Welcome to Psych With Kelsie
Education, Therapy, Medication
Hello and welcome to Psych With Kelsie! This is the biggest creative project I’ve ever undertaken, and I’m so excited to share it with you all! I started an independent practice as a psychiatric nurse practitioner this summer and am now creating this educational blog alongside it.
My experience working with patients in the outpatient community mental health space has opened my eyes to the gaps in mental health care for so many. I have created my own practice to provide mental health education and broaden access to mental healthcare in a system that isn’t built to serve those who need it most.
Leaving my position as a psychiatric nurse practitioner at a rural community mental health site was a difficult decision. It was so rewarding to provide mental health care for many who may have otherwise been unable to access it. My workplace was so supportive, and I feel so lucky to have had such a positive experience for my first advanced practice career. What I’m about to say is far from a critique of my previous workplace. My critique is much broader than that. My critique is the healthcare system as a whole. It is simply becoming increasingly difficult to provide quality care in our current system. Many practitioners are doing the best they can—I’d say in a broken system, but that’s not exactly right.
Our system isn’t broken. It’s doing exactly what a capitalist healthcare system is designed to do. It’s extracting as much money as possible very effectively.
Sitting across from a patient, tears streaming down their face, sharing the most intimate details of their lives. Hearing the blip from the computer that means the next patient has checked in and is waiting to be seen. Finding the right moment, the right words to interject to convey that we’ve run out of time in our 15-minute session. How can you make a patient feel important and heard in such a time crunch? How can you develop an individualized care plan that considers the entire person? Both patients and providers are cogs in a well-oiled machine that must keep moving, never slowing down, never becoming damaged or broken, so the system may continue to prioritize productivity over humanity.
I’m forging a new path to prioritize humanity. Respecting and prioritizing humanity in psychiatric care means recognizing each individual’s unique experiences and the factors that influence their mental health, while combining that understanding with interventions and treatments that work for them. The goal should be to proactively prevent mental illness or the progression of illness before it becomes so severe that reactionary management is necessary. Prevention takes time and understanding of a person’s specific concerns and experience. It requires a relationship and rapport that isn’t built in a 15-minute session. Many… Most patients I have treated were in crisis, at least initially. Of course, reactive symptom management was often necessary, but it should be far from the norm. Many struggling with mental illness understandably avoid or delay seeking care, whether it be due to stigma or lack of access, until it becomes a crisis. The current system disincentivizes preventative care through high costs and difficult access. Preventative care does not prioritize profit but, rather, humanity.
I recently came across a documentary discussing B. F. Skinner’s research on behavior and operant conditioning that concluded, ‘above all, positive reinforcement is the prime mover’ of learning. He argues that, instead of criticizing the behavior you want to eliminate, it is more effective to wait to praise behavior that contradicts what you wish to eliminate. In practice, encouraging patients to implement behaviors that promote mental health and praising progress is a much more effective tool than chastising unhealthy behaviors. A trusting relationship is built over time to prioritize humanity instead of pretending every problem can be solved with a 15-minute appointment and another prescription. Medication is often necessary, no doubt about that, but research has shown time and time again that medication is more effective alongside psychotherapy than medication alone. Prescribing without consideration of the whole person and their unique experience is like throwing medications against a wall and hoping something sticks.
What I love about psychology is that it is universal and applies to all people and all areas of life, not simply to the psychiatric profession. The benefits of positive reinforcement as a catalyst for learning are evident across society. From children in school to adult workplace dynamics to the criminal justice system, B. F. Skinner’s research gives us insights into human systems and dynamics. Have you ever witnessed a child being told no in line at the grocery store? Will a worker produce better results for a raise or under the threat of disciplinary action? There are numerous examples of rehabilitation programs being more effective than punishment in altering behavior in the criminal justice system, as well. The field of psychiatry is ever-evolving in helping us understand humanity and how to make the world a better place for everyone.
My goal is to help you better understand your mental health from the comfort of your own home. Whether that is through the education provided in this blog or through taking the next step and scheduling an appointment for individualized treatment. It can be extremely difficult to access our current healthcare system, often especially for mental healthcare. This will always be a human, professional resource to turn to, rather than Dr. Google or even ChatGPT nowadays. Please don’t use ChatGPT as a therapist, but that’s a post for another day…
I hope you will join me on this journey of navigating the complexities of mental health and wellness together.