What's it like to work at a community mental health clinic?

I work at a mental health clinic. Its a 24hr Crisis Center. Ive spent 11 years doing inpatient psych and mgmt. There are less resources and novelties (like pyxis machines). I do crisis assessnents on walk in clients and on Emergency Detention clients. It can be busy. I feel good about what Im doing. Its a great change for clinicians working unpatient. We save a ton of money for the county by evaluating clients here versus the ER. I would recommend the experience.

The exact duties in a public mental health clinic setting probably have a lot to do with the state you practice in. If your state has the ability to court order outpatient treatment I'm guessing the population varies. My state does allow court ordered outpatient, and has a large system of outpatient clinics set up. There are also 2 urgent care type centers that can hold people for up to 24 hrs.

I work on an ACT team, which is kind of a specialty within the specialty. We provide wrap around services- one stop shop type thing. There are usually around 10 case managers and they all have specialties- housing, transportation, rehab/employment, housing, substance abuse, etc. One doctor and me (RN). We do refer people out to day programs, and our voc rehab program, as well as intensive outpatient substance abuse programs. ACT started when they started opening the doors and dumping the chronic patients into the community with no support system. They kept ending up back inpatient, or in jail, homeless, etc. Someone started going into the community and teaching independent living skills IN the community. It worked. SAMHSA noticed. It seems to be very very popular recently- like, if you want a lot of funding, create ACT teams. I am thrilled that my experience doing a job that I love has made me so incredibly marketable. There is a future in it. I have worked on the traditional teams too, so can give you a run down of both.

Non ACT RN's work with a team of case managers and a doc, but refer people out for services more. The case managers have to see each client in the community once every 3 months, and once a month overall. There are about 250-280 patients assigned to a team with about 10 case managers. The nurse has all 250ish, as does the doctor. The day consists of appointments. Labs, injections, the q 3 month appointments to check in, annual health assessments. Dealing with refill requests, team meetings, and of course, the very very mentally ill patients, who make it all so interesting.

My day can be similar or drastically different depending on the needs of my team. I have about 75% of my time doing in clinic appts. I have 99 patients. I have to see them all monthly but most are on injections, clozaril, or come to fill their medisets once or twice weekly. The team overall has to deliver 50% of care in the community so the rest of my time is doing home visits, or jail and hospital visits. I met a girl last week at her GYN's office to provide moral support while she had an IUD inserted. I have testified in court to get a client a guardian when his health declined and he was too delusional to accept care (he had MRSA, but we hadn't ruled out TB). I went with a case manager to be in the room when a client was taken off life support. He had no one but his team, so it seemed like the right thing to do. It is a little weird, but I was proud that I had managed to bill for talking to someone who was brain dead. Almost forgot- in the end it's all about billing. It sucks but it's as much a part of the unpleasantness as bed bath's are to long term care RN's. I love that I get to drive around and give injections to people who are court ordered to have them but scared to go near a clinic. I don't like sitting in an office. I prefer to sit in a park and chart on my crappy but functional company laptop.....

You need experience in inpatient psych for both, and in outpatient too for ACT, but it is a career that has growth potential. I love it.