soft add-on. It is the mechanism through which everything else becomes possible.
Dr. Larsen framed it in terms of a question she carries into every encounter: “How do I talk with this person in a way that really is therapeutic and supports their goals?” That orientation, she noted, reflects something important about psychiatric training that often gets lost in how the role is publicly understood – psychiatrists are trained in therapy, not just pharmacology, even if insurance structures have increasingly pushed the work toward medication management alone.
Team-Based Care in Practice
One of the starkest contrasts between Eliot’s model and the stereotypical psychiatry office is the centrality of team-based care.
For Dr. Herold, who works with the PACT (Program for Assertive Community Treatment) teams, the team isn’t a supplement to her work, it’s the architecture around which her work is organized. Every morning begins with a team meeting. She sees patients in the community alongside colleagues: nurses, therapists, case managers, peer specialists. “Everybody has a different kind of interaction,” she said, “and brings all of this data and information together.” The result is a constant influx of observations that no single provider could generate alone.
“You’re not just sitting with it alone — you really have people around you that are thinking about it together, thinking deeply, coming from such different vantage points.”
— Dr. Sarah Herold
She offered a telling example: a patient who was mistrustful of using an interpreter, despite English not being her first language. A team member was able to bridge that gap – and once language was no longer a barrier, the treatment opened up. “I had a better understanding of her internal experience, because she could communicate it,” Dr. Herold said. “I was able to target my interventions better.”
Dr. Nagle, as Chief Medical Officer, offered a broader institutional view. She noted that the role of psychiatrist at Eliot looks different depending on which program you’re in, and collaboration is always a priority, but acknowledged that the journey to genuine integration of prescribers within the agency has been a decade-long effort that is ongoing. She also noted that what a psychiatrist brings to any team extends far beyond medication expertise – and highlighted that the organization has long recognized that fact.
Dr. Larsen, who works embedded on PACT teams, echoed Dr. Herold in articulating what that integration looks like day to day. Psychiatrists on the teams attend morning huddles, go out on home visits – sometimes alongside a recovery coach when a patient is navigating substance use – and stay in close contact with the teams throughout the day. “If I find out in a visit that this person’s really stressed because of their financial situation and they don’t have their benefits,” she said, “I can go to the case manager on the team and say, can you help this person out with this.” The flow of information runs both directions: team members regularly flag observations for the psychiatrist, noting side effects, changes in functioning, or questions about next steps. “Lots of examples where team members are consulting me, or saying, is this something you can follow up?”
Rethinking the Medical Model
The “medical model” has become something of a shorthand critique in behavioral health circles – a stand-in for care that is symptom-focused, depersonalized, medication-first, and ultimately hierarchical. It is a critique with real roots, and the psychiatrists did not dismiss it.
But they did contextualize it. At Eliot, Dr. Nagle argued, the complexity of community mental health makes a purely medical model both clinically inadequate and culturally untenable. “Our patients are incredibly complex – from a psychosocial perspective, from a biological perspective, from a historical perspective.” The biopsychosocial formulation – understanding not just a patient’s diagnosis, but who they are, where they’ve been, and what their life looks like – isn’t a theoretical commitment. It’s the actual basis of clinical decision-making.
She made the point vividly: “Is this patient anxious because they have PTSD? Are they anxious because they have psychosis? Are they anxious because they’re using substances? You really have to get to the core – and in order to really understand what’s going on, you have to have that therapeutic alliance.”
Dr. Larsen offered a longer view on why the field has moved away from a purely biological framing. The pendulum swing from psychoanalytic to biological psychiatry in the late twentieth century – the desire to be seen as a rigorous medical discipline – came at a cost: it dismissed and disregarded psychological and environmental factors that were, in fact, inseparable from biology. “What we’ve learned is that the environment interacts with our biology and that they cannot be separated,” she said. “Our experiences change our brain, they change the biochemistry of our bodies, they can change our DNA and its expression.” The science has since caught up: cognitive behavioral therapy, she noted, has been shown to change the physical structure of the brain. The false distinction between talking and treating is no longer scientifically defensible.
Layered on top of those scientific developments, she pointed to the recovery movement as a further corrective, one that has pushed the field to ask not just whether symptoms have improved, but what the person actually wants from their life. “How do they define well-being? What is it that they want to achieve? How do they know when they’re well?” That reframe, she said, is especially important when medications and therapy can only do so much. The goal becomes walking a path with people – a little trial and error – toward the life they want to be living. “I’m very humbled,” she added, “a lot of the time, to be able to walk with my patients on these journeys – some people now over ten years – really getting to see all these different phases of their lives.”
Dr. Herold framed her relationship with the medical model as adaptive rather than rejected. She still believes clinicians owe patients their honest clinical thinking – a diagnosis, a recommendation, a clear perspective. But how that gets communicated depends entirely on the person in the room. “I’m trying to be really flexible in how I’m thinking about it and how I’m taking care of people.” The principle of being present to help, she said, must always be paired with humility about what the clinician doesn’t know or recognize.
Dr. Evins gestured toward a newer dimension of this cultural evolution: the changing relationship between psychiatrists and nurse practitioners within organizations like Eliot. It is a shift that requires new structures, new supervision models, and new conversations – and one Eliot has invested in deliberately, including through the NP fellowship program that Dr. Nagle has helped design and present at national conferences.
Diagnosis, Identity, and the Courage to Be Known
Perhaps the most resonant thread of the conversations emerged around identity. Specifically, the risk that a psychiatric diagnosis becomes not just a clinical label, but an entire self-concept.
Dr. Herold drew the distinction clearly: “I am bipolar” versus “I have bipolar disorder” – a difference in grammar that signals a difference in how illness has been integrated into identity. Her clinical approach is to find the patient’s own goals and use them as the organizing frame: where does the symptom interfere with what you actually want? That separation between the person and the diagnosis creates room for agency. “That’s what’s fun about psychiatry,” she added. “You get to have those kinds of conversations.”
Dr. Nagle amplified this, noting that the stakes are especially high in Eliot’s First Episode Psychosis program, where clients are often teenagers navigating a new diagnosis at the same developmental moment they are discovering their identity. “To help them figure out how to successfully integrate the mental illness – as a piece of their identity, without it overwhelming or overtaking or becoming their whole identity – is really crucial,” she said. “Sometimes it can really dictate how successful treatment is or is not going to be.”
“We treat people like people. We don’t treat people like the illness they have. We…align with their goals and help ultimately alleviate their suffering.”
— Dr. Nagle
Dr. Larsen described the practical work of keeping diagnosis and identity distinct as a kind of ongoing negotiation – one that plays out in language as much as anything else. She makes a point of using the words patients use to describe their own experience, adapting only when a term might cause confusion within the medical system. If a patient who experiences auditory hallucinations describes them as spirits, that’s how she talks about them too. “I don’t need to have my perspective be how it’s defined,” she said. Instead, they explore together: Are the spirits a positive presence? Are there challenges? Is there anything that could make it easier to have that experience while still doing everything they want to do? The goal, consistently, is to have the diagnosis be “just a part of them, and not the whole of them.”
She also pointed to the broader neurodiversity framework as a positive cultural development, in that it is driving a recognition that different ways of experiencing the world and organizing thought exist for reasons, that society benefits from that diversity, and that what looks like a deficit in one context may be a strength in another. It is a lens she finds particularly meaningful in her work with people living with serious mental illness. “I really love working with people with severe mental illness, like schizophrenia,” she said. “It kind of shapes them in these really interesting and positive ways.”
The conversation returned to a theme that Dr. Nagle felt hadn’t yet been named; one that runs beneath everything else: shame. “Shame can be such a tremendous barrier to effective treatment, to successful recovery,” she said. Much of what psychiatrists at Eliot do – the careful relationship-building, the non-judgment, the willingness to meet patients where they are – is, at its core, a sustained effort to reduce shame in the service of supporting the patient in creating a life worth living. To help patients see themselves the way their care team sees them: as people who deserve to be treated with dignity and respect, regardless of their diagnosis.
Dr. Herold’s closing thought returned to where the conversation had begun: the relationship itself. “There’s something really powerful about being known,” she said. The psychiatric relationship, she explained, often requires closing an enormous perceptual gap between clinician and patient – and that process is rarely fast. The work is incremental, trust-dependent, and sometimes measured in years. What makes it possible is a sustained commitment to being present: not rushing toward a predetermined outcome, but trusting that showing up, again and again, is itself the intervention. That patience, and the relationship it sustains, is what heals.
Dr. Larsen, asked what gives her hope, pointed to Eliot’s ability to stay committed to its patients in the face of mounting external pressures – to keep aligning treatment with people’s values and goals, to maintain a commitment to acknowledging the role of economic, racial and cultural disparities in mental health, and to keep finding new ways to meet people where they are.
That patience – that trust in the process – may be the most defining thing about the way Eliot’s psychiatrists work. Not the prescription pad. Not the diagnosis. The relationship that makes everything else possible.
