Diversity in Medicine: Psychiatry and Mental Health

Report
Vivien Chan, M.D., DFAPA
Distinguished Fellow of the American Psychiatric Association
Diplomate, American Board of Psychiatry & Neurology in
Psychiatry
Diplomate, ABPN in Child & Adolescent Psychiatry
Associate Clinical Professor,
Department of Psychiatry & Human Behavior
UCI School of Medicine
Chief of Psychiatry, Student Health Center
Community Mental Health Psychiatrist
Orange County Center for Resiliency, Education & Wellness
 Psychiatry:
Scope of Practice
 Socioeconomic
Diversity of Mental
Disorders
 Emerging
Adulthood: Issues in Colleges
and Universities
 Medical
Specialty (M.D. or D.O.) with + 4
years of post-graduate training
• Medical treatment + Talk (Psychotherapy) and
Other Therapies
 Up
to 1 – 4 additional years of
subspecialty training (fellowships)
• Child & Adolescent; Geriatric, Forensic (legal),
Psychosomatic, Addiction, Sleep and more . . .
 Board
Certification by the American
Board of Psychiatry & Neurology
 Meet
Curtis Adams, M.D., a community /
public-health psychiatrist in Maryland
• Real Psychiatry: Doctors in Action a production
of the American Psychiatric Association
Department of Minority and National Affairs
 Video (9:28)
 20%
of all adults in the U.S. had a mental
illness in the past year (2010 SAMHSA)
• ~ 45.9 million Americans, or 1:4
• 4 - 6% suffer from a serious mental illness (SMI) 1:17
 There
are about 40,000 psychiatrists
practicing in the United States
 There
are 4,800 Child & Adolescent
Psychiatrists in the United States
 Last
Census Data: US – 313.9 Million
 About
45,000 more psychiatrists needed
 Definition
/ Criteria of Serious Mental
Illness
• Mental, Behavioral or Emotional Disorder
• Did not include substance abuse or
developmental disorders (e.g. autistic disorder)
• Diagnosed with in the past year
• Met criteria found in DSM-IV TR
• Resulted in serious functional impairment which
substantially interferes with or limits one or
more major life activities
 Developmental
and Learning Disorders
• E.g. Autistic Disorder, ADHD, Intellectual Disability)
 Mood
Disorders (e.g. Major Depression, Bipolar)
 Anxiety Disorders (e.g. Panic, Phobia)
 Trauma (e.g. PTSD)
 Thought Disorders (e.g. Schizophrenia,
Psychosis)
 Delirium
and Dementia
 Impulse Control Disorders
 Substance Use Disorders
 Often
work in a multidisciplinary team
 Physician
Assistants (PAs)
 Advance Practice Nurses / Nurse
Practitioners; Registered Nurses (APRNs)
 Medical Assistants / Psychiatric Technicians
 Psychologists (Ph.D. or Psy.D.)
 Social Workers (LCSW, MSW)
 Therapists (MFT, LPCC)
 “Counselors” (usually, drug & alcohol)
 Wellness educators
 Patient Advocates
 Public
or Community Mental Health
• MediCare or MediCaid (Medi-Cal)
• Indigent
• Uninsured
 Insurance-Based
 Private
/ 3rd Party Payor
(out-of-pocket, outside the
insurance system, self-pay)
 Supplemental
Security Income (SSI)
• Disabled Adults and Children with Limited
Income and Resources
• $1 – 721 / month per individual + the ability to
earn $1070 / month in substantial gainful activity
 Social
Security Disability Insurance
(SSDI)
• No income eligibility capitation
• MUST have previously “paid into” the system by
earning S.S. work credits (~ 5 yrs full time work)
 The “other” 42%
 75%
of incident cases occur by age 25
years (National Comorbidity Study, 2005)

Major Depression is the Leading Cause
of Disability
 Suicide
is the 2nd leading cause of death
in college and university students
(behind accidents)
A
population often seen as privileged
 Stressors often misunderstood
• “all they have to do is go to school”
 Social
Norms: drinking, partying
 Facts:
• Multiple stressors and pressures
• Living, financial, relational + expectations
• Graduate school carries higher vulnerability
 Access in a Fragmented System
• Public or Community Mental Health
• Insurance-Based, 3rd Party Payor
• Private, out-of-pocket self-expense
 Most
managed-care systems encourage
other specialty visits within 15 days
 In
the U.K., a goal benchmark is to get a
child/adolescent psychiatric consultation
within 26 weeks (i.e. 6 months)
 Suicide
is Preventable
 The
Truth about Suicide: Real Stories of
Depression in College
• The American Foundation for Suicide Prevention
• Video (26:00)
 Using Sensitive Language
• Death by Suicide / Death By Suicide Attempt
• NOT “successful,” “gesture,” “suicided,” or
“committed”
• Controversial: using complete / incomplete or
“aborted”
 Overcoming
 Class
Stigma
Choice
• Last Video: “Conversations”
 Brook Shields (2007)
 Lorraine Bracco (2011)
• Or AFSP Video
End: Week 10 Winter Quarter 2014

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