Need advice - how to set up physical office for mental health

[FullGlass, BSN, MSN, NP]

I just started a new job working for a large FQHC. Due to the shortage of mental health providers in California, they hire non-PMHNP NPs and train them to provide mental health (they hire PMHNPs, too, if they can get them). And before people start complaining, I was just accepted by the Hopkins PMHNP Post-Master's Cert program and will be starting that in Fall 2020. I have a consulting psychiatrist I can contact at any time, as well as another doctor with a lot of experience in outpatient psych and substance abuse treatment. I treated substance abuse and basic mental health in my previous primary care job.

My question is about my physical office, therapeutic environment, and safety. I alternate between 2 clinics. In my primary clinic, I have a decent office in a section of the building with other rmental health professionals. In the other clinic, I was dismayed to find that they put me in an exam room that is 8' x 8', but the sink takes up 2', so I am literally in a windowless space that is 6' x 8'. I don't know how that is even considered a decent size for a primary care exam room, as the exam table is pushed up against a wall, so you can't get to all sides of the patient. At any rate, they put 2 chairs in there for patient and companion (but patients can bring 2 other people sometimes, like parents). Across the hall is a one-person bathroom which is bigger than my office. There is no phone. The room is way in the back of the building, so if I screamed, no one would likely hear me. I do treat some rough characters, like people who just out of jail, just got off parole, etc. I am also a bit claustrophobic and this space is freaking me out. Some of my patients are also uncomfortable being in such a confined space. In addition, I am worried about my personal safety. In such a confined space, if a patient attacked me, I would have no time to prepare - they would be on me instantly. In addition, probably no one would hear me yell for help. I told my manager that I would not work out of that clinic until basic safety measures are implemented, such as moving me to the front of the building, where other people are around, and a basic alarm system (a $12 air horn is fine). It's also not therapeutic for the patients.

My experience is that mental health providers have good-size offices with a desk for them, and usually a loveseat or small couch and armchair. There are some lamps for softer lighting and an effort is made to create a soothing and aesthetically pleasing office. I should have a budget to decorate the offices in both clinics, it doesn't have to be fancy.

I haven't heard back from my boss yet, but part of me is worried because I am new. However, the consulting psychiatrist was furious when he saw the pictures of the "office. The clinics are only about 5 or 6 miles apart, so it should not be an undue hardship for all the patients to come to the better office until the situation is rectified.

Since I'm new to mental health, would appreciate advice.

[FullGlass, BSN, MSN, NP]

In case anyone cares, I told my manager I would not work out of the second location until suitable safe space is provided. He agreed, so I will just work out of one location for the time being.

Nurses are great at advocating for others, but we often have a hard time standing up for ourselves!

[Rnis, BSN, DNP, APRN, NP]

Good for you for advocating for yourself. I am glad they agreed

[myoglobin, ASN, BSN, MSN]

Here are the office elements for Psych that I found helpful (at my clinical sites) although all factors may not be available/possible:

a. Space/machinery to conduct weight(s) and vital signs. Although, not all providers get vitals on all patients, I believe it to be optimal practice since many psych medications can affect weight, bp, and other factors.

b. Continuous video recording (better still if it is monitored) this helps protect you from unfounded allegations of abuse. This occurred to a counselor at my clinical site and devastated his career. After that they went to "digital/video recording" that can be recalled in the event of a need.

c. Internal communication phones/intercom with front desk is useful to get help quick and or a "panic" button.

d. Tech's/MA's for vitals and depression anxiety screenings GAD-7/PHQ are great. They can also ask about side effects to medications, changes in sleep appetite and put in some of the billing codes. This was almost a necessity with the "Florida" model of 15 minute appointments (for medical management, but the 30 minute model may allow for the provider to do more.).

e. Toys/puzzles to keep kids somewhat occupied so they or their parents can be interviewed more effectively.

f. My preceptor had beautiful Harry Potter artwork painted as murals on his walls which seemed to put many clients at ease or serve as conversation starters.