Paul Szmal: Good morning, it's 816, it's FLX Morning Friday, the Friday Extravaganza, it's our monthly check-in with Finger Lakes Community Health, which operates eight community health centers all across our listing area at localcommunityhealth.com, and we're joined by Heather Burchell this morning. Good morning.
Heather Burchell: Good morning.
Paul Szmal: Now, you're a psychiatric nurse practitioner, so let's talk a little bit about, we've talked about the various levels of nursing and what nurse practitioners do, so talk about your training and background, and then specifically how you became interested in the psychiatry part.
Heather Burchell: Yeah, so I went to school for nursing and got my bachelor's in nursing up in Rochester, and so my first few years of nursing, I worked only in psychiatry, so I worked on the inpatient unit at Strong Memorial Hospital, I went outpatient and worked at the outpatient health centers up there as well, and then went back to school and got my master's to be a nurse practitioner in psychiatry, so what that means is I can have my own patients, I can prescribe medications, I can diagnose, and then once I graduated school, I had my first job here at Finger Lakes Community Health.
Paul Szmal: Now I'm learning all kinds of things before this interview even started, just reading the notes. Number one, I didn't know that Finger Lakes Community Health had psychiatry services, but this one blows my mind. I always thought psychiatry meant lie down on the couch, tell me about your childhood, that's what we call therapy. So what are the differences, what specifically is psychiatry?
Heather Burchell: Yeah, so at Finger Lakes Community Health, we have psychiatry, and then there's also counseling or therapy, those words are usually used interchangeably. So psychiatry, you would meet with either myself or we do have a psychiatrist there as well, Dr. Killies, and our role is really just medication management. Now as far as counseling or therapy goes, those are usually longer appointments, usually 45 minutes to an hour. You're spending a lot more time talking about your history, symptoms you're having, learning new coping skills, learning new distress tolerance skills or things that you can do aside from medications. Meeting with me or Dr. Killies, it's really just medication management symptoms that you're having that can be treated or better relieved with medications as far as mental health symptoms go.
Paul Szmal: Now, can patients' existing medications affect their mental health? Do you have to look at what they're taking for other things too and seeing if there might be any effect or any side effects if you prescribe psychiatric medications?
Heather Burchell: Yeah, definitely. So that's really the nice part of us being integrated in the primary care office, because in order to see us, you have to be an active patient under primary care. And so first you'll meet with primary care and they'll look at all those things. They'll look at the meds that you're on from a medical standpoint. They'll do some blood work. A lot of times our physical symptoms or if there's an underlying disorder medically can present as depression or anxiety or something from a mental health standpoint. So then when the patient comes and meets with me, I look too at the medications they're on and if they are on a medication for blood pressure or something and I'm not sure how it'll interact with the meds I have them on, I can just walk right down the hall and talk to primary care and collaborate and have that approach to see which med would be best to interact with what I would want to prescribe them.
Paul Szmal: I know this time, first of the year, is when we think about making changes. We think about our resolutions and things. Do you see an upturn in the number of patients seeking services this time of year because they just feel like something wasn't right in 2024 and I want to be better?
Heather Burchell: Yeah, I think definitely the change of the new year, but also just the holidays in general. Holidays, wintertime is pretty tough for people. So I feel like November, December, now even still, I've been pretty busy as far as new patients or patients that I was seeing in the summer that were doing okay, but now we're coming back. So definitely a lot of new patients, a lot of returning patients. I think just like I said, the holidays, wintertime, people are wanting to make changes, but also just have a lot of stress going on and want to get some better assistance with that.
Paul Szmal: Now, I know one of the concerns people have is they say, oh, I don't want to be on a drug for the rest of my life, but very often that's not the case. Sometimes you can manage this through medication and maybe for a few months, give them some coping skills, talk to them, and a patient might be able to proceed without the medication.
Heather Burchell: Yeah. So some patients, they'll be on medications for longer than others and that's okay too. That's why we're here to monitor that. But yeah, there is a fear that, you know, if I'm on this med, do I have to be on this forever? Am I relying on it? But that's not the case at all. There's a lot of patients that once they're on a medication, if they're stable for a few months, you know, we'll like to monitor how they're doing. And if they want to stop it, see how they do stopping it, they can definitely do that. And there's a lot of patients that once they stop it, they still do okay. And exactly like you said, Ted, a lot of times once they're on the meds, they're also in therapy learning these new skills, learning new habits in their day-to-day life that then they can, you know, apply to their symptoms better to where they don't need to rely on the medication.
Paul Szmal: Who's a good candidate for psychiatry? What sort of symptoms or what sort of mental health problems can someone be going through where you say, okay, you should really come see us?
Heather Burchell: So really it's hard to put it in a little bubble because there's a lot of different scenarios. You know, really anyone that, you know, is struggling with their mood, is struggling with their anxiety. Sleep is a big one too. Sleep, you know, affects all of us, but a lot of times from a psychiatric approach, we can better help that as well. So really anything, if you just, you know, your mental health, you're just feeling not the best, or maybe you've tried, you know, lifestyle changes such as, you know, sleep hygiene, eating better, exercising, that's not helping, or you've tried therapy that hasn't really helped and it's gotten to a point where maybe you would benefit from medication intervention. So really anyone that kind of questions that or if their primary care doctor meets with them and is like, hey, you know, we've tried a few different meds because primary care can do that too, and these meds haven't helped you, you'd be best to, you know, meet with one of our specialists in psychiatry to see what other options are available.
Paul Szmal: Right, and interestingly, sometimes there are physical symptoms that might make someone think they have mental health problems. For example, a thyroid disorder can look like it's giving you mental health symptoms.
Heather Burchell: Yeah, exactly. So that's why it's super helpful that, you know, we're right in the primary care office. That's why it's helpful to get those, you know, baseline labs because someone could be having, you know, chest pain, feeling sweaty, feeling anxious, you know, then their mind starts to spiral of like, oh no, what's happening to me, but when really they might have an underlying cardiac issue or thyroid issues are a big one. So we do like to check, you know, a full blood panel, like I said, especially thyroid, vitamin levels as well. You know, living in upstate New York, everyone's vitamin D is super, super low, but that can make people more depressed, not sleep right, have no energy, or just present a little more anxious than they typically would. So that's why it's really helpful to look and see if there's an underlying medical cause that could be, you know, treated from a medical medication. And if, you know, there is and it's treated and then they feel better, then that's best case scenario. If the labs come back normal and everything from a medical standpoint is normal, that's when it's a good time to meet with one of us to see, you know, what else is really going on here.
Paul Szmal: Whether we seek psychiatric services or don't, what are some of the things that we can do in our lives and in our habits to improve our mental health?
Heather Burchell: Yeah, so there's a few different things and it's really, I feel like, things we all know, but we just tend to forget, myself included. But I always tell my patients, you know, back to the basics. So are you drinking enough water? Are you getting daylight, you know, even though it gets dark super early, but are you at least going outside for a few minutes to just get some fresh air, some daylight? Are you eating well? Obviously, the holidays, this is the time people now want to make some changes. So, you know, getting in some fresh vegetables, getting in some fruit, getting in some protein if you can, having more of a balanced diet, and then also just some light exercise if you can. Walking is a huge thing. Even if you're just, you know, going out and getting your mail or just, you know, walking down the street a little bit, bundling up, those things can really, really help your mental health. And I think it's things that we think are just, you know, we do day to day anyways, but a lot of times if we can just put a little bit more effort into that, our mental health symptoms could get a lot better as well.
Paul Szmal: I'm old enough to remember when a vice presidential candidate had to resign from the ticket when it was learned he was taking antidepressants. Are we making progress in that stigma about mental illness where we've so long, we've treated it differently from a physical problem?
Heather Burchell: Yeah, I definitely think that the stigma's gotten much, much, much better, and I do attribute that to, you know, social media, just day and age of everything is kind of thrown in your face. But also there is still a tiny bit of stigma, and that's why it's always helpful that if you're a little bit hesitant, I have patients all the time that, you know, come in, they're a little, you know, hesitant, don't really know how they feel about meeting with psych, taking medications, but nothing is mandatory. So we always say you can always meet with us, have that conversation, and then once you leave the office, you know, it's totally up to you whatever you want to do. But we do say that a lot of times people do come in, and then once we have these conversations, they do feel a lot better at least wanting to try a medication, especially if then they have relief with their symptoms. And a lot of times people will be on these meds, and like we said, don't have to stay on them long-term, so then they feel better about that as well.
Paul Szmal: Heather Burchell, our guest, psychiatric nurse practitioner with Finger Lakes Community Health. They operate health centers all across our area. Find out about these services and more at localcommunityhealth.com. Heather, thanks. Great conversation and great information and education. Really appreciate it.
Heather Burchell: Yeah, thanks so much.
