Behavioral Health Integration in Primary Care
[Music] [Music] hello and welcome to this episode of registered nurses in primary care I’m your host Emily Patton we are privileged to have dr. Carmy Johnson with us today dr. Johnson is an assistant professor and the Paul D Coverdell peace corps fellows coordinator at UAB School of Nursing dr. Johnson is also a psychiatric mental health nurse practitioner with a faculty practice at path clinic for diabetes which is a UAB nurse managed clinic additionally she is the Wellness nurse for the nurse Family Partnership of central Alabama welcome dr. Johnson happy to be here Emily today we will be talking about behavioral health integration and primary care so dr. Johnson what exactly is behavioral health integration so behavioral health integration is a newer term for a concept I think nurses have been doing for decades which is when we talk about mental health and that’s kind of a newer term too I think for years we’ve used the term psych psych helping and people don’t like that term because of the stigma that have been related to it about I don’t need to psych help I’m not crazy but we’ve ignored the relationship with the brain with our overall mental health in our body for years and we what we’ve ignored too is that when we’re not feeling well when we’re depressed when we’re anxious when we’re stressed that we’re not going to attend to the things that we need to do to make us healthiest we’re not going to be you know in terms of healthcare compliant with our medication we’re not going to watch our diet the way we should we’re not going to want to get up and exercise we’re not going to want to concentrate on spending time with our family and friends we won’t be able to even do that stuff and so then all of that the the kind of that relationship does affect our behaviors and so what we’re specifically looking at with behavioral health integration is if you’re not feeling well what are you not able to do and how do we normalize that how are we able to just kind of talk about that for people so that they don’t feel oh I’m you know I’m not crazy I’m just not feeling as well as I can and that’s a really important thing so why do you think that behavioral health integration is essential in primary care I think it’s essential in all aspects of care I share this that I teach at the School of Nursing in the undergraduate program and I ask you know one of the first days of class how many of you think that you will go into psychiatric nursing and very few students raise their hand everyone’s like no I don’t I don’t want to do that and I share that sentiment when I was in nursing school I thought no I’m I’m gonna work in the ER I’m never gonna be a psych nurse and I tell them every single one of you will be a psych nurse you will all be mental health nurses because what’s a normal day to us what’s us clocking in is a traumatic experience for most of our patients if we’re talking about the hospital if you’re talking about in a clinic what is a normal day for us is a chance for someone to say you know I don’t feel as good as I as I should or you know I’ve been having these thoughts all right I can’t get out of bed the way that I used to so I think that integrating that into primary care is something again that nurses have probably been doing all of you know throughout the entirety of Nursing it’s a profession of caring and so asking those questions about how people feel has always been really important to us I like that you mentioned that as nurses we all are mental health nurses it’s something I definitely experienced as a med-surg nurse that surprised me yeah so were there any instances that you can remember as an ER nurse where you thought that it would have been helpful to have some kind of integration of behavioral health or ways that you saw it being integrated appropriately do you know I think and that’s what led me to it again I in nursing school I was like I mean you are all day I like the pace I you know mental health that’s for people that again thats that stigma that taboo that’s for people with these problems and and we tend to put it in this idea of the severely mentally ill and the fact is it’s all of us every single person is going to have times in which you know they have anxiety when they have stressors that weigh them down and to be able to talk about that and I think that the thing that really struck me and it’s it’s the area of Nursing I love the most which is the ability to establish let’s report to therapeutically communicate it’s the thing that we I think across all other disciplines teach the best it’s why people trust nurses the most it’s why there was this really great study that I’ll just refer to quickly that looked at the amount of time that providers spend with their patients and they gave them the same amount of time ten minutes but when they asked patients later how much time do you think your nurse or your nurse practitioners spent with you the patient said fifteen minutes and it was like no they they really only spent ten but that idea of establishing rapport of asking questions to elicit how the patient feels what’s really going on with them we do that very very well and so I think that that’s something that as a primary care nurse says as a registered nurse just being able to utilize that because I’ll be honest when my nurse when my nursing instructors told me that you will have this skill I was very interested in starting IVs and and that kind of thing and that has been the skill that has helped me out the most prior to me deciding to specialize in psychiatric mental health nursing that was the skill I thought that really connected with my patients because I could listen to them and they felt at their most vulnerable enough trust in me to share this kind of information they trusted me enough for when I said you know have you thought about doing this how do we normalize the way you’re feeling with what you can do that to me is a gift that’s a that’s a gift that nurses both have and are given yeah I think that’s so important so you have a faculty practice at the path clinic tell us a little bit about ways that behavioral health is integrated into that primary care setting yeah it’s what’s wonderful is we get to utilize the ICPC model so we you know have an interprofessional collaboration model that we use doctors and optometry and Social Work dieticians and so what’s great is I think often times we are hesitant to ask people about how they feel about if they’re depressed if they’re anxious if they’re suicidal because we’re afraid that we don’t know what to do if the answer is we’ll avoid the question because we’re like I just I don’t know what to say if the answer is yes and I think having that model being able to work within that clinic and integrate some of what I do I tell people that what what I do not that it’s easy it’s not as difficult as people want to make it it’s not as difficult it’s just caring enough to ask it’s the thing I tell my students you don’t have to know all the answers but you should know some resources and you shouldn’t be afraid to ask those questions and so I think that one of the things that I think has been great for me is it’s given the other providers a level of comfort to ask we’ve had the same thing happen with the other partnership that I work with the nurse Family Partnership which we have home visiting nurses that go to first-time moms in Jefferson Fayette and Walker County and on there as a resource to them but what’s been wonderful is that the connection that they’ve made with their assigned registered nurse so much is revealed so much that we’ve seen that that we did not anticipate people being able to talk about intimate partner violence people being able to talk about this concept that we don’t assign under mental health but loneliness what happens when you’re isolated and being able to feel open to talk about that has been something that just just me providing backup for these wonderful nurses who who do the work and to make these strong connections because we’re trained to do that because we have been given the gift of being able to do that it’s something that I’ve just loved being a part of I like that you mentioned the interprofessional care team and the different roles can you tell us a little bit more about specifically the role of the RN as part of the interprofessional care team and integrating behavioral health yeah I think that again it goes back to that level of trust that I think that when people are going to open up with their vulnerability with how they’re feeling I do think it’s going to be to nurses you’re going to be the it’s that it’s not even that friendly face its that caring face that also is matched with that professionalism to know I think that that’s the person they’re going to share these things with they’re going to feel they have the time they’re going to feel that this person is going to want to hear these things and so I think having that openness to hearing that to knowing that you also have the professional backup to do it is going to be is huge and that’s what patients want they want that great combination that nurses can provide yeah well dr. Johnson this has been very informative and we thank you for being here with us today thank you so much yeah thank you so please join us for our next episode of registered nurses and primary care [Music]
Behavioral health is an important component of primary care. Learn the role of the RN in behavioral health integration.
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