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Physical cure, mental care

Overcrowded psychiatric hospital wards plus record numbers of ER patients presenting with mental illness means nurses across the hospital system need to be equipped to recognize, diagnose, and treat mental illness… but most are not.

During her time as a psychiatric nurse, Judy Kangas gave medication to patients from behind shatter-proof glass windows, participated in putting patients in restraints if they became physically aggressive, and even sat with them in group therapy sessions.

“Psychiatric nursing was the last thing I ever wanted to do,” says Kangas, a nurse of 39 years with five years of experience in psychiatric nursing, “but it was probably the most rewarding nursing experience I ever had.”

But she says most nurses today haven’t had the same amount of involvement with mental illness as she has.

“Today, when I’m working with a nurse who hasn’t had my level of exposure to mental illness, they let me take over because I have more experience,” she says. “They recognize that they’re not equipped to handle these cases and they back off. It’s very frustrating.”

Kangas says that nurses who do not specialize in psychiatric nursing are not prepared to work with patients who come into a public emergency room with a mental illness, despite the prevalence of it. One in five adults experiences a mental illness in the U.S. per year, and depression is the leading cause of disability in the world.

When a patient enters an emergency room due to a manic episode, their heart rate and blood pressure may be elevated. Nurses will know how to treat the physical aspects of that episode but, in Kangas’s experience, most will not know how to treat the root of the problem—the mental illness.

However, the problem extends beyond just the widespread presence of mental illness. A severe shortage of psychiatric beds has been plaguing the nation for years. This forces patients with mental illnesses into emergency rooms and, in more extreme cases if their behavior summons police presence, jails, where they encounter staff and personnel who are untrained to provide the proper care they require. The United States only has 21 psychiatric beds per every 100,000 people and needs more than 120,000 more to end the shortage.

Nurses like Kangas are prepared to help all patients because of their extensive and specialized training in psychiatric care, but for many more, their education in treating mental illness is happening on the job. This approach to mental health within nursing is not sustainable because, as Kangas has experienced, nurses become fearful and reluctant to tackle the issue head-on.

“Most nursing programs don’t get into great depth when it comes to mental health education,” says Shannon Whitehead, director of the RN-BSN program at Dallas Nursing Institute, which is partner institution to The Chicago School under the nonprofit system of colleges and universities TCS Education System. “There are usually some foundational classes, but the majority are core nursing classes.”

By including mental health education and training in nursing, nurses will find themselves ready and able to help a broader range of patients and will be more confident in their ability to help those with mental illness. This not only eases the pressures placed on nurses but also benefits patients.

“Having a solid knowledge of mental illness is beneficial not only for nurses and their longevity in their career but also in taking care of patients,” Kangas says. “Patients know when they’re being taken seriously and when someone really cares.”

The future of health care will surely require a closer marriage between the physical and the mental: ensuring that everyone is properly cared for and that all nurses are ready to tackle anything they may encounter, whether that be treating a broken wrist or providing care to someone with bipolar disorder. This type of training can ease the fears many nurses have about treating mental illness, as Kangas has witnessed, and help hospitals and emergency rooms save time and effectively provide care.

“As time has moved on, we have found that integrated care works,” says Dr. Sandra Siegel, The Chicago School counseling psychology faculty member and former director of community mental health at Mount Sinai Hospital. “It’s good for patients because they can go to one place with multiple services. But you need to have people that are prepared to provide that type of care.”

This integrated approach is explored in The Chicago School’s new online bachelor of science nursing degree program. Set to equip students with the mental health component that is all too often missing from nursing education, this program will help students go on to provide patients with the highest level of care possible—not just by treating them physically, but also in recognizing and responding to their mental state as well.

Hospitals can be frightening enough as it is, with loud noises, unfamiliar machines, and lots of people. It can be a very triggering experience even for those who don’t live with mental illness. But at the end of the day, as Kangas notes, nursing is about empathy, ensuring that a patient doesn’t suffer more than they need to. With nurses at the frontline of health’s defense, integrated training is vital to providing the highest quality care possible.

“When you’re in a clinical hospital setting, you’re seeing people at their worst,” Kangas says. “Nobody asks to be mentally ill, but it affects so many people. That’s why every nurse should have extensive mental health training. Combining psychology and nursing is invaluable and necessary.”


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Evelyn Metric


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