Vital Views

Joe Gaccione 0:03
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joe Gaccione, communications director for the School of Nursing. The need for more mental health awareness and treatment is ever present in Southern Nevada, but help is on the way through a new clinic developed by both UNLV Nursing and UNLV Health, the practicing branch of Kirk Kerkorian School of Medicine at UNLV. Known as the School of Nursing Clinic, it is an advanced practice registered nurse program that specializes in primary care for adults within a mental health facility at Mojave Counseling Center on East Charleston and Las Vegas. In addition to direct patient assistance, there are new avenues for nursing students getting their advanced degree, as well as the inner professionalism of working with medical providers. We have two very special guests with us today to fill us in on the clinic. First is Dr. Terry Bartmus, APRN clinic lead, and assistant professor at UNLV Nursing. We also have Kathleen Wild, agency director for Mojave Counseling. Thank you both for coming in.

Terry Bartmus 0:58
Thanks, Joe for having us.

Kathleen Wild 1:00
Thank you.

Joe Gaccione 1:01
So, where did the idea come from for opening the clinic?

Terry Bartmus 1:04
So, basically this has been an initiative between UNLV School of Medicine and School of Nursing for quite some time. I was hired specifically to start moving this initiative forward. So, basically right now, UNLV School of Nursing has no faculty practice clinic, our nurse practitioners that are faculty and teaching in the university practice in the community at various entities, so this is the first initiative to basically provide students with training within the School of Nursing at clinical site with faculty that are working at the site. Also, the main point of this clinic is to also help serve a need for the community and also to help with student training.

Kathleen Wild 1:53
And Mojave Counseling has been in the community for 30 years. We're under UNLV Health. When we remodeled a few years ago, we had in mind having collaboration and interdisciplinary treatment. We built exam rooms with this in mind that, with the hope that we could institute a primary care clinic within our mental health agency, which services people with serious and persistent mental illness.

Terry Bartmus 2:21
Also, I wanted to add that this overall academic health center that's interdisciplinary, interprofessional, is part of the overall strategic plan of UNLV. So, it is promoting, you know, interdisciplinary collaboration amongst the professions.

Joe Gaccione 2:36
I wanna pivot for a second on advanced practice registered nurses. I think of nurses, and I'm sure a lot of people think of nurses, the, the stereotype of the scrubs and the emblem, like for undergraduate students. What does a nurse learn, what do they need to become an advanced practice registered nurse?

Terry Bartmus 2:54
Sure. So, specifically for nurse practitioners, there's different types of specialty. For example, at UNLV right now in the School of Nursing, we have a branch for family nurse practitioners and psych nurse practitioners. So, their training is different but similar in that it is a clinical master's program after the nurse has obtained their bachelor's of science in nursing and has practiced as nurses in the field. So once that's done, they apply for their master's program and they go through didactic courses focused on treating patients and diagnosing. And then, you know, graduating, have to take certifying, certifying board exams.

Joe Gaccione 3:38
With the target population for the clinic, I want to go a little more into that as far as we talked about adults’ primary care, but who does that target specifically?

Terry Bartmus 3:45
So, the clinic is open to the community. Just as Kathy said, it made the most sense for us to start services in these unused primary care rooms at Mojave Counseling. They serve over 400 clients, is that right?

Kathleen Wild 3:58
Oh, we have far more than that.

Terry Bartmus 4:00
So far more than, it does feel like that, but I just wanted to clarify. So, they serve quite a few, hundreds of clients that qualify as severely mentally ill by this state, and a lot of them can't get into primary care. Whether it be a transportation issue, a funding issue, you know, it's very difficult also, because Las Vegas is, has such a, a vast area that, you know, we all live in. So from one end of Las Vegas to the next is just very, very inconvenient for someone taking the bus or someone who may not have transportation. So, you know, the target population is, is this Mojave mental health patients; however, we are open for community patients and people that need primary care services.

Kathleen Wild 4:42
I was gonna add to that, Mojave, one of Mojave's most robust programs in addition to psychiatry and therapy on counseling, we have a case management program, which employs about 40 case managers, and each of the case managers have, you know, anywhere from 30 to 40 patients or clients on their caseload, and they help them with a lot of different basic needs, psychiatric medications, links to resources, housing, medical, legal, emotional services, and then also pro-social development, like volunteering, education. So, I just wanted to add that by having Terry and the primary care clinic there, it has increased access to medical care for some people that haven't had medical care in quite some time. And one of the barriers I think we have to acknowledge can be paranoia or fear of, of going to a new provider or to a new service. And so, I think having her on-site has really helped people access service that otherwise wouldn't be able.

Joe Gaccione 5:46
That workload where you have 40 case managers, and just to clarify, you said each have about 30 patients, roughly?

Kathleen Wild 5:52
Correct.

Joe Gaccione 5:53
Is that a normal ratio?

Kathleen Wild 5:55
It's gotten higher over the years. I think that the, the service population that we serve has increased, you know, with the growth of the city and the population. Unfortunately, I also think that over the years, less people are going into mental health just because of the limited resources, limited funding, and, and lower pay, so we are in constant pursuit of, of increasing our teams and professionals and, and this program has helped with that. We wanna bring in service lines from, you know, all of the services that we provide: psychiatry, nursing, social work, mental health professionals.

Joe Gaccione 6:36
It's, it's sad to hear that less people are going into mental health. Mental health has been one of the biggest topics on this show since we started it. Just in passing conversation, it always seems to come up, whether it's nursing mental health or patient mental health. Is there still such a, a stigma around it that makes it harder for people to, as a patient, go see someone or as a nurse, harder to get into because of the, the kind of patients that you're gonna see?

Kathleen Wild 7:05
Well, I, I think it's fair to say that people with serious and persistent mental illness, unfortunately, you know, it can impact them in many ways, and one of the areas that we see the most at Mojave is housing. People that have SSI for income only get $915 a month. There isn't an apartment complex in Las Vegas where you could get housing for that right now. So, unfortunately, it perpetuates poverty and instability in people's lives when they don't have basic needs met. So, you know, we're, we have a lot of barriers and it's never been necessarily a glamorous profession, but I think the people that go into it are, have a real love for the clients and our strong advocates against stigma for mental illness. You know, we're really proud of the work we do there and, and the teamwork and the collaboration that we have with Terry and all of our professionals.

Terry Bartmus 8:00
Just to add to that, I, I really feel, truly feel just from what I've observed in my patient care, and with other colleagues, that COVID pandemic kind of increased people's ability to speak about their mental health. Clearly, there's still stigma associated for some people, but I think that the pandemic created some unfortunate new things on the forefront in terms of mental health: isolation, you know, people in quarantine that would normally go to work every day. I, you know, worked in the emergency room, front lines during the pandemic, and even homeless people, you know, their, their environment got completely uprooted in some shelters because they couldn’t, this, you know, some of these facilities couldn't follow the guidelines in place. So, there was a lot of upheaval of, of a lot of people, you know, whether they had all the resources available to them or didn't. So, I think stigma is kind of going away because I think people realize what that did for them. I don't know one person who was not affected mentally by the pandemic.

Joe Gaccione 9:00
I mean, it affected everyone differently, especially older populations, you talk about the isolation, where they can't even leave their, their rooms, if they were in a nursing care facility or their homes, people can't visit them. I always wonder about the long-term effects. I don't think we've, we've yet to see that, because we're still sort of in a pandemic, like there's COVID still around, not as severe as it was when it first started, but I don't think we've yet seen the full effects, and I don't know if we ever will.

Terry Bartmus 9:29
I would agree with that. And I did want to add that we also service a youth population and we have seen the referrals and numbers go up to an all-time high of, you know, people with anxiety and people calling for support and help who maybe are first-time seeking psychiatric support.

Joe Gaccione 9:47
Is that encouraging to see more young people reach out as much as it is, maybe not to sound dramatic, but disheartening that they would want to call in because they're feeling this pressure? Like, to your point, Dr. Bartmus, just to say that they're willing to speak up and willing to say that, “Regardless of what my age is, I need to talk to someone.”

Terry Bartmus 10:06
I'm always very impressed when I encounter anyone that is growing up in this pandemic. It's, again, gonna be some interesting insight in the future as to how that has, this has truly affected individuals, but in, in my opinion, what I've experienced, and maybe a little biased, but the, you know, younger individuals that I experienced, they do seem more upfront and honest about how they're feeling, and I think that's, you know, a good thing. For us, that can be difficult for, for anybody, especially the, a younger population, to disclose that they're feeling a certain way. So, it is very encouraging, but you're right, it is disheartening to know that. But you know, you think about all of our youths and we all, you know, had our unique experiences. And mental health I don't think was very much addressed, at least in my childhood, and it just wasn't really talked about as much as, as now, so I think any small steps forward we take in terms of addressing these you know, really, really major issues we can create better, you know, resilient, healthy minds especially for the younger population that, you know, are still forming their, their trust and their opinions.

Joe Gaccione 11:12
Regarding the clinic, how do the nursing students and the medical students benefit from such an interdisciplinary resource?

Terry Bartmus 11:20
There's so many initiatives right now that are looking at interprofessional collaboration and, really, the, the evidence and, and all the research, whenever they've looked at these types of things, are pointing that it's proven to improve patient outcomes, it's improving patient satisfaction. There's more people involved in these cases, so it's not just one person providing care, there's somebody to take up some of the tail end, for example, social work case managers. When us as clinicians can't provide, you know, the resource that they need in terms of housing, you know, we at least know we can refer to social work, we can consult with them to get, to come up with a plan of care. It's also shown to reduce errors in healthcare costs. So, I think how the students benefit is they're learning to work together in their training. It's funny because nurses need doctors and doctors need nurses, so anytime we have opportunities to really form strong bonds between the two professions, I think should always be encouraged and should be a part of all the training. I can't, again, I can't think of one nurse that doesn't need a doctor and vice versa. We need each other. And you know, for whatever reason, we've kind of existed, some programs, some not, just kind of in a siloed way where we're not really providing the opportunities for these students to get to know each other. In fact, even today, so, you know, I've been a part of an interprofessional collaborating event that is involving all the health science specialties right now: social work, physical therapy, occupational therapy, dentistry. And the unified practice plan for the overall academic health center is also encouraging these, everyone to band together because that's what we need to do right now to help address these healthcare disparities.

Joe Gaccione 12:54
Where can people learn more about the clinic?

Terry Bartmus 12:56
So, we currently don't have an advertisement on the UNLV Health landing page for Mojave, but it is the, it is located at the Mojave East Counseling Center on 4000 East Charleston. There's a phone number to call, 702-968-4000, if anyone wants to call for any more information, they'll direct them to me and I can provide them with that. We are, you know, we're starting, we just started. So, you know, it's an exciting opportunity. We've already hosted our first nurse practitioner students, they love it. I feel that the case managers and I have developed a very, very close relationship in the short amount of time I've been there. Kathy's been definitely nothing but amazing and supportive of everything we're doing. Dr. Netski and Joann Strobbe, who are, you know, part of this initiative as well, that are part of the, the UNLV Health initiative to do this overall practice plan, have been very supportive and encouraging all us all to just, you know, keep moving forward. So in the short amount of time, I just, I've, it's just been great. I just, I've, I just love it.

Kathleen Wild 13:57
I couldn't agree more. I think that it's very progressive. I think exciting things are happening because of this collaboration, and I'm positive that people are getting better care. It's, it's helping in academia and patient care, which is what matters most. And if I could just throw out there, I, I do like to remind everybody as much as possible nowadays that there is a national phone number now and it is 988, and that is a mental health service number. So, anyone that's experiencing any kind of mental health or crisis emergency can call that and receive support.

Joe Gaccione 14:30
We will have the national number and the Mojave number and the Mojave website on this episode page when it drops. That is all the time we have today. Thank you both for coming in.

Terry Bartmus 14:39
Thanks, Joe.

Kathleen Wild 14:40
Thank you for having us.

Joe Gaccione 14:41
Thanks for listening out there. Hope you have a great day.