Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment
Some of the professionals that work most with helping people with schizophrenia are nurses. There are so many types with different skill sets. Host Rachel Star Withers and Co-host Gabe Howards learn who these often overlooked healthcare workers are.
Dr. Tari Dilks, Professor and President of the American Psychiatric Nurses Association, joins with insight on what goes into being a psychiatric nurse.
Highlights in “The Role Nurses Play in Schizophrenia Treatment” Episode
[01:14] Doctor sidekicks?
[04:00] The types of nurses
[06:40] Nurse Practitioners
[11:00] Nurses specialties
[13:00] Psychiatric Nursing
[17:00] Where do psychiatric nurses work?
[21:00] Home Health Care
[24:10] Guest Interview with Dr. Tari Dilks
[26:17] How psychiatric nursing is different than other types
[34:00] Be the hope for someone
[45:16] Appreciation for what goes into being a nurse
About Our Guest
Sattaria ‘Tari’ Dilks, DNP, APRN, PMHNP-BC, FAANP
Professor and Co-coordinator of Graduate Nursing, College of Nursing and Health Professions, McNeese State University
Dr. Tari Dilks is a professor of nursing at McNeese State University and co-coordinator of McNeese’s Master of Science in Nursing programs. She is also director of the psychiatric/mental health track for the Intercollegiate Consortium for a Master of Science in Nursing partnership involving McNeese, Nicholls State University, Southeastern Louisiana University and the University of Louisiana at Lafayette.
Currently the President of the American Psychiatric Nurses Association, she consistently advocates for awareness of psychiatric-mental health issues. She the past chair of the APNA Practice Council and was the 2017 recipient of the APNA Award for Excellence in Education.
Dilks obtained her Doctorate of Nursing Practice in psychiatric mental health advanced practice nursing from the University of Tennessee, her Master of Science in Nursing degree and her Master of Arts degree in psychology both from McNeese and her Bachelor of Science in Nursing degree from West Texas State University. She is a family nurse practitioner, psychiatric mental health nurse practitioner and a licensed professional counselor in Louisiana.
She has also been recognized for her leadership by the American Association of Nurse Practitioners with the Louisiana Award for Nurse Practitioner Excellence and her induction into the academy as a Fellow.
Computer Generated Transcript of “The Role Nurses Play in Schizophrenia Treatment” Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a look in to better understanding and living well with schizophrenia. Hosted by renowned advocate and influencer Rachel Star Withers and featuring Gabe Howard.
Sponsor: Listeners, could a change in your schizophrenia treatment plan make a difference? There are options out there you might not know about. Visit OnceMonthlyDifference.com to find out more about once monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia, a Psych Central podcast. I’m Rachel Star Withers here with my co-host, Gabe Howard. And this episode, we’re gonna be talking about the roles nurses play in our mental health care.
Gabe Howard: It’s weird to think that nursing has anything to do with schizophrenia, when you suggested the topic was like what? How are we going to get an hour out of this?
Rachel Star Withers: I agree. It really blew my mind. Learning what nurses do has actually been incredible because there is so much that goes into nursing.
Gabe Howard: Sincerely, before we started this, I thought that nurses were Dr. Sidekick’s. I want to be completely honest. I thought that nurses were doctor assistants. Hard stop. That’s it. There was nothing more that they did. The end. And wow, was I wrong.
Rachel Star Withers: If you look at like different TV shows, Scrubs, ER, like when you’re watching them, it’s very segregated. The nurses and the doctors and you just kind of get that idea that they’re two separate things, you know, and obviously doctors what you want. That’s the vibe you get from TV if you don’t know who these people are.
Gabe Howard: It’s very interesting to me, as much as we talk about how. Don’t learn about schizophrenia and mental illness from pop culture and media representations. We’ve had to have said that at least a dozen times over the course of Inside Schizophrenia. And yet here we are learning about the nursing industry from their portrayal on media and pop culture. And it just goes to show you that it’s easy to fall into this trap, that what we’re seeing on TV is somehow some sort of accurate portrayal when in actuality it’s not, it’s fictitious at best.
Rachel Star Withers: All I’m going to say is thank you to all of our wonderful nurses. Obviously we have the pandemic and stuff going on. So thankfully, a lot of people that don’t get seen have been pushed into the spotlight and all the work they’re doing. So any level of nursing, medical, health care. Thank you so much right now, because all those people are giving more than they should have to.
Gabe Howard: I completely agree. Thank you so much for all that you do, and nurses are as a man with red hair, meaning I grew up as a redhead. I’m allowed to say this. The nurses seem to be the red headed stepchildren of the medical industry. They’re so necessary and they do so much. And yet they’re often ignored. And we want to talk about specifically how nurses are helping people with schizophrenia, because, as it turns out, they’re doing an incredible amount of work and even us. Rachel, before we started this show, we’re like, wow. I mean, what do they do? Like what? They check us in when we get there?
Rachel Star Withers: Take my blood pressure?
Gabe Howard: Yeah. They check our blood pressure before, you know, the real person comes in to help us. And that’s really the crux of this conversation. Coming up later, we have a wonderful guest, a woman who has been a nurse for a long time and has done a lot of work. And she’s a psychiatric nurse. And I am excited to have everybody listen to her because, I mean, frankly, she really set us straight.
Rachel Star Withers: Oh, yeah.
Gabe Howard: Rachel, there are different types of nurses, and I don’t mean like psychiatric nurse versus surgical nurse. I mean, like there’s different educational levels. Who have access to do different things. And I was kind of surprised by that as well, because I, I really sincerely thought it was one size fits all.
Rachel Star Withers: So the three basic types. OK. Three general basic types. We have an RN, a Registered Nurse. That’s kind of what I would say most of us think of in our head when we picture a nurse is what is the traditional registered nurse. A lot of times, you know, you go to the hospital, that’s who you are interacting with. They do like the vitals. So you are talking to that person kind of on that level. They can, as we’ll get into, do diagnoses, different assessments, like they play a major part because a lot of times the doctor will only see you for, like, you know, five minutes. But it’s the nurse who does all the work of, hey, this is what I think’s going on, then pulls the doctor in. Then you have licensed practical nurse or vocational nurse, depending on what country or state you’re in, and they are under the supervision of the nurses. I don’t want to say nursing assistant, but kind of. It’s the next level down. But they do a lot of important stuff also. And then there is the CNA, Certified Nursing Assistant. And that’s I hear the most, I guess, with people. I’ll have people talk about what our jobs are. I hear oh, I’m a CNA. I hear that all the time. And I really didn’t know what that meant. But there are ones who do like routine and daily tasks. CND are usually the ones you get to talk to the most. That kind of interact with you, that kind of help you form, like, I don’t want to say emotional bond, ’cause it sounds a little creepy in the medical sense, but, no, that, like the ones you’re like talking to. You know, more one on one. So these are like the three big ones.
Gabe Howard: One of the things that, of course, was most impressive in all of this is that no matter what kind of a nurse you see there on the front lines, it means they have a lot of patient interaction. So when we talk about how nurses help people with schizophrenia, they might be the first medical person that somebody who is in crisis sees. When you walk into the emergency room, the first person that you see is not a doctor. It’s not a psychiatrist. It’s a nurse of some sort. Nurses often see people with schizophrenia and start the process towards diagnosis long before you reach a doctor. So in that way, nurses are extraordinarily vital to noticing the symptoms of schizophrenia and reporting them back up the chain. And I don’t think many people really realize this and that. And that alone shows you the importance of nurses in the treatment of schizophrenia and other mental health issues. Nurses don’t just change bedpans. They’re really doing a lot to keep people with schizophrenia safe. And I was very surprised by that. Rachel, I understand that you’re not as surprised as me because you see a nurse practitioner for your schizophrenia treatment, which I did not know and blew me away.
Rachel Star Withers: Yes. So what that is, though, if you’re listening at home, you’re thinking, Rachel, didn’t go over nurse practitioners as one of her three things. So there are advanced nurses that they are highly trained. Lots and lots of college and lots of certifications having to constantly keep up on what’s going on. These are the people that they can diagnose you. They could actually prescribe medicine. Where I go twice a month for the past, like eight, 10 years is a center. It’s a mental health center. And I have never met the psychiatrist there. I think there’s one or two on staff. But they are over these nurses. So I’ve always met with, like a different nurse over the years. And I assumed I was meeting with the doctor, really. Just like in the past where I met with psychiatrist. You sit down, we discuss the symptoms, what’s been going on, any changes that I might need to take, where we’re at, checking to make sure nothing else is going on that might be interfering.
Gabe Howard: I remember a long time ago when Gabe Howard was but a young mental health advocate. I really pushed people only to get mental health care from a psychiatrist. I would always say some form of, well, if you had cancer, you would only go to an oncologist. And, listen, in a perfect world, I still stand by that. We don’t live in a perfect world. And I realized in many places there can be a one, two, three, four month wait, if not longer, to see a psychiatrist. And if you’re in crisis, you need somebody. Now, I’ve realized that licensed nurse practitioners, especially psychiatric nurse practitioners, are really pulling a lot of weight. They’re trained, they’re specialized, and they do a really, really great job. And do I wish that there were a million more psychiatrists? Do I wish that you could see a psychiatrist at the drop of a hat in a moment’s notice? Do I wish that the health care system works differently for people living with schizophrenia? Absolutely. But this isn’t the world that we live in. And it’s important to understand that psychiatric nurse practitioners are a very vital stopgap and have saved a lot a lot of lives. And it’s something that I didn’t give enough credit to. And I imagine that when I said things like you should only see a psychiatrist, it’s possible that somebody who listened to my words might have sat at home and gotten zero care because they were waiting on that psychiatrist. And that’s not good. That’s a very bad idea. You should always get any care that you can find before getting no care, whether that’s from a general practitioner, from an emergency room, from a Wal-Mart clinic. All of these things are much, much better options than getting zero care. And the licensed nurse practitioners are, they’re an excellent resource.
Rachel Star Withers: And to be fair, Gabe, I would say most of the time you are having to get a referral. And I don’t think other doctors are so quick to send you to nurse practitioner versus doctor. I know in the past. They’ve always been like, oh, we’ll write a referral. We’ll find a psychiatrist on your insurance. That’s always how it’s been worded to me. So it’s not just you, I would say, like just the people in the offices, doctors’ offices, they word things a certain way that makes you think, oh, I can only see a psychiatrist.
Gabe Howard: It’s understandable that people would believe this, and I think that’s something that we want this particular show to sort of open up the idea that there is a wide variety of care that a person can get. It’s also possible that when you’re in crisis, when you first need diagnosed, that a psychiatrist is where you should go. But I’m going to use you as an example, Rachel. You were diagnosed, what, 15, 20 years ago? It’s certainly possible that now while you’re in recovery and you’re, you know, month to month or even quarterly to quarterly med checks, etc., don’t need to rise to the level of a psychiatrist. You can be checked out by a nurse practitioner or even a general practitioner, etc. It’s all about finding the best care for you and the stage of your disease process. And I think that’s something that we need to be open to. Let’s make sure that people who are seeing licensed nurse practitioner or psychiatric nurses aren’t thinking that they’re getting bad care, they’re just getting different care. And I think that really needs to be the message. It’s not bad care. It’s different care.
Rachel Star Withers: And all of these nurses that you’re coming in contact with, they have a passion and they have found like who they want to help. Like when you specialize in certain things, whether you want to, like, work with kids, adults, older people, ones who want to work with like pregnant women. So pediatric nurse, you have like geriatric nurse. When my grandparents were both suffering very, very badly from Alzheimer’s, we actually had geriatric nurses coming to the house and one of them was so great with my grandfather. He was mentally gone. And she was like, I remember telling me she had been trained to deal with that, to deal with people in their 80s, 90s who were not themselves anymore. And we were just like really impressed with that.
Gabe Howard: This specific part that I want to zero in on is where you said that, where she said this is what I’ve been specifically trained for, and that’s what we want the audience to understand about psychiatric nurses helping people with schizophrenia lead their best lives, get their best care. That is what they’ve been specifically trained for. And, you know, so often let’s go back to the top of the show where we thought that doctors were best and nurses were second best. But wait a minute. What if you have a doctor who’s been specifically trained in geriatric issues and a nurse who’s been specifically trained in psychiatric issues? Well, now, depending on where you are. Well, the doctor is better. The doctor has to be better, they’re a doctor. But they have no specialized training in schizophrenia or mental health issues. They only have the broad training. So in this way, we need to start thinking, well, now, wait a minute, a nurse with specific psychiatric training and in my mind, and the research holds out, a nurse with specific training in psychiatric disorders is going to be better than a doctor with broad training and nonspecific issues. And this is where we need to start being aware that that just because you’re a doctor doesn’t mean that you’re better than a nurse. Every situation is different. And it’s important to understand that we’re different, right? We have specialized needs. People with mental illness have specialized needs. And I always want to be in a room with a practitioner who understands the illness and who understands my specific needs, because that’s going to give me the best path to wellness. Is that how you feel, Rachel?
Rachel Star Withers: Absolutely, Gabe. And with it, these specialized like that’s something they’ve chosen. That’s something that they’re passionate about. Like usually these people, they specialize for a reason. OK, they are interested in helping people with mental disorders or whatever they specialized in. A little bit later, we talked to Dr. Dilks. That becomes so clear how passionate she is and you will see why she chose psychiatric nursing. And it kind of makes me feel better to know that you have somebody who’s like, I can work with anybody, but I’ve chosen to work with people who are in crisis like you. I don’t know, that’s just really cool to me that someone has decided you are specifically what I want to focus on.
Gabe Howard: So let’s break this down a little bit. You know, psychiatric, mental health nurse, it tends to be an umbrella term. There’s a ton of titles. They vary by state. But let’s talk about the roles and duties of a psychiatric mental health nurse. What do they do?
Rachel Star Withers: So they are going to be the ones that assess you when you come in there. I’m having a situation. They’re going to be figuring out what are the symptoms, what’s going on? They can help diagnose and treat patients, depending on what type of nurse they are. They may be actually prescribing your medication. If you are in a actual facility, where you’re staying inpatient, there’s so many different nurses there that are going to be monitoring you, taking your weight, monitoring your food like just so many different levels, just the basics. And then the brain, the mentally. How is this person responding to these medications? You know, where are they mentally? Their jobs are also to educate family members, which is so important. I remember one of my past mental health nurses actually asking, could my parents come in. If I would feel OK about bringing them in so they could all be on the same page of what needs to happen for Rachel. But of course, they had to ask my permission as I am an adult. Just really incredible. They help the patients set your goals short term, long term. Where do I want to be mentally?
Gabe Howard: And they also have subspecialties, so not only are they focusing on, you know, schizophrenia, psychosis and the things that are important to people living with severe and persistent mental illness, living with schizophrenia, but then they come up with a subspecialty which zeroes in their ability to help even more. And those subspecialties, well, there’s a ton of them, Rachel.
Rachel Star Withers: Yep. Wherever you live, you might not have an office that has all of these wonderful subspecialties, but you’re going to people who specialize in children and teens, adolescent kind of ages. Substance abuse is a big difference. Then let’s say schizophrenia. You have others that their main job is to be the go between, that they’re more of an administrative kind of office type person. That is their job to kind of help you outside of this. Like, once you get out, what happens once you’re not inside the office? Who’s helping you? And I think that’s a really cool one. Like, I kind of thought those people, which I know I’ve come in contact with, they actually know. They have a medical background. They have lots of training to be able to make these connections that are best for you.
Gabe Howard: We’ve heard a lot about what they can do, how they’re trained, how they specialize and why they’re great, but where do they work? Where would we run into or meet up with a psychiatric nurse or a mental health nurse?
Rachel Star Withers: Hospitals. Psychiatric style hospitals, different doctor’s offices across the board, home health care organizations. One that I hadn’t thought about till we were researching, prisons. There are a lot of psychiatric nurses that work in the prison system. Whoo! Wow.
Gabe Howard: And that’s one to really consider, because prisons have sort of become the new asylums. There’s a lot of people with schizophrenia that unfortunately, because of the mental health safety net being so holy, they find themselves in prison. So, thankfully, these nurses are in there because they may well be the only people looking out for the mental health and the well-being of people with schizophrenia who find themselves in prison.
Rachel Star Withers: Another area I wasn’t thinking about would be schools. Schools employ a lot of different nurses. And I do remember my college. You could, like, have free basic checkups and things like that. And then they also had free counseling that I would go to. And looking back, I don’t remember who it was I was talking to. I just assumed it was a psychologist. So looking back, I’m like, oh, well, I’m seeing how many nurses are employed. And I was probably talking to a specialized nurse back those many years ago. And understand like to become one of these people, it’s not just about my two year degree. You have to get multiple licenses. You have to have all these different certifications and so many different hours practicing at different areas. You know, and then you’re looking at some have their masters, some have their doctorate in nursing, which is kind of weird to think. So you’re a doctor of nursing? That concept was a little odd to me because we don’t understand nursing correctly. Like, honestly.
Gabe Howard: Well, yeah. Yeah. At the top of the show, we thought that nurses were doctor assistants, so yeah, I’ve been shocked at the amount of training and again, it just shows you the base misunderstanding that we have about the profession.
Rachel Star Withers: Let’s swing over. What are the other nurses? So we know we’re gonna run into some psychiatric nurses. It’s common with schizophrenia, we’re probably going to, at some point, interact with some E.R. nurses. E.R. nurses are like, incredible. They’re gonna be the ones who have to spot the crisis situation first on what’s happening, especially if you are in the middle of psychosis and you can’t really tell them what’s going on. Your reality is all messed up. I know a lot of times when I kind of I call it being mentally off. But a lot of times when I am in the middle of a psychotic episode, I have really bad headaches. If you were to ask me, Rachel, what’s going on? I’m probably not going to tell you I have a headache. You’re gonna see me trying to find a hammer to pull the nails out because it hurts so bad, it feels like a nail. So I need to get a hammer to pull the nails out. That would be what I would be telling you. And you’re like, what? But I’m trying to tell you, that’s how bad my headache is. Psychotically, though, in my mind, my head literally has nails in it. So imagine being a nurse and you have someone coming in there trying to explain symptoms in those ways. And you have to be smart enough to figure out what is this person saying in a very intense time. Very kind of, I would say, scary. You have family members who might have brought the person in. It’s just amazing, though, that what E.R. nurses have to be able to do and remain calm doing that.
Gabe Howard: Switching gears, just ever so slightly, Rachel, you know, the demand for mental health services has increased significantly in recent years, primarily because more Americans have health insurance because of the Affordable Care Act. From 2014 to 2015, there was a 58% increase in mental health nursing jobs, which required an R.N. and a 17% increase in demand for psychiatric nurse practitioner jobs because of the increased demand for mental health services and the diminishing stigma surrounding mental health conditions. A major void in psychiatric care still exists, and nurses are in great demand to fill these mental health jobs. So nurses are out on the front lines trying to solve a lot of these problems that we have been advocating about for years. They’re also doing large amounts of stuff outside of the E.R. with home health care. And this is amazing to me because we’re sort of back to like America in the 1800’s where people are making house calls.
Rachel Star Withers: Yes, when I hear home health care, I think the nurse is having to come to your house because you’re old or you have like a physical disability, not mental. So I didn’t even know that could be an option for some people. Unfortunately, a lot of us with schizophrenia and other very severe mental disorders, we can be really bad at taking your medication. In fact, as many as 60% of patients with schizophrenia do not take their medication as prescribed, which means they take less, they take more. This is me. I’ve had this happen too. They feel like they’re better. So, OK, I’m going to go off my meds and then they’re not better. And having like a home psychiatric nurse who like travels and checks on different people, they’re able to notice if that person isn’t taking their medication a lot quicker than if I just go to the psychiatrist once a month. This person is the one who is coming regularly and checking on me. And that is just like a really awesome thing. If you’re out there, you’re listening or you’re a loved one of someone with schizophrenia, you might want to look into those different programs, especially if, you know the medication situation is one that you struggle with. Even looking into people who, if you are out of a hospital and having a hard time transitioning into the world, they have different organizations that can help you with that. And part of that is the nurses who can come and check on you.
Gabe Howard: I think it’s also very interesting and probably important to consider the role of home health care during the pandemic. It probably saved a lot of lives and we won’t know the full extent of everything for probably another year or so. But I got to tell you, you know, during times like quarantines, things being closed, people not being able to leave their house, people with schizophrenia, having access to home health care, it did a lot of good for both those folks and no doubt their caregivers. Another nod to just how important this overlooked occupation is.
Rachel Star Withers: And we’ll be right back after this message from our sponsor.
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Rachel Star Withers: And we’re back talking about the roles nurses play in our mental health care.
Gabe Howard: As promised, everybody, I would like to introduce Dr. Tari Dilks. She is a nurse practitioner with a PhD and she’s the president of the American Psychiatric Nurses Association. And honestly, this was probably one of the most illuminating and enlightening interviews that we’ve ever done on Inside Schizophrenia. She just makes so many incredible points. And Rachel, I’m jealous that you got to talk to her, and I didn’t. She is very, very cool. And I think all of you are gonna get a lot out of this. Here we go. Here is that interview.
Rachel Star Withers: Today, we are excited to be talking with Dr. Tari Dilks, who is the current president of the American Psychiatric Nurses Association (APNA). Thank you so much for talking with us today.
Dr. Tari Dilks: Well, I so appreciate the invitation, Rachel.
Rachel Star Withers: Now you have a really, really extensive background.
Dr. Tari Dilks: Oh god.
Rachel Star Withers: Let our listeners know a little bit about yourself.
Dr. Tari Dilks: Okey-doke. I am, first of all, a registered nurse. And then I got a little bored with floor nursing and got a master’s degree in counseling psychology. And I’m also a licensed professional counselor. So I began to get a little burned out. So my husband said, go back to school and become a nurse practitioner. And I said, you’re out of your mind. But I did. And I have another master’s degree in nursing. And I went back and got a doctorate in psychiatric nursing practice. And now I teach and have a consulting type business.
Rachel Star Withers: And that’s really awesome to me. What we’ve been talking about on this episode is to like the lay person we hear nurse and honestly, you know, you think assistant to a doctor
Dr. Tari Dilks: Right.
Rachel Star Withers: And you don’t realize like how much goes into nursing and the different levels. It’s incredible. So it’s I love your background is just it’s a lot. It’s way more than most people think. You know, unfortunately, most of us kind of think of Scrubs or E.R. or one of those type
Dr. Tari Dilks: Right.
Rachel Star Withers: Of shows when they think of a nurse.
Dr. Tari Dilks: Right. There’s not very many people like me out there, but all of us have a different journey, though. And it you know, my sister’s journey went to the emergency department. My mother’s went to the operating room. I ended up in psych almost by accident and have loved it ever since I found it.
Rachel Star Withers: [00:01:48] So what made you decide exactly to switch over to psychiatric?
Dr. Tari Dilks: So what made me decide to become a psychiatric nurse was an accident in a large part. My mother was an operating room nurse. Then I thought that just doesn’t sound exciting to me. And I ended up going to nursing school up near Amarillo, Texas, at West Texas State. And while I was there, I got a job at a children’s psychiatric hospital and I thought I have died and gone to heaven. This is what nursing ought to be. I was able to do so many things that appealed to me at that time. I played guitar and I could bring my guitar and sing with the kids. I did art and I could bring that playing cards. It was amazing to me how much information you can get from playing cards with people. What sort of selections they make, what their hand-eye coordination is. And so when I came back to Lake Charles, they had a job on a med surg unit, which I kept one day. And then a job opening came up on psych and I had never looked back. That has been such a powerful journey for me and to be able to help people in a very creative way. There’s no algorithm that tells you, say this. Say this. This. It is what’s going on in the moment. It’s a collaboration between you and that particular person.
Rachel Star Withers: You’ve spoken a little bit, but how exactly would you say psychiatric nursing really differs from general nursing?
Dr. Tari Dilks: General nursing, there are skills and certainly psychiatric nurses have skills as well. Starting an IV. Putting down an NG tube, the things that you were talking about earlier, that nursing, you know, on E.R. or Scrubs or one of those shows, they show nurses as very proficient at doing different types of skills. And for me, psychiatric nursing is while it engages the science of nursing. It is all about the art of nursing. It is about the relationship. It’s about the whole person, not just a particular disease or just a particular procedure. It’s about trying to see a person in a very holistic type of context so we can navigate these interpersonal relationships and we can engage with people on a very deep level. And that’s really, to me, the essence of psychiatric nursing. And I think it’s the essence of it for all of us.
Rachel Star Withers: What are the biggest challenges that come along with your profession?
Dr. Tari Dilks: You know, I’ve been in this field a very long time. And when I was started out in it, there was stigma and there is still stigma today, not only against the patients, but also the nurses had a stigma about becoming a psychiatric nurse for some reason. It’s not perceived, at least by the students, as being real nurses. So I talked to an undergraduate nursing class pretty much every semester. And the first question I ask is how many of you are gonna be in psychiatric nurses? And two might out of 60 raise their hands. And then I look at them and I say, all of you are gonna be psychiatric nurses, because what you learn in this class and what you learn about psychiatric nursing permeates throughout the entire profession of nursing. Everybody takes the skills that they learn in undergraduate training as a psychiatric nurse. And you apply it to every patient you see, every family you see. A lot of people are afraid of going into psychiatric nursing because they’ve seen things that show psychiatric patients as being very violent and being out of control and out of touch with reality. And while that is a part of the patient population that we see, it is such a small part of the patient population we see all of us could be psychiatric patients at different times in our lives. All of us get overwhelmed. All of us get depressed. All of us get anxious. And at some point in time, for some people, it just becomes too much. And really, about close to 50 percent of people over the course of their lifetime are going to be affected by a psychiatric illness on either a mild or a major level. And so what I do really, really matters in a very different way. We’ve got a really severe workforce shortage and a lot of that is is how people perceive us.
Rachel Star Withers: How do most patients respond to you?
Dr. Tari Dilks: You know, I have worked a lot over the years on how I talk to people and recognizing that I can’t fix them. And, you know, I think that was something that I came out of nursing school with, was I was here to save the world. Right. Because nurses are great caregivers. They take care of other people. And it took me a while to realize that’s not what my job was. My job is to sit with that person and to help them figure out what they’re going to do, what works in their life, what works for me may not work for them. And I think and that’s what frustrates I get some family nurse practitioners that come in for a post, masters in Psych, and they want algorithms, you know, because they’ve got that for blood pressure. Somebody comes in and they have high blood pressure. This is what I do. Boom, boom, boom. Well, somebody comes in and they’re crying and they’re depressed and they’re in an unhealthy relationship. There is no boom, boom, boom. It’s not a one, two, three. It’s let’s get in there and dig around. And unfortunately, part of our digging involves pain. Oftentimes a lot of psychological pain. And that’s hard for people. And you’ve got to lay the groundwork before you get there. That’s very frustrating for other nurses because like I said, some of them have these algorithms. You do A B C and things get better. Well, this is you might do A and Z and maybe W and then get back to B and C before the patient really begins to respond. So I find that with experience has also come a lot of empathy. People respond well to me. I’ve worked really hard on vocal modulation because that makes a difference when you’re talking to somebody. If they’re getting more and more upset, the lower you talk, the slower you talk, the more you look like you know what you’re talking about, the greater the chance that they’re going to respond to you and begin to calm down.
Rachel Star Withers: What would you like to say to people who are in a crisis when they come in contact with you?
Dr. Tari Dilks: There’s always hope. You know, I had have had patients who’ve come in who’ve been fired by every provider they’ve ever had. And that was part of what led to some of my burnout early on, was that I really felt like they needed to have hope. And it required that I have hope. And sometimes when they didn’t, I needed to have it for them. And I had a patient who really, really, really wanted me to give them permission to commit suicide and asked me, you know, Tari, why do you want me to stay in this kind of pain? And it took me aback. I thought, oh, my goodness, is that what I’m doing? Am I making people stay in pain? And then I realized my job was to have the hope for them, for them to always be able to see that that there was an option, that there was another chance. And that person is alive today. And it’s a wonderful thing.
Rachel Star Withers: That’s amazing. What helped you kind of come out of your burnout?
Dr. Tari Dilks: That requires self-care. And that was another thing that they really did not teach me in nursing school, was that I needed to figure out how to take care of myself. So to do that, I’ve been in therapy a couple of times and I play very hard. I scuba dove. I do art. I try to take time out to enjoy my 10 grandchildren. You know, I try to make sure that I carve out time for me. I love to read. So I always make sure every day I had the opportunity to read and I read junk fiction, you know? But it’s escapist. And I a lot of ways. I love music. So I listen to all the corny music shows that are out there, you know, journaling and all of that gets together with helping me relax. I’m sitting here looking out my window on a lake and I’m watching the wind play on the water. All of those things contribute to self-care. There’s all different types of things that that I try to do to take care of myself. When I do those things, I don’t burn out.
Rachel Star Withers: That’s great advice for anyone. That’s awesome.
Dr. Tari Dilks: Absolutely, absolutely.
Rachel Star Withers: Now, what advice do you have for anyone who is thinking of becoming a psychiatric nurse?
Dr. Tari Dilks: Just do it. It is a wonderfully rewarding profession we’re nurses at heart; we understand how to assess people. We understand the interplay between different disease processes and psychiatric manifestations. Like I said, it’s the most rewarding thing in the world for me. And people that are attracted to this profession should just go into it and learn everything they can, absorb everything they can and develop mentors and find people that they can emulate and learn from. And always keeping in mind that their job again is not to fix the person, it’s to walk with the person on their journey. And I’m not walking in front of them and I’m not walking behind them. I’m walking side by side. Let me help you get through this. Let’s figure it out.
Rachel Star Withers: What resources does the American Psychiatric Nurses Association have for those who are interested in becoming a psychiatric nurse?
Dr. Tari Dilks: Well, we have several things. We have a student membership that’s only twenty five dollars. There’s the opportunity with that membership to network on a platform we call Member Bridge. There are free education and resources there. There also is a mentoring program there. There is a tip sheet for new nurses and we have a program for people who are becoming new nurses where they can do an educational process that helps them understand the basics of psychiatric nursing. We offer an educational scholarship to students every year for our annual conference. There are 10 undergraduate and 10 graduate scholarships and we’re working on beginning to expand that to where we can offer more. But that was one reason I got very involved with a Pinay several years ago. I got one of those scholarships and was able to go to an annual conference at where was at Long Beach, California. And it was like I was home. Everybody there spoke my language. Everybody there understood. When I talked about a patient issue, what I was talking about, they understood when I talked about somebody having a really manic episode that got out of control, they knew what that was without me having to explain to them. So the resources with a PMA are incredibly deep. There are very many different ways to be a psychiatric nurse.
Dr. Tari Dilks: You don’t have to go into advanced practice nursing. You might go into administration. You might choose to stay and be the front-line R.N. and that be what you want and that be the kind of service that you can offer to others. And that’s perfectly OK. When I was a young nurse, that was a great thing because I didn’t have to worry about additional responsibility when I had young kids. But then as my kids grew, I wanted to grow as well. And so then I started looking for more and more education. And I think APNA just is an incredibly rich resource. And I don’t say that just as the president of the organization, I say it because I came up through the ranks. I met the executive director at that meeting in Long Beach, and he and I developed this incredible relationship over the years. Of just I could call him and ask him any question he could guide me on. I was involved with the state nurse practitioner organization. He helped me figure out the type of executive director that we needed to do. And every single person that’s on staff at APNA is like that. They are there to help you. And it’s a wonderful thing.
Rachel Star Withers: And what does APNA do to support people with mental illness?
Dr. Tari Dilks: Well, we’re very big into wellness promotion and prevention of mental health problems into what’s called the recovery type attitude, which, you know, a lot of times some people hear the word recovery. They think only addiction. Well, there is a recovery from mental illness as well. And when we start employing those principles, like involving the family, involving the community, then we get better responses. We work with people who are in crisis. We have a psychopharmacology thing every year that assists our nurse practitioners and clinical nurse specialists to prescribe to keep up with the latest information that’s out there on psychopharmacology. We look at a recovery focused person centered. We talk about cultural awareness, trauma informed care. I’m doing some consulting work in an addictions area now and it amazes me, and it shouldn’t, but it amazes me the number of people with addictive issues who have significant childhood trauma and how that has contributed to how they’ve gotten into their addiction. We have consumers that give us input in our education and our conferences. We try to provide the resources and support the members to advocate for their patients. You know, I was at a meeting where they talked about that all school shooters were mentally ill.
Dr. Tari Dilks: And I had to stand up and say, that’s not true. People with mental illness are much more likely to be shot than they are to shoot people. But a lot of times the press picks up on, well, they got treated for depression way back when. Or they should have been treated for depression or whatever. And it has nothing to do with why they chose to shoot up the school or whatever area they’re in. We do everything we can to build up the psychiatric nursing workforce and we need more. We need to make this type of nursing profession important to young nurses and get them to see the incredible growth that can happen with you, with your patients, with the families, with everybody that’s involved with that particular patient. We provide education to all nurses. We’ve opened up some of our courses, especially during the pandemic. To anybody, any nurse that wants to get on there and take it, there is a technique called motivational interviewing that is a way to talk to and partner with a patient in their road to hell. And any nurse can take that now for free.
Rachel Star Withers: Oh, wow.
Dr. Tari Dilks: Yeah. Those are the types of things that a APNA tries to do. They try to be nimble, they try to be responsive and provide resources that all nurses need, really.
Rachel Star Withers: That’s absolutely awesome. Thank you so much, Dr. Dilks. Was there anything that you wanted to promote?
Dr. Tari Dilks: I want to promote getting rid of stigma. That’s what I would like to promote. Is that the people who are mentally ill are you and me. They are just exactly like you and me. They are just at a point in their life where their survival skills, their ability to handle things are down low. And so treat folks, everybody with kindness, treat them with compassion. And please, if you’re a nurse listening to this and psych appeals to you at all, please come into the profession. We need everybody.
Rachel Star Withers: Awesome. Thank you so much for speaking with us today, Dr. Dilks. I absolutely love this interview. And I personally learned so much.
Dr. Tari Dilks: Oh, great.
Rachel Star Withers: This has been very wonderful speaking with you today.
Dr. Tari Dilks: Well, Rachel, I so appreciate the opportunity to do this. Like I said, it’s a passion of mine. I really enjoy trying to get people to see things a little bit differently.
Gabe Howard: Rachel, Tari was very, very cool. Thank you, Tari, for taking time away from your duties as the president of the American Psychiatric Nurses Association. You were there, Rachel, what were your initial thoughts going into the interview vs. your thoughts when the interview was over?
Rachel Star Withers: Going in, I thought it was gonna be pretty boring, just that, you know,
Gabe Howard: It’s honest, I understand. I understand.
Rachel Star Withers: I mean, you know, not going to be that exciting and it for me was the opposite. I think what stands out most about her is her passion. She loves what she does. And she is incredibly passionate about it. And that was just the coolest thing to me. Like, she got me passionate about psychiatric nursing. She just sounded so excited about what she does and what she’s been doing for many, many years and has went to so much schooling in. And obviously, she’s very knowledgeable.
Gabe Howard: She said so many things that I didn’t think about, Rachel, what was the thing that just really blew your mind? That you thought, wow?
Rachel Star Withers: The coolest thing I think overall for me is how much schooling, how much work goes in to being that person. To being that person that you come in contact with. I’ve never in the past, really, I don’t want to say I don’t respect those people because I did. But I respect them on a much deeper level now. And that is like so cool. When Dr. Dilks was talking, I was thinking like, oh, my gosh, I want to be your patient so bad because I was blown away. Like, you are so knowledgeable, like I want you treating me. You probably know so much. And that’s just really cool to think. The people you are coming in contact with have put in so much work to get to come in contact with you. That’s just amazing to me.
Gabe Howard: The most shocking thing to me was just how much on the frontlines the nurses are. And I want to give a big, big thank you to Dr. Dilks for really just explaining that every nurse is a psychiatric nurse because they come into contact with people first. And that was a big aha moment for me, because she’s right. People with severe and persistent mental illness, people with schizophrenia, we do often talk to nurses before we get to doctors. So if they’re on their game and they notice that something’s off, they can really point us in the right direction. Because, again, we often think of the nurses as the people standing between us and the medical care that we need, rather than the nurses assisting in us getting the medical care that they need. They really can be a great patient advocate.
Rachel Star Withers: I totally agree, Gabe. An absolute thank you to all of those who work in nursing, who come in contact with anyone who has a mental disorder, who comes in contact with the family, the friends of people who have a mental disorder, because yeah, it takes a village.
Gabe Howard: Rachel, any encouraging words for people living with schizophrenia?
Rachel Star Withers: Yes. To my people with schizophrenia and the loved ones and whatnot, educate yourself on the people who are treating you. For one, it’s going to really help to build trust between you and that person. When you’re sitting in that office and there’s all these like certificates and degrees on the wall, you might want to read a few of them. I’ll be honest, I usually don’t read them. Because that’s going to help, you know. Who is this person who’s talking to me? They’re not just some random person. And to all of my nurses out there and mental health care workers, I encourage you to tell your patients your basic credentials, kind of give them some reassurance, you know, oh, I’m this type of nurse. I’ve studied blah, blah, blah for so many years. I just think that’s going to build that trust between you two.
Gabe Howard: Rachel, that is excellent advice and along the lines of excellent advice, wherever you download his podcast, please subscribe. Please leave us a review. Rank us, say nice things about us. Rachel and I like hearing nice things. When you share us on social media, use your words and tell people why they should listen. If you’re involved in any sort of schizophrenic support group, please share this podcast with them. We want to go as far and wide as humanly possible. We will see everybody next time on Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail [email protected]. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
Withers, R. (2020). Inside Schizophrenia: The Role Nurses Play in Schizophrenia Treatment. Psych Central. Retrieved on May 30, 2020, from https://psychcentral.com/blog/inside-schizophrenia-the-role-nurses-play-in-schizophrenia-treatment/