Dr. Reginald Casilang, DNP, PMHNP-BC, FNP-BC

Quick facts

A path through medicine and psychiatry

My career in healthcare began in the late 1990s in emergency nursing — a setting that teaches you, quickly, to take a whole person seriously. In an emergency department you cannot afford to look at one symptom in isolation; the chest pain might be cardiac, or it might be panic, or it might be both, and the cost of guessing wrong is high. That habit of thinking — gather the full picture before you commit to an explanation — has stayed with me through every role since.

Over the following years I moved into advanced practice and then into clinical leadership, spending more than a decade as a regional clinical manager responsible for care quality across a large patient population. That work gave me a vantage point most clinicians never get: I saw, at scale, where care succeeds and where it quietly fails. I saw how often patients fall through the cracks not because anyone was careless, but because the system is built for speed, and speed is the enemy of an accurate psychiatric evaluation.

Alongside that leadership work, my clinical interests deepened. I worked in interventional psychiatry, including transcranial magnetic stimulation (TMS) for patients whose depression had not responded to medication — exactly the population for whom the easy answers had already been exhausted. I completed advanced training specifically in psychiatric-mental health, earned my doctorate, and built a clinical practice around the kinds of cases that had always drawn my attention: the complicated ones, the ones where the diagnosis never quite fit.

The MindCounsel is the result. It is a telehealth-first psychiatric practice for adults in California and Hawaiʻi, designed from the ground up around the principle that a thorough evaluation is not a formality to get through on the way to a prescription — it is the most important thing I do.

Training that spans psychiatry and medicine

My training reflects a deliberate choice to understand both the mind and the body, because in real practice they are never as separable as the textbooks suggest.

Board certifications and licensure

I am dual board-certified, which is less common than it sounds and genuinely changes how I evaluate patients. Most psychiatric prescribers are certified in psychiatry alone. Because I am also board-certified in family medicine, the medical contributors to psychiatric symptoms are part of my evaluation by default, not an afterthought.

A note on titles: I am a nurse practitioner, not a physician. The "Dr." reflects my doctoral degree in nursing (DNP). Psychiatric-Mental Health Nurse Practitioners are independently licensed to evaluate, diagnose, and prescribe; in California and Hawaiʻi this is well established. If the distinction between a PMHNP and a psychiatrist matters to you — and it is a fair question — I've written about it plainly in PMHNP vs. Psychiatrist.

Diagnosis before medication

If there is a single idea this practice is built on, it is this: when treatment hasn't worked the way it should, the most useful question is usually not "what medication next?" but "are we treating the right thing?"

Psychiatric diagnosis is not a lab value. It is a clinical judgment formed from history, pattern, timeline, and context. When that judgment is made in a fifteen-minute visit, it is necessarily a quick estimate — and quick estimates, repeated across providers, can harden into a label that no one ever steps back to re-examine. I have seen patients carry a diagnosis for years that, on careful review, never fit the evidence. Each subsequent provider inherited the label and adjusted the medication rather than the diagnosis.

My approach is to slow that down. I want the full history — not just the current symptoms, but how they started, what came before, what helped and what didn't, what was happening in your life at each turn. I want to know every medication you've tried and what actually happened on each one. And because I'm trained in family medicine as well, I want to rule out the medical contributors — thyroid, sleep, hormones, substances, pain — that are so often missed when psychiatry is evaluated in isolation.

From there, decisions are made together. I will tell you what I think and why. I will tell you what the alternatives are. And I will treat you as the person best positioned to weigh those options against your own life. That is what collaborative, evidence-based care looks like in practice.

What I evaluate and treat

Telepsychiatry across California

I see adults throughout California by telehealth, from the Inland Empire and Orange County to the rest of the state. Telehealth is not a compromise here — for the diagnostic and second-opinion work that defines this practice, it works exceptionally well, because that work rests on history, conversation, and careful review rather than anything that requires being in the same room.

Several commercial insurance plans are accepted for California patients, and self-pay is available. You can read more on the California practice page, or about specific local services such as adult ADHD evaluation in California and care for Orange County.

Telepsychiatry across Hawaiʻi

I am licensed in Hawaiʻi and see adults across all islands by telehealth, with an in-person option in Honolulu by request. Access to thoughtful psychiatric care can be genuinely difficult on the neighbor islands, and telehealth closes much of that gap — the same unhurried evaluation, available whether you are on Oʻahu, Maui, Kauaʻi, or the Big Island.

In Hawaiʻi the practice is in-network with HMSA PPO, HMSA QUEST Integration, and AlohaCare QUEST. As a Filipino-American provider, I can also conduct evaluations in Tagalog for patients who prefer it. See the Hawaiʻi practice page for details on coverage and access.

When it's worth getting another look

A psychiatric second opinion is not a statement that someone got it wrong. More often it is a recognition that the picture has become complicated, and that a fresh, independent review — by someone with the time to do it properly — can move things forward. The adults who come to me for this tend to share a few things in common:

• They have tried several medications without the result they hoped for.
• They have been given different diagnoses by different clinicians and don't know which to believe.
• They have a nagging sense that their diagnosis doesn't actually explain their experience.
• They were diagnosed quickly — sometimes in a single brief visit — and were never sure it was thorough.
• They have a medical history that no one has connected to their psychiatric symptoms.

If any of those sound familiar, the second opinion and diagnostic clarification pages explain exactly how that process works.

The diagnosis determines the treatment

In psychiatry, the diagnosis is not a label you file away — it is the thing that decides what treatment you receive. A presentation read as depression leads to antidepressants. The same presentation, if it is actually bipolar disorder, calls for a very different approach, and antidepressants alone can sometimes make it worse. ADHD treated as anxiety, anxiety treated as ADHD, autistic burnout treated as treatment-resistant depression — each wrong turn costs real time, and often real confidence.

This is why I resist the instinct to reach for a medication change before the diagnosis is solid. When several treatments have failed, the more likely explanation is frequently not that you need the next drug on the list, but that the target was never quite right. Getting the diagnosis right is not academic. It is the single highest-leverage thing a thorough evaluation can do for you.

Verify and connect

Credentials should be checkable. My practice information is listed in public registries and professional directories:

• National NPI Registry — provider identifier and credential verification
• Psychology Today — practice profile
• Healthgrades — patient ratings and profile
• LinkedIn — professional background

Teaching, writing, and the field

Clinical work is only part of the picture. I serve as a clinical preceptor and supervisor for psychiatric-mental health nurse practitioner students, helping train the next generation of careful diagnosticians. Earlier in my career I published peer-reviewed clinical work and presented at professional symposiums on advanced clinical care.

That teaching role keeps me honest. Explaining your reasoning to a student who is allowed to ask "but why?" is one of the best ways to make sure your own thinking still holds up. The Clinical Perspectives series is an extension of the same instinct — writing plainly about how psychiatric diagnosis actually works, for patients and clinicians alike.

Working with therapists and primary care

A significant share of my practice comes from other clinicians — therapists, primary-care providers, and psychologists who have a patient who is stuck and want a thorough diagnostic evaluation or second opinion. I see this collaboration as central, not incidental. I provide a clear written formulation, communicate back to the referring clinician, and am explicit that I am not trying to take over a patient's care unless that is what everyone wants.

If you are a provider considering a referral, the pages for therapists, primary care, and psychologists describe how the process works, or you can start at the provider consultation page.

Common questions

How a first evaluation actually goes

People are often surprised by how different a thorough evaluation feels from what they are used to. The initial visit is long by design — there is no way to do this work in fifteen minutes, so I don't try. We spend the time on history: not just your current symptoms, but the whole arc. When did things first start? What was happening in your life then? What changed, and when? The timeline is frequently where the answer hides.

We go through every prior diagnosis and every medication you have tried — including the ones that didn't work, because those are often the most informative. A medication that made things worse, a diagnosis that never quite landed, a treatment that helped briefly and then stopped: each is a clue. I will also screen for the medical contributors that my family-medicine training trained me to look for, the ones that can imitate or worsen psychiatric symptoms.

By the end, my goal is for you to leave with something you may not have had before: a clear formulation of what I think is going on and why, laid out in plain language, along with the realistic options and my honest read on each. Sometimes that means a confident diagnosis. Sometimes it means naming the uncertainty honestly and proposing how we'd resolve it. Either way, you should understand your own situation better than when you arrived. You can read the new patients page for the practical details on booking and what to bring.

The patients I'm built for

I want to be honest about fit, because not every situation calls for what I do. If you have a straightforward presentation, a diagnosis that fits, and a treatment that is working, you may not need a long diagnostic evaluation — and I would tell you so. Where I add the most value is precisely where the standard approach has run out of road.

That includes adults who have cycled through multiple antidepressants without lasting relief, where the more likely issue is an incomplete diagnosis rather than the wrong drug. It includes people who have been handed conflicting diagnoses over the years and want someone to reconcile them. It includes adults who suspect they have ADHD or are autistic but were never properly evaluated, sometimes because they learned to mask so well that no one looked closely. And it includes people whose psychiatric symptoms have a medical thread no one has followed — the thyroid, the sleep disorder, the hormonal shift that reframes everything once it's named.

This is the work I built The MindCounsel to do. If you've read this far and recognized yourself, that recognition is worth taking seriously. The complex cases and who we help pages go deeper into whether this practice is the right fit for your situation.