September 11, 2018

CON Focused on Mental Health Care Improvement

As depression and suicide rates continue to rise across the country, more health care providers and educators, including at the UAMS College of Nursing, are focused on doing more to address the problem.


Recent data from the Centers for Disease Prevention show suicide rates increased by 30 percent in the U.S. between 1999 and 2016, and by 37 percent in Arkansas during that time. Arkansas ranks 43rd in the nation in access to mental health care and 10th in suicide prevalence.


Two CON faculty members — Melodee Harris, PhD, RN, APRN, and Sara Jones, PhD, APRN — want to see those stats improve. Both see the answer lying in a team approach that brings together doctors, nurses, nurse practitioners, pharmacists and other health care professionals to provide a holistic approach.


Harris is focused on a blind spot she sees among older adults, who usually do not garner as much attention for mental health as younger people who suffer from depression or suicidal thoughts.


Suicide rates for older adults and seniors is higher in Arkansas than in other regional states, as well as compared to the average American.


Her two-year, $100,000 grant — funded by NEXUS with matching funds from the UAMS Provost Office and UAMS College of Nursing Dean’s Office — aims to bridge the gap in older adults by increasing awareness, and the breadth and level of care provided by involving the next generation of health care professionals. That includes nurse practitioners, pharmacists and doctors.


“Students have to learn to work together now,” said Harris, who is specialty coordinator for the Doctor of Nursing Practice program’s adult-gerontology primary care specialty. “There needs to be communication between the health care team to improve patient outcomes and this grant involves students from the colleges of Nursing, Medicine and Pharmacy to do just that.”


The grant’s work started in 2016, with faculty from UAMS colleges of Nursing, Pharmacy and Medicine producing modules on mental health, as well as guidelines on anti-depressant prescriptions and depression screenings. Paired with student-led videos on how to screen for depression, students conducted geriatric simulations to test the modules. Nearly 200 students have been trained through the simulation.


In July, students took their training and hit the road to screen older adults across Arkansas in clinics and nursing homes around the state for depression, including at the UAMS North Street Clinic in Fayetteville and the UAMS12th Street Health & Wellness Center in Little Rock. The students use iPads to connect all members of the health care team in screening a patient.


At any given time, a couple of nursing students might be with a patient in Searcy while a medical student and pharmacy student observe from Texarkana and Little Rock.


In addition to screening more individuals for depression — which Harris said has shown decrease hospitalizations — it also brings quality health care to rural parts of the state where depression is worse and shows students the benefits of working together.


“We’ll need an interprofessional team with greater awareness of this issue to see improvement in our state,” said Harris. “It is not just physical care or mental care, it’s about an approach to treat the whole patient.”


Jones is focused on a whole-team approach as well, specifically at 12th Street. Jones said there is a tremendous need to blend mental health care with primary care because studies show a large portion of patients seek mental health care with their primary care physician and many refuse referrals to mental health specialists.


“Unfortunately, few health care providers are trained in an integrated health care model, and even fewer students are exposed to it. This presents a clear need for early interdisciplinary education and training that provides future providers with knowledge and skills to care for patients with mental health problems in any setting.


It is for this reason she wants to create a mental health education program at 12th Street.


“We know that mental health is a facet of whole health and we are striving toward an integrated health care model so we can improve patients’ overall well-being,” said Jones, coordinator for the master’s program specialty in psychiatric-mental health. “To do so, we need an interdisciplinary mental health education program that will educate and train students how to recognize, screen for and provide brief interventions for individuals with mental health problems.”


Strategic planning for the program in 2018 identified six objectives, including increased interprofessional mental health education at UAMS, improved training in using mental health screenings and increased exposure to providing mental health care.


“Meeting these objectives will improve the overall mental health education and training provided to students from various health care professions,” said Jones. “Long term, when these students become health care providers and encounter a patient with mental health problems in any setting, they will have the knowledge and skills to recognize, screen for, provide brief interventions and refer for mental health services.”


Jones’ work in the psychiatric-mental health track of the college’s master’s program has also directly impacted mental health services in Arkansas, Since coming to UAMS in 2014, the number of graduates from the specialty has grown from five to 21 this year.


“As board-certified psychiatric mental health specialists, those graduates are key to the future of mental health services and care in Arkansas,” said Jones.