As a family nurse practitioner in rural New Mexico, Diana Portillo, RN, MSN, DNP, felt confident caring for patients with complex chronic conditions such as diabetes and COPD. Those who came to her with mental health conditions anxiety, depression, post-traumatic stress disorder were another story.
Like many primary care providers, she had not received much training in mental health. But she had nowhere to refer them. Mental health professionals in the area were almost nonexistent. If I didnt treat them, who was going to? she asked.
Portillo did the best she could, but it bothered her that these patients were not getting the care she thought they needed. So when she was invited to apply for a job caring for mental health patients in rural communities near the Texas border while receiving intensive training and support from mental health experts in Albuquerque, she jumped at the chance.
Project ECHO (Extension for Community Healthcare Options), based at the University of New Mexico Health Sciences Center in Albuquerque, links patients and providers in rural areas with specialists in the treatment of complex conditions such as hepatitis C, HIV and chronic pain, and runs a weekly telecommunications clinic on addictions and psychiatry. Recently, ECHO received a three-year grant to train NPs and community health workers in eight rural community health centers to screen for, diagnose and treat mental health and addiction problems.
NPs receive two weeks of intensive training in behavioral healthcare, followed by weekly classes and consultations through the telecommunications mental health clinic, where they present cases and receive support from each other and mental health specialists. Each is paired with a community health worker, who is trained to assist with screening, conducting brief interventions, basic case management and health education. Project supporters hope that after completing the program, the participants will serve as resources in their communities for other providers and for patients with mental health conditions.
Recruiting primary care NPs to work with mental health patients was not easy, said Cristina Carlson, APRN, MSN, PMHCNS-BC, clinical nurse specialist with Project ECHO. Many PCPs dont know how to begin to care for patients with issues such as extreme anxiety, depression, schizophrenia or bipolar disorders, she said. Theyre scared to step into a new area. But once they begin the process [of assessing, diagnosing and treating mental health conditions]it becomes this wonderful journey. They start to develop a sense of competence.
For Portillo, the job has been life-changing. She has learned to confidently assess and treat mental illnesses including anxiety disorders, depression, severe bipolar disease and schizophrenia, and to work with patients who have addictions. She and her community health worker partner find resources for those who cant navigate the system on their own. She has watched patients turn around their lives.
One such patient was referred to Portillo by another provider in the clinic who was treating her for hypertension. The patient had been taking medication for depression but stopped nearly a year ago after losing her health insurance. Portillo helped her find a medication she could afford that helped stabilize her mood. Then Portillo offered to work with her to set goals. The patient said she would like to get a high school diploma, but she had no idea how to go about it. Big crowded classrooms made her anxious.
Portillo and the community health worker began checking with local community colleges. They found a school that could set up one-on-one tutoring in a separate room. She started tearing up, Portillo said. She couldnt believe she was going to get her diploma.
Spurred by her experiences, Portillo is looking into programs that would certify her as a psychiatric nurse practitioner. She plans to keep providing mental healthcare even after her work with Project ECHO ends.
The need for primary care in the area is huge, she said. But its even greater for mental healthcare.
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