Coping With Stress During Infectious Disease Outbreaks
Information taken from SAMSHA flyer:
HHS Publication No. SMA14-4885 (2014)
What You Should Know
When you hear, read, or watch news about an outbreak of an infectious disease such as Ebola, you may feel anxious and show signs of stress—even when the outbreak affects people far from where you live and you are at low or no risk of getting sick. These signs of stress are normal, and may be more likely or pronounced in people with loved ones in parts of the world affected by the outbreak. In the wake of an infectious disease outbreak, monitor your own physical and mental health. Know the signs of stress in yourself and your loved ones. Know how to relieve stress, and know when to get help.
Know the Signs of Stress
What follows are behavioral, physical, emotional, and cognitive responses that are all common signs of anxiety and stress. You may notice some of them after you learn about an infectious disease outbreak.
Your Behavior:
- An increase or decrease in your energy and activity levels
- An increase in your alcohol, tobacco use, or use of illegal drugs
- An increase in irritability, with outbursts of anger and frequent arguing
- Having trouble relaxing or sleeping
- Crying frequently
- Worrying excessively
- Wanting to be alone most of the time
- Blaming other people for everything
- Having difficulty communicating or listening
- Having difficulty giving or accepting help
- Inability to feel pleasure or have fun
Your Body:
- Having stomachaches or diarrhea
- Having headaches and other pains
- Losing your appetite or eating too much
- Sweating or having chills
- Getting tremors or muscle twitches
- Being easily startled
Your Emotions:
- Being anxious or fearful
- Feeling depressed
- Feeling guilty
- Feeling angry
- Feeling heroic, euphoric, or invulnerable
- Not caring about anything
- Feeling overwhelmed by sadness
Your Thinking:
- Having trouble remembering things
- Feeling confused
- Having trouble thinking clearly and concentrating
- Having difficulty making decisions
Know When To Get Help
You may experience serious distress when you hear about an infectious disease outbreak, even if you are at little or no risk of getting sick. If you or someone you know shows signs of stress (see list at left) for several days or weeks, get help by accessing one of the resources at the end of this tip sheet. Contact the National Suicide Prevention Lifeline right away if you or someone you know threatens to hurt or kill him- or herself or someone else, or talks or writes about death, dying, or suicide.
Know How To Relieve Stress
You can manage and alleviate your stress by taking time to take care of yourself
Keep Things in Perspective:
Set limits on how much time you spend reading or watching news about the outbreak. You will want to stay up to date on news of the outbreak, particularly if you have loved ones in places where many people have gotten sick. But make sure to take time away from the news to focus on things in your life that are going well and that you can control.
Get the Facts:
Find people and resources you can depend on for accurate health information. Learn from them about the outbreak and how you can protect yourself against illness, if you are at risk. You may turn to your family doctor, a state or local health department, U.S. government agencies, or an international organization. Check out the sidebar on the next page for links to good sources of information about infectious disease outbreaks.
Keep Yourself Healthy:
- Eat healthy foods, and drink water.
- Avoid excessive amounts of caffeine and alcohol.
- Do not use tobacco or illegal drugs.
- Get enough sleep and rest.
- Get physical exercise.
Toll-Free: 1-877-SAMHSA-7 (1-877-726-4727) | Info@samhsa.hhs.gov | https://store.samhsa.gov
Use Practical Ways to Relax:
- Relax your body often by doing things that work for you—take deep breaths, stretch, meditate, wash your face and hands, or engage in pleasurable hobbies.
- Pace yourself between stressful activities, and do a fun thing after a hard task.
- Use time off to relax—eat a good meal, read, listen to music, take a bath, or talk to family.
- Talk about your feelings to loved ones and friends often.
Pay Attention To:
- Recognize and heed early warning signs of stress.
- Recognize how your own past experiences affect your way of thinking and feeling about this event, and think of how you handled your thoughts, emotions, and behavior around past events.
- Know that feeling stressed, depressed, guilty, or angry is common after an event like an infectious disease outbreak, even when it does not directly threaten you.
- Connect with others who may be experiencing stress about the outbreak. Talk about your feelings about the outbreak, share reliable health information, and enjoy conversation unrelated to the outbreak, to remind yourself of the many important and positive things in your lives.
- Take time to renew your spirit through meditation, prayer, or helping others in need.
Information taken from SAMSHA flyer:
HHS Publication No. SMA14-4885 (2014)
During the coronavirus|covid-19 pandemic we want to minimize the risk of exposure and infection for our patients and staff. At the same time, we know you, like everyone else, are anxious, afraid and depressed. We want to continue to provide you with the recovery support you need and help you feel connected at this extraordinary time.
Beginning Wednesday, March 25 your counselor will be making weekly check-in calls to you via the phone number we have listed in your patient record.
Make Sure We Have the Right Number
If you need to update your phone number, please call the main number of If you need to update your phone number, please call the main number of your clinic location (click here to go to our “Locations” page) and our staff will update your patient record.
Take the Call
The call from your counselor may appear as “blocked” or “private.” If you do not answer the counselor will leave a message for you.
Schedule a Phone Appointment
You can make an appointment for a telephone check-in by calling the main number of your clinic. Phone numbers for each location are on our Locations page here. When you call, press “0” to speak to a front desk person who will schedule a time for your counselor to give you a call.
Be safe and stay well!
Therapeutic Health Services cares deeply about the health of our patients and of our community. We will be posting information as needed regarding any changes in program and service delivery at THS related to coronavirus (covid-19). Our goal is to keep our patients safe and provide the care they need. Please remember to watch our website’s Services Updates page (https://ths-wa.org/news-events/ths-service-updates-coronavirus-covid-19/) page for any changes in service. We will post on our website if there are any changes to daily dosing.
Temperatures
All patients and staff must have their temperature checked upon entering the building. All individuals with a fever or other symptoms will be provided a mask and will receive their dose individually in an alternate office. If you feel sick in the morning before you come to the clinic, please call ahead and notify our staff so you can receive instructions for when you arrive at the clinic. We will make sure our staff are ready to receive you and ensure you get your medication safely. The branch phone numbers are listed here and on our Google Business listings.
Social Distancing
To protect everyone, all patients and staff are requested to observe a social distance of six feet. For patients in line waiting to receive medication, we have marked out the distance to stand apart on the floor at each of our locations.
Medication
In this uncertain and rapidly changing time, we want all of our medication-assisted treatment (MAT) patients to know that they will receive their medication. Our medical staff are evaluating patients for temporary or increased carries. Please follow any instructions given by nursing staff when you receive your medication.
All MAT Patients, please remember to bring your lock box to the clinic on your next visit.
Please remember to watch our website’s News & Events (https://ths-wa.org/news-events/) page for any changes in service. We will post on our website if there are any changes to daily dosing.
Emergency or Crisis Help
If you are experiencing a medical or other emergency, Call 911 immediately.
If you are in crisis and need help you can call the King County Crisis Line at 206-461-3222or 1-866-4CRISIS (1-866-427-4747).
In Snohomish County, please call 2-1-1 or the Care Crisis Line at 1-800-584-3578 to get help.
Therapeutic Health Services cares deeply about our patients and our community, that’s why we want to share this notification and any others in the future to keep you informed of any changes at THS regarding coronavirus (covid-19). Our goal is to keep our patients safe and provide the care they need.
MAT Dosing at our Branches
Daily dosing will continue until further notice. We urge patients to please follow dosing line instructions and be aware they may be screened prior to dosing. We will keep you updated on any developments affecting care at THS.
Please remember to watch our website’s Services Updates page (https://ths-wa.org/news-events/ths-service-updates-coronavirus-covid-19/) page for any changes in service. We will post on our website if there are any changes to daily dosing.
Symptoms
Symptoms for the coronavirus include the following:
- Fever
- Cough
- Shortness of breath
If you experiencing these symptoms, we recommend visiting your primary care provider.
Prevention
These are important ways to prevent infection:
- Wash hands with water and soap/hand sanitizer for 20 seconds
- Avoid contact with infected people
- Don’t touch eyes, nose or mouth with unwashed hands
Emergency or Crisis Help
If you are experiencing a medical or other emergency, Call 911 immediately.
If you are in crisis and need help you can call the King County Crisis Line at 206-461-3222 or 1-866-4CRISIS (1-866-427-4747).
In Snohomish County, please call 2-1-1 or the Care Crisis Line at 1-800-584-3578 to get help.
Questions or Concerns
If you have questions or concerns, please contact your branch. Our locations and their phone numbers are found here.
By Benedict Carey
Reposted from New York Times
Feb. 25, 2020
For years, Claire Bien, a research associate at Yale, strained to manage the gossipy, mocking voices in her head and the ominous sense that other people were plotting against her. Told she had a psychotic disorder, she learned over time to manage her voices and fears with a lot of psychotherapy and, periodically, medication. But sometime in late 1990, she tried something entirely different: She began generating her own voices, internal allies, to counter her internal abusers.
“I truly felt I was channeling my father, my ancestors, a wise psychiatrist, giving me advice,” said Ms. Bien, who has written a book about her experience, “Hearing Voices, Living Fully.”
She added: “Recovery for me means knowing that my mind is my own, and even when it doesn’t feel that way, I know it’s only temporary. Knowing that allows me to hold a job — a good job — and be productive, respected and even admired by the people with whom I work.”
Mental-health researchers have numerous scales to track symptom relief, like the easing of depression during talk therapy, for instance, or the blunting of psychotic delusions on medication.
But the field has a much harder time predicting, or even describing, what comes next. How do peoples’ lives change once they have learned to address their symptoms? Mental disorders are often recurrent, and treatment only partially effective. What does real recovery — if that’s the right word — actually look like, and how can it be assessed?
This is what people in the thick of mental distress desperately want to know, and a pair of articles in a recent issue of the journal Psychiatric Services shows why good answers are so hard to come by.
In one, the first study of its kind, Dutch researchers tested a standard life-quality measure, the Recovery Assessment Scale, that is typically used to rate an individual’s confidence, hope, sense of purpose, willingness to ask for help, and other features of a full, stable life.
The team administered the 24-item questionnaire to three groups of people: one with a diagnosis of a psychotic disorder, like schizophrenia; the siblings of members of this first group, who had no such diagnosis; and a control group of unrelated people who had no history of mental-health problems. The scale found little detectable differences between the groups.
The widely used R.A.S., as the scale is known, is “of questionable usefulness,” the authors concluded. If everyone looks roughly the same on the scale, then how can the scale be used to measure improvement?
In the other paper, an editorial, Larry Davidson, a psychiatric researcher at Yale, pointed out that the results were not surprising. The researchers had intentionally left out a subset of R.A.S. queries that probably mattered most, involving how well respondents were managing their symptoms — statements like “Coping with mental illness is no longer the main focus of my life” and “My symptoms interfere less and less with my life.”
By taking out these questions, Dr. Davidson said, the study demonstrated only that, in the absence of mental distress, “the everyday lives of people with a mental diagnosis are just like everyone else’s.” The authors, however, noted that those questions were excluded because, by definition, the comparison groups had no symptoms.
In effect, both parties agree: The R.A.S., and many similar scales, amount to little more than symptom checklists, in the end not much different from those used to track the short-term effects of a drug. The field could use different, and better, means of assessing how people shake off or learn to manage a mental-health diagnosis.
The scales originated decades ago with mental-health consumers, or “survivors,” who saw the usual clinical definitions of symptoms relief, like the Hamilton Depression Scale, as unable to capture the fullness of personal recovery.
The scale analyzed in the Dutch study, for instance, asks people to rate, on a scale of 1 to 5, how strongly they agree with various statements like, “If people knew me, they would like me,” “If I keep trying, I will continue to get better” and “It’s important to have healthy habits.” Researchers rely on scales like this to gauge the longer-term, real-world effects of all variety of mental-health programs, like group therapy for rape victims in the Democratic Republic of Congo or community outreach for psychosis in Wisconsin.
But as the new study finds, questions like these are applicable to anyone, with a diagnosis or not; not to mention that responses can vary by the day, or even the hour, depending on what insults or encouragements hold sway in the moment.
People who find a way to move on with their lives after receiving a psychiatric diagnosis — depression, anxiety, bipolar disorder, schizophrenia — generally must do so the hard way: gradually, by fine-tuning some combination of personal rituals, social connections, work demands, therapy and, when necessary, medications. And these idiosyncratic regimens of self-care are not easily captured by the measures currently available to researchers.
Now, given the clear limits of the R.A.S. and other quality-of-life measures, some experts say it is time to find ways to better assess how a person’s daily experience changes in the months and years after receiving a mental-health diagnosis. “Personal recovery,” Dr. Davidson wrote, “has as much to do with the quality of a person’s sense of identity and belonging to a community as it does to subjective experiences of mental illness per se.” He argues that the field needs to develop reliable tools to assess what it’s like to live with mental distress over time, in the same way that cardiology and other branches of medicine use “patient-reported outcomes” to track longer-term responses to treatment.
Gail Hornstein, a professor emerita of psychology at Mount Holyoke College, has been tracking a group of more than 100 people who attend or have attended meetings of the Hearing Voices Network, a grass-roots, Alcoholics Anonymous-like group where people talk with one another about their mental distress and possible ways of managing it.
Most people in the study have a diagnosis of a psychotic disorder, like schizophrenia, and consider their experience in the groups to have been supportive, even transformative. But many still hear voices, and sometimes reassuring ones, Dr. Hornstein said in an email. So assessing improvement by asking the usual kinds of questions — for instance, “Are the voices gone?” — isn’t necessarily useful.
Instead, Dr. Hornstein asks whether the voices — like those that Ms. Bien still occasionally encounters — or other aspects of an individual’s life have changed as a result of participating in the groups.
People’s responses are extremely varied, Dr. Hornstein said in a phone interview. They might say, “I have a different relationship with my voices now.” Or, “My voices used to bully me, and terrify me; now I have relationship with them based on mutual respect.”
“That’s a change, for the better — it’s improvement,” Dr. Hornstein said: “But you wouldn’t pick it up unless you knew how to ask.”
Reposted from New York Times: https://www.nytimes.com/2020/02/25/health/mental-health-depression-recovery.html
The Therapeutic Health Services team had a great year, especially on our website, where we saw a 118% increase in total web traffic! You have our sincerest thanks for visiting our site, sharing us, and connecting to care with us. We wanted to take a moment to compile some of the great stories, videos, and posts we shared in 2019.
Patient Stories
Brenda’s Story – Recovering from Opioid Addiction – Brenda’s fall into opioid use stripped her life of the joy and happiness she lived for. Brenda almost lost everything, but when she decided to enter treatment her hard work helped her win it all back and more.
Betty’s Story – Recovery Through Time – Betty’s life teaches us about how opioid use disorder is a chronic condition and MAT isn’t a cure. However, with care, support, and treatment, Betty has lived a beautiful life confidently knowing she has the support she’s needed.
Rachelle’s Story – Life isn’t always kind, and Rachelle was dealt with some of the worst curve balls life can throw. She was diagnosed with cancer, fell into drug use, and had her child taken away from her…but she didn’t give up. When she became pregnant, Rachelle took that as the inspiration she needed to take her life back into her own hands. Her story of taking back her child, beating cancer, and beating heroin, is a testament to the power of hard work and quality care.
Debra’s Story – Debra had a harder start to life than most people can even imagine. She was born addicted to heroin and was actively using by age 13. Debra’s life was a struggle for survival, but after decades of use and intermittent treatment, she made the decision to finally quit. With the support she needed, Debra met her goal.
Dwayne’s Story – The promise of success, the power of potential, that’s what Dwayne possessed when he started a new career. A young man with talent and skill, he was set for the big leagues, but what started as an after-work calmant quickly took over his life. Dwayne didn’t let heroin stop him, the story of his recovery and fresh start are an inspiration for anyone.
THS Programs
Central Youth Development – Developing Youth and Making Bright Futures – Our Central Youth Development program is serving youth where they are by partnering with Seattle Public Schools to provide quality services and youth development. Their California summer trip with students took them on a tour of many of the biggest and best colleges in the state. Check out this fun video and story and see why the Central Youth Development program are the best at what they do; developing youth and making bright futures.
Staff Profile
I’ve Been There, You Can Do This – Peer Support Specialists at THS – Marissa is one of our amazing Peer Support specialists. She uses her knowledge and experience gained in her own struggles with addiction and mental illness, to better help, connect, and serve our patients. Marissa’s story is one of our favorites from 2019.
by Elena Renken, NPR
More than three in five Americans are lonely, with more and more people reporting feeling like they are left out, poorly understood and lacking companionship, according to a new survey released Thursday. Workplace culture and conditions may contribute to Americans’ loneliness.
And loneliness may be on the rise. The report, led by the health insurer Cigna, found a nearly 13% rise in loneliness since 2018, when the survey was first conducted. (Cigna is a provider of health insurance for NPR employees.)
The report surveyed over 10,000 adult workers in July and August 2019, relying on a measure of loneliness called the UCLA Loneliness Scale, used as a standard within psychology research. Respondents rated their reactions to statements such as “How often do you feel outgoing and friendly?” and “How often do you feel alone?” which were used to calculate a loneliness score on an 80-point scale.
Pervasive loneliness “has widespread effects,” says Bert Uchino, a professor at the University of Utah who studies relationships and health. It’s strongly linked to mental health issues such as anxiety and depression.
It’s an urgent time for the study of loneliness, Uchino adds. More and more research suggests that its impacts don’t end with mental health. “Evidence is really pointing to the fact that relationships — the kinds of bonds you have with people, how close you are, how connected you feel to others — impact physical health as well,” he says.
With only one follow-up report, it’s unclear if the year-over-year rise in loneliness is a trend or just a blip in the data, says Uchino. There are ways to sample the population and control responses that would produce more reliable results, but surveying so many people strengthens these findings, he adds.
The report found several factors that were linked to increased feelings of isolation in 2019. Loneliness appeared to be more common among men. The survey found 63% of men to be lonely, compared with 58% of women.
Social media use was tied to loneliness as well, with 73% of very heavy social media users considered lonely, as compared with 52% of light users.
But feelings of isolation were prevalent across generations. Gen Z — people who were 18 to 22 years old when surveyed — had the highest average loneliness score on the 80-point scale (about 50), and boomers had the lowest (about 43). We might think of older people as being the loneliest, but this pattern is actually consistent with results from other studies, says Julianne Holt-Lunstad, a psychology professor at Brigham Young University. “We need to recognize that no one is immune,” she adds.
This new research dives deeper into the factors behind these feelings of isolation than the previous report, and it found that conditions in the workplace made a difference in how lonely people felt.
The report found people with good co-worker relationships were 10 points less lonely on the 80-point scale, and those who reported a good work-life balance were less lonely as well. When colleagues felt like they shared goals, average loneliness scores dropped almost eight points.
Employees in the first six months of their jobs had loneliness scores more than six points higher than those who had held their positions for over a decade. Workers who said they had a close friend at work were less lonely.
“In-person connections are what really matters,” says Doug Nemecek, chief medical officer for behavioral health at Cigna. “Sharing that time to have a meaningful interaction and a meaningful conversation, to share our lives with others, is important to help us mitigate and minimize loneliness.”
Employers also have an incentive to address loneliness: Lonely workers were more likely to miss work due to illness or stress, and more of them felt their work wasn’t up to par, according to the report. Researchers are still struggling to find effective methods to ease loneliness, and this data could spark ideas for interventions, Holt-Lunstad adds.
One optimistic note: More than three-quarters of survey respondents had close relationships that bring them emotional security and well-being. And respondents without such relationships had a loneliness score of 57 out of 80, almost 15 points higher than those with them.
Elena Renken is the NPR science desk intern.
Meet Marissa, Peer Support Specialist
Sitting down with Marissa is like sitting down with a friend you’ve known forever but haven’t seen in a while. She’s both energetic and relaxed, which is perfect because Marissa is a Peer Support Specialist at Therapeutic Health Services (THS). As a Peer Support Specialist, Marissa helps people in need connect to mental health treatment. Marissa is the person at the door welcoming new patients. She’s the voice on the phone reaching out to people who are taking their first tentative steps towards treatment. Marissa loves being the person who helps empower patients on the path to recovery. “My job is not to solve people’s problems. My job is to support people in finding the answers to their own problems” Marissa said. There’s a reason Marissa is a peer; she’s been where many of THS’ patients once were. Marissa struggled with mental health and addiction for a long time.
A Hard Road
Marissa was misdiagnosed with bipolar disorder* when she was 13. She spent half her life taking medication she didn’t need. As she puts it, this changed her outlook on life for the worse. Marissa started using methamphetamines when she was 15. She began to use alcohol and other drugs to help her cope with the mental health symptoms she’d been experiencing. It was a dark time in her life. “You know I’ve been there I’ve been hospitalized over 20 times…when you look at me you don’t see somebody who was addicted to drugs,” said Marissa.
Life became even more challenging when Marissa found out she was pregnant. It was when Marissa met with her OB/GYN that they found that she wasn’t bipolar. Her doctor changed her medication and she entered evidence-based treatment for both her mental condition and her addiction. With time, hard work and compassion, it wasn’t long before she was living life on her own terms. Marissa said, “I’ve been off my meds for 10 years now and it’s the strongest I’ve ever been.” Being someone who’s been there, Marissa speaks to what is important to remember when in treatment, “It’s just about being honest and vulnerable…It’s a difficult transition but we (THS) provide hope…to people who are ready to take it back.”
On Being a Peer Support Specialist
Marissa takes her years of experience struggling and recovering from mental illness and addiction and uses them every day in her role as a peer support specialist. “I love just being that light of hope…they feel connected because they’re like ‘Oh you know, you’ve been there, you’ve gone through what I’ve gone through’” said Marissa. She says that when she sits down with a patient and is honest about her recovery, she can establish an instant connection. “I just really like supporting people to where they can get to the next step in their recovery,” said Marissa.
Having gone through recovery herself, Marissa is a living example of the hope that everyone should feel about their own recovery. “There is hope and I think a lot of people lose that side of that hope because they think it’s always going to be like this. (They feel they will) always going to be a slave to their addiction” said Marissa.
Sometimes We Trip, Sometimes We Fall
Marissa is the first person to tell you that recovery is not an easy or linear process. “I relapsed almost six years ago while I worked here” said Marissa. “This organization just rallied around me because they get it. They understand that it’s part of the recovery process.” Marissa took time off work to recover and given time, treatment, and lots of support, she was soon back to work helping patients. “I’m very vocal about it especially with co-occurring* clients, because when people relapse it’s part of the addiction process and they don’t realize that” said Marissa.
New Home, New Room
Marissa’s position with THS is the longest job she’s ever had. It’s given her the opportunity to get off disability and become an independent earner, an accomplishment she is very proud of.
“I’m not on any type of assistance. I’m a single mother. It’s just me and my son and I take care of us independently and because of this job I am able to buy my own home. (My son) will have his own room for the first time since he was a baby.”
Marissa Brooks, Peer Support Specialist
Marissa was able to create a beautiful life and future for herself and her son while spending her days providing the support and care needed to help dozens of others in recovery.
Don’t Have Doubt, We Can Help
Marissa wants everyone to get the care they need. “I think that if you are ambivalent at all, just come and talk to a staff member. We are so client-centered. It’s always about what is best, what will foster the client’s wellness and treatment…We work for you” said Marissa.
*Co-occurring Disorders or Dual Diagnosis is the condition of suffering from a mental illness and a substance abuse problem
BY: Carole Jakucs, MSN, RN, PHN on September 11, 2019
There is a shortage of psychiatrists in the U.S., but some states are in greater need of psychiatrists than others.
One example is the state of Washington, which has only met its need for psychiatrists for its population size, by just more than 11%, according to a recently published report by the Kaiser Family Foundation.
The state needs a minimum of 165 more psychiatrists to remedy its current shortage.
“The shortage has greatly impacted the state of Washington and parallels with the shortage of medical doctors in general,” said Susan Caverly, PhD, ARNP-BC, director of psychiatric services and the integrated cognitive therapies program at Seattle-based Therapeutic Health Services.
Susan Caverly, PhD, ARNP-BC, Director of Psychiatric Services and ICTP (THS)
For 12 years, Caverly also has been involved with the recruitment of psychiatric mental health nurse practitioners (PMHNP). One of the challenges Caverly faces when recruiting the PMHNP role for community mental health is competition with other employers.
“Hospitals often have higher salary structures when compared to community mental health,” she said. “Given the cost of a college education, new NPs come out of school with high loan burdens so choose an employer that pays the highest salary. Also given that PMHNPs and all NPs in Washington have full practice authority, many find it more lucrative to go into private practice.”
Texas is another state with a deficit of psychiatrists.
Jon Stevens, MD, MPH, chief of child and adolescent psychiatry and chief of outpatient services at the Menninger Clinic in Houston, who recruits and hires PMHNPs, said psychiatric NPs are valuable members of the care team in mental health.
“In the last 10 years we’ve seen a rise in the number of psychiatric NPs and they are part of the solution to this shortage,” he said. “However, there is a shortage of PMHNPs too.”
Jon Stevens, MD, MPH
PMHNP shortage decreases mental healthcare access
The impact of the psychiatrist shortage in mental health affects access and creates long wait times for psychiatry, especially in ambulatory settings, said Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP, chief nursing officer, vice president of operations and patient care services at the University of Pittsburgh Medical Center’s Western Psychiatric Hospital in Pennsylvania.
“As an academic center we’re more successful in recruiting and hiring psychiatrists, although it remains a challenge even for us,” she said. “The larger struggle presents with our community settings. As the need for behavioral health services continues to expand, access becomes an issue and the use of NPs can assist with getting needed behavioral health services to people in need of those services.”
Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,
Herisko said it can be challenging to recruit PMHNPs as there are not enough — only limited numbers graduate each year — and demand is high.
“I’ve heard more psychiatric nurse practitioner programs will be offered soon by colleges and universities,” Herisko said. “I believe that this is a great way to address the shortage.”
Providing working nurses with flexible schedules so they can attend NP school could help increase their numbers, Herisko said.
“I believe more nurses would continue their education in this field if they had a flexible schedule from their current employers to begin such a program,” she said. “At Western Psychiatric Hospital we are very flexible and accommodating with school schedules.”
Strategies to successfully recruit psychiatric NPs
Having a background in psychiatric nursing first, prior to completing a PMHNP program, can help prepare a new grad PMHNP for practice, Stevens said.
“We can’t fill this gap with just anyone,” he said. “When PMHNPs practice to the highest level of their NP license, training and experience, it’s good for patients and an organization.”
Stevens points out when hiring a PMHNP it’s important to have them interview with their co-workers first. If that goes well and the team likes the candidate, the next step of the process is typically an interview with Stevens and other leaders.
“This is important as a new hire may have a good interview with me and other key leaders,” Stevens said. “However, may not click with their colleagues and people they’ll actually be working with on a day-to-day basis.”
Jon Stevens, MD, MPH
Meeting the needs of patients is the goal and one way to achieve this is by using the skills and talents of PMHNPs along with all other mental health staff, including MDs, psychologists and social workers, Stevens said.
“Focusing on what a person can bring to the practice, building on their strengths, and not focusing on their deficits is a good strategy for successful hiring,” he said.
Finding the right person for a job who has a passion for this specialty, can empathize with their patients who are many times in the darkest moments of their lives, as well as building on that person’s talents, can also help with retention, Stevens said.
Herisko said NPs want to start practicing to the full scope of their license upon graduation so look for some independence in practice.
“They want to make clinical decisions and manage patients independently,” Herisko said. “This will require a shift in how programs operate and also the comfort level of having a NP lead the treatment planning.”
Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,
Additional recruitment perks to provide PMHNPs
Other recruitment strategies Herisko suggested are providing a thorough orientation program, continuing education and financial support for continuing education.
“New hire support and mentoring are very important,” Herisko said. “Transitioning from a nurse to a nurse practitioner can be challenging for new graduates. Additionally, NPs are required to obtain continuing education credits each year and having these paid for by an employer is very enticing to recruits.”
Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP,
Herisko said in addition to offering competitive salaries, offering a comprehensive and competitive benefits package is also important. “Scholarship programs or tuition forgiveness programs are also great ways to support nurses returning to obtain this degree.”
Kristine Highlander, MSN, ARNP, PMHNP-BC, who works for Lakeside Milam Recovery Centers in their residential treatment program in Kirkland, Wash., is president-elect of the Association of Advanced Practice Psychiatric Nurses.
“Offering residencies can be an attractive opportunity for new PMHNPs,” she said.” I’ve seen these offered to new graduates, but if an organization is looking for a seasoned provider, it could be reasonable to also tailor these opportunities to PMHNPs who are transitioning from one specialty to another, such as moving from a private practice focused on pediatric patients, to hospital-based acute care of adults.”
Kristine Highlander, MSN, ARNP, PMHNP-BC,
With the variety of work settings to choose from, including private practice, employers need to set themselves apart, Highlander said.
“Most important is making sure employers are aware of ARNP scope of practice in Washington state, and ensuring that job opportunities utilize this full scope,” Highlander said. “Creating stable work environments, investing in patient care including maintaining multidisciplinary teams, and offering flexible work hours are some additional strategies that may be effective for recruiting psychiatric ARNPs.”
Kristine Highlander, MSN, ARNP, PMHNP-BC,
Susanna Harris was sitting in her lab class for her graduate program at the University of North Carolina at Chapel Hill when she received an email that told her she had failed what she describes as “the most important exam in grad school,” the doctoral qualifying exam. She took the rest of the day off, went home and baked cookies.
Harris continued with her regular schedule: lab, work, home, repeat. Everything seemed fine until she realized she was having a hard time focusing due to lack of sleep. That’s when she decided to go to campus health to ask for a prescription for a sleeping aid. The doctor said they could give her a prescription, but it would be for antidepressants instead.
Harris was surprised how common depression is among Ph.D. students, so she began sharing aspects of her own mental health journey on social media by creating the Twitter account and hashtag #PhDBalance. People share the stories they might otherwise keep private — stories of anxiety, depression, abuse, substance use, PTSD. Others comment on the posts and reach out to the author. “People have found friends and compatriots through our page based on what they are going through, and I think that is beautiful,” said Harris, who has also shared her experiences onstage at The Monti — a nonprofit organization in North Carolina that invites people to tell personal stories.
While struggles with mental health were traditionally kept private, in recent years a growing number of sufferers are adopting the opposite tack: sharing their mental health battles with the world, via social media.
Celebrities and public figures like actors Dwayne Johnson and Gina Rodriguez and singer Ariana Grande have used social media as a platform to share stories about their mental health and encourage others. Kevin Love of the Cleveland Cavaliers began using his Twitter account to share the story of his struggles after writing an article for The Players’ Tribune — a new media company that provides athletes with a platform to connect directly with fans. The article highlighted how he came to realize that sharing improves not only his life, but the lives of others.
Sammy Nickalls of Lebanon, Pa., is an editor and writer who created the hashtag #TalkingAboutIt in 2015. Nickalls said she did it because, as a University of Michigan study has found, Facebook and other social media can make people feel worse because they tend to show the happier aspects of users’ lives. “When all you see are highlights from people’s lives, social media encourages comparisons, FOMO [fear of missing out], all that good stuff,” Nickalls said. “That’s why I wanted to start #TalkingAboutIt — because if we’re open about the dark times, too, social media will be less likely to make users feel lonely and like their lives don’t measure up.”
People often connect with one another by using hashtags like #TalkingAboutIt and #mentalhealth that have a broad target audience. Others such as #YouGoodMan and #YouOkSis were created specifically for mental health concerns in the African American community. #ThisIsWhatAnxietyFeelsLike is used by people with that specific problem.
People have also used social media to express their increased anxiety about mass shootings. Hashtag #ItsGettingTooHardTo began being used on Twitter in response to the mass shootings that occurred in El Paso, Texas, and Dayton, Ohio. The hashtag #IAmNotDangerous was used to combat erroneous statements that mental illness is responsible for driving people to commit mass shootings.
Lauren Evans, a Philadelphia public relations professional, is a survivor of domestic violence who was diagnosed with post-traumatic stress disorder, depression and anxiety in 2013. The community she found on Twitter, Instagram and Facebook helped her cope. Evans keeps the hashtag #DVsurvivor and words “Mental Health Advocate” in her Instagram bio to help her find other mental health accounts on social media. Finding others who understood her struggle and didn’t discount her feelings was invaluable. She said social media “has been one of the most helpful things for me to have my voice feel validated, especially regarding past trauma. It’s also super cool to network with others who are on their journey, and it makes it seem more socially accepted.”
It is also common for organizations to use social media as a platform to share information, tips and strategies. The National Alliance on Mental Illness has a Facebook page that provides information about events and a safe space for people to discuss their concerns.
Dr. Isaiah Pickens, a clinical psychologist in Los Angeles and founder of IOpening Enterprises, believes that, when used the wrong way, social media can have a negative impact. “Social media can also exacerbate problems if it’s not the right kind of community and if it’s a community that potentially responds in ways that are toxic,” Pickens said. “When people sometimes try to share their experience and their experience is received in a way that increases the type of harassment, intimidation and bullying that happens.”
He cautions that people should think of social media as a secondary tool and get help from professionals and traditional support groups. Seek out groups on social media that share your problem, he said, and give yourself permission to hold back some aspects of your life. It’s important to set boundaries.
For people who are open about their mental health on social media, there is a possibility that they will face backlash from friends, family or co-workers. “One time, when I made an understandable and human — in my opinion, anyway — mistake at work and had also been open about my mental health online the same day,” Nickalls said, “a former employer said something along the lines of ‘Maybe you should focus more on your work and less on your mental health.’”
But overall, she said, “I think people in general are thinking about mental health differently than they did before, and they’re using social media to reach out for community and support.”
If you or someone you know has talked about contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Crisis Chat, both available 24 hours a day, seven days a week.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
THS wants to share this story in order to highlight the use of new technologies in serving an individual’s mental health on a cultural level.
Coping With Stress During Infectious Disease Outbreaks
Information taken from SAMSHA flyer: HHS Publication No. SMA14-4885 (2014) What You Should Know When you hear, read, or watch news about an outbreak of an infectious disease such as Ebola, you may feel anxious and show signs of stress—even when the outbreak affects people far from where you live and you are at low or no risk of getting sick. These signs of stress are normal, and may be more likely or pronounced in people with loved ones in more..
Weekly Check-Ins By Phone
During the coronavirus|covid-19 pandemic we want to minimize the risk of exposure and infection for our patients and staff. At the same time, we know you, like everyone else, are anxious, afraid and depressed. We want to continue to provide you with the recovery support you need and help you feel connected at this extraordinary time. Beginning Wednesday, March 25 your counselor will be making weekly check-in calls to you via the phone number we have listed in your patient record. Make more..
New Procedures for Protecting Health and Ensuring Safety
Therapeutic Health Services cares deeply about the health of our patients and of our community. We will be posting information as needed regarding any changes in program and service delivery at THS related to coronavirus (covid-19). Our goal is to keep our patients safe and provide the care they need. Please remember to watch our website’s Services Updates page (https://ths-wa.org/news-events/ths-service-updates-coronavirus-covid-19/) page for any changes in service. We will post on our website if there are any changes to daily dosing. more..
We Care About Your Health – Coronavirus (Covid-19)
Therapeutic Health Services cares deeply about our patients and our community, that’s why we want to share this notification and any others in the future to keep you informed of any changes at THS regarding coronavirus (covid-19). Our goal is to keep our patients safe and provide the care they need. MAT Dosing at our Branches Daily dosing will continue until further notice. We urge patients to please follow dosing line instructions and be aware they may be screened prior more..
Mental-Health Researchers Ask: What Is ‘Recovery’?
By Benedict CareyReposted from New York TimesFeb. 25, 2020 For years, Claire Bien, a research associate at Yale, strained to manage the gossipy, mocking voices in her head and the ominous sense that other people were plotting against her. Told she had a psychotic disorder, she learned over time to manage her voices and fears with a lot of psychotherapy and, periodically, medication. But sometime in late 1990, she tried something entirely different: She began generating her own voices, internal allies, more..
THS 2019 Year in Review
The Therapeutic Health Services team had a great year, especially on our website, where we saw a 118% increase in total web traffic! You have our sincerest thanks for visiting our site, sharing us, and connecting to care with us. We wanted to take a moment to compile some of the great stories, videos, and posts we shared in 2019. Patient Stories Brenda’s Story – Recovering from Opioid Addiction – Brenda’s fall into opioid use stripped her life of the more..
Most Americans Are Lonely, And Our Workplace Culture May Not Be Helping
by Elena Renken, NPR More than three in five Americans are lonely, with more and more people reporting feeling like they are left out, poorly understood and lacking companionship, according to a new survey released Thursday. Workplace culture and conditions may contribute to Americans’ loneliness. And loneliness may be on the rise. The report, led by the health insurer Cigna, found a nearly 13% rise in loneliness since 2018, when the survey was first conducted. (Cigna is a provider of health insurance for NPR more..
I’ve Been There, You Can Do This – Peer Support Specialists at THS
Meet Marissa, Peer Support Specialist Sitting down with Marissa is like sitting down with a friend you’ve known forever but haven’t seen in a while. She’s both energetic and relaxed, which is perfect because Marissa is a Peer Support Specialist at Therapeutic Health Services (THS). As a Peer Support Specialist, Marissa helps people in need connect to mental health treatment. Marissa is the person at the door welcoming new patients. She’s the voice on the phone reaching out to people more..
Recruiters tap PMHNP role to fill psychiatrist shortage
BY: Carole Jakucs, MSN, RN, PHN on September 11, 2019 There is a shortage of psychiatrists in the U.S., but some states are in greater need of psychiatrists than others. One example is the state of Washington, which has only met its need for psychiatrists for its population size, by just more than 11%, according to a recently published report by the Kaiser Family Foundation. The state needs a minimum of 165 more psychiatrists to remedy its current shortage. “The shortage has greatly more..
category-mental-health.php