#bc that should help me find a vocational job
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hearteyesdiaz · 1 year ago
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We just signed up for German classes. In 5 weeks I should have my A1 certificate!! :D
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0ystercatcher · 2 years ago
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What would make you think that this career was the wrong choice for u? When i graduated i was hyped but a year later i worry i might have wasted my degree idk if its a long depression stunt or a moment of self awareness or just losing rose tinted glasses aaaa idk
lol i already kinda think it was in some ways, i especially relate to having rose tinted glasses post graduation and i do still think i wasted a degree. its many things tbh but perhaps the main one is that design isnt. really all that much? its making pictures and i dont necessarily think i needed (or should have spent sooo much fucking money on) a 5 year degree for making pictures. not that uni was Bad, but im not convinced it was worth it considering avg designer salary here and the fact that its not a career that requires a degree to make sure youre able to design or get a job (tho it never doesnt help). design is at best a trade im not sure why it became a Degree its not worth that lol.
the second is that design is very "limited" and the field is so closely tied to advertising it made me wanna kms every time i looked at job offers and thought id end up doing that. thankfully i ended up getting a job in a field i always liked where i get to do design but also fuck around w other things so not all was lost idk. in general....idk. starting to work makes you actually see what you went to university for and i dont think theres many career options out there where its a particularily Nice realization to see the way the job market actually works.
but honestly despite this im not...unhappy either. its really not as bad as it looks and i do not think designers are the only ones to struggle with this. we live in hilariously bad times for labor and universities really are very disconnected from what the world needs, its not really surprising so many of us end up feeling fucked up after grad.
but umm first and you have t realize youre not as stuck as you might feel. dont focus on finding the "right career for you" bc there is no such thing, there are going to be soooo many types of work you can find fullfillment in you will not have time to do them all, thinking you have one "vocation" is not a good framework and will just give ou insane fomo. focus on getting a job in an area you are at least interested in (designers r lucky bc our work crosses paths with soooo many industries) and then see whats up. you can work yourself into different disciplines and get enough experience to change lanes if you want to later it just takes a little time. but as i said we live in a shitty time for labor in general so always b cautious abt work conditions and dont overwork yourself if you can help it its not worth it.
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princess-of-france · 5 years ago
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I’m interested in your take on Angelo & Isabella w/ personality parallels (also just your opinion on Angelo especially tbh because I feel like I under-analyzed him when I read the play bc I was just. Well, found him scary :P) because obviously w/ your production you’re pretty deep in and I don’t see a lot of MFM content
Oof, this is a loaded question.
I’m happy to answer it, but I think I should make a disclaimer that—as you point out—my opinions of Angelo are skewed by my experiences as an actor inside a specific production. I’m also not an English scholar; I’m a theater artist. My lit crit skills are dodgy at best (as @lizbennett2013 knows all too well), and I don’t believe there is a single way to interpret any character in drama, especially when you’re dealing with heightened text. All I can do is give my honest appraisal of Angelo as I have encountered him dramaturgically through cutting our script, rehearsing Isabella, and seeing his iterations in other productions. 
So! Angelo and Isabella. Two sides of the same coin. I really think they are.
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Let’s get the obvious stuff out of the way first: Angelo is scary. He just is. His sexually motivated exploitation of authority continues to be one of the most transcendent aspects of this ever-timely play. However you stage it, however you trim the text, whatever charismatic actor you slot into the role, Angelo is a capital-T-Terror and there’s no getting around it. Coercive, manipulative, hypocritical, ruthless, misogynistic, fraudulent, and cruel, he basically spends the entirety of MEASURE FOR MEASURE committing crimes and then soliloquizing about how painful it all is for his bargain-price conscience. You’ll never hear me say he doesn’t deserve his reputation as one of the most reprehensible tyrants in all of Shakespeare. 
But.
Of the three defining qualities I see in Angelo—ideological dogmatism, rhetorical prowess, and professional pride—there’s not one of them that is not blisteringly prominent in his antagonist, Isabella. Despite the fact that she’s a Catholic republican (“Butt out of people’s lives, Big Government; God will judge us when we die!”) and he’s a Puritan[ical] bureaucrat (“My job is to regulate people’s lives because purgatory is a myth!”), they have far more in common, cognitively, than not. Understand: I’m not saying that Angelo is not a piece of shit for how he behaves throughout course of the play. Nor am I implying that Isabella is somehow culpable for his masturbatory exercise of power over her. My girl has flaws, but she’s unquestionably the hero of M4M. What I’m trying to articulate is that Angelo and Isabella were born with the same psychological toolkit, which they elect to apply towards radically different purposes. (Think Parseltongue and “It is our choices that show who we truly are, far more than our abilities…”) This shared intellectual arsenal is what makes their pair of scenes in Act Two so iconic. We basically get to watch them play out Newton’s Third Law in real time: for every action, there is an equal and opposite reaction… As far as rhetoric goes, neither Isabella nor Angelo can overwhelm the other. For every argument she makes in favor of mercy, he punctures it with legalism. For every judicial explication he provides, she dissolves it with morality. One minute, we’re nodding our heads along with Angelo as he explains why Christian values should have no place in a court of law; the next, we’re on our feet cheering for Isabella to convince him to factor human integrity into his role as a public servant. I can’t read 2.2 as anything other than the blueprint for every screenplay Aaron Sorkin ever wrote. It is the ultimate courtroom drama.
Just look at the play’s opening act. Angelo’s hasty promotion aside, both he and Isabella begin the story at the lowest rung of their respective vocational ladders: he’s a would-be Chief Justice, she’s a would-be Prioress. Deputy/nun. Politics/religion. Different spheres/same ambition. And, in like true zealots, both Angelo and Isabella express their commitment to their new duties in terms of self-flagellation:
“You may not so extenuate his offenseFor I have had such faults, but rather tell me,When I that censure him do so offend,Let mine own judgment pattern out my deathAnd nothing come in partial.”        (Angelo, II.i.29-33)
“And have you nuns no farther privileges?[…] I speak not as desiring more,But rather wishing a more strict restraintUpon the sisterhood, the votarists of Saint Clare.”        (Isabella, I.iv.1, 3-5)
It’s also worth mentioning that our first introduction to these characters features them scurrying along in the wake of an authority figure they respect. 
Act 1, Scene 1: Angelo wants to know the extent to which he can wield his law degree at the pleasure of the Duke of Vienna (the Duke himself!). 
Act 1, Scene 4: Isabella wants to know the extent to which she can practice self-denial for the glory of God and the approval of Mother Superior. 
They are both drawn to gravitas, to figures who represent order and authority. They are also drawn to discipline. He’s a non-drinking, non-smoking Precision. She’s a gluttony-abhorring Bride of Christ. Let the rest of the world eat cake. They will be eating their sins and purifying their souls, thank you very much.
At the risk of descending into the flaming pits of cliché, I’ll also touch on those three qualities I mentioned earlier, because who says the TPE (Three Paragraph Essay) is dead? 
First up: ideological dogmatism.
[Side note: I may be a crappy historian, but I do recognize there’s a historical paradigm at play in this text. Vienna needs to be a Catholic city and Angelo’s Protestantism needs to be allusive because Shakespeare presumably valued all his limbs and didn’t relish the idea of rotting in a Cheapside prison. If he’d lived in a “free press” kind of sociocultural context, he might have endowed his religious figures with a bit more Opinion. I digress.]
In the M4M-centered episode of Isaac Butler’s phenomenal podcast, “Lend Me Your Ears,” he interviews JohnPaul Spiro (Assistant Director of the School of Liberal Arts, Villanova University), who does a wonderfully unfussy job of summing up the Angelo/Isabella ideology parallel:
“In much the same way as our era is filled with political zealots—as well as, to a certain degree, religious zealots—what you’ll find when you look closer is there’s a small number of very loud people who are dominating the discourse. And a lot of people are in the middle and would rather not have to take sides. Claudio, he seems to be monogamous, he seems to want to just live a very simple life, he’s not really concerned with theological things. And when pressed on theological things, his point is: ‘I don’t really know. No one really knows what happen when you die, so I’m scared.’”
Because religious extremism lies at the heart of the rhetorical warfare between Angelo and Isabella, I think there’s a misconception that M4M is a Play About Religion. But the ONLY characters who canonically go to the mat about the finer points of theology are…wait for it…Angelo and Isabella. This is an early modern text brimming with religious figures (Sister Francisca, Friar Thomas, Friar Peter, even the phony Friar Lodowick), but not a single one of them gets on the pulpit about ANYTHING in the course of the entire play. Sister Francisca’s role consists of bemusedly listening to her youthful novitiate describe her desire for stricter prohibitions at the cloister. Friar Thomas, a sycophantic priest whose parish coffers are probably lined with Vincentio’s gold, spends his one onstage scene nodding his head sympathetically as the Duke over-explains why he is disguising himself as a monk. Friar Peter, the poor Jesuit roped into delivering the Duke’s messages, forgoes moralizing and instead uses his limited dialogue to try to help two disenfranchised women receive justice for their abuse. And Friar Lodowick, of course, is nothing but an alias for a cowardly sociopath who wants to run the world without being held accountable for his mistakes. Nothing evangelical about any of that.
But Angelo and Isabella? They can’t shut up about religion. 
Isabella wants Angelo to temper his punitive Weltanschauung with morality, ideology, Platonic ideals, metaphysics…in short, all of the intangibles that can’t be used as evidence in a court of law. 
“Why, all the souls that were were forfeit onceAnd He that might the vantage best have tookFound out the remedy. How would you be,If He, which is the top of judgment, shouldBut judge you as you are? O, think on thatAnd mercy then will breathe within your lips,Like man new made.”        (Isabella, II.ii.97-103)
Angelo, in turn, wants Isabella to recognize the futility of Catholicism as a proper tool for creating heaven on earth because Catholicism permits withdrawal from the world and the abdication of earthly responsibility (cf: nunnery). Instead, he argues, what God actually needs is for people to actively toil in their communities to criminalize, punish, and eradicate sin. 
“I show [pity] most of all when I show justice,For then I pity those I do not know,Which a dismissed offense would after gall,And do him right that—answering one foul wrong—Lives not to act another.”        (Angelo, II.ii.128-132)
They take up the two sides of a theological debate that predates Christianity: ethics vs. justice. And that conflict is itself inextricably tied to the timeless political debate of non-intervention vs. regulation. And the thing is: even when Angelo and Isabella realize the irreconcilability of their respective schools of thought, they KEEP ARGUING ABOUT IT because extremism is just that: extreme. Angelo and Isabella may be major players in M4M, but they represent the radical minority of their world. They are the “small group of very loud people” and literally everyone is a moderate next to them. Ideology, not desire, is the bedrock of their personhood. When confronted with a person of an uncompromisingly polar viewpoint, they behave as if it might be possible to change the viewpoint of that person because the alternative is to admit defeat. To tragic effect, they hold their ideals more sacred than human life. For Angelo, that ideal is the law (i.e. integrity of action). For Isabella, it’s chastity (i.e. integrity of the soul). They are dogmatic in their beliefs, inflexible in their opinions, and inalienably convinced of their own “rightness.” They are austere, incisive, independent, articulate, and sharp. They are disgusted by the depravity of the world around them and determined to transcend it. What differentiates them is the content of their convictions, but they rate the value of that conviction equally.
So, yes, M4M is a play acutely interested in how religion shapes the law and human behavior. But I would argue that it is really only about one thing: power.
Which brings me to rhetoric.
Angelo and Isabella are lawyers. Both of them. High-powered, quick-thinking, weakness-sniffing, self-righteous litigators. Sure, Isabella may not have the paperwork to prove it; she was conceived by an Englishman in the early 17th century. But much in the same way that it’s obvious to everyone with eyes that would-be nun Maria [von Trapp] is a born music teacher from the first scene of The Sound of Music, so is it evident from Isabella’s first moments onstage that she is a born lawyer. She was, quite simply, born to argue.
Consider her first scene onstage: in the nunnery, with Lucio and Francisca. Unlike the audience, Isabella doesn’t have empirical evidence of Lucio’s amorality and notorious womanizing. She doesn’t need it. She can smell it on him. And in six short lines, she wipes the mosaic-laced marble floor of the cathedral with his ass:
LUCIOCan you so stead meAs bring me to the sight of Isabella,A novice of this place and the fair sisterTo her unhappy brother, Claudio?
ISABELLAWhy her “unhappy brother”? Let me ask,The rather for I now must make you knowI am that Isabella, and his sister.
LUCIOGentle and fair, your brother kindly greets you.Not to be weary with you, he’s in prison.
ISABELLAWoe me, for what?
LUCIOFor that which, if myself might be his judge,He should receive his punishment in thanks:He hath got his friend with child.
ISABELLASir, make me not your story.
LUCIO‘Tis true.I would not, though ‘tis my familiar sinWith maids to seem the lapwing and to jest,Tongue far from heart, play with all virgins so.I hold you as a thing enskied and sainted,By your renouncement an immortal spiritAnd to be talked with in sincerityAs with a saint.
ISABELLAYou do blaspheme the good in mocking me.
        (I.iv.18-40)
I’m not going to venture down the English professor’s rabbit hole of rhetorical devices and syntactical analysis—partly because there are thousands of scholars who have already done it better than I ever could (check out Claire McEachern and Julie Felise Dubiner!) and partly because I’ve been blathering for too long in general. But sufficed to say that three hallmarks of a good lawyer are as follows: 
The ability to seize and repurpose the language of one’s opponent (“Why her ‘unhappy brother?’”)
The ability to spot and sidestep landmines (“Sir, make me not your story.”)
The ability to redirect conversation (“You do blaspheme.”)
By that metric alone, Isabella’s performance here is worthy of the Harvard Law Review. 
And then, of course, two scenes later, she meets her match. 
A dear friend of mine, who is a first-year at Georgetown Law and basically the smartest person I’ve ever met, once told me: “The best and worst thing that can happen to a good lawyer is to meet another good lawyer with different ideas.” I do apologize for invoking Sorkin twice in one essay, but honestly: “The President likes smart people who disagree with him” (Leo, The West Wing, 2x05). It is a truth universally acknowledged that however infuriating it is for a highly intelligent person to debate with an equally intelligent person who disagrees with everything they stand for, it can also be unbelievably stimulating and monumentally entertaining to watch. (Hello, 50 million seasons of Law & Order.)
I’m now two weeks deep into rehearsals for M4M and I still get gobsmacked, daily, by the sheer majesty of Angelo’s and Isabella’s rhetoric. Theirs goes so far beyond the mental agility of anyone else in this play, or even—dare I say it—in Shakespeare’s canon. They are beyond intelligent. They are freaky genius kids with the kind of sanctimonious stubbornness that would be obnoxious if it weren’t so damn compelling. Between the two of them, between their two infamous scenes, they pull out every rhetorical trick in the book and play approximately seventeen unique rounds of intellectual checkers. (I say checkers because chess is too slow for them. If you want chilly brinksmanship, check out the Roman plays. Angelo and Isabella have agendas and professional pride on the line. Time is of the essence.)
ISABELLAI do think that you might pardon him,And neither heaven nor man grieve at the mercy.
ANGELOI will not do it.
ISABELLABut can you, if you would?
ANGELOLook, what I cannot, that I will not do.
ISABELLABut might you do it, and do the world no wrongIf so your heart were touched with that remorseAs mine is to him?
ANGELOHe’s sentenced. ‘Tis too late.
ISABELLA“Too late”? Why, no. I, that do speak a word,Might call it back again.
        (II.ii.67-78 [italics are mine])
Things get even more complicated when they start moving into those same theoretical marshes I described earlier:
“If he had been as you, and you as he,You would have slipped like him, but he like youWould not have been so stern.”        (Isabella, II.ii.84-86)
“The law hath not been dead, though it hath slept.Those many had not dared to do that evilIf the first that did th’ edict infringeHad answered for his deed. Now ‘tis awake…”        (Angelo, II.ii.117-120)
ENOUGH WITH THE METAPHORS ALREADY. CLAUDIO IS ON DEATH ROW.
And even when they finally, finally get to the point, they remain at an impasse:
ISABELLAYet show some pity.
ANGELOI show it most when I show justice.
        (II.ii.127-128)
Which causes Isabella essentially to lose all sense of self-awareness and control because goddam it, never once in her entire life has she met a person she couldn’t out-argue, who the fuck does this deputy think he is, this was supposed to be a simple mission and she’s been standing in this room for ten minutes and he’s still siTTING THERE SMILING AT HER WHAT THE F—
“So you must be the first that gives this sentence,And he that suffers. O, it is excellentTo have a giant’s strength, but it is tyrannousTo use it like a giant[…]Could great men thunderAs Jove himself does, Jove would never be quiet,For every pelting, petty officerWould use his heaven for thunder,Nothing but thunder. Merciful heaven,Thou rather with thy sharp and sulfurous boltSplits the un-wedgeable and gnarlèd oakThan the soft myrtle. But man, proud man,Dressed in a little brief authority,Most ignorant of what he’s most assured,His glassy essence like an angry apePlays such fantastic tricks before high heavenAs makes the angels weep, who with our spleensWould all themselves laugh mortal.”        (Isabella, II.ii.134-152)
Which causes ANGELO to lose all self-awareness and control because goddam it, never once in his entire life has he met a person he couldn’t out-argue, who the fuck does this nun think she is, this was supposed to be a simple smackdown and she’s been standing in this room for ten minutes and he’s still waiting for her to admit defeat and oh God oh no oh no oh no why can’t he look away from her face, what the fuck is happening what the F—
ANGELOWHY DO YOU PUT THESE SAYINGS UPON ME?
ISABELLABecause authority, though it err like others,Hath yet a kind of medicine in itselfThat skins the vice o’ th’ top. Go to your bosom,Knock there, and ask your heart what it doth knowThat’s like my brother’s fault. If it confessA natural guiltiness such as is his,Let it not sound a thought upon your tongueAgainst my brother’s life.
ANGELO, asideShe speaks and ‘tis such senseThat my sense breeds with it.
        (II.ii.163-173)
Finally, Angelo gets her to leave and faces the music. My tremendous co-actor, Jude Van der Voorde, always slays this soliloquy.
“What’s this, what’s this? Is this her fault or mine?The tempter or the tempted, who sins most, ha?Not she; nor doth she tempt, but it is IThat, lying by the violet in the sun,Do as the carrion does, not as the flower,Corrupt with virtuous season.”        (Angelo, II.iv.199-204)
[Non sequitur: Jude is the kind of actor actors dream of acting with. He’s always got at least one trick up his sleeve, so my Isabella is constantly second-guessing herself around him. And he does the “sleazy wunderkind act” with a panache rivaling BJ Novak’s in Season 4 of The Office. He’s also one of the funniest people I’ve ever met. Kids, don’t be Method. Make friends with your fellow actors. Leave the emotions onstage and go get a midnight pizza. You will be so much happier.]
With regards to the M4M narrative, we all know what happens next, although it takes an agonizing 175 lines of text in 2.4 before Shakespeare levels off and gives us the canonical threat:
“Redeem thy brotherBy yielding up thy body to my will,Or else he must not only die the death,But thy unkindness shall his death draw outTo lingering sufferance. Answer me tomorrowOr by the affection that now guides me mostI’ll prove a tyrant to him. As for you:Say what you can, my false o’erweighs your true.”        (Angelo, II.iv.177-184)
What precedes this is the kind of tension-groaning, hair-splitting, goosebump-raising rhetorical tarantella that television writers today spend their entire careers trying to emulate. Isabella plays the fool for as long as she possibly can…
ANGELONay, but hear me.Your sense pursues not mine. Either you are ignorantOr seem so, crafty, and that’s not good.
ISABELLALet me be ignorant, and in nothing goodBut graciously to know I am no better.
        (II.iv.79-83)
…but eventually Angelo forces her hand and she has to deflect his onslaught with the sleek diplomacy of a kidnapping victim.
ISABELLABetter it were a brother died at onceThan that a sister, by redeeming him,Should die forever.
ANGELOWere not you then as cruel as the sentenceThat you have slandered so?
ISABELLAIgnomy in ransom and free pardonAre of two houses. Lawful mercyIs nothing kin to foul redemption.
ANGELOYou seemed of late to make the law a tyrant,And rather proved the sliding of your brotherA merriment than a vice.
ISABELLAO, pardon me, my lord. It oft falls out,To have what we would have, we speak not what we mean.I something do excuse the thing I hateFor his advantage that I dearly love.
        (II.iv.114-128)
Remember when I said that Angelo and Isabella are alike in that they are inalienably convinced of their own “rightness”? That still holds true. But now Angelo, without warning, has moved beyond the conceits of debate and is taking Isabella’s rhetorical arguments from 2.2 at literal face value in order to trip her up. He’s brought ideology crashing down to earth and introduced their physical relationship into the conversation…again, without warning and very much without her consent. And she has to figure out a way to back-peddle on her words without yielding defeat of the argument. It is nigh impossible. And I bring it up because guess who gets trapped in the exact same situation three short acts later?
LUCIOCome, sir; come, sir; come, sir; foh, sir! Why, you bald-pated, lying rascal, you must be hooded, must you? Show your knave’s visage, with a pox to you! Show your sheep-biting face, and be hanged an hour! Will ‘t not off?
        (LUCIO pulls off the friar’s hood and reveals the DUKE.)
DUKEThou art the first knave that e’er made’st a duke.—First, Provost, let me bail these gentle three.—Sneak not away, sir, for the friar and youMust have a word anon.—Lay hold on him.
LUCIOThis may prove worse than hanging.
DUKEWhat you have spoke I pardon. Sit you down.We’ll borrow place of him.       (to Angelo)Sir, by your leave.Hast thou or word, or wit, or impudenceThat yet can do thee office? If thou hast,Rely upon it till my tale be heardAnd hold no longer out.
ANGELOO my dread lord,I should be guiltier than my guiltinessTo think I can be undiscernible,When I perceive your Grace, like power divine,Hath looked upon my passes.         (V.i.395-421)
Game, set, match.
As for ego… Do I really need to talk about professional pride? I don’t think so. It’s Angelo and Isabella. Pride leaks out of every virtually every line they speak in this play. Pride in their conviction, pride in their moral righteousness, pride in their intellect, pride in their ability to judge the world with clarity (or whatever). Angelo actually admits it out loud to us in perhaps his most famous soliloquy, because the little fucker has a lot more Catholic guilt about lusting after a novitiate nun than his Protestant heart would like to admit:
“The state whereon I studiedIs, like a good thing being often read,Grown sere and tedious. Yea, my gravity,Wherein—let no man hear me—I take pride,Could I with boot change for an idle plumeWhich the air beats for vain.”        (Angelo, II.iv.7-15)
And even though Isabella could easily be the poster child for Christian piety, she’s so damn proud of her own humility that she occasionally threatens to void it altogether. 
ANGELOWhat would you do?
ISABELLAAs much for my poor brother as myself.That is, were I under the terms of death,Th’ impression of keen whips I’d wear as rubiesAnd strip myself to death as to a bedThat longing have been sick for, ere I’d yieldMy body up to shame.
        (II.iv.107-111)
Look at me, Angelo. Look at this body. It’s mine. Mine and God’s. I see what you’re doing, I know where you’re trying to go. And it is never. going. to happen.
Two weeks into rehearsal and I’m still not sure I’m convincing in my delivery of these lines. I’ve watched every filmed production of M4M I can get my hands on, and it’s no help. I just don’t know what to make of this. Scholars disagree virulently about these lines, but also…scholars aren’t actors, you know? I find myself questioning everything every time I get to this passage. Is Isabella actually a virgin? I’m not sure. Chastity and virginity aren’t actually the same thing and Isabella, for all her idealism, is more worldly than many of her ingenue brethren. One thing is for sure: she’s flushed with self-righteousness when she speaks these words. Angelo may be a haughty son of a bitch, but so is she, so is she, so is she.
Ugh, these characters. I love them so much. I hate Angelo, I do. I also love him. And God help me I love Isabella. They’re dumpster fires of human conviction and I’m so grateful to Shakespeare for giving us their story and for understanding four hundred fucking years ago, that this, THIS is the pinnacle of hell in the female experience: “Who would believe thee, Isabel?”
#MeToo
Thank you, Will. Thank you.
I feel like I should apologize for the length of this reply, but I’ve had so much freaking fun that I also don’t feel apologetic. Thank you for this amazing question! Hope you’re doing well! xx Claire
Tagging @malvoliowithin @measureformeasure @harry-leroy @suits-of-woe
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manchestereyes · 5 years ago
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(dark star emoji anon- i'm on my computer rn so no emojis lmao) I'm still struggling to find a job. Honestly at this point, I'm considering going back to school... Which kills me to say bc I know it's not what my family wants to hear. They really wanted me to go into the medical field and were really proud of me when I did, but not only can I not find anything, but I don't even know if I'd be able to function in that type of environment. (1/3)
I've tried a number of differnent things to apply to but no one wants me because I only have resturant experience for highschool and intership experience from college and nothing else. I just don't want to actually admit it's not working out.. Not to mention I hated college so to go back would be.. a lot to say the least. I tend to pour myself into school way too much and end up burnt out. I hate not knowing what to do, I seemed like i had it all figured out and now i just... dont (2/3)
I was looking at the vocational school the next town over because it's not as long as normal college. I saw this program for Digital Graphic Design that looked really cool but at this point, I'm scared to even try because of how it worked out the last time I went to school. I thought FOR SURE i'd have a job straight out and I don't. Should I go for something I think is interesting or should i go for what i think has the most job openings... im just so confused tbh... (3/3)
(dark star emoji anon again) also sorry for like being all negative in your ask box. i hope you're doing well by the way. I'm really digging Dans new merch, and am so excitred for the futrue with them (lol). (also he looked sooo good in those pictures, he's one of the few people who have the ability to bring my tiny bit of straight out haha)
omg i absolutely 10000% feel you, friend!!! being in this stage of life SUCKS because nobody tells you how hard it‘s gonna be, probably since most of our parents had it easier which sucks even more. i was feeling the exact same way last fall and it was pretty brutal since it felt like i didn’t have a purpose anymore and that was really scary. but in your case, i think it would be best to go for whatever sounds most interesting! that way, at least you can hopefully enjoy what you’re learning and if it leads to a job (even if it’s not the best job at first) that you can see yourself maybe enjoying, then that makes everything at least a bit easier!
and i don’t blame you one bit for not wanting to go into the medical field! from everything i’ve seen, it seems like SO much work and really stressful so i could never do it either. but i think it’s super great that you figured that out about yourself so now you hopefully won’t be stuck there! also literally SAME about college, which is why i’m kinda terrified to go back too hahahaha. perfectionism is a bitchhhhh but if it helps at all, maybe you could try breaking things down into a few steps at a time and taking lots of breaks? that helps me sometimes anyway lol
you’re definitely not alone in the “not having it all figured out” camp though! when i was getting ready to apply to my new school, my parents asked me if teaching was what i really really wanted to do and honestly, it threw me for a loop since idk what i really really wanna do. like, i always thought before that i’d be happiest in that job but now that i know how hard it is too, idk if i can see myself doing it. and then it spirals into idk if i can see myself doing anything and aaaahhhhh lol. not very fun, but it seems pretty common, despite what facebook might have you believing! i haven’t had the “traditional” 4 year college experience and neither have my 2 irl friends and that’s totally okay! everyone’s just taking life at their own pace and as long as you’re listening to yourself and know what‘s right for you and what isn’t, that’s all that really matters imo. :)
and no worries, you can be as negative as you need! life really really sucks sometimes and we need to let that out. and i’ll always be here to listen and help in any way i can! (also moooodddd lol i have no idea how straight i am since it changes every day but dan in those photos is.....really something hahahaha) and sameeee i’m already dying to see what’s next in store for them!! i’m not expecting it at all but a mukbang this week or next would be AMAZING
i really hope things start looking up for you soon!! quarter life crises are hard and awful and i wouldn’t wish them on anyone but i think it’s amazing that you’re pushing through this anyway! i’m sending you all the best vibes and motivational support (is that even a thing? well now it is lol) that you need! it’s soooo much work but i believe in you!! ❤️❤️❤️
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brentrogers · 5 years ago
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Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse. 
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
 Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
www.apna.org
APNA Report: Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment syndicated from
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Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse. 
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
 Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
www.apna.org
APNA Report: Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
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Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse. 
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
 Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
www.apna.org
APNA Report: Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
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Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse. 
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
 Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
www.apna.org
APNA Report: Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
from World of Psychology https://ift.tt/2TnfOiS via theshiningmind.com
0 notes
10071991 · 5 years ago
Conversation
Lynn:
23:17
The counselor has joined the conversation.
Lynn:
23:17
Hi, welcome to Lifeline
Lynn:
23:19
Are you there?
Anonymous9806:
23:22
oh sorry
Lynn:
23:23
Hi there
Anonymous9806:
23:23
hi
Lynn:
23:23
Sorry about the wait
Anonymous9806:
23:23
im sorry the thing doesnt make a noise so i was trying to get some stuff sorted out and i didnt realize anyone was ready
Anonymous9806:
23:23
it ok
Lynn:
23:24
So what brings you here tonight?
Anonymous9806:
23:25
i dont feel well
Lynn:
23:26
How so?
Anonymous9806:
23:27
im very sad
Lynn:
23:27
Over what?
Anonymous9806:
23:27
everyone around me hates me
Lynn:
23:28
Can you tell me more about what's making you feel that way?
Anonymous9806:
23:28
but i cant be who they want me to be to make it stop
Lynn:
23:28
Who do you think they want you to be?
Anonymous9806:
23:29
my family yells at me and doesnt listen to me when i try to explain
Anonymous9806:
23:29
not me at least, but they dont listen to me when i try to explain why im me
Anonymous9806:
23:30
they tell me to kill myself and that im not a person
Anonymous9806:
23:30
theyll scream in public and disturb the neighbors
Lynn:
23:30
Your family says that??
Anonymous9806:
23:30
yes
Lynn:
23:30
Wow. It doesn't sound like you're the problem there.
Anonymous9806:
23:31
and im a dumb cunt, the stupidest, how could i be one of them, im a drain on society, i deserve to have my things destroyed
Anonymous9806:
23:32
but i have to be because why would everyone else treat me this way? i dont know anybody who doesnt act like ive done something awful to them but i dont understand why im so awful for needing help and i dont know how to help myself understand
Lynn:
23:33
That's awful and no one deserves to be treated that way
Anonymous9806:
23:33
dad says my cats should be killed too and the kitten i was fostering from the humane societys head should be ripped off
Anonymous9806:
23:33
he says i do
Lynn:
23:34
Do you live with them?
Anonymous9806:
23:34
he says hes tired, i quote, of me "treating him like a n*****"
Lynn:
23:34
Wow...
Anonymous9806:
23:34
i live with dad and ive lived with my uncle before
Anonymous9806:
23:35
so when he destroys my stuff dad says "the n* is pissed" as his justification
Anonymous9806:
23:35
we are white
Anonymous9806:
23:36
and if i try to calmly say "lets talk about your concerns" or something like they taught me in therapy, he just goes even more ballistic, and screams at me to shut up, and says its my fault hes mad and gets more mad
Lynn:
23:36
That sounds terrifying
Lynn:
23:36
How long has he been like this towards you?
Anonymous9806:
23:36
then hell say stuff like theres something wrong with me, i cant follow instructions, i cant do this or that, im stupid and stuff..... but then says theres nothing wrong with me so i should be capable of stuff
Anonymous9806:
23:37
yeah its scary his gf says she thinks its scary too so when he starts shell leave after a while
Anonymous9806:
23:37
uhhhh a few months? mom died in march so 4 months?
Lynn:
23:37
This started right after your mom died?
Anonymous9806:
23:37
it happens 1-3 times a week
Anonymous9806:
23:38
yeah when i moved in with him
Anonymous9806:
23:38
he says terrible things about her too
Lynn:
23:38
Do you think it could be grief that he's mishandling?
Anonymous9806:
23:38
no
Lynn:
23:38
Ok
Anonymous9806:
23:38
he treated her like this too
Lynn:
23:38
Is there anywhere else you an go?
Anonymous9806:
23:38
when she was alive
Anonymous9806:
23:38
no
Lynn:
23:39
*Can* sorry
Anonymous9806:
23:39
no one believes me but im disabled
Anonymous9806:
23:39
so they blame me bc i deserve it all bc i havent been working since mom died
Anonymous9806:
23:40
im supposed to go to school i think in a couple weeks if they help me figure out a dumb hangup thats happened with it
Anonymous9806:
23:40
im hoping i can do it bc i dropped out of high school bc it was hard
Lynn:
23:41
I get that, but it could help you get a job in the longrun that will allow you to get away from him.
Lynn:
23:42
In what way are you disabled?
Anonymous9806:
23:42
im autistic and mentally ill, i have really bad legs too
Anonymous9806:
23:43
ive been institutionalized numerous times and ppl threaten me with it
Anonymous9806:
23:43
i hate it a lot so i hope i dont say anything so you dont have to put me somewhere
Anonymous9806:
23:44
this is my first time using a support chat and thats scared me from using it before
Lynn:
23:44
I don't have the authority to put you anywhere, so no worries about that.
Anonymous9806:
23:45
oh im sorry i should have clarified im "high functioning" aspergers so my strength is linguistic
Anonymous9806:
23:45
im relieved
Anonymous9806:
23:46
if i flap or rock or pace i get in trouble
Anonymous9806:
23:46
so i try to stim swinging at the park so nobody realizes im doing it as much
Anonymous9806:
23:46
its not as obvious i mean
Lynn:
23:47
Right
Anonymous9806:
23:47
so it gets hard if im in public otherwise bc i want to but i dont want to bc i dont want people to treat me weird like family does
Lynn:
23:48
I can understand that.
Lynn:
23:48
Do you feel like you're in physical danger there?
Anonymous9806:
23:49
i dont know
Anonymous9806:
23:49
i worry about my computer and my cats but i dont care if im threatened
Anonymous9806:
23:51
i guess maybe he threatened me the other night? he put his fist close in my face and was like "now im threatening you" after i told him he was getting violent
Anonymous9806:
23:51
throwing things and destroying property is violent to me but maybe im wrong
Lynn:
23:51
That sounds violent to me.
Lynn:
23:52
Have you considered calling the police when he gets like that? I'm afraid of you getting hurt.
Anonymous9806:
23:52
yeah like way across the room and stuff
Anonymous9806:
23:52
ive told HIM to call the police when hes screaming at me to get out of his house and stuff
Anonymous9806:
23:53
otherwise if they try and have me press charges or something i have nowhere else to go or anything
Lynn:
23:54
Ok, I just want to make sure you're physically safe
Lynn:
23:54
I am so sorry about how he treats you, though, that's horrible.
Anonymous9806:
23:55
its my fault but i dont know how to change and be more quiet
Lynn:
23:55
It's not your fault. He needs to be more understanding of your condition.
Anonymous9806:
23:56
nobody is
Lynn:
23:56
That's such a horrible position to be in.
Anonymous9806:
23:56
i tried to bring a chair upstairs the other day, and it was so heavy? but i didnt have help and if i didnt do it hed punish me. i got so exhausted i passed out at the top of the stairs
Anonymous9806:
23:57
so tonight i was being mimicked with like..... you know that whimpering "hng hng hng" people do to make fun of people? that about it
Anonymous9806:
23:57
ive also fallen down the stairs because he ripped the bar off at the landing
Anonymous9806:
23:58
and i was screamed at for being lazy and not doing my volunteer work at the humane society bc i sprained my ankle and knee
Anonymous9806:
23:58
its been uhhhh a week and it still hurts a lot
Anonymous9806:
23:58
but im told i have to go through pain and im weak
Lynn:
23:58
Yeah, that sounds really painful
Anonymous9806:
23:59
i have to do things that cause me physical agony
Anonymous9806:
23:59
im sorry if that sounds extreme im not just uhh. i cant remember the word for making something sound worse? im not just trying to make it sound worse it hurts so bad i just want my legs amputated a lot
Anonymous9806:
23:59
if they were gone they wouldnt hurt
Lynn:
00:00
You might try calling 211 to see if they have any resources to help someone with special needs find employment, find housing etc. to try to help you be more independent and get out of there.
Anonymous9806:
00:00
but then im scolded and called a dumbass and im trying to "become a drug addict" trying to find a solution to my pain
Lynn:
00:00
You should not have to put up with being treated that way.
Anonymous9806:
00:01
ive tried to work with vocational rehab before but they kind of get to a point where they get to buck up too
Anonymous9806:
00:02
it was through them i became a debt collector because we thought it wouldnt hurt my legs and idk, they figured i could handle talking to people constantly but
Anonymous9806:
00:02
i coudlnt
Anonymous9806:
00:02
people would call me fat and an asshole and im ruining their life and stuff in that job, and people would do it in tech support jobs ive tried before
Anonymous9806:
00:03
but debt collecting was the worst and im sorry i feel weird saying this but in that job it.... kinda turned into something similar to what you do here? i talked a guy out of suicide on the phone and it was really triggering
Anonymous9806:
00:03
i dont want to be around people and thats why i volunteer at the humane society because the animals dont yell at me
Anonymous9806:
00:04
or trigger me really
Anonymous9806:
00:05
and then it also gets hard bc ive been struggling a lot more with stuff. applying for college and trying to get financial aid and sign up for classes and stuff has been a nightmare because i haavent figured out howto navigate their websites and stuff, my friend.... um. shes also named lyn. but shes helped me every step of the way. every step has felt like a hurdle
Lynn:
00:07
If you want help I can let social services know what's going on, but I would need your information so I can tell them who you are and where to go.
Anonymous9806:
00:08
what kind of social services? like someone that would help me figure out how to sign up for college classes and stuff or help me make doctor appointments and stuff like that?
Anonymous9806:
00:08
that would help me
Anonymous9806:
00:09
i feel bad for lyn helping me figure stuff out all the time but i need help understanding it
Lynn:
00:09
211 might be able to help with that, but no, I mean DHR to help make your dad stop hurting you like this.
Anonymous9806:
00:09
when i get frustrated i cry and have meltdowns and stuff and then that doesnt make situations better
Anonymous9806:
00:10
oohhh ok. i dont know what dhr means?
Anonymous9806:
00:10
but if im living at his place hes allowed to treat me how he wants to or ill be homeless
Lynn:
00:10
What he's doing is verbal and mental abuse and DHR would get the state involved to investigate and monitor the situation. No, he is not allowed to do that.
Anonymous9806:
00:11
i dont care much about me, been there done that, but my cats i love and i dont want them to not be cared for
Anonymous9806:
00:11
even if i dont pay rent...?
Anonymous9806:
00:11
if i.... have recordings.... does that help...?
Lynn:
00:11
It could, yes.
Anonymous9806:
00:12
he got mad and threw my phone at me the other night because "im so stupid bc im always on it" but uh. its hyper vigilance i guess that if he starts screaming i start recording
Lynn:
00:13
Your autism is documented right?
Anonymous9806:
00:13
um... would they be able to talk to me.... and not involve him yet...? its a situation where i dont know if it would do more harm than good? but maybe they could help me like. i dont know....
Anonymous9806:
00:13
yeah it should be on file at uhhh
Lynn:
00:13
I don't need to know where
Lynn:
00:13
It's ok, just so long as it's somewhere.
Anonymous9806:
00:13
when you say documented you mean my doctors and therapists ive had are aware of it?
Lynn:
00:14
Yes
Lynn:
00:14
Do you still have a therapist?
Anonymous9806:
00:14
i moved from a different state but they could probably send papers and stuff? i had dbt therapy there
Anonymous9806:
00:14
i miss it
Anonymous9806:
00:14
no, i havent been able to find one that accepts my insurance but also accepts new patients
Anonymous9806:
00:14
i tried to find grief counseling too for my mom
Anonymous9806:
00:14
i miss my mom
Anonymous9806:
00:15
she understood me
Lynn:
00:15
I'm so sorry you lost her.
Anonymous9806:
00:15
thank you for your condolences
Lynn:
00:16
Of course
Anonymous9806:
00:16
i cry because i miss her every day but i dont know how to stop missing her
Anonymous9806:
00:17
dd sys he gave me three weeks before cutting into me so i could grieve but i dont think even after three years ill be done with it
Anonymous9806:
00:17
or 30 or 300
Lynn:
00:17
Before cutting into you?
Anonymous9806:
00:17
yelling at me and stuff
Anonymous9806:
00:18
im sorry i didnt mean literally
Anonymous9806:
00:18
im scared of knives so im glad not literally lol
Lynn:
00:19
So that means he can control it.
Anonymous9806:
00:20
when he gets drunk theres no controlling anything i dont think? even if i try there doesnt seem to be rationalizing but my idea of rational and other peoples i guess is different
Anonymous9806:
00:21
his girlfriend says hes an asshole when hes drinking tequila
Lynn:
00:23
I don't know what DHR will do, if anything, but do you want me to call them for you?
Anonymous9806:
00:23
um
Anonymous9806:
00:24
would they let you ask them questions?
Anonymous9806:
00:24
or would we get in trouble for wasting their time?
Anonymous9806:
00:24
i say we because youd be asking for me but i dont want to get you in trouble
Lynn:
00:25
No, not at all. Because of your autism what he's doing is illegal, it's verbal and mental abuse.
Anonymous9806:
00:26
even if im 'high functioning"?
Anonymous9806:
00:26
even if im 'high functioning"?
Anonymous9806:
00:26
dont like those terms but that helps ppl understand what i mean i think
Anonymous9806:
00:26
like i was a "gifted student" but.... i dropped out of school and stuff
Lynn:
00:26
Does he have legal rights over you, like guardianship?
Anonymous9806:
00:26
oh im sorry i didnt mean to send the one thing twice
Anonymous9806:
00:27
i dont think so, i was an adult when we found out? because im "high" im kind of left to me but it doesnt mean its not..... really hard...
Anonymous9806:
00:28
i didnt have anywhere to go when our room mates bailed on us (im blamed for this too but it wasnt my faul my room mate lost her job) so i had to come here when mom died a week after i left the state
Anonymous9806:
00:29
i was her caregiver because im more able bodied than her with final stage copd, and otherwise myuncle wanted her to be put in a nursing home but i didnt want that, so i tried to take care of her as best as i could but its hard bc i cant take very good care of me i guess
Anonymous9806:
00:29
she probably wouldnt have died if id been better
Anonymous9806:
00:31
if we didnt go to colorado with our room mates i mean
Lynn:
00:31
No, that wasn't your fault. I'm sure she was grateful and you did a great job with her.
Anonymous9806:
00:31
but i made the bad decision to go with them so we could afford rent
Anonymous9806:
00:32
well.... she didnt want me to leave? i think she liked being with me
Anonymous9806:
00:33
when she broke ribs falling out of her bed once she had to stay in a nursing home for a month and the food was so so bad so she liked if i baked some stuff if i felt well enough to
Anonymous9806:
00:33
like liver in a gelatin served with broccoli bad
Lynn:
00:33
Oh wow, yeah. That does not sound good
Anonymous9806:
00:34
i guess im biased but id take my shake and bake over that too lol
Lynn:
00:34
Lol, for sure!
Anonymous9806:
00:34
so id smuggle her in some food when id visitor
Anonymous9806:
00:34
*visit her
Lynn:
00:34
That was nice of you
Anonymous9806:
00:34
she liked little debbie nutty bars a lot, and coca cola
Anonymous9806:
00:36
and she didnt like usual "old people" stuff i guess? she liked watching shows on her amazon fire stick, so shed make the trip from the bed to the stuffed armchair she had, turn that on, and then i was on call when she needed me for stuff, and the cats would come and go but they liked to sleep on her bed a lot lol
Anonymous9806:
00:36
i hope it wasnt a bad life for her
Lynn:
00:37
So what do you think about getting some help with your dad?
Anonymous9806:
00:38
it would be nice, but i dont know if it would be beneficial or waste everyones time. if i cant stay here then i have nowhere to go, and my cats dont, so im worried
Anonymous9806:
00:39
would someone be able to talk to me first so we could figure out if its worthwhile? im so worried they wont believe me either and then ill be in more trouble and everyone just wasted time and resources
Lynn:
00:39
Ok, if you don't want to give me your information I understand that, but look up adult protective services in your area or call 211 so you can ask what you need to and decide what you want to do. You don't have to let him treat you like this.
Anonymous9806:
00:40
im sorry im not trying to cause problems for you or um. make it seem like im turning my nose up at your health i appreciate you
Lynn:
00:40
Just explain to whoever you talk to why you're so scared and ask for them to help you make sure he doesn't make things worse for you.
Anonymous9806:
00:41
okay, thanks so much! i will do this when hes not around to hear me
Lynn:
00:41
You're not at all. Your concerns are valid, I'm just trying to give you ways to find help.
Anonymous9806:
00:41
thank you
Lynn:
00:41
Ok, good. Please do call them. You don't deserve this.
Anonymous9806:
00:41
ive just been so sad
Lynn:
00:41
You're welcome!
Lynn:
00:42
I know and I get why.
Anonymous9806:
00:42
ive been overwhelmed and it doesnt help to be screamed at
Lynn:
00:42
No, it doesn't.
0 notes
hadleighpitman · 7 years ago
Text
PECHA KUCHA
Tumblr media
1.WHERE IT STARTS: Growing up my mom only made homemade, handmade cookies. I still to this day believe that store bought cookie dough is for eating without being cooked and unfortunately I am a cookie snob. I have a great appreciation for the handmade because of my mothers influence, and thats were it started for me.
2.DEFINING THE HANDMADE When I say the handmade I really mean skills and sets of knowledge that a computer cannot accomplish. An object created with a personal story, a person that answers your plumbing phone calls, a welder, and a fresh baked cookie.
3.PROBLEM AT HAND: DEPENDENCE We are losing the ability to operate as a fully self dependent human beings. While technology is helpful, we are so busy connecting that we have a created a disconnect with everyday life skills, like buying all of our produce instead of growing it. Being able to have anything at the snap of our fingers has created a loss of appreciation for creating and doing for ourselves. As one article states “We have bred a generation of highly-educated college graduates who lack the basic skills of self-reliance.”
4.WHAT HAPPENED?:EDUCATION Vocational schools were popular choices prior to the Vietnam war because companies would hire directly from these elite schools. However, when many districts decided it was unfair to a majority of the students who could not afford the schooling, tech skills were moved into high schools. In the 70’s world academic rates were climbing and in order to keep up, the US defunded vocational training and switched focus to academia.
5.WHAT HAPPENED: SOCIAL STIGMA The sacrifice of technical skills for education left us at a place where we frown upon those who choose technical jobs and schooling over a 4 year education. vocational training is seen as the “second-rate” education and it ultimately discourages people like you and me to learn to work with our hands. we discredit and disvalue jobs like that of a mechanic, all while forgetting how much patience and intellect it takes to work on a car.
6.WHAT HAPPENED?: CONDITIONS With technology comes improved work place conditions. Jobs of technical skilled workers are no longer desired due to the hopeful end result of a corner office with air-conditioning that a degree can provide. We want convenient and care-free instead of weather fighting and bad hours.
7.COMMON SENSE Every single time something has gone wrong on my car, I have approached my dad and mimicked the sound to him and 99% of the time he was right on the money for diagnosis. He actually quit college in his second semester and worked for 18 years at a Kaolin mine. While his work conditions were long hours, hard work, and hot, he gained common knowledge about so many things that a college degree couldn’t offer.
8.THE NECESSITY We are so quick to feel sorry for someone like my dad who worked a rigorous job, and even he, himself, preached to me and my sisters about how important a 4 year degree is for a career. But really those people are so valuable for our everyday lives and as much as they depend on us, we depend on them too. Their skills need to be passed down and valued.
9.WHAT NEEDS TO HAPPEN A happy medium. We have to reteach upcoming generations to appreciate these skill-sets. Offer vocational training as a viable option for a career path and learn to respect  the handmade, and hands-on career choice. Whether that be bringing tech prep back into high schools or incorporating hands-on skills into each of our own lives.
10.RESTRUCTURE EDUCATION I read an article that talked about blending old and modern technique: so they skills are modern in how you use them but techniques are old. I think this approach to the education system would be beneficial to students. I saw a lot of things regarding education and the need to restructure to incorporate vocational training.
11.BENEFITS: FINANCIAL Our country is currently in 1.2 trillion dollars of student loan debt. Some people assume technical career education ends after high school, but 2 year colleges offer affordable degrees with a direct career path. White collar jobs are no longer the highest paying jobs. Think about it, with a lack of skilled workers, a good plumber can make well more than a bad lawyer due to demand. I actually read that there has been a rise in tech school enrollment for people who have other degrees, simply bc they cannot find a job in their field.
12.BENEFITS: SOCIAL Appreciation for skilled workers starts with your own ability to understand how important their job is. Knowing someone like your local baker instead of getting Starbucks delivered, allows a social connection to be made. Appreciating the handmade also promotes heritage and keeps tradition alive. For example: Gullah basketweaving.
13.BENEFITS: ACADEMIA What is crazy is how we eliminated vocational training to focus on education ratings, yet failed to recognize that education is not math, science, literature, etc. Every child learns differently. Hands on training would benefit classrooms and allow children to explore with their minds instead of a textbook and train them to truly realize that there is a job for everyone and all roles in society are important.
14.BENEFITS: TRANSPARENCY Along with the recent dietary and health movements, people have become increasingly interested in the food they’re buying. Where its from, who grew it, what chemicals are in it. Tools and other products are just the same. We should be conscious of the things we buy from start to finish and know that what you’re purchasing is lasting and made with real effort.
15.PLAY A PART: BUY LOCAL Although a blue collar lifestyle is not for everyone, we can all support local artisans and workers by buying local. It is one way for everyone to be involved in promoting the handmade/hand-grown
16.MY INSPIRATION: 1. CRAFTIVISM Craftivism is exactly as it sounds, craft for activism. Art for Athens does just that right in this area. It is a program founded by a UGA student that brings in artists to teach the homeless in this area to create and make in order to give them a skill set to make money.
17.MY INSPIRATION: 2. Bloodroot Blades Bloodroot blades was founded by a former UGA PHD student. He and his business partner began creating knives as a hobby and it turned into a full time job. They both have a strong connection to the land and try to live sustainably. They use found materials to create their knives and build strong relationships with each customer to help tell their story.
18.MY INSPIRATION: 3. ARISANAL MOVEMENT “The Artisanal Movement is a journey of expanding one’s imagination, not only limited to design and aesthetics, but also amassing a modern living culture through our persistence in delivering bespoke craftsmanship manifested by originality” its part of the resurgence to explore past flavors and techniques in order to understand them
19.MY INSPIRATION: 4. RICHARD PROENNEKE Richard Proenneke moved to Alaska alone for nearly 30 years and lived totally off of his own self-taught skills. Hunting, fishing, growing, building, creating. His years as a mechanic allowed him to expand his knowledge of using his hands to live self-sustainably.
20.MY GOALS: ultimately I want to somehow promote and inspire appreciation for the handmade, whether thats creating a private grade school with vocational training incorporated with academia or highlighting careers surrounding hands-on skills. I would like to learn a hand creating technique.
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brentrogers · 5 years ago
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Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse. 
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
 Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
www.apna.org
APNA Report: Expanding Mental Health Care Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference?  There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
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