Diversity in Medicine: Psychiatry and Mental Health

January 24, 2018 | Author: Anonymous | Category: Science, Health Science, Neurology
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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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