The panel from right to left includes:

•    Whitney Erickson, FNP, Alma Wellness Associates, Memphis, Tennessee
•    Kendra Wiseman, PMHNP, Appalachian Regional Healthcare, Hazard, Kentucky
•    Cindy Lau, NP, UCSF Medical Center, Oakland, California
•    Jenny Melguizo, RN, BSN, MSN, PMHNP-B, Compass Wellness LLC, Boston, Massachusetts 

Transcript:

Samantha Lau:

Hello, I'm Samantha Lau, Nurse Practitioner, and steering committee member at Elevate. And I'm so happy today to be surrounded by our new Psych Congress Elevate family members. We're all nurse practitioners, so why don't you tell us about your experience.

Whitney Erickson:

I'm Whitney Erickson. I live and work in Memphis, Tennessee. I own a private practice, Alma Wellness Associates, and I predominantly take care of adults that have treatment-resistant depression, bipolar disorder, perinatal care, a lot of post-traumatic stress disorder (PTSD), and have a few kiddos as well in the mix.

Cindy Lau:

Hi, I'm Cindy Lau. I am certified in acute care, and I also obtained recent certification in psych mental health as a nurse practitioner. My training: I worked at Asian Health Services, which is an amazing nonprofit in Oakland, California, that serves the refugee immigrant Asian population.

Kendra Wiseman:

I'm Kendra Wiseman. I'm from Hazard, Kentucky. I work in a state hospital working for Appalachian Regional Healthcare, and we service 24 counties focusing on the adult population. I take care of everything—PTSD, anxiety, depression, bipolar disorder, schizophrenia, personality disorders, eating disorders—just anything that comes down the pike.

Jenny Melguizo:

My name's Jenny Melguizo. I live and work in Boston and have a private practice. I mostly see college students for a particular university in Boston, and mostly see patients with depression, anxiety, eating disorders, bipolar disorder.

Sam Lau:

That’s great, thanks. So, we are all nurse practitioners here so I would love to hear your perspective on how to address the stigma of depression, as we know how harmful that can still be, even though we've made a lot of progress in the field, it still influences the chances of people seeking treatment and remaining in treatment.

I want hear from all of you who are working in different areas with different populations. What have you seen?

Whitney Erickson:

I would say one of the greatest joys of my career is taking care of other mental healthcare professionals. Even within those that are providers that become patients, we really walk a fine line of acceptance and annihilating stigma.

The example I would use is recently I had a client that is actually a professor at our local teaching facility and she walked into the hospital with her psych NP students. These blossoming students, very open-minded students, and they ran into a situation where travel nurse and resident said, "Oh, patient in 108 is crazy".

You know, the statement that we've all heard, and everyone uses, and she immediately responded "What drew you to that conclusion?” They simply stated “Lamictal 100.” They identified not even a particular behavior pattern to make that association. They identified exclusively a drug and a dose, which happened to be the exact same drug and dose that I had my client on.

We really had to walk through that she didn't need to identify how other people had perceived her and in our own conversations, provider and patient, it was just very complex.

Samantha Lau:

How about you, Cindy—what have you seen?

Cindy Lau:

Well, during my training at Asian Health, I mean, I think specifically Asian Americans are a very diverse group, but my particular experience with Asian Americans in the open population, it's extremely underutilized, the mental health, because there's a couple of divisions, there's a primary care division, but there's the Asian Health division.

Specifically in that area, a very small percentage of people who need mental healthcare are accessing it. That is due to the stigma specifically within the Asian American community. I know there's stigma in the general population, but I think it's specifically for males due to cultural reasons in the Asian American community. There's the internal stigma, because the Western paradigm of ‘you're individually responsible for yourself’ versus ‘you are more of a unit’ in Asian culture.

If you admit or go seek help, you are not just doing that to yourself. You are bringing shame upon your family. And there's also stigma with Asian American immigrants, which is the population that primarily this community center serves. There's huge, tremendous pressure to become to, for economic and financial mobility. So, if you see CalCare also affecting that, for example, “I have an issue, will I be able to be successful for my family?”

The other thing I think is this concept of model minority for Asian Americans and we're seen in the community as being very successful, not having issues. If you're going out to seek help in a setting like a psychiatric or a therapeutic session, you are breaking out of that and you're not complying to that model minority. These are the issues around or what I've seen as barriers to people seeking help within this community that I had experience with.

Samantha Lau:

Thanks for your perspective. How about you Kendra?

Kendra Wiseman:

I think the region I work in, it's more of a geographical stigma as well. I live in a very rural area. The access to care is not as readily available as it is in the big cities. We come from small communities, small families, and if your mom has mental illness, you're automatically assumed to have mental illness, you've got “bad blood,” “bad genes,” that kind of thing. There’s also discrepancy between who can suffer for mental illness.

I have barriers every day where I will have a homeless person or a prostitute, a drug addict, somebody that's really well off. Like you have witnessed medical providers, mental health providers themselves. I then have to tell them that it doesn't discriminate. Mental illness affects everybody. It doesn't say, "Oh well, you're black, you can't be depressed" or "You're Asian, you can't be schizophrenic". So, that's what I think I deal with the most is just trying to educate the people in my areas.

Jenny Melguizo:

For me, the patient population kind of self-selects when coming to see me just because I see so many college students and really all of them are engaged in therapy. So the stigma, does not necessarily impact their access to treatment because to some degree they understand that what they're struggling with and that they need more support. I think the stigma plays a role in continuing treatment and it mostly comes in through their own family.

I see this when students go on break and go home for periods of time where they disclose that they're taking medication to their family or that they're struggling with certain things, and depending on cultural aspects of their background, that becomes an issue because the families sometimes believe that this isn't something that's actually real or that this is something that's actually caused by different aspects of assimilating or trying to adjust to a different culture, to different expectations.

That's where I think the adherence to treatment is an issue is because of other people's views of how these people should be presenting or should be addressing the things that they're experiencing during these times. I see this a lot with new students; I see a lot of international students.

Oftentimes that becomes an issue is not necessarily them understanding what they're experiencing and being able to seek out services, but actually adhering to medication or to even to therapy.

I also sometimes see some students will potentially thinking, "Well, I'm not sure I should be accessing these services because I'm not struggling as much as others". So that becomes an issue where it requires a lot of psycho education and sometimes family involvement. It involves trying to help them understand, "Well, this is, what's important right now is being able to support this individual with what they're experiencing. And part of this will be medication and therapy".

It’s not necessarily the individual that struggles with the stigma. It's more others that potentially will amplify this or question whether or not some of what they're experiencing is real.