DiversityNursing Blog

While physical health is undoubtedly important, so is Mental Health. Millions of Americans are affected by mental illness each year. Psychiatric Nurses have the specialized knowledge and skills needed to treat these illnesses. 

According to the American Psychiatric Nurses Association (APNA), Psychiatric Nurses make up the second largest group of behavioral health professionals in the U.S.

In the United States, suicide is a leading cause of death and in 2020, about:

• 1 in 5 American adults experienced a Mental Health issue
• 1 in 6 young people experienced a major depressive episode
• 1 in 20 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression

The pandemic has increased the need for Mental Health care. According to a report from the Centers for Disease Control (CDC), the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5% from August 2020 to February 2021.  

There is a dire need for more Psychiatric Mental Health Nurses (PMHNs).

More than 75% of all U.S. counties have a shortage of Mental Health professionals and almost all counties have an unmet need for Psychiatrists.

Mental Health Nurses work in a wide variety of inpatient and outpatient work settings, either as a specialty position or in primary care. Some job opportunities include military care, forensics, private practices, clinics, community health centers, public health facilities, schools, substance abuse centers, senior centers, hospice, rehabilitation services, telehealth and case management.

The day to day duties of PMHNs include:

• Conducting an assessment of a patient’s status
• Conducting intake screenings, initial evaluation, and triage
• Providing nursing care following a treatment plan
• Administering medication and/or other treatment regimens
• Teaching patients self-care activities
• Engaging in crisis intervention and situation stabilization (when necessary)
• Educating patients on how to manage their condition
• Providing education to patients’ families and communities
• Working efficiently alongside other members of an interdisciplinary team

“It’s a very rewarding field. As a Psychiatric health care provider, you may be the first person to talk to someone about why they are in crisis, and that can be a humbling experience," said Emma Mangano, DNP, PMHNP at Johns Hopkins Hospital. 

Some essential traits of a Mental Health Nurse include:

• Critical Thinking
• Good Communication
• Empathy
• Reliability 
• Confidence
• Compassion

The salary of a PMHN depends on their level of experience and the amount of specialized training they have undergone. According to Indeed, the average Mental Health Nurse's salary in the U.S. is $87,156.

A career in Mental Health Nursing can be demanding, but it is extremely rewarding.

Psychiatric/Mental Health Nurse Practitioner (PMHNP) Windi Woods, says that the best part of the job is “knowing that this team is the end of the road for most of these patients and we give them hope." 

Art therapy is a growing trend throughout hospitals in the United States. Art therapy is an evidenced-based practice that supports the emotional, physical, social and spiritual well-being of patients of all ages through the therapeutic use of art-making. 

These programs use a wide range of outlets such as drawing, painting, sculpting, collage, and photography as tools to:

• Process feelings about a new diagnosis 
• Provide a sense of control through normalizing activities to help them adjust to hospitalization and/or illness
• Cause relaxation and reduction of anxiety
• Rebuild self-esteem
• Help manage pain
• Support groups of patients with similar diagnosis
• Support siblings and family members in caring for their loved one in the hospital
• And more!

Childrens National Hospital uses trained art therapists who offer resources like nature art therapy in the Healing Garden and gallery displays to give children the opportunity to express themselves through creative activities. They are also a Beads of Courage member hospital.

The University of Florida Shands Hospital arts in medicine program started small back in 1990. Jill Sonke, an artist at the hospital said, "No one is suggesting in arts and health that the arts can replace medicine or health care or other therapies or interventions. But the arts have a place in the sphere of whole person care. There's so many ways in which the arts can address things like loneliness and social isolation."

Not every hospital has an in-house art program, many bring in outside help from organizations such as, the Museum of Fine Arts (MFA) or the Caring Arts Foundation Program.

MFA Artful Healing offers art-making activities for children, teens, young adults, and their families in Boston-area hospitals and healthcare centers. The MFA currently provides off-site workshops at Boston Children's Hospital, Massachusetts General Hospital, and Dana-Farber Cancer Institute.

A Parent at Boston Children's Hospital said, "We’ve been here more than ten times in the last two weeks . . . but this is the first time I’ve seen my son smiling. Thank you for that!”

The Caring Arts Foundation Program uses professional photographers to take portraits of patients and their families at Lurie Children’s Hospital. They provide fun wardrobes and props. A common area in the hospital is transformed into a studio with lighting and backdrops. Parents are provided with a full set of photos of their child at no cost — a priceless keepsake. These photo sessions give patients and their families a break from cancer treatment while providing lasting memories. 

There are large disparities in mental healthcare across races and ethnicities in the U.S. Many factors contribute to the poor mental health outcomes of minority populations. Such as:

• Inaccessible mental healthcare services
• Transportation issues, difficulty finding childcare/taking time off work
• Lacking health insurance coverage
• Cultural stigma regarding mental healthcare
• The lack of Black, Indigenous, and people of color (BIPOC) healthcare professionals
• Racism, bias, and discrimination in healthcare
• Language barriers

Even before the pandemic, healthcare providers experienced burnout and other negative mental health issues. Now more than ever, it is critical health systems take steps to support their staff's well-being.

Recently, more healthcare organizations have started to hire Chief Wellness Officers (CWO), as a strategy to address burnout, mental health, and compassion fatigue.

Jonathan Ripp MD, MPH, Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai, said there were only a handful of Chief Wellness Officer positions when he was appointed to the role in May 2018. “There has been at least a dozen more who have been named in the past year, and several more places that are looking to create the position,” said Dr. Ripp. “I would not be surprised if, 10 years from now, it's commonplace for most large organizations to have a Chief Wellness Officer or equivalent, taking this challenge on, and doing so in a way that is effective.”

The ultimate goal of this role is to aid system-wide changes that enable staff to practice in a culture that prioritizes and promotes mental health and well-being.

The CWO is responsible for measuring well-being across their organization. Then, they create and implement wellness programs that address the current environment causing burnout and stress.

The hiring of a CWO is not a remedy all on its own. The CWO works in collaboration with other leaders and staff to prioritize well-being and would ultimately lower costs and improve patient care.

According to Beckers Hospital Review, burnout and depression result in major costs to health systems due to an increase in medical errors, reduced quality of care, and turnover. Research has found that for every dollar invested in wellness, hospitals can see a $3 to $6 return on investment.

Medical Schools are also following the hiring trend.

Holder said, "Mental and emotional wellness is essential to complete health. We simply cannot ignore this fact. I view my role as another way to serve the students, faculty and physicians in Brown’s medical school, and aid them in not just meeting their immediate self-care needs but also creating and developing plans that can help them learn more about how to take care of themselves in a way that's sustainable for a profession that demands a lot."

“Wellness and self-care is more important than ever before. These next few years will be critical for health care workers as we address the mental and physical burdens from COVID-19,” said George Washington University's Chief Wellness Officer, Lorenzo Norris, MD.

Hopefully this position sticks around, even after the pandemic passes, because burnout and mental health have been issues in the healthcare field all along.

Hospitals are seeing more cases of severe depression and suicidal thoughts among children, particularly attempts to overdose. 

The coronavirus pandemic has drastically changed the way children and teens learn, play and socialize. Many studies found forced isolation and loneliness among children correlated with an increased risk of depression.

Children’s Hospital Colorado, declared a "State of Emergency" in youth mental health. Jena Hausmann, CEO said, "It has been devastating to see suicide become the leading cause of death for Colorado’s children." 

According to the CDC, the proportion of children who arrived in emergency departments with mental health issues increased 24% from March through October 2020, compared with the same period in 2019. Among preteens and adolescents, it rose by 31%. 

Matthew Davis, MD, MAPP, Chair of the Department of Medicine at Lurie Children’s, emphasized the need for accessible, affordable mental health care for pediatric patients has greatly increased because of the pandemic. In fact, nearly 1 in 5 parents said they were unable to access  mental or behavioral health care for their child at some point, most often because they could not find a specialty provider, they could not afford it, or they could not get an appointment in a timely fashion.

Some hospitals like Cincinnati Children’s Hospital Medical Center in Ohio report running at full capacity and having more children “boarding,” or sleeping in EDs before being admitted to the psychiatric unit. 

Terrie Andrews, a Psychologist and Administrator of behavioral health at Wolfson Children’s Hospital in Florida said, "Up to 25 children have been held on surgical floors while waiting for a spot to open in the inpatient psychiatric unit. Their wait could last as long as five days."

Hospitals are not only seeing a higher volume of patients, but these patients have more intense illnesses.

Dr. Jennifer Downs, a pediatric psychiatrist at Connecticut Children’s said, “Instead of seeing kids who are saying, ‘I’m thinking about suicide,’ we’re seeing kids who have had attempts. Instead of seeing kids who are maybe brought in because of parents who feel that they’re verbally out of control, yelling, screaming, saying awful things, we’re seeing kids who are having physical aggression.”

According to The American Academy of Pediatrics, if you notice any of the following symptoms in your children, be sure to contact your child’s Physician as soon as possible:

– unusual changes in mood, such as ongoing irritability, feelings of hopelessness or rage, and frequent conflicts with friends and family
– changes in behavior, such as stepping back from personal relationships
– a loss of interest in activities previously enjoyed
– a hard time falling or staying asleep, or starting to sleep all the time
– changes in appetite, weight, or eating patterns
– problems with memory, thinking, or concentration
– less interest in schoolwork and drop in academic effort
– changes in appearance, such as lack of basic personal hygiene
– an increase in risky or reckless behaviors, such as using drugs or alcohol

If you have contemplated suicide or someone you know has talked about it, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Chat, both available 24 hours a day, seven days a week.

Before the COVID-19 pandemic, Nursing was known to be a stressful profession. There was plenty of data showing burnout to be a significant problem among US Nurses.

With increasing stress placed on front line Nurses during this pandemic, hospitals are investing in initiatives and programs to support the mental health of these employees.

Mount Sinai Health System, created recharge rooms for healthcare workers. Dr. Putrino and his team created multi-sensory experiences that can reduce stress in just 15 minutes. These rooms are filled with faux plants and candles, illuminated with calming lights and one wall displays relaxing scenes and sounds. Putrino said, "Listen, what we need is a space or a series of spaces where our healthcare workers can sit down and for just a moment have a lot of their stress just relieved and taken away from them."

Stony Brook Medicine used a similar idea when creating a respite room called "Resilience at the Brook." The large, peaceful area features plants, calming wall art, a pod for private mediation, and relaxing materials, such as coloring books and miniature Zen gardens, to help employees rejuvenate. Employees can also add encouraging messages and quotes to inspire each other on the Motivation Mural Wall.

Ohio State University Medical Center (OSUMC) Stress, Trauma and Resilience (STAR) Program uses the Buckeye Paws program. A group of certified therapy dogs visit to provide comfort and emotional support to healthcare staff.

Emily Fawcett, R.N., a float Nurse on all floors at Lenox Hill hospital, started "hope huddles." Hope huddles are held at the beginning of shift changes and Nurses gather together to share news of patients recovering and other inspiring, and even humorous, stories.

Cody Regional Health created a wellness area for employees. The new space, staffed 24/7, includes a meditation room, eight bedrooms with private bathrooms, laundry and shower facilities, on-site access to licensed therapists for emotional support, puzzles and games, and an exercise area to meet employees’ needs.

Elise Phelan, a surgical unit Charge Nurse at UCHealth created the Resilience Program. Phelan would bring in massage therapists, movement therapists, yoga instructors, nutritionists and sometimes therapy puppies.

Code Lavender began in 2008 with Earl Bakken at North Hawaii Community Hospital. Calling the code signals to the Code Lavender team that an individual or group of individuals are in need of emergency psychological assistance.

Many hospitals like Cleveland Clinic have started implementing this code. The Code Lavender team usually comprises representatives from the spiritual care and healing services departments, and other hospital-based support services (such as employee assistance, music therapy, wellness, the ethics consultation service, and art therapy), and volunteers.

Bayhealth offers staff Code Lavender Kits. Kits include a back massager, aromatherapy inhalers, LED candles, a sound machine, Code Lavender journals, and a tote to store everything in.

It's very clear there is a need for this kind of support and innovation. The well-being and morale of front line workers should remain a top priority even after the pandemic.

Many Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!

Approximately 56 million American adults are struggling with a mental illness or substance use disorder, according to the American Psychiatric Nurses Association (APNA).

An article from mentalhealth.gov, shows the current mental health workforce shortage is projected to grow and would leave the country 250,000 professionals short by 2025.

Only 44% of adults and 20% of children in the U.S. receive the mental health and substance use care they need because there is a growing shortage of qualified professionals trained to provide timely and effective treatment.

This lack of treatment significantly contributes to one of the leading causes of death in the U.S, suicide.

According to the same mentalhealth.gov article, suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 lives each year, more than double the number of lives lost to homicide.

An article in the Journal of the American Medical Association (JAMA) discusses the increase in children under 18 going to emergency departments due to attempts of suicide or suicidal ideation.

One reason demand for mental health professionals has increased is because more Americans are gaining health coverage. It's the law per the Affordable Care Act that insurers can no longer deny coverage to people who have diagnosed mental illnesses.

Also fewer medical students are specializing in psychiatry because psychiatry jobs don't pay as well as other fields. Students facing high medical school debt are more likely to pick the jobs offering better pay.

There has also been a surge in substance use disorders and greater public awareness of mental illness. Increased public awareness means more people living with mental illness will seek treatment.

Healthcare providers and the medical community at large need to implement a more supportive environment for the psychiatry profession. There should also be increased compensation for psychiatry jobs and student loan forgiveness or free/low-cost psychiatry schooling.

Policy makers should support and enact quality mental health services that will improve public health, particularly populations who most often have no access to mental health services.

Mental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, background and identity can make access to mental health treatment much more difficult.

July is National Minority Mental Health Awareness Month and the month offers organizations an opportunity to create mental health awareness in diverse communities. 

In May of 2008, the US House of Representatives announced July as Bebe Moore Campbell National Minority Mental Health Awareness Month.

The resolution was sponsored by Rep. Albert Wynn and cosponsored by a large bipartisan group to improve access to mental health treatment and services and promote public awareness of mental illness.

Bebe Moore Campbell was an author, advocate, co-founder of NAMI Urban Los Angeles and national spokesperson, who lost her battle with cancer in November 2006.

One in 5 Americans is affected by mental health conditions. Stigma is toxic to their mental health because it creates an environment of shame, fear and silence that prevents many people from seeking help and treatment. The perception of mental illness won’t change unless we act to change it.

Ways to get involved

• National Minority Mental Health Awareness Month Facebook page
• Tweet using #MinorityMentalHealth
• Take the pledge to raise awareness

America’s entire mental health system needs improvement, including when it comes to serving marginalized communities. With all of our help, we hope this month brings awareness to this issue.