Bipolar Disorder Psychiatrists in Greenville, SC

Photo of Hannah Heusing, Physician Assistant, PA-C
Hannah Heusing
Physician Assistant, PA-C
Greenville, SC 29611
I enjoy working with a diverse background of conditions, such as depression, anxiety, trauma, bipolar disorder, substance use, and attention concerns.
I utilize a combination of traditional medications and newer approaches to individualize treatment for each client. I also utilize psychotherapy techniques to identify mental wellness needs, helping improve clients' lifestyles and removing barriers so that my clients can achieve their mental health goals.
I enjoy working with a diverse background of conditions, such as depression, anxiety, trauma, bipolar disorder, substance use, and attention concerns.
I utilize a combination of traditional medications and newer approaches to individualize treatment for each client. I also utilize psychotherapy techniques to identify mental wellness needs, helping improve clients' lifestyles and removing barriers so that my clients can achieve their mental health goals.
(864) 535-0213 View (864) 535-0213
Photo of Stephanie Manceor, Physician Assistant, PA-C
Stephanie Manceor
Physician Assistant, PA-C
1 Endorsed
Greenville, SC 29611
I'm here to help clients struggling with mental health conditions such as depression, anxiety, bipolar disorder, PTSD, ADHD, substance use, or severe mental illness.
As a Board-Certified Physician Assistant with a CAQ-Psy certificate, I specialize in psychiatric care and offer expert treatment for conditions such as depression, bipolar disorder, addiction, and more. I provide personalized, evidence-based care tailored to each client, and my approach combines empathy, education, and teamwork to ensure lasting success.
I'm here to help clients struggling with mental health conditions such as depression, anxiety, bipolar disorder, PTSD, ADHD, substance use, or severe mental illness.
As a Board-Certified Physician Assistant with a CAQ-Psy certificate, I specialize in psychiatric care and offer expert treatment for conditions such as depression, bipolar disorder, addiction, and more. I provide personalized, evidence-based care tailored to each client, and my approach combines empathy, education, and teamwork to ensure lasting success.
(864) 479-4207 View (864) 479-4207
Photo of Sia Komba, Psychiatric Nurse Practitioner, MSN , APRN, PMHNP-B
Sia Komba
Psychiatric Nurse Practitioner, MSN , APRN, PMHNP-B
3 Endorsed
Greenville, SC 29611
Hello. My name is Sia. I am a Psychiatric Mental Health NP and also an Adult Gerontology Acute Care NP. I received my Bachelors degree in Nursing in 2008 from Howard University in Washington DC. In 2017, I completed my Masters Degree in Nursing from Walden University where I was a member of the Sigma Theta Tau Nursing Honor Society. I have been an Adult Nurse practitioner since 2017. I have always been fascinated about how the brain works and its impact on other parts of body. I worked briefly as an Neurosurgery NP where I learned in great detail each section of our brains and how they connect to our body and emotions.
Hello. My name is Sia. I am a Psychiatric Mental Health NP and also an Adult Gerontology Acute Care NP. I received my Bachelors degree in Nursing in 2008 from Howard University in Washington DC. In 2017, I completed my Masters Degree in Nursing from Walden University where I was a member of the Sigma Theta Tau Nursing Honor Society. I have been an Adult Nurse practitioner since 2017. I have always been fascinated about how the brain works and its impact on other parts of body. I worked briefly as an Neurosurgery NP where I learned in great detail each section of our brains and how they connect to our body and emotions.
(864) 734-0902 View (864) 734-0902
Photo of Anglique Rich, Psychiatric Nurse Practitioner, MSN, APRN, PMHNPBC
Anglique Rich
Psychiatric Nurse Practitioner, MSN, APRN, PMHNPBC
2 Endorsed
Greenville, SC 29607
Do you struggle with feeling anxious, disconnected, or stuck in patterns that drain your energy and joy? Maybe you’ve noticed that constant stress, overthinking, or people-pleasing is affecting your focus, motivation, or sense of purpose. Many people today feel overwhelmed and emotionally exhausted trying to balance work, family, and the pressure to appear “okay” while everything feels off-center inside.
Do you struggle with feeling anxious, disconnected, or stuck in patterns that drain your energy and joy? Maybe you’ve noticed that constant stress, overthinking, or people-pleasing is affecting your focus, motivation, or sense of purpose. Many people today feel overwhelmed and emotionally exhausted trying to balance work, family, and the pressure to appear “okay” while everything feels off-center inside.
(864) 531-8377 View (864) 531-8377
Photo of Kiana Huston-McNair, Physician Assistant, PA-C
Kiana Huston-McNair
Physician Assistant, PA-C
Greenville, SC 29611
I have experience in medication management, particularly for anxiety, depression, bipolar disorder, ADHD, and schizophrenia.
My ideal client is anyone struggling with mood stability, anxiety, or depression, and who wants to be involved and collaborate in their medication treatment plan. A willingness to make lifestyle changes to improve their overall health is important, and I will be there to support them every step of the way.
I have experience in medication management, particularly for anxiety, depression, bipolar disorder, ADHD, and schizophrenia.
My ideal client is anyone struggling with mood stability, anxiety, or depression, and who wants to be involved and collaborate in their medication treatment plan. A willingness to make lifestyle changes to improve their overall health is important, and I will be there to support them every step of the way.
(864) 713-9659 View (864) 713-9659
Photo of Jessica Stoelting, Psychiatric Nurse Practitioner, DNP, APRN, PMHNP
Jessica Stoelting
Psychiatric Nurse Practitioner, DNP, APRN, PMHNP
3 Endorsed
Greenville, SC 29607
I specialize in diagnosing and treating a broad spectrum of mental health conditions, including depression, anxiety, ADHD, bipolar disorder, OCD, and more.
Welcome to Hope and Purpose Wellness – Where Mental Health Meets Root-Cause Healing. Are you struggling with anxiety, depression, ADHD, or OCD—and tired of feeling like a list of symptoms rather than a whole person? At Hope and Purpose Wellness, I take a comprehensive, personalized approach to help you rediscover stability, clarity, and connection in your life. My clients often come to me after feeling dismissed or overmedicated. Here, you’ll find a collaborative space to explore treatment options—including medication management when appropriate, natural interventions, and lifestyle strategies that support long-term healing.
I specialize in diagnosing and treating a broad spectrum of mental health conditions, including depression, anxiety, ADHD, bipolar disorder, OCD, and more.
Welcome to Hope and Purpose Wellness – Where Mental Health Meets Root-Cause Healing. Are you struggling with anxiety, depression, ADHD, or OCD—and tired of feeling like a list of symptoms rather than a whole person? At Hope and Purpose Wellness, I take a comprehensive, personalized approach to help you rediscover stability, clarity, and connection in your life. My clients often come to me after feeling dismissed or overmedicated. Here, you’ll find a collaborative space to explore treatment options—including medication management when appropriate, natural interventions, and lifestyle strategies that support long-term healing.
(864) 475-9482 View (864) 475-9482
Photo of Sia Komba, Psychiatric Nurse Practitioner, PMHNP
Sia Komba
Psychiatric Nurse Practitioner, PMHNP
Online Only
Hello. My name is Sia. I am a Psychiatric Mental Health NP and also an Adult Gerontology Acute Care NP. I received my Bachelors degree in Nursing in 2008 from Howard University in Washington DC. In 2017, I completed my Masters Degree in Nursing from Walden University where I was a member of the Sigma Theta Tau Nursing Honor Society. I have been an Adult Nurse Practitioner since 2017. I have always been fascinated about how the brain works and its impact on other parts of body.
Hello. My name is Sia. I am a Psychiatric Mental Health NP and also an Adult Gerontology Acute Care NP. I received my Bachelors degree in Nursing in 2008 from Howard University in Washington DC. In 2017, I completed my Masters Degree in Nursing from Walden University where I was a member of the Sigma Theta Tau Nursing Honor Society. I have been an Adult Nurse Practitioner since 2017. I have always been fascinated about how the brain works and its impact on other parts of body.
(864) 387-4653 View (864) 387-4653
Photo of Chrisanthe Garilas, Psychiatric Nurse Practitioner, PMHNP
Chrisanthe Garilas
Psychiatric Nurse Practitioner, PMHNP
Greenville, SC 29611
I am looking to work collaboratively with my clients by identifying key concerns that are diminishing their quality of life mentally, emotionally, physically, and spiritually. Together with the client's preferences, wants, and needs, in combination with my clinical and professional advice, we will form a healthy treatment plan and healing regimen.
I am looking to work collaboratively with my clients by identifying key concerns that are diminishing their quality of life mentally, emotionally, physically, and spiritually. Together with the client's preferences, wants, and needs, in combination with my clinical and professional advice, we will form a healthy treatment plan and healing regimen.
(864) 465-8629 View (864) 465-8629
Photo of Shannon Sozzi - Keeley Psychiatry, Psychiatric Nurse Practitioner, PMHNP
Keeley Psychiatry
Psychiatric Nurse Practitioner, PMHNP
Online Only
I have treated clients with diagnoses such as bipolar disorder, anxiety, panic attacks, depression, personality disorders, ADHD, substance abuse, Schizophrenia with delusions, and various types of dementia.
Keeley Psychiatry is currently accepting new patients in the Greenville area. Timely, convenient, and affordable appointments by video for medication management and psychiatric services. It is easy to fit in a visit from the privacy of your home, car or office. We offer daytime, evening, and weekend appointments. Now, more than ever, we are suffering from anxiety, sadness/depression, and uncertainty regarding our health and world. It helps to talk to someone who is a safe, dedicated person for your mental and emotional health. Call or email our office to schedule your initial appointment.
I have treated clients with diagnoses such as bipolar disorder, anxiety, panic attacks, depression, personality disorders, ADHD, substance abuse, Schizophrenia with delusions, and various types of dementia.
Keeley Psychiatry is currently accepting new patients in the Greenville area. Timely, convenient, and affordable appointments by video for medication management and psychiatric services. It is easy to fit in a visit from the privacy of your home, car or office. We offer daytime, evening, and weekend appointments. Now, more than ever, we are suffering from anxiety, sadness/depression, and uncertainty regarding our health and world. It helps to talk to someone who is a safe, dedicated person for your mental and emotional health. Call or email our office to schedule your initial appointment.
(864) 202-4797 View (864) 202-4797
Photo of Chinenye Loveth Chukwu, Psychiatric Nurse Practitioner, MSN, APRN, PMHNPBC
Chinenye Loveth Chukwu
Psychiatric Nurse Practitioner, MSN, APRN, PMHNPBC
8 Endorsed
Greenville, SC 29601
Life can feel overwhelming, and finding the right support is essential. I love working with people who struggle to be heard and understood. My clients are eager to improve but often feel stuck, anxious, and overwhelmed. At Mind Haven Psychiatry, I offer a safe, compassionate space to explore emotions, process challenges, and create meaningful change. As a Psychiatric Mental Health Nurse Practitioner, I provide therapy and medication management tailored to your needs, helping you build resilience, clarity, and balance.
Life can feel overwhelming, and finding the right support is essential. I love working with people who struggle to be heard and understood. My clients are eager to improve but often feel stuck, anxious, and overwhelmed. At Mind Haven Psychiatry, I offer a safe, compassionate space to explore emotions, process challenges, and create meaningful change. As a Psychiatric Mental Health Nurse Practitioner, I provide therapy and medication management tailored to your needs, helping you build resilience, clarity, and balance.
(341) 237-4060 View (341) 237-4060
Photo of Kimberly Parker, Psychiatric Nurse Practitioner, PMHNP, FNP-BC, APRN
Kimberly Parker
Psychiatric Nurse Practitioner, PMHNP, FNP-BC, APRN
15 Endorsed
Serves Area
It's important to find the right provider, who you can trust to walk with you. I'm open, caring, and create a nonjudgmental, empathetic space to work through life. Receiving the correct diagnosis, and understanding your symptoms and diagnosis will help you manage life better. My treatment takes a holistic approach. Sleep, nutrients, stress management, and exercise all affect our physical and mental health. I can prescribe medications and also recommend supplements to help improve symptoms. I've been a nurse practitioner for over 20 years, working with varying health conditions and clients across the lifespan.
It's important to find the right provider, who you can trust to walk with you. I'm open, caring, and create a nonjudgmental, empathetic space to work through life. Receiving the correct diagnosis, and understanding your symptoms and diagnosis will help you manage life better. My treatment takes a holistic approach. Sleep, nutrients, stress management, and exercise all affect our physical and mental health. I can prescribe medications and also recommend supplements to help improve symptoms. I've been a nurse practitioner for over 20 years, working with varying health conditions and clients across the lifespan.
(864) 774-5432 View (864) 774-5432
Photo of Ashley Cromer - Upstate Mental Health, LLC, Psychiatric Nurse Practitioner, PMHNP
Upstate Mental Health, LLC
Psychiatric Nurse Practitioner, PMHNP
1 Endorsed
Serves Area
Now Accepting New Patients with Primary Care Provider Referral: Upstate Mental Health, LLC is owned and operated by a Professional Psychiatric Mental Health Nurse Practitioner, ANCC Board Certified, serving patients with a range of mental health diagnoses in an outpatient setting. Beyond outpatient services, we also offer free collaboration with local therapist and psychologist for the better care of patients within our community.
Now Accepting New Patients with Primary Care Provider Referral: Upstate Mental Health, LLC is owned and operated by a Professional Psychiatric Mental Health Nurse Practitioner, ANCC Board Certified, serving patients with a range of mental health diagnoses in an outpatient setting. Beyond outpatient services, we also offer free collaboration with local therapist and psychologist for the better care of patients within our community.
(864) 365-2729 View (864) 365-2729
Photo of Chinenye LOVETH Chukwu - Mind Haven Psychiatry, Psychiatric Nurse Practitioner, APRN, PMHNP
Mind Haven Psychiatry
Psychiatric Nurse Practitioner, APRN, PMHNP
1 Endorsed
Serves Area
Life can feel overwhelming, and finding the right support is essential. I love working with people who struggle to be heard and understood. My clients are eager to improve but often feel stuck, anxious, and overwhelmed. At Mind Haven Psychiatry, I offer a safe, compassionate space to explore emotions, process challenges, and create meaningful change. As a Psychiatric Mental Health Nurse Practitioner, I provide therapy and medication management tailored to your needs, helping you build resilience, clarity, and balance.
Life can feel overwhelming, and finding the right support is essential. I love working with people who struggle to be heard and understood. My clients are eager to improve but often feel stuck, anxious, and overwhelmed. At Mind Haven Psychiatry, I offer a safe, compassionate space to explore emotions, process challenges, and create meaningful change. As a Psychiatric Mental Health Nurse Practitioner, I provide therapy and medication management tailored to your needs, helping you build resilience, clarity, and balance.
(803) 836-9544 View (803) 836-9544
Photo of Sejal Bhula, Physician Assistant, PA-C
Sejal Bhula
Physician Assistant, PA-C
1 Endorsed
Greenville, SC 29611
My areas of special interest include anxiety, depression, ADHD, and bipolar disorders.
My focus is on medication management while incorporating physical, social, environmental, and emotional wellness. Initial consultation includes a comprehensive assessment to determine an accurate diagnosis for symptoms. These symptoms can be made worse by lifestyle choices, sleep deprivation, and stressful situations at home or work.
My areas of special interest include anxiety, depression, ADHD, and bipolar disorders.
My focus is on medication management while incorporating physical, social, environmental, and emotional wellness. Initial consultation includes a comprehensive assessment to determine an accurate diagnosis for symptoms. These symptoms can be made worse by lifestyle choices, sleep deprivation, and stressful situations at home or work.
(864) 581-2759 View (864) 581-2759
Photo of Atrevia Brown, Psychiatric Nurse Practitioner, PMHNP
Atrevia Brown
Psychiatric Nurse Practitioner, PMHNP
Online Only
I typically partner with individuals navigating the heavy burdens of anxiety, depression, trauma, bipolar disorder, and schizophrenia, as well as insomnia—and those seeking clarity and stability while managing mood disorders.
My approach is rooted in integrative psychiatry—combining precise medication management with a deep focus on the mind-body connection. Rather than just treating symptoms, I look at the whole person: how lifestyle, environment, and biology intersect. When you work with me, you can expect a collaborative, transparent partnership where your voice leads.
I typically partner with individuals navigating the heavy burdens of anxiety, depression, trauma, bipolar disorder, and schizophrenia, as well as insomnia—and those seeking clarity and stability while managing mood disorders.
My approach is rooted in integrative psychiatry—combining precise medication management with a deep focus on the mind-body connection. Rather than just treating symptoms, I look at the whole person: how lifestyle, environment, and biology intersect. When you work with me, you can expect a collaborative, transparent partnership where your voice leads.
(864) 732-7599 View (864) 732-7599
Photo of Sarah Rolfe, Psychiatric Nurse Practitioner, APRN, FNP-C, PMHNP
Sarah Rolfe
Psychiatric Nurse Practitioner, APRN, FNP-C, PMHNP
12 Endorsed
Online Only
Waitlist for new clients
I specialize in ADHD, anxiety disorders, depression, bipolar disorder, trauma, and sleep concerns in adults.
I work with adults who feel stuck in survival mode—getting through the day but not truly feeling like themselves. Many come in feeling unheard or rushed in past care, still struggling with focus, anxiety, or mood. I provide thoughtful, individualized psychiatric care focused on understanding the full picture and creating a clear path forward. My approach is collaborative and intentional, helping you feel more stable, focused, and like yourself again. I bring over a decade of experience across inpatient and outpatient psychiatry, working with complex presentations requiring careful diagnostic assessment and medication management.
I specialize in ADHD, anxiety disorders, depression, bipolar disorder, trauma, and sleep concerns in adults.
I work with adults who feel stuck in survival mode—getting through the day but not truly feeling like themselves. Many come in feeling unheard or rushed in past care, still struggling with focus, anxiety, or mood. I provide thoughtful, individualized psychiatric care focused on understanding the full picture and creating a clear path forward. My approach is collaborative and intentional, helping you feel more stable, focused, and like yourself again. I bring over a decade of experience across inpatient and outpatient psychiatry, working with complex presentations requiring careful diagnostic assessment and medication management.
(864) 523-6776 View (864) 523-6776
Photo of Amanda Bentley, Psychiatric Nurse Practitioner, PMHNPBC
Amanda Bentley
Psychiatric Nurse Practitioner, PMHNPBC
Online Only
I specialize in working with teens, adults, and seniors who are struggling to cope with women’s issues, depression, anxiety, bipolar disorders, BPD, stress, adjustment-related issues, OCD, and more.
I earned my Master’s Degree in Nursing with a focus on Psychiatric Mental Health Nurse Practicing from Walden University. My love for this field motivated me to further my education so I could provide comprehensive care—offering medication management, counseling, and various forms of therapy.
I specialize in working with teens, adults, and seniors who are struggling to cope with women’s issues, depression, anxiety, bipolar disorders, BPD, stress, adjustment-related issues, OCD, and more.
I earned my Master’s Degree in Nursing with a focus on Psychiatric Mental Health Nurse Practicing from Walden University. My love for this field motivated me to further my education so I could provide comprehensive care—offering medication management, counseling, and various forms of therapy.
(864) 651-4083 View (864) 651-4083
Photo of Calissa Earle, Psychiatric Nurse Practitioner, DNP, APRN, PMHNP
Calissa Earle
Psychiatric Nurse Practitioner, DNP, APRN, PMHNP
Greenville, SC 29615
My ideal clients are adults navigating anxiety, depression, life transitions, and relationship challenges — people who feel exhausted, overwhelmed, and emotionally stuck, often unsure of how they got there or how to move forward. They may be struggling with communication, setting boundaries, or a sense of purpose that feels just out of reach. I help clients find clarity and relief by creating a safe, nonjudgmental space where they feel genuinely heard — and then guiding them toward accountability, practical tools, and real, lasting change.
My ideal clients are adults navigating anxiety, depression, life transitions, and relationship challenges — people who feel exhausted, overwhelmed, and emotionally stuck, often unsure of how they got there or how to move forward. They may be struggling with communication, setting boundaries, or a sense of purpose that feels just out of reach. I help clients find clarity and relief by creating a safe, nonjudgmental space where they feel genuinely heard — and then guiding them toward accountability, practical tools, and real, lasting change.
(864) 432-5559 View (864) 432-5559
Photo of Arielle Hipp, Psychiatric Nurse Practitioner, PMHNP
Arielle Hipp
Psychiatric Nurse Practitioner, PMHNP
1 Endorsed
Greenville, SC 29615
I'm Arielle Hipp, a board-certified psychiatric mental health nurse practitioner with a Master of Science in Nursing from Anderson University. I have 10 years of clinical experience supporting adults with anxiety, depression, ADHD, PTSD, and more. My approach emphasizes holistic, evidence-based therapy and building strong therapeutic relationships. I believe in collaborative, patient-centered care to help individuals achieve lasting mental wellness through personalized treatment plans and ongoing support.
I'm Arielle Hipp, a board-certified psychiatric mental health nurse practitioner with a Master of Science in Nursing from Anderson University. I have 10 years of clinical experience supporting adults with anxiety, depression, ADHD, PTSD, and more. My approach emphasizes holistic, evidence-based therapy and building strong therapeutic relationships. I believe in collaborative, patient-centered care to help individuals achieve lasting mental wellness through personalized treatment plans and ongoing support.
(864) 362-3194 View (864) 362-3194
Photo of Svetlana Robinson, Psychiatric Nurse Practitioner, FNP-C, MS, APRN
Svetlana Robinson
Psychiatric Nurse Practitioner, FNP-C, MS, APRN
1 Endorsed
Greenville, SC 29611
My areas of interest include depression, anxiety, insomnia, grief, separation disorders, PTSD, bipolar, and ADHD.
I recognize that mental health is just as important as physical health and believe that accurate medication management, including genetic testing, is an important piece of the treatment plan. It is most successful in combination with maintaining healthy lifestyle habits, staying active, managing stress, and having a positive outlook on life.
My areas of interest include depression, anxiety, insomnia, grief, separation disorders, PTSD, bipolar, and ADHD.
I recognize that mental health is just as important as physical health and believe that accurate medication management, including genetic testing, is an important piece of the treatment plan. It is most successful in combination with maintaining healthy lifestyle habits, staying active, managing stress, and having a positive outlook on life.
(864) 860-2931 View (864) 860-2931

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FAQ - Bipolar Disorder Psychiatrists
How can psychiatrists help with bipolar disorder?
Bipolar disorder is a serious mental health condition marked by significant fluctuations in mood, including episodes of mania—characterized by elevated energy, impulsivity, and heightened mood—and periods of depression, often involving sadness, low energy, and feelings of hopelessness. Psychiatrists play a vital role in helping individuals manage the complex and often unpredictable nature of bipolar disorder, typically through a comprehensive treatment plan that includes both medication and therapy. One of the most commonly prescribed medications for bipolar disorder is lithium, a mood stabilizer that helps prevent the occurrence of severe manic or depressive episodes by regulating brain chemistry. In addition to medication—or as a first-line intervention when appropriate—psychiatrists may also draw upon evidence-based therapies, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or psychoeducation, to help clients better understand their condition, build effective coping strategies, and reduce the impact of mood swings on their personal well-being and relationships.

What does the initial assessment and treatment planning process look like?
The starting point for treatment often depends on whether the individual has already received a formal diagnosis of bipolar disorder. If a diagnosis has not yet been established, the psychiatrist typically begins with an assessment to evaluate the client's symptoms, history, and risk factors. This initial evaluation helps determine whether medication, talk therapy, or a combination of both would be most beneficial. If the individual has an existing diagnosis, the psychiatrist may move forward with designing a personalized treatment plan in alignment with the client's goals, often working in collaboration with other care providers, such as a primary care physician (PCP), therapist, or other behavioral health professionals. Due to the severity and chronic nature of bipolar disorder, ongoing psychiatric care is often required over the long term, sometimes for several months or even years. However, long-term care may not be necessary in every case, particularly if the individual shows sustained progress and has access to a stable support network.

How can I find a psychiatrist who specializes in bipolar disorder?
Psychology Today's online directory is a valuable resource for finding psychiatrists (MDs) and psychiatric nurse practitioners (PMHNPs) who focus on bipolar disorder and related conditions. When searching for a psychiatrist, it is important to look for a provider who has specific training and experience with bipolar disorder, as they will be better equipped to understand the challenges that can arise with the condition, such as managing rapid mood shifts and minimizing the risk of suicide, which is higher in individuals with bipolar disorder. Psychiatrists who specialize in bipolar care are also more likely to be knowledgeable about appropriate medication options and dosage strategies. When evaluating potential providers, clients should also consider whether their practice is accessible—whether that means being located nearby or offering care through telehealth—and whether they accept insurance. Additionally, for some individuals, especially those from marginalized communities, finding a psychiatrist who shares or has familiarity with their cultural, racial, or gender identity can make a signifiant difference in the effectiveness of care.