When someone walked into the MultiCare Rockwood Clinic Quail Run location earlier this year and told the front desk they were having thoughts of suicide, staff turned to Taylor Keating, ARNP.<\/p>\n
As a psychiatric mental health nurse practitioner embedded in the clinic, Keating assessed the situation and had the person transported to the closest emergency department.<\/p>\n
Luckily for everyone, Keating happened to be available and says she\u2019s glad the clinic could help, even as a non-emergency location.<\/p>\n
About four years ago, the Rockwood Clinic behavioral health team relocated from their clinic at MultiCare Deaconess Hospital and embedded their providers in primary care locations across the region. The move allowed for a more seamless patient experience and enhanced collaboration with primary care providers.<\/p>\n
Here\u2019s a day in Keating\u2019s life caring for patients as a behavioral health provider.<\/p>\n
Keating typically comes in early to catch up on messages and prepare for the day\u2019s appointments. Once her day begins, it\u2019s nonstop.<\/p>\n
Most days include two 60-minute intake appointments with new patients and as many 30-minute follow-up appointments she can schedule.<\/p>\n
Follow-ups involve checking in with patients, their care plans and medications. They\u2019re either in-person or virtual, depending on what patients are being seen for and their ability to make it to the clinic. Many must travel across town or farther because there are only three MultiCare behavioral health providers in the Inland Northwest.<\/p>\n
Today\u2019s schedule was half virtual.<\/p>\n
\u201cWith therapy, you\u2019re following up either every week or every other week, and that\u2019s a lot on a person and their schedule, so having this option has been a game changer,\u201d Keating says. \u201cIf a patient has a sick kid, or something comes up but they can have a phone call, we do that. That\u2019s not always a luxury other specialties have.\u201d<\/p>\n
We don\u2019t want things to slip through the cracks when it comes to mental health, she says, so it\u2019s most important to see patients in a timely manner. Ultimately it comes down to the patient \u2014 they get what they put into mental health treatment, she adds.<\/p>\n
Keating conducts all new patient intakes in person so she can get a good feel for the person and their condition and begin building a trusting relationship. She describes that first appointment as an \u201cinterview\u201d of herself, too.<\/p>\n
\u201cI try to get them comfortable and to not make mental health treatment this big, scary thing. I don\u2019t wear the white jacket and I don\u2019t keep a lot of clinical stuff in my office,\u201d she says. \u201cI love when I can win over somebody\u2019s previous negative experience with mental health treatment \u2026 and give them hope that\u2019s not how it\u2019s supposed to be and won\u2019t be from now on.\u201d<\/p>\n
Developing a good therapeutic relationship is important to Keating \u2014 it ensures she\u2019s doing the best she can for her patients, that they\u2019re getting what they need and they feel heard and respected. If a patient doesn\u2019t feel that, she encourages them to advocate for themselves and find a better fit.<\/p>\n
When the relationship does work, though, great things can happen.<\/p>\n
Keating recalls one patient she saw earlier in the day who had been a no-show for months. In those months out of treatment, their mental health declined, and shortly into the appointment they shared that they\u2019d been preparing to take their life.<\/p>\n
\u201cHow I react in that moment can make or break the rest of their view on mental health treatment. To just sit there and talk through it with them \u2026 and to show them that opening up is not a scary thing, but a good first step,\u201d she says. \u201cWe took time to lay out a safety plan and what options were reasonable for them right now. They work and have financial restrictions to seeking care, so we have to understand that full piece of it, too.\u201d<\/p>\n
Some patients struggle to get care because of life circumstances or challenging systems, Keating acknowledges.<\/p>\n
\u201cIt\u2019s tough for those living paycheck to paycheck, and you have to respect patient autonomy,\u201d she says. \u201cSome choose that this isn\u2019t the right time, and that can also be a necessary part of their treatment journey.\u201d<\/p>\n
Sometimes, though, it\u2019s necessary to share her outside perspective and suggest that \u201cmaybe it\u2019s worth investing the time, finances and energy to focus on this now, not later, so you can reenter life as it was with more tools and a better approach,\u201d Keating says.<\/p>\n
\u201cI love when I can win over somebody\u2019s previous negative experience with mental health treatment \u2026 and give them hope that\u2019s not how it\u2019s supposed to be and won\u2019t be from now on.\u201d<\/p><\/blockquote>\n
There are also factors outside everyone\u2019s control, she explains. In the case of her patient expressing suicidal ideations, they\u2019d been struggling to get their prescription medications over the past month due to a national stimulant shortage and changing insurance providers.<\/p>\n
\u201cSometimes the health care system as a whole makes you want to hit your head against a wall. \u2026 I think every provider is dealing with that right now. Everyone is trying to find something to help,\u201d Keating says. \u201cThose are the frustrating things, but they have a solution somehow, some way. But in the case of this patient, that will keep me up at night.\u201d<\/p>\n
The COVID-19 pandemic played a significant role in medication shortages, as there\u2019s been an increase in ADHD diagnoses, she explains. For many people, coping skills they developed to adapt to the dramatic shifts to daily life suddenly don\u2019t work anymore.<\/p>\n
There\u2019s also been an increase in anxiety, especially in social settings.<\/p>\n
\u201cWhen the pandemic hit and we stayed home, there was a lot of anxiety and depression, which became the new normal. Now there\u2019s a lot of fear of going into social settings,\u201d Keating says. \u201cParticularly with that group of kids in high school who missed out on junior and senior year and now are in college \u2014 there\u2019s a lot of developmental stages that got missed.\u201d<\/p>\n
Self-care is a universal need<\/h2>\n
Keating says it\u2019s important to remind her patients and herself that there will be ups and downs, and that\u2019s OK. She\u2019s developed her own routines to decompress.<\/p>\n
\u201cYou have to develop a mindfulness routine to shut down after the day. After I drive to pick up my daughter from day care, I sit in the car for two minutes and breathe and remind myself, \u2018This is time for you and your family,\u2019\u201d she says. \u201cI know my patients still have access to care after I leave if they need, and I need to take care of myself, too, so I can be there for them.\u201d<\/p>\n
Even on the hardest days, Keating says she\u2019s never felt she chose the wrong profession.<\/p>\n
\u201cI love what I do, and it makes the challenge worth it,\u201d she says. \u201cWhen you find a treatment plan that\u2019s working and patients can start doing the things that help maintain that, like being more social and active, applying for that scary job or leaving that unhealthy relationship, that\u2019s my favorite.\u201d<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"
When someone walked into the MultiCare Rockwood Clinic Quail Run location earlier this year and told the front desk they were having thoughts of suicide, staff turned to Taylor Keating, ARNP. As a psychiatric mental health nurse practitioner embedded in the clinic, Keating assessed the situation and had the person transported to the closest emergency […]<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"author":115,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[39,99,79],"tags":[],"class_list":["post-26851","post","type-post","status-publish","format-standard","hentry","category-behavioral-health","category-primary-care","category-profiles-stories"],"acf":[],"yoast_head":"\n
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