Diversity in Medicine: Psychiatry and Mental Health
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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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