Welcome to the newest feature of the SVSU PMHNP program - our blog! We are excited to reach out to those who are interested in becoming Psychiatric Mental Health Nurse Practitioners and those who are currently practicing in that capacity. Our goal with this blog is to share information about different aspects of the prevention and treatment of mental health conditions and substance use disorders. We plan to discuss a range of topics, including evidence-based treatments, recovery options, current hot topics regarding mental health, and stories from students, faculty, and those recovering from addiction. Plus more!!!
This blog is going to be a new adventure for us. We invite you to follow along and hopefully gain important insights that can help you better serve those with behavioral health conditions.
If you have any comments on our content or suggestions for future topics, please reach out to us at email@example.com and share your thoughts with us!
The Center for Rural Behavioral Health & Addiction Studies will periodically partner with other programs at SVSU to offer training opportunities for the students and professionals who are aspiring to learn new skills. One such program took place this past month when we held our NADA (National Acupuncture Detoxification Association) acupuncture training. This event was a 3 day class that allowed 34 of our PMHNP students to gain the necessary knowledge and training to become certified in auricular acupuncture. This particular form of acupuncture allows health providers to use a simple, safe and standardized ear acupuncture protocol to treat addictions, behavioral health, trauma and disaster relief. The CRBHAS parntered with Kimberly Kile to teach this class. Kimberly has extensive experience working with Substance Abuse and MAT (medication for addiction treatment). She has been teaching NADA classes since 2012. The class participants not only learned about this form of treatment, they had the opportunity to practice acupuncture with each other, and were given the supplies necessary to complete the NADA protocols so they can become certified Acupuncture Detoxification Specialists.
The class was also given a presentation by our team member Dr. Miriam Adams, who stated "I use it on patients with mood disorders (depression, anxiety, PTSD), I use it on patients who would like to stop a behavior, such as smoking cigarettes/vaping, using substances such as marijuana and alcohol, nail biting and compulsive overeating. There is, of course scientific documentation of why this is useful, but has to do with altering the brain chemistry. I have seen patients make significant changes, and it has been very beneficial for them. Many of them have had ongoing sessions, and have enjoyed the way it has helped them to relax, to calm, to practice their mindfulness skills and to experience times that a non-pharmacologic intervention can be helpful.
I use the acupuncture on patients between 8-10 visits. They don't usually come to my office only for the acupuncture, but some have! Each person has reported that it has helped."
For more information on this type of acupuncture, visit the National Acupuncture Detoxification Association's website at https://acudetox.com/.
The Psychiatric Mental Health Nurse Practitioner program at SVSU is proud of its current and past students. There are numerous success stories that come from our program. One such story is highlighted in the following interview with alumni Gladys Kimeli.
Please tell us about yourself.
My name is Gladys Kimeli. I am a board certified family and psychiatric mental health nurse practitioner. I completed my PMHNP certificate from SVSU in August 2020 after graduating with a master’s degree in nursing with a specialization in family nurse practitioner in May, 2017 from Indiana State University. I was then offered a full time NP position at Jafferany psychiatric services in Saginaw, MI where I have been working for the last 2 years. Currently, I am in transition to moving to our new practice, State Street Behavioral services, that is located here in Saginaw MI. I love working with my patients and it’s been my passion to help people in need.
Why did you choose a PMHNP certificate instead of other types of graduate certificates?
In the medical field there are many different and important job titles. For me I chose a PMHNP certificate because I had been already working in a psychiatric office, which gave me a sense of fulfillment and purpose. It solidified my interest in mental health and I wanted to continue providing effective care for my patients with complex psychiatric and physical needs
Why did you decide to pursue the PMHNP certificate through SVSU?
I decided to pursue the PHMNP certificate through SVSU because first, I wanted to support a local university. Secondly, SVSU’s program focused on equipping nurse practitioners with the tools to care for a rural population who are impacted by mental conditions and substance use disorder. SVSU’s program is designed to prepare nurse practitioners to deliver integrated mental care with physical care in addition to substance use, which is much needed in our communities.
After completing the program, what advice would you give to others that are considering the PMHNP certificate?
Being certified as a PMHNP is very rewarding. I would advise them that their position in the healthcare field means they are able to help others and at the same time find fulfillment in caring for patients. Also working with mental health patients comes with its own distinct set of challenges. It is by no means an easy profession to pursue, but those that are dedicated can find tremendous rewards in the field.
How has gaining this certification affected your professional career?
Gaining a PHMNP certification has affected my professional career greatly. It opened a door for me to see the needs in our community. There are many patients out there that are looking for psychiatric care, yet they are told by many psychiatric offices they have waiting list for couple months. This patient doesn’t have months to wait to be seen. Having learned more about mental health, my husband and I felt compelled to open a behavioral clinic: States Street Behavioral Services to cater to the needs of our vulnerable population.
Is there anything in particular that SVSU’s program offered or did that has enhanced your ability to perform in your career?
SVSU program did enhance my mental health knowledge and confidence in caring for complex psychiatric illness. In the current mental health model, care is often delivered in a “split model,” meaning that medication providers such as myself before PMHNP certification see patients, sometimes briefly for medication management and psychotherapists such as psychologists and licensed clinical social workers provide psychotherapy. I now find it difficult to provide psychopharmacologic treatment without including at least some psychotherapy. I was once counseled by a mentor to make every interaction with a patient therapeutic by providing respectful, engaged treatment, and I try to bring this to every patient I see. I am grateful to have learned about motivational interviewing, psychotherapy, addiction, and psychopharmacology at SVSU to strive to provide the best care to my patients.
How would you describe the PMHNP program at SVSU to other people?
The PMHNP program at SVSU is a place for anyone. The staff and professors are very knowledgeable and friendly. SVSU is committed to the success of their students. SVSU offers a rigorous curriculum and one of the first Psychiatric-Mental Health Nurse Practitioner (Lifespan) specialties in Mid-Michigan. SVSU’s program teaches how to use advanced clinical judgment and practice to assess, diagnose, plan, implement, intervene, manage and evaluate holistic plans of care – including treatment with psychotropic medications; individual, group and family psychotherapy; crisis intervention; case management and consultation. SVSU provides low faculty-to-student ratios, mentoring and personalized attention. I am proud to be a SVSU alumni.
The Brass Tacks
A blog for those interested in Mental Health Current Events
Created by Julia Reinhardt, PMHNP Student
The impact of the COVID-19 Pandemic on Mental Health and Substance Use
Events of the past year have certainly been one for the history books. We watched as life, as we knew it, changed swiftly and dramatically. We saw schools and businesses close; panic buying result in toilet paper and food shortages; social media consumption widen; and watched as debates soared about mask-wearing and loss of freedoms, related to safety measures implemented to slow the spread of the novel coronavirus (COVID-19). These last 13 months have certainly brought major challenges to individuals, businesses, healthcare systems and public health policies, around the world.
Significant social and economic changes have resulted in job insecurity or loss, financial instability, the transition of both occupational and educational formats to a home-based environment, isolation and the development of new or worsening mental-health conditions, such as anxiety, depression, substance misuse and suicidal thoughts. Last summer, a report from the Centers for Disease Control (CDC) revealed that 2 in 5 residents of the United States reported struggling with mental or behavioral health issues associated with COVID-194.
Regardless of whether or not you have an active substance use disorder (SUD) or are in recovery; stress, grief and fear related to COVID-19, along with disruptions in routines, isolation, and a lack of support, in conjunction with the above-mentioned changes, are all risk factors that can lead to substance use or relapse, as a method to temporarily escape from the pain of reality. Even more worrisome is information coming out about how substance use increases the risk of complications associated with COVID-19.
Emerging research suggests that people with substance use disorder (SUD), particularly opioid use disorder (OUD), and those who are African American are at a higher risk of contracting COVID-19, being hospitalized and dying as a result of their infection. The reasons for increased risk of adverse events are complex, but involves having a weakened immune system, as a result of substance use; a compromised cardiovascular and respiratory system, from damage and inflammation related to both reduced blood oxygen levels associated with opioid use and inhalation of substances; and changes in the brain and vascular system, including vessel narrowing, which can cause high blood pressure6. Despite the abundance of evidence available regarding the negative consequences of substance use, it is clear that this information has done little to deter use.
Data from an August 2020 report by the CDC showed that approximately 13.3% of people had increased or started using substances to cope with their stress or emotions related to COVID-191. In fact, sales of both alcohol and marijuana have increased since the start of the pandemic. Nielson, a global leader in retail measurement services, reported that in-store alcohol sales were up 54% in late March 2020, while online alcohol sales had increased by almost 500% the following month3. Sadly, increased reliance on substance use as a coping mechanism increases the risk for overdose and death.
The highest number of overdose deaths ever recorded in a 12-month period of time, 81,0000, occurred in the United States between May 2019-2020; largely related to synthetic opioids, such as illegally manufactured fentanyl, suggesting an overdose acceleration during the pandemic2. It’s possible that some of these deaths may have been related to concerns about obtaining addiction care, during the pandemic, causing substance users to dread going to medical settings where COVID infection risk was elevated, as well as, fears that they would not receive treatment for acute intoxication due to overburdened emergency rooms and staff. Furthermore, even pre-COVID-19, difficulties existed in gaining access to and maintaining adherence with treatment, for people with both mental health conditions and/or substance use disorder; the pandemic only making matters worse. These difficulties exist due to a serious lack of mental health and substance use education and awareness in this country, along with poor public policies and significant financial barriers to receiving treatment; a shortage of treatment centers and properly trained providers, social stigma and bias against individuals with behavioral health and substance use conditions, as well as, racial barriers that limit access to care for black, indigenous and people of color (BIPOC). Until the marginalization of people with these conditions is stopped and public policies are put in place to increase access to behavioral health and addiction treatment services, the number of casualties will continue to rise.
It can’t be all doom and gloom, though, right? Understanding the road blocks before us, how can we help support individuals with mental health and substance use disorders right now? First, clinicians should evaluate every patient for new or worsening mental health or substance use disorders. If identified, emotional support should be offered, with an emphasis on the fact that the individual is not alone and that they have a treatable condition. Supporting the patient and letting them know that you are there for them and willing to help, can make a difference in their willingness to accept treatment. At the start of the pandemic, federal agencies implemented policies which helped opioid treatment programs (OTP) distribute take-home doses of both methadone and buprenorphine, thus increasing access to substance use treatment medications, as well as, expanding access to telemedicine for treatment and counseling services5. Additionally, support group meetings, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) moved online. As these options provide treatment avenues and support for people with mental health disorders and SUD, their use should be recommended and encouraged by both clinicians and family members supporting loved ones with these conditions. Moreover, clinicians have an obligation to stay on top of new developments that can impact ways they deliver care; and should familiarize themselves with community programs, especially those accommodating people with limited resources or who lack insurance, so that they have a variety of support and treatment programs available to offer to their patient population. Clinicians treating people with SUD should encourage harm-reduction techniques for those individuals whom abstinence isn’t the goal, such as needle-exchange programs, to reduce the risk of acquiring hepatitis C or human immunodeficiency virus (HIV). Additionally, providers working in OTP, should emphasize realistic expectations and avoid criticizing individuals for “slip-ups”; praising small steps and encouraging abstinence behaviors. Most importantly, life-saving medication (Narcan) should be prescribed to anyone with an opioid use disorder, with instructions on use.
Uncertainty still exists in terms of when life may start to resemble the world we knew, over a year ago. In some ways; though, life will never be the same again, as people have said good-bye to their savings, businesses, health (following chronic changes associated with COVID infection), friends and loved-ones. Stress, related to the pandemic, is contributing to mental health and addiction issues across the nation. Addiction hides, and may not be immediately obvious; thriving in secret and progressing rapidly, especially when isolated. If you or someone you know is experiencing increased substance use and cravings, or has relapsed, please contact your provider or call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 24/7, 365-day-a-year treatment referral hotline at 1-800-662-4357 to reach out for assistance in locating mental health or addiction services near you.
and suicidal ideation during the COVID-19 pandemic — United States, June
during COVID-19. Retrieved from
health toll from COVID-19 stresses. JAMA Health Forum.
COVID-19 susceptibility. Nora’s Blog. https://www.drugabuse.gov/about-nida/noras-blog/2020/10/new-evidence-substance-use-disorders-covid-19-susceptibility
The following is a blog entry copied from the CDC's website. ( https://blogs.cdc.gov/publichealthmatters/2020/12/nivw/)
As flu viruses and the virus that causes COVID-19 can spread this season, getting a flu vaccine is more important than ever. Here are five reasons why you should:
Flu can cause signs and symptoms; such as fever, cough, and body aches, that can keep a healthy person home from work, school, and errands for a few days to a week or more.
The best way to prevent seasonal flu is to get vaccinated every year. Flu vaccination helps prevent millions of illnesses and flu-related doctor visits each year. CDC estimates that influenza vaccination during the 2019–2020 influenza season prevented 7.52 million illnesses, 3.69 million medical visits, 105,000 hospitalizations, and 6,300 deaths associated with influenza.(1)(3)
Flu vaccination can reduce doctor visits due to flu. Several studies have shown flu vaccination can reduce the severity of illness in people who get vaccinated but still get sick. And during seasons when the flu vaccine viruses are similar to circulating flu viruses, flu vaccine was shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.(2)
You may think of flu vaccine only as a way to protect yourself from flu. But getting vaccinated also may protect the people around you. Many people in the U.S. are at higher risk of getting very sick from flu because of their age, or because they have one or more of certain health conditions, like asthma, diabetes, or heart disease. Also, some people in your family or community may not be able to get vaccinated due to their age (children younger than 6 months, for example).(4) They rely on you to help prevent the spread of disease. When you get a flu shot, you help protect them.
Help CDC promote flu vaccination in conversations with friends, family, and neighbors, and post to followers on social media using resources available in this year’s #SleeveUp to #FightFlu digital media toolkit.
Getting a flu vaccine is more important than ever during the 2020-2021 season. A flu vaccine this season can help protect you and the people around you from flu, reduce the burden of flu on our health care systems during the COVID-19 pandemic, and save medical resources for the care of COVID-19 patients.
Since health care workers are needed to care for people sick with COVID-19 and may care for or live with people at high risk for influenza-related complications, it is especially important for them to get vaccinated.(5)
National Influenza Vaccination Week (December 6-12) is focused on highlighting the importance of influenza vaccination. It’s not too late for anyone 6 months and older to get a flu vaccine. Laboratory-confirmed flu activity is low now, according to the Weekly U.S. Influenza Surveillance Report (or FluView).
CDC has worked with vaccine manufacturers to have extra flu vaccine available this flu season. Manufacturers have distributed 197.4 million doses of flu vaccine this season so far. Use the VaccineFinder to find yours.
My experience with Body Dysmorphic Disorder (BDD)
I am an adult NP and a student at Saginaw Valley State University pursuing a post graduate certification in psychiatric mental health. My experience with Body Dysmorphic Disorder started when my son was 22 years old and was in college. He was having issues with anxiety and depression and one day while walking with him in Ann Arbor he shared his story about body dysmorphic disorder with me.
My son who was an attractive, 6-foot-tall male explained to me his despair and horror that he had perceived physical flaws that were causing him an immense amount of sadness and stress. He said he had been hesitant to share his story because he was embarrassed and thought he would sound like he was vain. He had been meeting with a psychologist while in college but had been doing research of his own and he explained to me that he believed he had something called Body Dysmorphic Disorder. He said he was spending hours and hours every day focusing on his perceived defects. He spent his time doing investigation on the internet to see if he was as abnormal as he believed he was and also looking in the mirror multiple times a day, horrified at his reflection. His illness was causing him much distress and was interfering with his ability to live his life successfully.
I was devastated, I had never heard of Body Dysmorphic Disorder. How could my beautiful, brilliant boy see himself in such a way, why couldn’t he see himself the way I did? I just couldn’t understand it, I couldn’t put my arms around it. I started by trying to help him see how perfect he was but my complements and intent to change his negative view of himself didn’t help. My son has worked hard to get better and has received therapy which included cognitive behavioral therapy, group therapy, exposure therapy as well as psychopharmacologic treatment which has resulted in much improvement. That was five years ago. During this time I have become more educated about Body Dysmorphic Disorder which I believe helps me to be a better mom and better support person for my son. As far as his progress, I’m happy to say he is doing much better though he still has occasions when his preoccupation with his perceived flaws overtakes him and causes him distress.
Body Dysmorphic disorder is listed in the DSM 5 under the heading of Obsessive Compulsive and Related disorders. In the DSM5, BDD is defined as a disorder where the individual who has it believes that he or she is unattractive and even hideous with one or more specific areas that they see as being flawed or deformed. To fill the diagnostic criteria, the individual at some point performs repetitive behaviors (compulsions) related to the flaw (obsession).
These repetitive behaviors can be something like mirror checking or grooming the specific area of concern which could take up hours of the individual’s day. The individual feels that performing the behaviors will decrease anxiety but if the anxiety is slightly decreased the relief doesn’t last. The DSM 5 also evaluates specifiers related to a patient’s insight or understanding of his or her illness. In the book Understanding Body Dysmorphic Disorder, An Essential Guide, by Katherine A Phillips M.D., she states that sometimes individuals describe the need to perform the compulsive behavior like an “itch that needs to be scratched.” These repetitive behaviors lead to impairment in social, occupational and other areas of function.
o BDD occurs slightly more frequently in females than males: 2.5% vs. 2.2%
o Mean onset age: 16–17
o Median onset age: 15
o Most common onset age: 12–13
o Environment: BDD is sometimes associated with childhood neglect and abuse
o Suicidal behavior: more predictive if onset prior to age 18
o Genetic: BDD is more prevalent in those who have a relative with OCD
o Gender differences: Males are more likely to have genital preoccupation and females are more likely to have eating disorders in addition to BDD (DSM5, 2013, 244)
o High economic cost explained by excessive medical care including medical and psychiatric hospitalizations as well as medical and surgical evaluation sought out to obtain unnecessary cosmetic procedure
o Decreased work productivity and job loss due to time spent on obsessions and compulsions
o Highest cost of all is suicide and 25% of the population that has Body Dysmorphic Disorder have attempted suicide. Dr. Phillips stated that approximately 80% of the people with Body Dysmorphic Disorder who had participated in her research had experienced suicidal thoughts (Phillips, 2009, 109)
o Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS) — 12 item scale. This scale gives a score that reflects the severity of the patient’s BDD.
o Body Dysmorphic Disorder (BDDQ) for adults — This tool screens for BDD but does not definitively diagnose BDD.
o The Brown Assessment of Beliefs Scale (BABS) — 7 item scale. This scale was designed to assess a patient’s conviction and insight related to their beliefs, and in the case of BDD, beliefs about their perceived physical flaw or defect.
o Multiple studies have shown that SRIs are effective for treatment of Body Dysmorphic Disorder.
o In the study done in 2002 by Phillips, Albertini and Rasmussen it was concluded that fluoxetine was safe and more effective than a placebo in treatment of Body Dysmorphic disorder. (Phillips, Albertini and Rasmussen, 2002)
o A study done in 2016 which looked at relapse prevention in BDD, found that prolonged treatment with the SSRI escitalopram caused continued improvement of symptoms as well as delayed time to relapse. (Phillips, Keshaviah, Dougherty, Stout, Menard, & Wilhelm, 2016)
o Phillips recommends the use of any of the SSRIs as first line treatment for BDD. (Phillips, 2009)
o Phillips also states that SSRI dosage needs to be individualized with BDD and she has found that higher doses are typical with BDD.(Phillips, 2009)
o If the SSRIs fail the tricyclic antidepressants clomipramine and desipramine have been studied with BDD but due to high rate of side effects Phillips states they should not be the clinicians first choice. (Phillips, 2009)
o Phillips states that SSRI should be continued for 12–16 weeks prior to giving up and changing to a different medication with possible need to continue increasing to maximum dose. (Phillips, 2009)
o Phillips states that pharmacotherapy with SRI should be continued for at least 1–2 years to prevent relapse. (Phillips, 2009)
o Augmenting agents suggested by Phillips are: buspirone, levetiracetam, clomipramine, venlafaxine, bupropion, neuroleptics such as ziprasidone, olanzapine, risperidone, methylphenidate, lithium and benzodiazepines. (Phillips, 2009)
o Cognitive Restructuring: This is used to help the client develop healthier thoughts related to their appearance.
o Exposure: The exposure aspect is that the client exposes themselves to people to see if they react to their perceived ugliness the way they expect them too.
o Ritual Response Prevention: With this therapy the client works to decrease and eventually stop the ritualistic behavior such as looking at themselves in the mirror.
o Perceptual (mirror) Retraining: This method instructs the client to look at their entire body and objectively describing themselves in a holistic fashion not just focusing on one perceived flawed area. (Phillips, 2009, 190–192)
This has not been proven to be effective as a stand alone treatment for BDD but can lead to better self understanding and self awareness which can be helpful. (Phillips, 2009,228)
This therapy is also not recommended as a stand alone therapy with BDD but this type of therapy offers to the patient understanding and emotional support which could help them to deal with their struggles with BDD. (Phillips, 2009, 228)
Also not recommended as first choice for therapy but may help therapist to gain some insight from family as well as to provide some understanding to family about client’s struggles with BDD.(Phillips, 2009,229)
This type of therapy allows the client to work in a group rather than individually and Phillips suggests that with the BDD population Group CBT is the most effective type of Group Therapy.(Phillips, 2009, 229)
American Psychiatric Association: Diagnostic and Statistical Manual of Mental disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
Hollander E, Allen A, Kwon J, et al. Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry. 1999;56(11):1033–1039. doi:10.1001/archpsyc.56.11.1033
Hong, K., Nezgovorova, V., & Hollander, E. (2018). New perspectives in the treatment of body dysmorphic disorder. F1000Research, 7, 361. https://doi.org/10.12688/f1000research.13700.1
Phillips, K.A.,(2009)Understanding body dysmorphic disorder: an essential guide. New York, New York: Oxford University Press.
Phillips K.A., Albertini RS, Rasmussen SA. A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry. 2002;59(4):381–388. doi:10.1001/archpsyc.59.4.381
Phillips, K. A., Keshaviah, A., Dougherty, D. D., Stout, R. L., Menard, W., & Wilhelm, S. (2016). Pharmacotherapy Relapse Prevention in Body Dysmorphic Disorder: A Double-Blind, Placebo-Controlled Trial. The American journal of psychiatry, 173(9), 887–895. https://doi.org/10.1176/appi.ajp.2016.15091243
Self-Harm In Adolescence: Understanding The Science Behind Why They Do It, And What We Can Do To Help
By Leah Magnuson, DNP, APRN, AGNP-C – Apr. 5, 2020
Think back to a time when you experienced physical pain (ex: removed a sliver from your finger; bit your lip; hit your head on a cupboard). What were the emotions you felt? Whenever I encounter pain, I naturally experience distress, anger, and frustration – all negative emotions. I like to think that these emotions are, in a sense, a “safeguard” to help me (and all of us) avoid future potentially painful events as much as possible. After all, one of our basic human instincts is to preserve life.
Self-harm, or the hurting of oneself on purpose (via cutting, burning, hitting, punching, etc.), is most prevalent among adolescents - around 17% have engaged in at least one episode. It is a tactic used to relieve negative emotions, such as sadness, anxiety, anger, guilt, emptiness, and self-disgust.
If physical pain naturally leads to negative emotions, but self-harm helps many teens relieve negative emotions, what is going on? To answer this question, we have to take a look inside the brain at what happens when someone self-harms. In a recent article in Psychology Today, author Terri Apter, Ph.D., explains that the sense of relief generated during self-harm stems from the activity of the amygdala, an area of the brain responsible for producing emotions. Rather than activation of the amygdala from physical pain (resulting in common emotions of anger, frustration, etc.), in some adolescents, self-harm results in a reduction of amygdala activity – thus, relief of negative emotions. Another explanation for self-harm involves the stress hormone, cortisol. This hormone naturally increases during moments of stress, but also during these times the body releases endorphins to help cope with stress and feel better. Cortisol levels are actually lower in self-harming adolescents, therefore, self-harm increases cortisol and endorphin levels and provides a sense of “feeling” to teens who feel empty.
Understanding the physiologic brain changes behind self-harm helps us to make sense of why certain strategies help adolescents cope. Let’s talk about what some of these strategies may be. Psychology Today suggests one tactic is to increase levels of “good stress” through activities such as physical exercise or learning a new hobby. Teens can also try other tactics, such as taking a cold shower, chewing something with a strong flavor (peppermint), journaling, or cuddling a pet when they feel an urge to self-harm.
Learning this information has been a game-changer for me, especially as a nurse practitioner working in mental health. My previous thought was that teens self-harmed as an attention-seeking technique…I was quite wrong. Learning that there are actual physiologic changes in the brain during self-harm has increased my understanding and empathy toward those who struggle with it. I hope it has for you, too. If you know someone who participates in self-harm, whether it is a friend, family member, or patient, I encourage you to think about the science behind their behavior and encourage them to use a safer, healthier skill when they get an urge to self-harm.
1. National Alliance on Mental Illness. (n.d). Self-harm. In National Alliance on Mental Illness. Retrieved from https://www.nami.org/learnmore/mental-health-conditions/related-conditions/self-harm
2. DeAngelis, T. (2015). Who self-injures? Monitor on Psychology, 46, 60.
3. Smith, M., Segal, J., Robertson, L., & Shubin, J. (2019). Cutting and self-harm. In HelpGuide: Your trusted guide to mental health & wellness. Retrieved from https://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm
4. Apter, T. (2020). The pain paradox. Psychology Today, 50-52
Social Isolation in COVID-19
written by: Jennifer Scott
In this challenging time of COVID-19, many out-patient substance use disorder (SUD) treatment centers are converting services to telehealth or limiting services. With Face to face interaction, a key element of recovery support, it is imperative to ensure that patients have meaningful virtual experiences with their healthcare providers. As many find themselves working from home, they are wanting and needing to treat their patients with substance use disorder (SUD), they find themselves utilizing either the telephone or video conferencing to reach out to their patients. During this time of social isolation, how do we reach out and keep our patients engaged in treatment to who are struggling with addiction and in recovery?
Social isolation is often difficult for those who have SUD and are in recovery. Addiction can be a lonely disease which leads to social isolation. Social support is imperative for a person recovering from SUD as social isolation is a risk factor for relapse. The COVID-19 pandemic has resulted in executive orders from many states that mandate social distancing and only allowing direct contact with those whom people currently live at the same address to reduce the disease transmission and flatten the curve. Social distancing can be especially difficult for individuals in recovery as much of their social interaction comes from appointments, meetings, and peer-support groups.
In order to address social isolation, those in recovery are encouraged to reach out to others or join a recovery group. Here, they meet other individuals who have went through similar circumstances. Reaching out and being a part of a group that has the same recovery goals makes one feel supported and cared for. The goal of being in a recovery group is to have the ability to feel and be open with those who have found themselves in similar situations. Recovery groups provide a safe place where feelings of fear, joy, substance use, and recovery can be shared and judgements are left behind. In this time of need, individuals in recovery need a safe place that feelings can be shared and be surrounded by people who understand their point of view, because they are in recovery themselves. With the COVID-19 pandemic, patient’s in recovery have reduced access to health care and recovery services and this can be challenging time for them.
In our community, Peer 360 is a local support group for individuals seeking therapy for SUD. Their vision is to create an environment where recovery from substances, such as alcohol and opioids is understood, embraced, and appreciated, while all who seek help will have access to support, care, and resources to achieve lifelong sobriety and a healthier life. In keeping with their vision, Peer 360 has moved from face-to-face meetings to an online format to reach those still in need. They have two meetings per day, one is at noon and the other at 6pm. Recovery coaches remain available to their patients via phone.
In addition, The Grace Project (Gaining Recovery in Addiction for Community Elders), located within the Bay Community Health Clinic provides a multidisciplinary team to meet the healthcare needs including, medication assisted treatment (MAT) to individuals with SUD. Our clinic has moved to online services, as well. Our patients connect telephonically or via video conferencing with providers to continue care and treatment. The providers at The Grace Project include a psychiatric nurse practitioner, family nurse practitioner, social worker, peer recovery coach, case manager, pharmacist, dietician, and occupational therapist. This provides us an opportunity to visually see them via a phone or tablet, while assessing mental and emotional status. It also provides an opportunity to ask, if they have enough food and toiletries in their home. We have the manpower, if needed, our team could drop off food.
During the telehealth visit, prescriptions are refilled as needed. Outside of their scheduled telehealth visits, a member of the interdisciplinary team calls to check-in on the patients on a daily to weekly basis, based on the patient’s needs. Providing our patients and community with these services will help combat the social isolation that may be felt during these trying times. It is important to maintain a therapeutic relationship, and through online means, we embrace the need we all have for human connection.
Telehealth Used for Substance Use Disorder Patient Care in The Flight Against COVID-19 Pandemic
Posted by Mindy Fabbro
The novel Coronavirus 2019 disease (COVID-19) pandemic has required healthcare providers to limit in-person patient visits and interactions to help decrease the spread of the virus. This is especially challenging for patients with substance use disorder (SUD), in particular those with opioid use disorder (OUD) who are receiving medication assisted treatment (MAT). This is due to the fact that prescriptions for agonist maintenance are limited in duration or administered at an Opioid Treatment Programs (OTP).
Several regulatory bodies have responded to the COVID-19 pandemic in attempt to flatten the curve with social distancing while still allowing patients with OUD to receive the care they need. The Centers for Disease Control (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA) have released guidance for healthcare providers to assist patient’s with SUD during this pandemic and social distancing. The CDC endorses using telehealth for patient’s healthcare needs during the pandemic. This past March, SAMHSA announced that blanket exceptions could be made by states and that OUD patients could receive 14-28 medication doses to take home based on the patient’s treatment stability. This exception is in effect only while the United States public health emergency is in effect. In addition to established patients, SAMHSA allows new patients to be prescribed buprenorphine via a telehealth visit and waived the exam in-person. However, an in-person initial exam is still required for methadone treatment.
During the pandemic, The Drug Enforcement Agency (DEA) has allowed for delivery and administration of controlled substances used to treat OUD. The DEA's exception allows staff from OTP’s, law enforcement, and the National Guard to make door step deliveries of take-home medications in particular methadone. The medications can be delivered to a patient’s approved lockbox at the patient’s home which allows for social distancing to help prevent the spread of COVID-19. SAMHSA has guidance afor OTP’s for delivery of medication if a patient is positive for COVID-19 to allow patients to receive their medication without leaving their home.
All of these aforementioned changes have allowed for the use of telehealth to be incorporated into SUD treatment and eliminated some of the barriers associated in-person visits and prescribing controlled substances. Healthcare providers use their clinical judgement to identify patients who can use telehealth. Some patients may require higher level of care and not be able to be managed without in-person visits. Patient’s with SUD and comorbidities including the elderly, immunocompromised, and pregnancy are at increased risk for complications from COVID-19.
By utilizing telehealth healthcare providers can safely communicate with patients about their healthcare needs. There are a variety of options for a virtual visit including mobile apps, video conferencing, and phone calls and texting. Seeing patients virtually decreases the spread of the virus to both the public and healthcare workers and decreases the use of personal protective equipment (PPE) that is in limited supply. There are a variety of virtual technology that can be used to assist a healthcare provider with assessment of the patient virtually including an electronic stethoscope, blood pressure cuff, and oxygen sensor. Patients can also access group support via telehealth. Many recovery support groups have quickly converted to virtual meetings and encourage attendance.
Patients are encouraged to check with their health insurance provider for access to telehealth services and coverage. Many of the health insurers are giving patients and healthcare providers incentive to use telehealth. In addition, The Federal Communications Commission has provided funding for healthcare providers. Two hundred million dollars was appropriated by Congress to help healthcare providers establish a telehealth service. The COVID-19 Telehealth Program will fund telecommunication and information services as well as devices to connect patients to their healthcare providers.
Disclosures: The author reports no conflicts of interest concerning the subject matter of this article.
Centers for Disease Control (CDC). Corona Disease 2019. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/preparedness-resources.html
Federal Communications Commission. COVID-19 Telehealth Program. Retrieved from: https://www.fcc.gov/covid-19-telehealth-program
Prevoznik, T. U. S. Department of Justice, Drug Enforcement Administration. DEA Qualifying Practitioners, DEA Qualifying Other Practitioners. Retrieved from: https://www.samhsa.gov/sites/default/files/dea-samhsa-buprenorphine-telemedicine.pdf
SAMHSA. Opioid Treatment Program (OTP) Guidance. Retrieved from: www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf.
6/15/20- The Important Need That PMHNPs Can Meet
written by: Patti Tieman FNP-BC and SVSU PMHNP student
I never thought about working with patients who struggled with substance use disorders- not once. But a door had opened, and life had taught me that unexpected journeys were often the intended path. So, I stepped tentatively across the threshold. As a family nurse practitioner, I am committed to passionate work. If I can’t be all in, I will find a place I can be. If the passion didn’t come, no harm done. There would be another opportunity.
But come it did, and before too long the humanity and melancholy beauty of the patients won my heart. With empathy and the art and science of advanced practice nursing, I became a channel of hope and healing as I learned to treat substance use disorders with medication and a caring relationship. I had my limits: I could not touch the companion that so many walked with-- a co-occurring disorder. Substance use disorders and mental illnesses are often closely intertwined. But my training hadn’t equipped me to treat mental illnesses. Some patients wished aloud that they could have both problems treated in our clinic. Another door was cracking open.
I discovered that the need for mental health providers is a great and complex problem. There is a marked shortage in psychiatrists nation-wide and psychiatrists are an aging population: 60% are greater than 55 years old. The problem is acutely felt in rural areas as most psychiatrists practice in more populated areas. 60% of counties in the US do not have even one psychiatrist. Urban areas also bear a heavy burden because 45% of psychiatrists don’t take private insurance or Medicaid. The impact of these disparities is felt far beyond the patient. A compelling JAMA infographic shows how It affects society as a whole; the disease burden of mental health disorders is greater than any other disease including heart disease and cancer. Tragically, only 5% of healthcare spending is for mental health disorders.
Psychiatric Mental Health Nurse Practitioners (PMHNP) are well suited to meet all of these disparities. Nurse Practitioners have historically met the needs of the poor and underserved. By training a large number of PMHNPs and allowing them to practice to the full extent of their license, the shortages can begin to be addressed. PMHNPs can work in traditional practice models such as community mental health and private practices. They can also branch out in new ways bringing services right to the patient. They can be imbedded in primary practices with an integrated practice model. PMHNPs can also use telemedicine platforms to virtually meet their patients at home wherever the patient is. This provides mental health access into any county and overcomes the transportation difficulties that patients often face.
As a family nurse practitioner completing my PMHNP certification, I am passionate about helping my patients attain their optimal health in all areas of health. Who knew that all the non-pharmacologic interventions that make a healthy mind also make health body? As I diagnose and treat mental health conditions, I prescribe medications without forgetting all the things that work so well without side effects: mindfulness meditation, counseling, yoga, tai chi and other forms of exercise, rest, and a healthy diet. As a PMHNP, I can help fill the gaping need with a holistic approach that embodies respect and dignity of all. My patients are not divided into mental, spiritual, and physical parts with a piecemeal approach to care. FNPs that have added PMHNP to the credentials are uniquely and holistically suited to meet the needs of those afflicted with mental health issues and walk along side them to their best life.
You may have never thought about becoming a psychiatric mental health nurse practitioner—not once. But one in five have a mental health disorder and at best, 50% get treatment. Consider this your open door to a need that reaches into every area of healthcare and society. If you follow the need, you too just might find your passion.
Harrar, S. (2020). Inside America's psychiatrist shortage. Retrieved April 10, 2020, from https://www.psycom.net/inside-americas-psychiatrist-shortage/ Levine, D. (2018). What's the answer to the shortage of mental health care providers? Retrieved from https://health.usnews.com/health-care/patient-advice/articles/2018-05-25/whats-the-answer-to-the-shortage-of-mental-health-care-providers Weiner, S. (2018). Addressing the escalating psychiatrist shortage. Retrieved from https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage
During this time of social reflection and change, the PMHNP program at SVSU wanted to reach out to all with the following message from the President of SVSU, Donald Bachand.
Dear university community,
Like many of you, I have watched the death of George Floyd at the hands of a Minneapolis police officer and the community reactions across the country. I have struggled to find the words to express my feelings. I am appalled at his death and the deaths and mistreatment of other people of color due to racism and hatred. As a former police officer, as a former professor of criminal justice, as a university president, and as a human being, it angers me.
Let me be clear: racism has no place at our university. It cannot and will not be tolerated. We can and must do more on our campus and in our communities to create justice and equity for all, and especially for those who have been disenfranchised.
These issues are deeply personal to me and have guided my life’s work. The late Martin Luther King Jr. said that “a riot is the language of the unheard.” Growing up in a diverse, working-class neighborhood in Detroit, I watched the famed 1967 riots outside our family’s living room window. To this day, the scenes are etched into my memory. The dry cleaning business that sponsored my Little League baseball team was among those vandalized. I watched as the fabric of my neighborhood was shredded. Those silenced voices unleashed in a scream. We see that again today.
Not too long thereafter, I chose to pursue a career in law enforcement. I joined the Detroit Police Department. In 1967, the city had only about 50 African-American police officers. Fifty in a city of more than 1.5 million people. It is no wonder why the cries of the oppressed went unheard. More than 50 years later, the wounds exposed in 1967 are still not fully healed in our community. In my most discouraging moments, I wonder if they have healed at all.
I know what it means to work in a community whose residents feel that the application of law and order is anything but equal. When the police arrive in their neighborhood, the residents do not feel “protected” or “served,” they feel fear. That fear is justified by too many examples of mistreatment and worse. When I joined SVSU to teach criminal justice, it was because I wanted to prepare men and women for the challenges of law enforcement and to teach them that everyone deserves justice. This justice was denied to George Floyd and too many others like him.
We have worked hard to create an inclusive environment and a culture at SVSU where diversity training and education are available and encouraged, and where there is zero tolerance for racism and discrimination. We must do more. We cannot be bystanders. We cannot wait for change. We must initiate change.
I will appoint a task force of faculty, staff and community members to further elevate equity and justice within SVSU, especially for those who are marginalized, and to provide recommendations for how we can extend those efforts into our surrounding community. Our university values of diversity and inclusivity and a safe, friendly and respectful campus climate support this important work. Please watch for more information on this in the coming days.
Finally, if you have been silent about an issue of racism or intolerance within SVSU, I want to hear from you. I want your voice to be heard. Please e-mail me at firstname.lastname@example.org.
These challenges are even more difficult during a global pandemic that prevents us from gathering on campus, but we cannot allow that to be an excuse for indifference or inaction. I implore each member of our Cardinal family to step up and join in the cause of moving our university and our community toward the ideals on which our nation was founded.
Donald J. Bachand, President
By Virginia Downey, FNP-BC, PMHNP student
Traumatic events and disasters can heighten a person’s anxiety. The COVID 19 pandemic with its tsunami of new infections, national surges and severe disruption of normal day-to- day routine creates increased stress in families. To weather these tumultuous times well and strengthen our emotional health, parents and caregivers must 1) assess their own stress levels and behaviors, 2) practice self-care, 3) recognize stress and anxiety symptoms in their children and 4) help them manage their fears in healthy ways. Equipping parents to care well for the mental and physical health of their children and themselves in the midst of the COVID 19 pandemic is my passion.
Signs of Stress in Adults
Sleep disturbances are common symptoms of stress and anxiety. This includes difficulty falling asleep, frequent awakenings, or inability to stay asleep, with daytime fatigue. Altered appetite and eating patterns may occur, with decreased appetite or eating for comfort. “Stuck thoughts” about the health of oneself and loved ones or worsening of one’s own chronic health problems may arise with increasing anxiety or stress (i.e. worsened Gastroesophageal Reflux Disease (GERD), Asthma, COPD, Irritable Bowel Syndrome (IBS), Crohn’s Disease, Hypertension and Heart Disease, Generalized Anxiety Disorder, etc.). Sometimes adults increase their use of substances when stressed (tobacco, alcohol, prescription drugs, marijuana and/or illicit substances).
SELF-CARE for ADULTS
Creating A Family highlights the importance of caregivers’ self-care, using the metaphor from the airline industry: in an emergency, an adult should place the oxygen mask on themselves first, and then help their child. Daily exercise, healthy meals, frequent hydration, reducing or avoidance of caffeine, alcohol and other mind-altering substances, regular time of sleep every night, with limited screen time about the pandemic are all healthy, self-care behaviors. Mindfulness, prayer, meditation, breathing exercises (slow and controlled in and out), plus neck, shoulder and body stretches (Yoga or similar) can reduce physical tension in your body, further reduce anxiety, and provide emotional strength for helping your children.
SIGNS OF STRESS AND ANXIETY IN CHILDREN
Children are not “little adults. They express anxiety and stress in developmentally distinct ways. Preschoolers may revert to thumb-sucking, toileting accidents and fear of parental separation. Crying for no reason, irritability, anger outbursts, excessive sadness and disinterest in toys may be their behavior. Physical symptoms (stomach ache, headache), and lack of appetite commonly arise. Preschoolers may mimic their parents’ stress emotions. They may draw faulty conclusions from what they hear about COVID 19, such as a fear of dying, guilt for someone becoming ill, or “something bad is going to happen to me.” Primary school children may struggle with concentration, require more parental attention or regress in their self-care abilities (dressing, hygiene, etc.). Sleep problems are common in all ages. Middle and high school-aged
children may display indifference or a “cool” attitude (“I’m doing okay”) when they actually have physical symptoms of stress: headaches, body aches, and increased irritability. Acting out and poor concentration are common. They might lose interest in activities that previously brought them enjoyment. When older teens are feeling stressed, they are at risk for trying alcohol or other substances. The Centers for Disease Control and Prevention (CDC) as well as Substance Abuse and Mental Health Services Administration (SAMHSA) provide resources for understanding how children from infancy through adolescence express stress and anxiety, as well as healthy ways adults can help them cope in stressful times.
Parents and Caregivers ARE “first Responders,” Helping children manage Their stress and Anxiety
The over-arching purpose of helping children manage anxiety and stress in disaster or pandemic situations is to restore safety, security, love and predictability to their lives. Creating a consistent daily routine while schools are closed reduces stress by restoring security and predictability for children. Be sure to incorporate meals, chores, academic work, recreation, reading and family fun into the schedule. Visuals help younger children follow the daily routine. Incorporating older children’s ideas into the schedule provides a sense of control over parts of their life when much else seems uncertain.
Exercise daily and outdoors whenever possible, while still following CDC guidelines regarding “sheltering at home” or social distancing. Intentionally ask your children how they are feeling and reassure them that you get similar feelings. Share facts about COVID 19 in age appropriate language. National Public Radio (NPR) posted facts in comic form. Teach them healthy self-talk, with singing or listening to uplifting music, prayer, grounding activities such as the 5 Senses, and relaxation exercises for lowering stress and anxiety. Creatively connect with loved ones, neighbors, school or sports friends, using social media, phone calls, handmade cards and “snail mail.” Limiting COVID 19 media exposure reduces anxiety for everyone. Frequently remind your children that expert adults are working hard to keep everybody healthy and the safest place to be is in your own home. Model for your children confidence, compassion for others, and how to find good in the uncertainty.
WHEN CHILDREN OR ADULTS NEED MORE…
If you or your child feel overwhelmed by your emotions due to this pandemic or the death of a loved one, speak with a local mental health professional or visit the
SAMHSA Helpful Resources Helplines or the
National Suicide Prevention Lifeline, 1-800-273-TALK (8255)
Wickes Hall 230
Program Coordinator - Dr. Kathleen Schachman
Wickes Hall 131-A