1. Meena Rajendren, MD, Emily Martin, BA, Christina Mangurian, MD, James W. Dilley, MD, Martha Shumway, PhD, Hung Ming Chu, MD University of California, San Francisco and San Francisco General Hospital Research Questions Who utilizes acupuncture treatment in a community mental health clinic? What is the reason for referral to acupuncture? What are the specifics of acupuncture treatment? Background  Methods Demographics Race and Language Other Demographics Results: Specifics of Acupuncture Treatment Common Mental Health Acupuncture Points  Discussion The majority of patients receiving acupuncture at Chinatown North Beach are older (mean age: 57), female (68%), Chinese (51%), and Cantonese speaking (47%) adults. There is also a number of English speaking (38%), Caucasian (27%) adults. The majority are unemployed (including those who are retired or disabled) and the majority have not been educated past high school. The reasons for referral to acupuncture varied, and many individuals had more than one reason for referral. The most common reason was depression, followed by psychosomatic complaints, insomnia, and anxiety. Despite the range of reasons for referral, every patient received a standardized acupuncture intervention. There were eight acupuncture points used for almost every patient in the clinic. In traditional Chinese medicine, all of these points are used for various emotional and mental problems. In traditional Chinese medicine, mental and emotional problems are a result of a stagnation of the qi in the liver. The therapeutic principle behind this standardized acupuncture treatment is dispersing the depressed liver qi in order to relieve emotional distress. Regardless of reason for referral, all patients received this standardized treatment. While our study did not explore the effect of acupuncture treatment on mental health, others have found it be positive. As a complement to traditional mental health treatment, acupuncture has multiple potential advantages. Compared to conventional treatment, acupuncture is relatively low cost, has relatively few complications, and offers possibilities for personalized treatment 2. Acupuncture may be particularly helpful to patients with mental health disorders who are dissatisfied with conventional treatment, who want to have a voice in decisions about their treatment, or who feel that complementary therapy is congruent with their philosophical values and beliefs 1.    Setting  Summary: There are 8 acupuncture points used for almost every acupuncture patient in the clinic, regardless of diagnosis or reason for referral. The standardized traditional Chinese medicine (TCM) problem for acupuncture patients in the clinic is “stagnation of the liver qi”. Qi is the circulating life force in TCM The standardized therapeutic principle that accompanies the stagnation of the liver is “to disperse the depressed liver qi in order to relieve emotional distress” Results: Reason for Acupuncture Referral Acupuncture, which was long used for emotional, psychological and spiritual disorders in China, Japan and Korea, has become a subject of major interest and a popular complementary therapy in the West. On the human body, there are more than 2,000 acupuncture points connecting with 12 main and 8 secondary pathways called meridians, which conduct "qi" between the surface of the body and internal organs. Qi is the circulating life force that regulates spiritual, emotional, and physical balance. The opposing forces of yin and yang influence qi. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind 2. Increasing evidence supports a biological basis for the use of acupuncture to treat mental health conditions. For example, in the treatment of depression, acupuncture stimulates Group 3 nerve fibers that transmit impulses to various parts of the central nervous system and induce the release of serotonin, norepinephrine, substance P, dopamine, b-endorphin, enkephalin, and dynnorphins, primarily in the hypothalamus. This suggests a direct influence on the pathogenic mechanisms of depression 2. Few studies have examined the use of acupuncture in the context of community mental health services for people with severe mental illness. By understanding the prevalence of complementary alternative medicine use, exploring its epidemiology and consequences, and determining how it can enhance physical and mental health treatment, public health professionals can better serve their patients and communities 3. Chinatown/North Beach Mental Health Services (CTNB) offers an array of mental health services to adolescents, adults, and older adult residents in San Francisco. Services include psychiatric evaluation, individual therapy/counseling, family intervention, urgent care, medications, group activities, acupuncture for psychiatric disorders, as well as adult/geriatric socialization program. CTNB operates with the basic philosophy that services must be accessible and culturally appropriate. The community mental health clinic serving San Francisco’s Chinatown has a full-time acupuncturist, providing an opportunity for this study. This population is predominantly Asian American, publically insured, and severely mentally ill. Chinatown, San Francisco Subjects: Patients who received acupuncture treatment from July 1, 2012 through June 30, 2013. Study type: Retrospective Chart Review Study Procedure: Paper charts and electronic medical records of patients receiving acupuncture treatment from July 1, 2012 through June 30, 2013 were reviewed. Demographic and diagnostic characteristics and mental health service utilization were abstracted. The reason for referral to acupuncture, the acupuncturist's clinical formulation, and the specifics of acupuncture treatment were recorded.  References 1. Badri Rickhi, Hude Quan, Sabine Moritz, Heather Stuart, Julio Arboleda-Florez: Mental Disorders and Reasons for Using Complementary therapy. Can J Psychiatry Vol 8: 475-479, 2003 2. Hao Wang, Hong Qi, Bai-song Wang, Yong-yao Cui, Liang Zhu, Zheng-xing Rong, Hong-zhuang Chen: Is Acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? Journal of Affective Disorders 111: 125-134, 2008 3. Lin Fang, Steven Schinke: Complementary Alternative Medicine Use Among Chinese Americans: Findings from a Community Mental Health Service Population. Psychiatric Services : 402-404, 2007  Summary: There are a variety of reasons for acupuncture referral, and many patients had more than one reason for referral. Regardless of reason for referral, the traditional Chinese medicine problem, therapeutic principle, and acupuncture points used did not differ between patients. NR1-045  This work was supported by the San Francisco Department of Public Health, Community Behavioral Health Services.