Sunday, December 19, 2010

How Do You Make Them See The Light?

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I see so many patients that are in various stages of mental health difficulties. Most are coping fairly well, but a few are not doing as well as others due to the time of year. I am sure that you all have noticed that October through January is a tough time for patients due to family member losses, changes in their income, insurance status or just the winter time blues.

I screen for anxiety and depression on just about every visit and it's not hard to do. Just ask them, "How are you really doing?" You will amazed at the number of patients who are struggling and just wanted someone to listen. In the rural setting where I work there is almost no access to mental health resources. It would be nice to just sit and talk to patients and counsel them but I only get paid by seeing them for medical reasons. I wish that we were in the old days when your health care provider took care of the entire person. I feel like the trend may be coming back with nurse practitioner led medical homes.

Unfortunately, I also get patients who try to take advantage of my concern for their mental health and ask for inappropriate medications such as xanax or valium without having tried any of the baseline drugs such as Celexa, Prozac, Lexapro, and Wellbutrin etc. I ESPECIALLY hate when patients ask for meds by their street names. Don't they realize that it makes big bells ring in our heads when that happens? Or the usual "I've tried all those and the ONLY thing that works is Xanie bars." I tell them that if that is the only medication that works, then they need to be under the care of a psychiatrist and that it's out of my scope of practice in Florida to write those meds.

As soon as our expansion finishes, I hope to hear that a mental health counselor will be available to help us with the longer consultations that are needed. For you new NPs, brush up on your mental health meds because it's becoming more and more part of Family practice.


  1. I am in the process of deciding whether or not to pursue a Psychiatric Nurse Practitioner degree. It seems everywhere I look, there is an increasing awareness and need for this specialty. Thanks for highlighting this issue.

  2. Kellgy, Unless you are in an area where Psych NPs are utilized a lot, Family NP is a more flexible route. I know that specialty NPs make more money though. Hard to decide.

  3. Anonymous2:31 PM

    What I would like in the ED is a good, reasonably safe package to offer someone when they screen positive for depression and/or anxiety. Starting psych meds out of the ED is not popular. Talk therapy is hard to find for people who can't pay.

  4. Anonymous, I know that often you see people in the Emergency room setting and probably never see them again. I imagine that it's hard knowing that their mental health is as much at stake and not being able to treat long term is nervewracking.

  5. sad to hear that there are patients who really take advantage of your concern for mental health and ask for appropriate medications. If these would be the dilemma I think patient should be reminded that medication is not only the solution to their problem there are a lot of things to consider if they want to get better.

  6. If you ask me, Family NP is a more flexible route to pursue.

  7. Working in the ED when I find people with depression that needs help I call a local non profit. I can get them in within a day or two and they will get a phone contact or face to face before Discharge.