Vivien Chan, M.D., DFAPADistinguished Fellow of the American Psychiatric

AssociationDiplomate, American Board of Psychiatry & Neurology in

PsychiatryDiplomate, ABPN in Child & Adolescent Psychiatry

Associate Clinical Professor, Department of Psychiatry & Human Behavior

UCI School of MedicineChief of Psychiatry, Student Health Center

Community Mental Health PsychiatristOrange 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 / 3rd Party Payor

Private (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 Stigma

Class Choice• Last Video: “Conversations”

Brook Shields (2007) Lorraine Bracco (2011)

• Or AFSP Video

End: Week 10 Winter Quarter 2014