Southern California PSYCHIATRIST September 2024

The ADHD Controversy

by Emily T. Wood, MD, PhD

Over the last decade, our society has gone through a major shift in how people experience and view personal identity. We have increasingly more individuals who do not check a single box on race and ethnicity forms (e.g. our Black-Indian Vice President) and we have come to recognize that gender and sexual orientation exist on multidimensional spectrums. Unsurprisingly, the concept of neurodiversity has arisen to explain the different ways we sense our environments and process our thoughts and emotions. In psychiatry, the evidence continues to mount for spectrums of brain function. We recognize that the symptom profiles of disorders exist on a continuum along with the degree of distress and dysfunction individuals experience due to those symptoms.

With these changing societal perspectives, Attention Deficit Hyperactivity Disorder (ADHD) has become a polarizing subject for many psychiatrists.^1,2 On one hand, there are concerns about overdiagnosis of ADHD, medicalization of normal behavior, over-prescribing of potent medications, and misuse of controlled substances. On the other hand, there is concern about the underdiagnosis of ADHD and the adverse outcomes associated with undertreatment of ADHD, especially in minoritized populations. Underlying these positions are different paradigms of ADHD that, in many ways, reflect the paradigm shift that is occurring societally.³

Under a more traditional paradigm, ADHD is a categorical, biological entity. The hallmark symptoms of inattention, hyperactivity, and impulsivity occur across multiple contexts, are pervasive and persistent, and cause significant functional impairment. ADHD is a neurodevelopmental disorder determined by genetics and emerges early in development. This paradigm is supported by the high rate of heritability of ADHD. ADHD symptoms are explained by lower concentrations of the neurotransmitters dopamine and norepinephrine in the frontal lobes of the brain. Therefore, treatment with stimulant medication that boosts the activity of the frontal lobes by modulating these neurotransmitters is the first-line treatment. Individuals without ADHD who take stimulants will experience performance enhancement at lower doses and euphoria at higher doses, which makes these medications addictive.

A newer paradigm posits that ADHD exists on a spectrum and the degree to which it is associated with dysfunction and distress for an individual is highly contingent on environment and social norms. In addition to the hallmark symptoms of inattention, hyperactivity, and impulsivity, individuals experience hyperfocus with preferred activities, sensory over- and under-responsivity, and difficulty with emotional regulation. The neurobiology underlying ADHD is governed by neurotransmitters in the frontal lobes that can be modulated by adding stimulant medications and by changing the context and drives of the individual. ADHD is a neurodevelopmental disorder with nature and nurture components. Parental ADHD contributions include both genetics and parenting behaviors that can be altered by ADHD symptoms from early bonding and attunement to modeling executive function skills. Other important contextual factors include poverty, trauma, early deprivation, and ubiquitous technology (e.g. screentime). Furthermore, social norms and biases lead to different behavioral expectations across the identity and sociodemographic landscape.

For many individuals diagnosed with ADHD, problematic symptoms are brought to light during early or middle childhood in the classroom setting where conformity is critical and each grade level has increasing expectations for focus, body control, cognitive flexibility, and emotional regulation. For others who find academics to be innately rewarding, thrive on certain kinds of structure, or have intellectual strengths to fall back on, their ADHD symptoms may not be uncovered in the classroom setting. Many individuals diagnosed with ADHD experience struggle and impairment due to their symptoms at times of major life transition. Environmental demands of school, social relationships, work, and what we currently call ‘adulting’ increase in quantity, extent, and complexity with age and growing independence while supports are falling away. For some, the transition to college or from college to work may be the circumstances that overwhelm their ability to cope with their relative distractibility, undeveloped executive function, and poor emotional regulation.⁴

Under the categorical paradigm, we would expect the rates of ADHD diagnosis to be similar across races and ethnicities since these are not biologically based. But, this is not the case. In the US, as early as kindergarten and continuing through adolescence, youth who are Black, Indigenous, or people of color (BIPOC) are less likely to be diagnosed with ADHD and more likely to be diagnosed with disruptive behavior disorders. Black and Latinx children are 69% and 50% less likely than White children, respectively to be diagnosed with ADHD.⁵ Instead, Black males and Black females are 41% and 60% more likely than White youth to be diagnosed with Conduct Disorder.^6,7 Importantly, these differences exist when accounting for factors such as trauma and confounders and evidence suggests that these diagnostic differences are due primarily to underdiagnosis of ADHD in BIPOC youth rather than overdiagnosis in White youth.⁸

Under the categorical paradigm, we would also expect males and females to display overall similar presentations of ADHD symptomology. Again, this is not the case. Girls with ADHD are less likely to exhibit hyperactivity and externalizing behaviors which are the most common causes for referral to assessment and treatment for boys with ADHD. Early data suggested that girls with ADHD have a lower average IQ than boys with ADHD.⁹ We now understand that girls with ADHD and above-average IQ are often masking their ADHD symptoms and utilizing their intellectual strength to manage academically, thereby avoiding diagnosis.¹⁰ Inattention in girls and women with ADHD often presents as being disorganized, overwhelmed, and lacking in effort or motivation. For many women, latent ADHD symptoms become obvious later in life during periods of social transition.¹¹

The categorical and spectrum paradigms are not specific to ADHD and can be applied to all psychiatric disorders. For example, mood disorders and psychotic disorders can be similarly modeled as categorical, biological entities or context-dependent symptom spectrums. But, ADHD has a feature that garners controversy in our field. The first-line treatment for ADHD is stimulant medication^12,13 – psychoactive drugs that are associated with addiction and abuse¹⁴ – and these drugs must be taken chronically to continue to alleviate ADHD symptoms. Unlike anxiety which responds quickly to addictive benzos but for which the more long-term effective treatment is CBT, ADHD symptoms do not respond well to psychotherapy. And, unlike the medications that are used for chronic treatment of mood or psychotic disorders, the active ingredients of ADHD meds can be used by individuals without the disorder to enhance cognitive performance or to get high (with greater doses and different routes of administration).

Furthermore, ADHD meds are Schedule II Controlled Substances with associated additional prescribing regulations compared to lower-scheduled or non-scheduled medications.¹⁵ We must carefully monitor these prescriptions with stipulated checks of the Prescription Drug Monitoring Program and general hypervigilance to avoid putting our medical licenses at risk. We are prohibited from prescribing refills for medications that we fully expect to be used chronically. Regulations necessitate frequent appointments with patients who may be otherwise completely stable on the same medications and doses for years.

These extra requirements may or may not limit the diversion of ADHD meds for non-medical use/misuse.^16,17 These requirements definitely impact our patients and our relationships with them. Many of our patients with ADHD have executive dysfunction that makes it challenging to maintain regular appointments and follow multiple steps and rules to obtain their medications. Other of our patients have learned to manage their ADHD symptoms through faithful medication adherence and rigid routine following. While the executive dysfunction group fits our view of ADHD, they too frequently annoy us with no-shows and last-minute prescription requests. On the other hand, the rigid group that shows up monthly, like clockwork, raises suspicion of misuse despite their unchanging dose and spotless PDMP report, and makes us fear losing our license. The system seems to be designed for our ADHD patients to fail and to create tension in the therapeutic relationship.

On June 13, 2024, the CDC issued a Health Alert in response to the US DOJ indictment for federal healthcare fraud of a large telehealth company that provided treatment to adults with ADHD. ^18,19 The Health Alert covered several important issues:

• ADHD is a disorder treated by stimulants. Without treatment, individuals with ADHD are at increased risk for injuries and death.^20,21 (In fact, stimulant initiation in ADHD has been shown to significantly lower all-cause mortality resulting in >80 per 100,000 lives saved.²²)
• While stimulant medication misuse is associated with risks, a much greater risk is associated with seeking unregulated drugs for treatment. The DEA reported that 7 out of every 10 pills they seized in 2023 contained a lethal dose of fentanyl.²³ The CDC advocated for providing psychoeducation about the risks of counterfeit pills, especially in light of ongoing ADHD medication shortages.
• They urged clinicians to avoid stigmatizing patients affected by the care disruption and to help them find new providers and treatment.

Regardless of the psychiatric diagnosis paradigm you lean toward – categorical or spectrum – we can all agree that shame and stigma surrounding mental health challenges hurts us and our patients. Numerous trials have demonstrated that stimulant medication is an excellent treatment for many people with ADHD both due to its high efficacy and relative safety. If ADHD is a largely categorical diagnosis, then stimulants must be readily and continuously available to our patients who meet the criteria. If ADHD exists on a spectrum with symptoms and severity influenced by environment and social norms, then we should be advocating for changes to our school system and other institutions that would make these environments more hospitable while we continue to treat the individuals who are suffering right now with first-line treatments.

Psychiatry holds a unique space in medicine and society because we specialize in the organ and pathologies that are inherently intertwined with identity. As psychiatrists, even when we are thinking categorically, we must learn about and engage with our patients within their worldview and how they perceive their distress or functional impairments, including the world of neurodiversity.

References

1              Lyhmann I, Widding-Havneraas T, Zachrisson HD, Bjelland I, Chaulagain A, Mykletun A et al. Variation in attitudes toward diagnosis and medication of ADHD: a survey among clinicians in the Norwegian child and adolescent mental health services. Eur Child Adolesc Psychiatry 2023; 32: 2557–2567.
2              Mykletun A, Widding-Havneraas T, Chaulagain A, Lyhmann I, Bjelland I, Halmøy A et al. Causal modelling of variation in clinical practice and long-term outcomes of ADHD using Norwegian registry data: the ADHD controversy project. BMJ Open 2021; 11: e041698.
3              Banaschewski T, Häge A, Hohmann S, Mechler K. Perspectives on ADHD in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use. Front Psychiatry 2024; 14: 1289157.
4              Turgay A, Goodman DW, Asherson P, Lasser RA, Babcock TF, Pucci ML et al. Lifespan Persistence of ADHD: The Life Transition Model and Its Application. J Clin Psychiatry 2012; 73: 192–201.
5              Morgan PL, Staff J, Hillemeier MM, Farkas G, Maczuga S. Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade. Pediatrics 2013; 132: 85–93.
6              Baglivio MT, Wolff KT, Piquero AR, Greenwald MA, Epps N. Racial/ethnic disproportionality in psychiatric diagnoses and treatment in a sample of serious juvenile offenders. Journal of Youth and Adolescence 2017; 46: 1424–1451.
7              ElHassan NO, Hall RW, Thomas BR, Palmer TW, Kaiser JR, Li C. Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities. J Racial and Ethnic Health Disparities 2022. doi:10.1007/s40615-022-01323-5.
8              Coker TR, Elliott MN, Toomey SL, Schwebel DC, Cuccaro P, Tortolero Emery S et al. Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. PEDIATRICS 2016; 138: e20160407–e20160407.
9              Berry CA, Shaywitz SE, Shaywitz BA. Girls With Attention Deficit Disorder: A Silent Minority? A Report on Behavioral and Cognitive Characteristics. Pediatrics 1985; 76: 801–809.
10           Lai M-C, Lin H-Y, Ameis SH. Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders. Current Opinion in Psychiatry 2022; 35: 90–100.
11           Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W et al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry 2020; 20: 404.
12           The MTA Cooperative Group. A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry 1999; 56: 1073.
13           Pittelkow M-M, de Vries YA, Monden R, Bastiaansen JA, van Ravenzwaaij D. Comparing the evidential strength for psychotropic drugs: a Bayesian meta-analysis. Psychol Med 2021; 51: 2752–2761.
14           Compton WM, Han B, Blanco C, Johnson K, Jones CM. Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. AJP 2018; 175: 741–755.
15           Federal Register. 21 CFR Part 1306 — Prescriptions. https://www.ecfr.gov/current/title-21/part-1306 (accessed 31 Aug2024).
16           Gunadi C, Shi Y. Prescription drug monitoring programs use mandates and prescription stimulant and depressant quantities. BMC Public Health 2023; 23: 1326.
17           Gunadi C, Shi Y. Association between prescription drug monitoring programs use mandates and prescription stimulants received by Medicaid enrollees. Drug and Alcohol Review 2023; 42: 1658–1666.
18           CDC Health Alert Network. Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose. Centers for Disease Control, 2024 https://emergency.cdc.gov/han/2024/han00510.asp (accessed 18 Jul2024).
19           Harris E. Fraud Involving ADHD Drugs Prompts CDC Warning About Injury, Overdose. JAMA 2024; 332: 362.
20           Levin FR, Hernandez M, Mariani JJ. Treating Attention-Deficit/Hyperactivity Disorder Matters. JAMA 2024; 331: 831.
21           Pliszka SR. Is There Long-Term Benefit From Stimulant Treatment for ADHD? AJP 2019; 176: 685–686.
22           Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I et al. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA 2024; 331: 850–860.
23           Drug Enforcement Administration. One Pill Can Kill. US Department of Justice https://www.dea.gov/onepill (accessed 31 Aug2024).

Proposition 35: Managed Care Organization Tax Authorization Initiative

by Laura Halpin, MD, PhD

This November, the California Managed Care Organization (MCO) Tax Authorization Initiative will be on the statewide ballot as Proposition 35. Voting yes on this will permanently authorize a tax on managed care organizations based on monthly enrollees, and require revenues to be used for increased funding to Medi-Cal programs. Below is additional history and information to support our members in making informed decisions on this ballot measure.

Within California, Managed Care Organizations contract with the state Medicaid (Medi-Cal) program to provide services to patients who receive care. Medi-Cal was significantly expanded in 2010 after the passing of the Affordable Care Act. Currently, Medi-Cal covers between 14-15 million Californians, or about a third of the state’s population. Medi-Cal is quite expensive (between $150-160 billion) and is funded by cost-sharing from both the federal and state governments. About 25% ($40 million) of this funding comes from the California State General Fund. It comprises around 15% of the total money budgeted from the CA General Fund, second only to education. Despite its significant cost, current Medi-Cal funding is not adequate for most physicians and health systems to function and cover costs, resulting in the closure of facilities and access issues for patients in recent years.

The MCO tax has been around in CA in some form since 2005, and at least 6 different forms of it have been approved since then. Throughout the years, different forms of the tax have been proposed and passed by the legislature. The way the MCO tax works in its current form is quite complex, and the overall goal is to increase federal funding for our state-based Medi-Cal program. To summarize how it works, under the MCO tax, a tax is imposed on each MCO on a per-member amount. In 2024, that amount was $182 per month per Medi-Cal enrollee and $1.75 per month per commercial enrollee. The state then increases the rate it pays to MCO plans for services to essentially pay back the tax to MCOs. This increase in payment from the state to MCOs triggers a match in federal funds due to the way Medicaid payments are structured federally. The actual fiscal benefit from this process comes from the Federal government matching the state funds through a set of federal rules from the Center for Medicare and Medicaid Services (CMS). The tax (as one can imagine) has also gone through various legal challenges through the years, which have resulted in additional rulemaking from CMS, and before it can generate revenues, each form of the tax has to be approved by the federal government.

Within California, the current form of the MCO tax was passed in 2023 and is set to expire in 2026. The plan for the current form of the tax, which is expected to raise about $19 billion dollars, was that revenues would be used to increase Medi-Cal reimbursements. More specifically, the plan was to increase rates for primary care, maternity care, and non-specialty mental health services to 87.5% of Medicare rates. In future years, the plan for revenues was to fund workforce programs (including funding for residency slots), further increases in primary care reimbursement, improvements in emergency room access, family planning and reproductive care access, and funding for behavioral health facilities, including inpatient beds. However, with the budget deficit ($45 billion), there has been discussion about sweeping the revenues from the MCO tax into the General Fund to cover the deficit. It is this consideration that has likely played a big role in the development of the ballot measure.

The ballot measure was developed by a group called the Coalition to Protect Access to Care, of which the California Medical Association is a key leader. It is designed to make the MCO tax permanent (vs expiring every few years). It also would guarantee that the proceeds generated from the tax will go towards Medi-Cal, Medi-Cal related programs, and workforce programs. In future years, a smaller amount of money is also allocated to the General Fund to offset Medi-Cal spending as well as for subsidies for drug pricing. The main supporter of the ballot measure is the same Coalition to Protect Access to Care and includes the California Medical Association, California Dental Association, California Hospital Association, the SEIU, Planned Parenthood, and both the California Democratic and Republican parties as well as many medical groups and health systems (Google the Coalition to see the full list; it’s long). There are no groups in clear opposition at this time; however there has been some discussion from individuals who more philosophically do not like the idea of a ballot measure being used to direct or limit what and how the state budget is managed (i.e. if these funds are set aside for Medi-Cal, they are not able to be used for other things, but again, that is the goal of the ballot measure).  The ballot measure has clear long-term benefits and your SCPS and CSAP Government Advocacy Committees will definitely be following this one closely as the November election approaches.

Miss Me with that Smoke: Wildfire Exposure and the Rising Risk of Dementia

by C. Freeman, MD, MBA, FAPA

Imagine inhaling a breath of wildfire smoke and unknowingly inching closer to dementia—it’s a frightening reality backed by recent research. As a geriatric psychiatrist, I’ve spent years helping older adults navigate the challenges of mental health. The recent study linking wildfire smoke exposure to a higher risk of dementia is a wake-up call, especially given the increasing wildfires we’ve been seeing.

We’ve known for a while that air pollution is bad news for our brains. Various studies have already shown that exposure to pollutants like fine particulate matter (PM2.5) can lead to cognitive decline and dementia. So, it’s not entirely shocking that wildfire smoke, packed with similar harmful particles, could also increase dementia risk. But what’s truly surprising is just how strong this new study found the link to be. This should make all of us sit up and rethink how we’re dealing with air quality, especially during wildfire season.

This recent study, conducted by researchers from the University of Washington and the University of Pennsylvania, provides some eye-opening insights. They tracked the health data of thousands of older adults over several years, cross-referencing this information with data on wildfire smoke exposure. Their findings were clear: individuals with higher exposure to wildfire smoke had a significantly increased risk of developing dementia compared to those with lower exposure levels. This robust link emphasizes the need for more aggressive public health interventions and preventive measures.

Climate change and extreme weather are throwing a lot at us, and wildfires are a big part of that. In my practice, I’ve noticed more dementia cases cropping up in recent years. While it’s tough to pin this trend directly on wildfire smoke without a deep dive into the data, it’s clear that our changing environment is having real impacts on our health.

Wildfires are getting more intense and frequent thanks to climate change, and that means more smoke in the air for longer periods. From a public health standpoint, this is a huge concern. The cognitive decline linked to this smoke isn’t just a personal issue—it’s a growing problem for families, healthcare systems, and society at large. We need to step up our game in preventing these health impacts.

So, what can Californians do to protect themselves from wildfire smoke? First off, keep an eye on air quality reports, especially during wildfire season. If the air quality index (AQI) shows levels that are risky, consider staying indoors or wearing an N95 respirator if you must go outside. These simple steps can help cut down on the harmful particles you’re breathing in. And remember, using air purifiers and creating clean air spaces at home can also make a big difference.

This new study also drives home a point many of us in the medical field have been shouting from the rooftops: climate change is a major threat to public health. The effects of climate change are speeding up and hitting us hard, particularly here in California. We need immediate action to address this crisis. And let’s not forget, the impacts of pollution and climate change hit hardest in poorer communities with fewer resources. This isn’t just about clean air—it’s about environmental justice and making sure everyone, regardless of where they live or their income, has the chance to live a healthy life.

Pollution and climate change disproportionately affect disadvantaged communities, and we need to ensure our healthcare system can handle these inequities. This means not only addressing the immediate health impacts but also creating long-term strategies to reduce exposure and build resilience.

In conclusion, the link between wildfire smoke and increased dementia risk shows us just how interconnected our environment and health are. As a geriatric psychiatrist, I’m seriously worried about what this means for my patients and the wider community. We must ramp up our public health strategies to tackle the risks associated with wildfire smoke and get to the root causes of climate change. Doing so will protect the cognitive health of older adults and build a healthier, more resilient future for everyone. So, miss me with that smoke—our collective future depends on it.

C. Freeman, MD, MBA, FAPA is an adult and geriatric psychiatrist practicing in Los Angeles and Contra Costa counties.

References

Alzheimer’s Association. (2024, July 29). From the Alzheimer’s Association’s International Conference 2024. Exposure to Wildfire Smoke Greatly Raises Risk of Dementia Diagnosis. https://aaic.alz.org/downloads2024/AAIC-2024-Wildfire-smoke.pdf

The Environmental Protection Agency. (2024, June 20). Particulate matter basics. https://www.epa.gov/pm-pollution/particulate-matter-pm-basics

Zhang B, Weuve J, Langa KM, et al. Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. JAMA Intern Med. 2023;183(10):1080–1089. doi:10.1001/jamainternmed.2023.3300

A Marriage of Inconvenience

by Reba K. Bindra, MD

They say there are two things in life that are guaranteed–death and taxes.  However,  here in California, there are some other things that we can count on pretty reliably.  The first is our criminal justice system being chaotic, at times unjust (depending on your race or socioeconomic status) and inefficient.  A rival to this is our mental health system with parts that are so broken that despite the best of intentions, practical solutions are elusive and feel futile.  These two systems have been forced into an acrimonious marriage because of the overrepresentation of individuals with mental illness in the criminal justice system.

In many ways, judges and psychiatrists serve as “mediators” of sorts in this marriage attempting to find common ground and compromise.  Unfortunately, when the two parties speak different languages, it’s very hard to build an alliance that will help sustain the union.  Co-existing in chaos generally only leads to more chaos.

Last year I learned about a program that uses judges and psychiatrists to bridge some of these language differences.  The Judges and Psychiatrist liaison initiative (JPLI) Is a unique national program that brings passionate psychiatrists and judges together to help remedy this national crisis.  It was started by Judge Steven Leifman from Miami-Dade County in Florida whose main goals are related to diversion and alternatives to incarceration.  One of the objectives of the program is to train judges in the criminal justice system on the basics of mental illness—what it is, what signs and symptoms to look for, and consider alternatives to incarceration.  Each team consists of a judge and psychiatrist who have both undergone an intensive training then return to their home states and present to judges.  The program is in about 20 states and counting and had not yet been activated in California, until now.

I was paired with LA County Superior Court Judge James Bianco who is somewhat of a legend in the Los Angeles County mental health court circuit.  We recently held the inaugural JPLI session in California which was held at the LA County Superior courthouse in downtown LA.  It was attended by mostly criminal court judges from LA county. I can’t say it wasn’t a little nerve-wracking speaking in front of so many judges at one time but once we started, it was evident that they were interested and engaged.  Judge Bianco and I split the presentation to provide insight from both perspectives, serving as the mediators if you will.  It felt good being a part of practical intervention where the goal really does focus on patients at a granular level.

Still so much work to do and I look forward to doing more trainings with Judge Bianco.  I am encouraged that more psychiatrists and judges will soon become part of the JPLI family in California.  Ideally, we would have teams up and down the state to help this marriage of systems find common ground for the sake of our patients.  Each system has to learn to adapt to each other to make things work since we know that all marriages require compromise.  We now have a practical intervention to help work towards that goal.

If anyone is interested in or wants more information about JPLI, please do not hesitate to reach out to me. It would be great to hear from you!  rkbhealth@gmail.com.

Private Practice Committee Update:
And an Open Invitation to all SCPS Members

From the SCPS Private Practice Committee Chair, Matthew Goldenberg, DO

At its origins, SCPS was founded by local psychiatrists who were primarily in private practice. As our field, and medicine as a whole has evolved, more of our colleagues practice psychiatrists as employees of hospital groups, public organizations and other organizations.

However, the tradition of private practice psychiatry lives on for many SCPS members. Some are in part-time private practice and others work in their private practice full time. Others are in the early stages of contemplating starting their own practice and others are close to wrapping up a long career in private practice.

The SCPS Private Practice Committee remains the key SCPS resource and opportunity for liaison for all SCPS members and especially those interested in and/or engaged in private practice psychiatry.

These are some of the reasons you should consider joining the SCPS Private Practice Committee:

• Liaison: You see the value in meeting colleagues, outside of the workplace and discussing topics and cases related to the life and work of private practice psychiatry.
• Advocacy: You want to effect change and improve the practice of psychiatry, you want to share your experiences and have your voice heard. Policy, legislation and barriers to quality care and the practice of medicine are discussed, ideas are proposed and forwarded to the SCPS Government Affairs Committee for proposed action.
• Networking and Mentorship: You are looking to find a colleague to mentor your transition into private practice or are looking to give back to the next generation by serving as a mentor.
• Staying Up to Date: You desire to discuss journal articles, presentations, cutting edge psychiatric treatments and/or new and emerging trends with colleagues.

The Private Practice Committee is a low time commitment, high yield opportunity to meet colleagues, discuss the practice of psychiatry in a safe and supportive environment and to help make sure SCPS is attuned and is attending to the needs of our colleagues in private practice. You are welcome and encouraged to come check it out!

The next SCPS Private Practice Committee Meeting is Monday, October 7^th at 7pm via Zoom. If you are not already a member of the committee and are interested in joining or would like to participate as a guest, you are cordially invited. Please email Mindi (socalpsychiatric@gmail.com) for the details.

I hope to see you there!

Classified Ad

Harbor-UCLA Medical Center is seeking one full-time attending psychiatrist for the Psychiatric Emergency Room and one full-time attending psychiatrist for the Psychiatric Consultation-Liaison service. Harbor-UCLA Medical Center is a public teaching hospital, affiliated with the David Geffen School of Medicine at UCLA. These positions require supervision and teaching of residents from the Harbor-UCLA Psychiatry training program and other programs, as well as medical students.  The positions are a core part of the Harbor-UCLA Psychiatry residency training program and applicants should have strong interest in teaching and contributing to the training of Psychiatry residents. These positions have the opportunity for an academic appointment in the Department of Psychiatry and Biobehavioral Sciences at UCLA. This is a Los Angeles County Department of Health Services position, with benefits that include 457(b) matching plan and Los Angeles County Pension plan

The Psychiatric Emergency Room position is part of the emergency mental health team. The position requires rapid diagnosis, acute pharmacological management, risk assessment, and crisis management in a culturally diverse patient population, many of whom come from socioeconomically disadvantaged backgrounds. The treatment team consists of attending staff, nurses, social workers, and trainees. Applicants should be board-eligible or board-certified in Psychiatry, able to thrive in an acute Psychiatry setting that requires rapid assessment and decision-making.

The Psychiatry Consultation-Liaison position provides psychiatric consultation to the patients hospitalized on medical/surgical floors, as well as supervision of a relatively new proactive consultation service. The treatment team consists of attending staff, a nurse practitioner, social work staff, and trainees. Applicants should be board-certified in Psychiatry, with a strong preference for board-certification in Consultation-Liaison Psychiatry as well.

We are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, pregnancy and pregnancy-related conditions or any other characteristic protected by law. Women and candidates from underrepresented groups are encouraged to apply.

Contact:  Michael Makhinson, Interim Chair, Department of Psychiatry

mmakhinson@dhs.lacounty.gov