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!
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.
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