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Psychiatric nurse practitioners improve care for kids in mental health crisis

One answer to the mental health care provider shortage may lie in the hands of a relatively new type of nurse. Psychiatric-mental health nurse practitioners provide care for children and families with a whole-person approach.

Rasmussen University School of Nursing assistant vice president Josh Hamilton: “A psychiatrist might come in, adjust the patient’s medication and leave. Who is with the patient for the rest of the day? The nurse.”
Rasmussen University School of Nursing assistant vice president Josh Hamilton: “A psychiatrist might come in, adjust the patient’s medication and leave. Who is with the patient for the rest of the day? The nurse.”

Children are one of the groups hit hardest by the mental health crisis in the United States. With provider shortages, limited care options and few treatment beds available, many struggling young people have fallen between the cracks of the health care system.

One answer to this shortage may lie in the hands of a relatively new type of nurse, said Josh Hamilton, Rasmussen University School of Nursing assistant vice president and dean of post-licensure programs. Psychiatric-mental health nurse practitioners, advance practice nurses with mental health training and prescribing authority, provide care for children and families with a whole-person approach, he explained.

A year ago in April, Rasmussen, a Twin Cities-based university with 23 campuses nationwide, launched a psychiatric-mental health nurse practitioner program, said Hamilton, who is himself a practicing psychiatric nurse practitioner. The program’s goal is to train more nurses to take on this key role and help fill some of the existing care gaps. “We currently have students in our program,” Hamilton said. “And it’s growing quickly. We started planning this before COVID. We know it is important.”

When I spoke with Hamilton last week, he explained what he sees as the key role that nurses like himself can play in helping children and families through mental health crisis. This interview has been edited for length and clarity.

MinnPost: How would you describe the role of a psychiatric-mental health nurse practitioner?

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Josh Hamilton: Psychiatric-mental health nurse practitioners do similar work to what a psychiatrist would do but with a nurse’s viewpoint. With a nurse practitioner, the idea is prevention, helping a person avoid the hospital bed, getting to know the patient more intimately, to say, ideally, “I’ve known you when you were well  and I know your family, I know your supports, I know the community you live in because I live here, too.” Our approach is holistic. We see it as our job to keep people away from the hospital and instead use community supports and preventative measures to keep them living as part of the community.

Ever since we went through deinstitutionalization in the ’50s, ’60s and ’70s, we’re trying not to put people in psychiatric beds anymore. That’s true for everyone across the lifespan, but especially for kids.

MP: How are psychiatric-mental health nurse practitioners different from psychiatrists? 

Josh Hamilton
Josh Hamilton
JH: Our training basically mirrors one another. Many psychiatrists will tell you this, too. Historically, a lot of psychiatrists’ formal training was earmarked to psychotherapy, but over the years,  there has been a shift to focus more on medication management. So there’s a lot of reasons why psychiatrists are the folks who handle most of the medication for patients and have less of a focus on therapy. That’s where their skill set is. For a few years, that was the direction that psychiatric-mental health nurse practitioners were going is, too. But a decision was made to train our students to also be really good counselors and psychotherapists. In our training, equal time is given to psychotherapy and medication management.

MP: You’ve talked about the importance of keeping as many kids in mental health crisis as possible in recovery at home and out of hospitals. How can psychiatric-mental health nurse practitioners help meet this goal?

JH: By the time we get to the hospital, by the time we have kids in mental health crisis boarding in ERs, we’ve already missed early opportunities to help a family is in crisis. We don’t want to get to that point. Psychiatric-mental health nurse practitioners want to be there at the beginning. So we and our grad students go out into the community, we meet people in the public schools, in community centers. We tell them, “Don’t wait until you get into a mental health crisis to ask for help.” We tell parents, “Understand the red flags and warning signs in your children’s mental health, like changes in their behavior and how they are performing in school.”

Psychiatric-mental health nurse practitioners also teach kids in age-appropriate ways about monitoring their own emotions and moods, about the early warning signs that say, “Let’s intervene now.” I always say that that’s the point when I really like to hear the phone ring —  when things are in the early stages and we can keep things from getting out of hand.

MP: How do you get connected to your patients?

JH: Referrals, usually. I also work in family primary care and I see a kids for things like sports physicals, and our connection grows from there. If a kid is not doing well, where do parents take them? Maybe to the pediatrician. How do I get to them sooner? One way to do that is to train the people who surround those kiddos to understand what services I can provide for them while they are still in the early stages of a mental health crisis.

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MP: Let’s talk more about the importance of early intervention in mental health crisis. Why is this so important for children? 

JH: Everyone wants to err on the side of caution. Delayed psychiatric treatment can have untoward effects on a young person. So how do we react to a need and design services and wrap-around interventions that don’t involve a kiddo in crisis camping out in the emergency department of a hospital for a week?

Depression and other mental health issues look and feel much different in a child than they do in an adult. It is important to communicate and understand those differences and have them properly evaluated. Without intervention, a lot of these symptoms just kindle.

Time is brain tissue. Something I like to tell parents is, “You have to notice there’s a change early, because two sticks being rubbed together can kindle and start a fire.” Before that flashpoint happens, the fire can be slowed or stopped with an appropriate intervention. We want to keep that first flashpoint from happening, prevent the crisis and avoid more invasive care models.

MP: If a parent is concerned about their child’s mental health, and not comfortable with the care they are getting from their pediatrician, what is a good next step?

JH: Some primary care doctors aren’t as comfortable working with mental health medications or counseling because they haven’t had that kind of training. If a parent doesn’t get the reassurance they need from their child’s doctor, one solution is to call their insurance company and say they’d like to see a psychiatric-mental health nurse practitioner, to find out if there is one in their network.

MP: There are situations where hospitalization can’t be avoided. Do psychiatric-mental health nurse practitioners work in the psych departments of hospitals?

JH: They do. Nurse practitioners who work in hospitals usually achieve good outcomes with their patients. When a kiddo has been moved out of a home and into a hospital setting, having a psychiatric-mental health nurse practitioner on the care team can change the outcome just because we are thinking about their case from a holistic perspective. A psychiatrist might come in, adjust the patient’s medication and leave. Who is with the patient for the rest of the day? The nurse. We’re used to having that level of involvement. We never lose sight of the relationship that we’ve always had with our patients, and that makes a big difference in their care.

Editor’s note: Several readers have written asking for clarification of a statement made by Josh Hamilton stating that training for psychiatric-mental health nurse practitioners and psychiatrists, “basically mirrors one another.” There actually is a quantifiable difference between training for psychiatric-mental health nurse practitioners and psychiatrists. Training for psychiatrists is more extensive, lasting approximately eight years. They are MDs who complete four years of residency. Psychiatric mental-health nurse practitioners have a master’s degree or doctorate in nursing with a psychiatric nurse practitioner concentration. Their training lasts approximately six years. In many states, a psychiatric-mental health nurse practitioner must work under the supervision of a psychiatrist. More information on professional certification requirements for mental health professionals in Minnesota can be found here