A Conversation with Dr. Yuto Tobin-Miyaji, GW Psychiatry Resident

McClendon Center’s work doesn’t happen in isolation. For nearly two decades, the organization has partnered with George Washington University’s Psychiatry Residency Program — welcoming a new class of third-year residents each year for a yearlong clinical rotation at the heart of community mental health in Washington, DC.

Under the guidance of Dr. Samuel Allen, McClendon Center’s Medical Director, residents gain hands-on experience serving some of the District’s most vulnerable residents while contributing meaningfully to the care the Center provides every day. It is a partnership that has shaped generations of psychiatrists, and one McClendon Center is proud to be part of.

Dr. Yuto Tobin-Miyaji is finishing that rotation now. A third-year GW psychiatry resident, Yuto came to medicine by way of Japan, New York, the Bronx, and a life shaped by movement — across countries, cultures, and health systems. He arrived at McClendon Center last summer and leaves this July. He will go on to spend his final year of residency split between the Virginia Community Services Board, Inova Fairfax Hospital, and George Washington University.

Before he goes, we sat down to hear what brought him here, what surprised him, and what he’s carrying with him.

You have a wide-ranging background. Can you walk us through the road to psychiatry?

It’s a little complicated — which I think is actually pretty typical of anyone who ends up in community mental health.
I was born in Japan, came to the United States in middle school, went back and forth for a while due to my parents’ work. I didn’t speak English when I arrived. I ended up in Westchester County, graduated from Valhalla High School, and went to Binghamton University with the idea that I’d go to medical school.

My mother is a psychiatrist in Japan. Growing up, I’d sometimes go with her to her clinics — she was doing substance abuse work at a time when that was heavily stigmatized in Japan. The patient population was honestly very similar to what I see here, just in a completely different cultural context. That was an early exposure I didn’t fully appreciate until much later.

At Binghamton University, where I did my undergrad, I got involved in Alzheimer’s research and respite work for elderly community members. I didn’t yet know where in medicine I was headed. Then I went to Albert Einstein College of Medicine in the Bronx, and that’s where things shifted. I did a rotation in addiction medicine with an internist who had a genuinely patient-centered approach to substance use disorder care — harm reduction, safe injection programs, the works. That was my real introduction to community mental health.

And through the COVID pandemic, watching how much mental health need went unaddressed across medicine, I kept coming back to the same realization: psychiatry is one of the only fields where you actually have the time to listen to a patient’s full story. That mattered to me.

What brought you to McClendon Center specifically?

In our third year, we have some say over our clinical placements. I read the description of McClendon Center and it stood out. It seemed like a place where the work actually makes a difference for patients — not just processing people through a system, but real longitudinal care. That’s what I was looking for.

And it’s delivered on that. This has been the most educational rotation of my third year. I’m currently working in four different clinics, and McClendon is the one that’s challenged and taught me the most.

What surprised you when you got here?

The complexity of the patients, honestly. I came in with some assumptions — that a clinic with fewer resources would have simpler cases. That was completely wrong. It was the exact opposite. Patients here often carry multiple diagnoses, complex medication regimens, and significant limitations around finances, transportation, and housing. The clinical picture is anything but simple.

What surprised me equally was how warm and resilient these patients are. Despite everything they’re navigating, they keep showing up. I think a lot of that has to do with the environment here. There’s something about walking through the door at McClendon Center that feels different from a standard outpatient clinic. People who don’t even have appointments will come in, get a coffee, sit for a while, talk to someone. That doesn’t happen at most psychiatry offices. But it matters. It lowers the barrier. It builds trust. And trust is what makes treatment possible.

How does McClendon Center compare to other clinical settings you’ve trained in?

The integration is what stands out most. At a typical outpatient clinic, you see a patient once a month, maybe once every three months. You might interact briefly with the front desk — that’s it. Here, there’s a whole team: community support specialists, nursing staff, care coordinators, all working together around the same patients. You can walk down the hall and have a real conversation with a colleague about someone you’re both seeing. That changes the quality of care in ways that are hard to quantify but very easy to see.

Dr. Allen is a tremendous supervisor. He knows the patients — not just their charts, but their histories, their trajectories, sometimes going back years. There are notes in our system from residents who trained here long before me, and you can actually trace how patients have evolved over time. That kind of longitudinal continuity is rare.

I’ve also been struck by how hard everyone here works, and how much flexibility the team extends to patients who would be turned away elsewhere. Someone shows up 20 minutes late, or without an appointment — here, you find a way to help them. That’s not the norm in most clinical settings.

But in community mental health, it has to be. If you don’t meet people where they are, they don’t get care.

Are there patients here you’ll carry with you?

There are several. The ones I’ll remember most are the ones who taught me the most — and those tend to be the most complex cases.

One patient comes to mind who had been misunderstood in other medical settings for a long time. Over the course of this year, we built a relationship where they trust that I’m looking out for them, even when I’m making difficult decisions about their care. They don’t take it as an offense because the relationship is real. That took time, and I think it’s only possible in a setting like this one.

Another patient, probably the most difficult case I’ve managed this year, came to us from another clinic and presented with real challenges from the start. A lot of places would have turned them away. McClendon didn’t.

Over time, through consistent care from the whole team, they found their footing here. There’s still a lot of work ahead, but there are new residents coming who can continue that work, and I think they’ll be okay.

They taught me more about how to hold boundaries with care and intention than any textbook has.

What would you tell a new resident coming into this placement?

Listen before you lead. The nurses, the case managers, the community support specialists — they know these patients better than you will for the first several months. That knowledge is invaluable, and the only way to access it is to ask and to listen.

It’s a busy rotation. I didn’t feel fully comfortable here until February or March — about six or seven months in. Give it that time. And listen to your patients. No matter how complex the case, they will teach you what you need to know. That’s been true every single time this year.

You’re heading to the Virginia Community Services Board next. What’s after that?

I want to stay in outpatient, community-facing work rather than inpatient. Beyond that, I’m keeping my options open. I’ve moved around a lot in my life — Japan, New York, the Bronx, DC — and I’m genuinely curious about other health systems, other communities. I might do locum work, experience different parts of the country. Maybe New Zealand or Australia at some point. I think having moved around as much as I have actually prepared me well for that kind of adaptability.

What I know for certain is that I’m taking what I’ve learned here with me. I hope this partnership between McClendon Center and GW continues for a long time. The residents who come here are better doctors for it.

A Conversation with Margaret de Pont, Mental Health Therapist

Individual counseling is one of the most personal forms of care McClendon Center offers, and for a period during and after the pandemic, access to it was significantly disrupted. That’s changing.

Margaret de Pont is one of two new therapists who have recently joined the team as part of a deliberate effort to restore and expand that access. A graduate of George Washington University’s Clinical Mental Health Counseling program, Margaret came to DC by way of Vermont, Wisconsin, and nearly five years in international development — including work on the mental health side of refugee resettlement that fundamentally shaped how she thinks about culture, language, and care.

We sat down with her recently, coincidentally during National Counseling Awareness Month, to talk about the road that brought her here, what she’s seeing and hearing from clients right now, and how she draws inspiration from the McClendon Center community.

Your background before McClendon Center is pretty wide-ranging. Can you walk us through how you got here?

It’s a winding one. I grew up in Massachusetts, studied French and international relations in Vermont, and then spent time teaching English on a small island in the Indian Ocean. After that, I did a master’s program in Wisconsin, conducted entirely in French, with an international development focus. While there, I interned with an organization providing mental health support to newly resettled refugees, which taught me a lot about navigating complex systemic constraints while providing client-centered care. I was also working with a really great therapist of my own.

Those experiences opened something up for me.

I moved to DC to pursue my master’s in clinical mental health counseling at GW. I also got a job working full time in international development. I had always planned to shift into the mental health space after graduating, at least until I completed my licensure hours. I imagined the transition would be more gradual, but with all the changes in federal funding we saw last year, I ended up losing my job alongside a lot of my international development colleagues.

At the same time, I was completing a clinical internship at another community mental health organization in DC. That experience affirmed how much I love working with this population and so finding an opening at McClendon felt like a really fortunate turn.

It might not be obvious to most people how international development connects to community mental health. Do you see a link?

I see it constantly. So much of my perspective and approach to counseling comes from my experience living in different countries, speaking another language, and working across cultures. It gives me a framework to understand the role of systems, culture and identity within the mental health space – how people describe their experiences, where they feel it in their bodies, what words they reach for or avoid.

In refugee resettlement work, we were taught to talk about mental health without using clinical language – because it didn’t always translate across cultures. Instead of naming anxiety, we might ask about someone having too many thoughts in their head or explore more somatic symptoms like muscle tension, an upset stomach, or racing heart. That approach has stayed with me and informs how I work with clients here.

And then there’s the logistical piece. Working in international development, I’ve provided project management support to teams around the world, balancing donor expectations with realities on the ground. I know it’s a different context, but it helps me understand how a place like McClendon operates, and where I fit within it. I thrive in collaborative, care-coordination environments, and community mental health is exactly that.

What are you seeing and hearing from clients right now? Are there themes that feel particularly present?

There’s a lot. The pandemic left behind unresolved grief that I don’t think has fully surfaced for many people – not just the losses, but the disorientation of that period. For some clients, current stressors are activating that. When something in the present feels threatening or unpredictable, it can resurface older experiences of loss, fear, or persecution in ways that are very real and very immediate.

We also see an increase in mania and suicidality each Spring. For some clients in recovery, warmer weather can bring about additional concerns surrounding substance use.

Beyond that, clients are navigating changes to Medicaid and insurance coverage, a difficult job market, housing uncertainty, and concerns about personal safety. For clients who are exploring aspects of their identity, especially those accessing gender affirming care, this is an especially difficult moment.

That sounds like heavy work. How do you sustain yourself in it?

I think there’s an assumption that doing this kind of work means spending your day absorbing other people’s pain and walking out depleted. And sure, some days are heavy, but I genuinely don’t experience it like that. There are so many moments of joy and connection – celebrating client wins, hearing about their pets, laughing at something completely unexpected. When someone tells me they can finally see a future for themselves, even if it feels scary because now they have to plan for it – that’s not draining. It’s a part of the work that feels incredibly meaningful.

I’ve also invested in my own process. I’ve been in therapy myself and learned to recognize when something is coming up for me in my own body. I have supervisors I trust and the team at McClendon has been welcoming since day one, which matters more than people might realize.

I get to hear, through the work, how much our colleagues mean to clients. Our office coordinator is an example – clients tell me in session how much it means to see a familiar, warm face at the front desk when they walk in.

Sometimes that’s what gets them through the door on a hard day.

Is there something you wish the broader community better understood about living with serious mental illness?

I think we sometimes underestimate not only the reality of serious mental illness, but the amount of effort it takes for our clients to live with it every day. The people we work with are not choosing these experiences; they’re doing the best they can with symptoms and life circumstances that can be extremely difficult to manage. And they’re often just as frustrated as the people around them – sometimes more so.

I also think there’s a tendency to group everyone with serious mental illness into one big category and project a lot onto that. The reality is much more nuanced. Everyone experiences mental health, and our clients are still whole people, often living full lives, despite their diagnosis.

The people I work with are incredibly resourceful and resilient. Many have been navigating complex lives, largely on their own,for a long time. I see them for an hour every week. The other 167 hours, they’re doing that themselves. And so, I try to keep that in perspective.

There’s been a lot of conversation lately about AI and mental health — people turning to chatbots for support, even therapy. What’s your take?

I hesitate around AI therapy. I think there’s a world in which it can be a supportive addition to treatment for some people. I’ve had clients talk about using it between sessions to brainstorm activities or provide validation. And I think, depending on the client, there can be a lot of value in that. I’d just be cautious about the idea that AI can fully replace therapists.

A huge part of the healing process,especially for people working through complex trauma, comes from actually being in relationship with another person.

So much of therapy happens in that space: navigating rupture and repair, practicing vulnerability, experiencing consistent attunement and boundaries from another human. I don’t think AI can replicate that. And that’s not a small thing to lose.

 

McClendon Center has served the Washington, DC community since 1980, providing integrated behavioral health care to individuals living with serious mental illness and co-occurring substance use disorders. 

Join us this Wednesday morning, May 13 for a Special Fundraiser with Call Your Mother

Use the code McClendon when you order in-person or online and 25% of the proceeds will be donated to our mission!

In honor of Mental Health Awareness Month, we are excited to announce a special partnership with Call Your Mother Deli! On Wednesday morning, May 13, you can support our mission simply by enjoying your morning coffee or breakfast.

For every order placed at the Park View location at 3301 Georgia Ave NW (or online) during the event window, Call Your Mother will donate 25% of the sales back to our work serving vulnerable communities.

THE DETAILS

Call Your Mother – Park View
🗓️ Wednesday, May 13 from 8 am – 12 pm
📍 3301 Georgia Ave NW (Park View)

HOW TO PARTICIPATE

Use code McClendon at checkout.

HOW TO ORDER

In-Person:
Mention the code “McClendon” at the register when you order at the Park View shop.

Online:
Place an order for pickup through the Call Your Mother Website and enter code “McClendon” at checkout.
Order Online Wednesday

Every order helps us continue our vital work during Mental Health Awareness Month and beyond.