GU nursing professors seek to overcome stigma, improve care
by Marilyn Urness, EWU Intern
With one in five Americans diagnosed with mental illness and more health care providers needed as access to care improved under the 2010 Affordable Care Act, two Gonzaga faculty members seek to improve care for those mental health patients.
Jeff Ramirez, associate professor of nursing at Gonzaga University and doctor of nursing practice program director and Carol Kottwitz, assistant professor of nursing and the program director for GU’s psychiatric nurse practitioner program, believe that part of improving care is to end the negative stigma of mental illness in the medical field and society.
Their work has taken them from changing the lives of students and patients one at a time, to advocating for changes in legislation.
Mental illness has always held a negative stigma in the health care industry. Only in the last two decades has mental health been considered a legitimate health condition. In 2010, the passage and enactment of the Affordable Care Act (ACA) gave access for treatment to people with mental illness who didn’t have it before, according to a 2016 report of the Washington State Nurses Association calling for mandatory suicide prevention education.
With access to treatment, the number of patients has outweighed the number of qualified caregivers, the report said.
In addition, emergency room staff often lack training to treat patients who are mentally ill and may not understand the seriousness of a situation, Jeff explained.
“Emergency room staff are burned out in dealing with overdoses and suicide attempts. They don’t understand why patients don’t just take their medication and stop using substances,” he said. “It’s a complex situation. We just need to fix the system and help people understand why some people overdose on heroin, attempt suicide or have other crises.”
According to a Catholic journal article Jeff wrote in 2016, the consequences of untreated mental illness affects society and the community as a whole. The high rate of incarceration, homelessness, overdoses, drug and alcohol addiction, and high suicide rate are all symptoms of untreated mental illness.
Gonzaga University’s program for psychiatric nurses strives to address these issues. Students in this program can earn either a master’s or doctoral degrees.
The program is now mostly online courses with some on-campus immersions to give students more time to focus on their in-field training.
To keep the professors up to date, they are required to stay in practice.
“They can’t just teach in a classroom. They have to be part of delivering care.” Carol explained.
Students often come with experience in the medical field, see how patients with mental illness are treated and want to learn more in order to help.
“We have students who have worked in the emergency room and are driven here to earn their psychiatric nurse practitioner degree because they didn’t like the way patients with mental illness were being treated,” Jeff said.
A focus of this program is to eliminate the stigma for mental health. Gonzaga has two strategies to do this.
First, students have to reflect on themselves. By addressing their biases, they gain clarity so they can focus on the patient instead of their own problems.
Second, students are required to complete volunteer hours at nonprofits or charities, such as homeless shelters or free clinics, where they can see how serious untreated mental illness is.
Students are to look past the stigma and see the human being hidden by their illness, said Jeff.
“I tell students, when looking into the eyes of somebody who is mentally ill, psychotic or depressed, to see how the person is struggling,” he said.
Carol grew up in Othello, a small farming community. She graduated from Eastern Washington University with a nursing degree before attending the University of Washington and earning her master of psychiatric nursing and doctor of psychiatric nursing practice degrees.
She had always had a passion for psychiatric nursing. While working for Sacred Heart Medical Center, she was assigned to patients with mental illness because she was able to connect with them.
“I asked questions to understand how they were feeling. I was supposed to focus on medical conditions, but I was talking to folks to find out about their lives,” she said.
Carol began working at Eastern State Hospital, which funded her master’s degree. While she was there from 1984 until 2015, she witnessed changes in treating patients with mental illness. She said there was a major change in the community perceptions about mental illness and approaches to care within the system.
Since joining the GU faculty, she has started her own private practice. Her passion is to change one life at a time, whether it be her students or her patients.
Seeing strict rules at state hospitals increased Carol’s understanding of challenges people with mental illness face. In her private practice, she can connect with patients more and align business practices to favor patients’ wellbeing.
Many think private practices are cash pay, but she sees Medicare and Medicaid patients, who may have challenges with access to care and are grateful the bus stop is right outside.
Often state funded practices limit patient sessions to 15 minutes, not allowing enough time to connect and treat the patient. Some clinic policies may result in denial of care because of cancellations or missing appointments, effectively “firing” them from care.
Carol finds this frustrating, considering the challenges her patients face just to make it to an appointment. She is aware that mental illness may impair a patient’s ability to make and keep appointments, many patients do not have their own vehicle or reliable transportation, and they face other hurdles in making appointments.
She doesn’t believe in “firing” clients because they miss two appointments, knowing they may struggle to get out of bed, be thinking about killing themselves or lack access to transportation. She reaches out and checks up on patients to make sure they’re okay.
Jeff shared his background, growing up in a Catholic family in the Tri-Cities, where he attended a Catholic elementary school before public high school and community college for a nursing degree and continued his education earning a doctorate in nursing science.
He started in cardiac care at Sacred Heart Medical Center, later working in management. He soon found his passion was treating and connecting with patients with mental illness.
When he went to Eastern State Hospital, where he first met Carol, he found few families were around to be involved with the patients, and there were fewer services.
Although he never served in the military, Jeff saw the high suicide rate in returning veterans when his niece came back from Afghanistan. He wondered how he could help. This led him to work with patients with PTSD at the Veterans Administration Medical Center in Spokane.
Jeff learned to reflect on himself to keep from falling into negative stigmas about mental illness.
“I have to understand my own problems in order to see what’s going on. What is going on may be my issue, not the patient’s,” he said.
“It’s not fair to a patient when I have a bad day from having a flat tire or being late to work,” he said.
He knows to be aware of his bad day and separate himself from it when he is dealing with a patient who just attempted suicide.
“As I have matured and had exposure to folks who live different lives from my ‘house jazz,’ I realize that some of the strongest, most courageous people I’ve ever met are some of my clients,” he said.
Carol and Jeff, who both seek to lower suicide rates, had the chance to affect thousands of lives in 2014 by being appointed to serve on a committee to carry out Washington State House Bill 1424.
The Washington State Legislative passed a law requiring nurses and other health practitioners to complete six hours of continuing education in suicide assessment in order to combat rising suicide rates.
They were on the team assigned to evaluate state programs to determine if they complied.
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Copyright@ The Fig Tree, February, 2020