The Human-Made Mental Health Crisis
- Megan Hawk
- Oct 29
- 6 min read
Updated: Oct 30
My job is tough right now.
I direct a psychiatric mental health nurse practitioner (PMHNP) program. When learners complete this program, they will be eligible to sit for ANCC board certification for the same title. They can then obtain state licensure and see patients under the scope and standards of practice of a PMHNP. Only PMHNPs don't typically practice to the full extent of their scope in the currently flawed medical system.
I want to embrace the role of the PMHNP in its full scope. The expertise of the PMHNP has potential long-term benefits that should not be overlooked.
We're practically superheroes.
According to the American Nurses Association (ANA) and American Psychiatric Nurses Association (APNA), Scope and Standards, the PMHNP can also:
•Critically evaluate the manner in which environmental health issues are presented by the media and understood by the general public
• Create partnerships that promote sustainable, global environmental health policies and conditions
• Utilize organizational and community resources to formulate interprofessional plans of care and policy
• Promote a climate of research, practice improvement, and clinical inquiry
• Strive to be open and curious about the experiences and treatment desires of patients/clients and families that come from and hold diverse health care perspectives.
•Engage in frequent self-reflection to assess for presence of personal biases when working with culturally diverse individuals, groups, and communities
•Utilize ethical principles to advocate for access and parity of services for mental health problems, psychiatric disorders, and addiction services (ANA, 2022).
This is a huge jump from our role as psychopharmacologist at mental health agencies. Even private practice is tough due to inconsistencies in state laws for advanced nursing practice including the need for collaboration among other regulatory and legislative hurdles.
But advocating for access?
Evaluating environmental health issues presented by the media?
We have the expertise. We should be doing these things.
So, I also run the final course in the program and I want to share some of the content with you.
I've fine tuned it to align with the full scope of the PMHNP and our humanist approach to care.
I can't describe it as well as I'd like in a single blog post, but the course focuses on special populations (pregnant patients or the elderly are examples of groups that require extra considerations in clinical practice).
Weekly topics include:
Perfecting the biopsychosocial assessment. Learners use their psychiatric interviewing skills to create full profiles of their clients. They use this profile to work together with the client/family to develop a plan everyone agrees with that aligns with current evidence. You can reflect on your life and complete one, too. You might find it enlightening.
Motivational Interviewing. It's not a type of therapy, it's simply a way to get clients to reflect on their own thoughts and get them thinking about change. It was initially used in substance abuse, but has been extended into use in stopping smoking, even in making dietary modifications. Think of it as a technique for bad habits.
The course references frameworks like the Minority Stress Model devised by Ilan Meyer in 2003:
According to Meyer, there are three underlying tenets in minority stress.:
Minority stress is in addition to the regular stressors that everyone experiences such as job pressures or relationship issues. Hence, stigmatized people must cope with more stress than those in dominant groups.
Minority stress is chronic because it is derived from stable and ongoing social and cultural processes.
Minority stress is societally based: “it stems from societal processes, institutions, and structures beyond the individual … (Meyer, 2003, p. 4).
Bearing this in mind, the students navigate managing pregnant clients in psychiatric distress, psychiatric emergencies, polypharmacy in the elderly; in children; in the developmentally disabled. They learn to manage sleep disturbances in all ages, trauma-related syndromes, disordered eating, all while acknowledging the impact that social determinants of health have on American citizens' health status.
The course naturally uncovers disparities in American healthcare and highlights an uncomfortable truth:
Our current mental health crisis is largely societally-based.
It has been cultivated over time, alongside a rapidly changing sociopolitical landscape. Of course I don't explicitly state this; it just becomes evident the more I read.
Let me provide a few excerpts that inspired me to write this post.
Poignant Quotes from Recent Advanced Psychiatric Mental Health Nursing Literature:
"Sexual and gender minorities are disproportionately impacted by suicide, homelessness, HIV/STIs, substance use, and alcohol use, among other disparities (U.S. Department of Health and Human Services, 2020). Gender minorities face additional challenges relating to discrimination, victimization, mental health, insurance coverage, and access to care (James et al., 2016). Gender and sexual diversity exist on a continuum of normal human characteristics. Sexual and gender diversity are not the reasons why SGM people face greater mental health disparities. Rather, the effect of being confronted with social stigma and discrimination based on identity drives these health disparities" (Fitzpatrick et al., 2022, p. 548).
"Family support is the single greatest predictor of subsequent mental health outcomes for SGM youth. SGM people who grow up in families that are affirming of their identities have risk behaviors similar to other youth (Kahn et al., 2018; Ryan et al., 2010) and can lead happy, productive lives.
Sexual minorities experiencing higher rates of family rejection reported poorer health outcomes including increased depression and increased likelihood of suicide attempts, substance use, and unprotected sex (Ryan et al., 2009)." (Fitzpatrick et al., 2022, p.548).
"Most often, perpetrators of child maltreatment are the people who are closest to the child, including parents (77.6%) and relatives other than a parent (6.2%), with 53.7% of offenders being women and 45.3% men (USDHHS 2018). Parents constitute the largest group of offenders (80%), with biological parents comprising nearly 90% of the parent offender group.... In 2016, 3.5 million referrals were made to child protection agencies for 676 000 children who had been determined to be victims of child maltreatment...Children younger than 1 year of age account for the highest victimization (24.8%) (USDHHS 2018). Children under age 1 are at the greatest risk of death and serious injury resulting from child maltreatment, with this risk decreasing with age..." (Yearwood et al., 2022, p. 427).
Finally, a succinct synthesis from Boland et al.'s Synopsis of Psychiatry (2021):
"Most rapists are male, and most victims are female. Male rape does occur, however, often in institutions where men are detained (e.g., prisons). Women between the ages of 16 and 24 years are in the highest risk category, but female victims as young as 15 months and as old as 82 years have been raped. More than a third of all rapes are committed by rapists known to the victim, 7 percent by close relatives. About one-quarter of rapes involve more than one rapist (gang rape)."
So many man-made tragedies and traumas.
The words we use matter, the action we take (or don't take) matters. In some instances, silence carries a heavier meaning than any words said.
But as Desmond Tutu famously stated, "There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in". This quote indicates that we should be investigating the root case of these issues rather than treating them as they occur.
What are the roots?
Alongside the obvious meeting of course andf program outcomes, my hope is that the learners who complete my PMHNP program are ready to look at the whole person and emphasize genuine mental health. This includes examining our roots; the long-held beliefs we have, along with the biological, psychological, and social factors that influence our mental health.
Due to the sensitivity of some of the topics, PMHNP students are encouraged to engage in frequent self-reflection for implicit biases or areas of discomfort.
The PMHNP helps people impacted by tragedies; it's heavy work. They are prepared to treat challenges with family dynamics; poor family dynamics may lead to depression in youth (Shi et al., 2023).
It's a career that evolves along with humanity; I love nursing for that.
I completed my doctoral work on mental health literacy (MHL), or the knowledge, skills, and attitudes that enable individuals to understand, recognize, and manage their own mental health and the mental health of others. We all have a role to play in the mental heath crisis. In future posts, I'll spend time digging into these mental health literacy topics more.
Would you like specific mental health literacy content?
No
Yes - ADHD
Yes - Autism
Yes - Anxiety
Until next time!
~Megan
References
American Psychiatric Nurses Association (2022). Psychiatric-mental health nursing: Scope and standards of practice (3rd ed.). American Nurses Association ISBN: 978-1947800977
Boland, R., Verduin, M., Ruiz, P. (2021). Kaplan and Sadock’s Synopsis of psychiatry (12th ed.). Wolters Kluwer.
Fitzpatrick, K.T.J. J. (2022). Advanced practice psychiatric nursing (3rd ed.). Springer Publishing LLC.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Shi, J., Tao, Y., Yan, C., Zhao, X., Wu, X., Zhang, T., Zhong, C., Sun, J., & Hu, M. (2023). A study on the correlation between family dynamic factors and depression in adolescents. Frontiers in psychiatry, 13, 1025168. https://doi.org/10.3389/fpsyt.2022.1025168
Yearwood, E. L., Pearson, G. S., & Newland J. A. (2021). Child and adolescent behavioral health. Wiley-Blackwell.
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