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一道本不卡免费高清Alvin had become a dark statistic: one of nearly 3,000 people living unsheltered in Oakland and one of the 45 percent who report problems with psychiatric or emotional conditions.

When psychiatrist Aislinn Bird, MD, MPH, and her street medicine team discovered Alvin on that gloomy day, he also became another statistic: one of the 14 percent of homeless in San Francisco and Alameda counties who receive mental health services.

一道本不卡免费高清Bird is the staff psychiatrist at the LifeLong Medical TRUST Clinic, which provides physical and mental health care for the homeless in downtown Oakland, and the founder of the StreetHealth program, part of Alameda County Health Care for the Homeless. Every weekday morning, a team of doctors and social workers visit homeless encampments, handing out basic necessities like clean socks and granola bars, but also medications to treat depression, anxiety and nightmares from post-traumatic stress disorder. People aren’t always receptive, but the team comes every day offering help, hoping to build enough trust that people will visit the clinic for care.

一道本不卡免费高清“The StreetHealth Team came through and it was a match made in heaven,” Alvin said of his first contact with Bird. “They saved me and I did the best I could to go into the clinic.”

two doctors put medicine bottles into a box
two vials of medicine
At the TRUST Clinic, Aislinn Bird (right), MD, MPH, staff psychiatrist, and Kate Benham, MD, a fellow in the UCSF Public Psychiatry Fellowship, check the medications they bring on visits to homeless encampments. Photo by Noah Berger

一道本不卡免费高清Bird and the TRUST Clinic are one example of public psychiatry services. The homeless population living on the streets in the Bay Area are the most visible of public psychiatry needs ­– but also just the tip of the iceberg.

一道本不卡免费高清“Public psychiatry is the mental health care in the safety net,” said , MD, MAS, who co-founded and co-directs the UC San Francisco at Zuckerberg San Francisco General Hospital. “So think about it as the system where people who are uninsured or have public insurance, like Medicaid, can get psychiatric treatment.”

一道本不卡免费高清While Bird, who is an alum of the UCSF fellowship, and others are working daily to serve the psychiatric needs of the underserved, nationwide there is a growing demand for these types of services.

Increasing Need for Mental Health Professionals

一道本不卡免费高清There is increasing recognition that mental health care can be key to improving overall health outcomes and may be a doorway through which someone can then access the help they need.

“This is happening everywhere,” Mangurian said of the increasing attention being paid to the need to address mental health issues. But she notes inequities in access to care. “As treatment for mental illness gradually becomes less stigmatized, people with means can find care in the private sector. But for those without means, especially the poor and marginalized, the public sector needs to expand to provide the care needed by this population.”

One problem is that there are fewer psychiatrists available to care for the most vulnerable. Forty percent of psychiatrists now work in private practices that accept only cash. The rest – the number of psychiatrists working with public sector and insured populations – has declined 10 percent from 2003-2013, according to a report by the National Council Medical Director Institute.

一道本不卡免费高清[F]or those without means, especially the poor and marginalized, the public sector needs to expand to provide the care needed by this population.

Christina Mangurian, MD, MAS
UCSF professor of psychiatry
Christina Mangurian portrait

一道本不卡免费高清Reasons for the decline include low rates of reimbursement, burdensome requirements for documentation, restrictions on sharing information that can better coordinate care, and high rates of burnout.

一道本不卡免费高清And, of course, there’s the pay – especially in areas with high costs of living, like the Bay Area.

“So why does a psychiatrist choose to go to work in the public sector when they could work somewhere else for $50,000 or $100,000 more a year?” Mangurian said. “They do it because they find meaning in this work and because they are dedicated to social justice and equal care for all populations.”

The Road to Public Psychiatry

, MD, chief of psychiatry at ZSFG at the time, had been thinking the same thing. He recruited Mangurian and they now co-direct the fellowship.

That was the beginning of the first and largest public psychiatry fellowship program west of the Mississippi. The fellowship is made possible with financial support from the San Francisco Department of Public Health.

Mangurian, a graduate of UCSF medical school, attended the public psychiatry fellowship at Columbia University, which was the first such program in the nation.

She modeled the UCSF program, which launched in 2011, after the one she attended at Columbia, and added a research component. Fellows are fourth-year psychiatry residents or those who’ve completed their residency.

一道本不卡免费高清The fellowship has grown over the years, and now partners with San Francisco, Alameda and San Mateo counties as well as other nonprofits for funding and to place fellows into clinical settings four days a week.

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