Public safety personnel focused psych practice?

FullGlass, BSN, MSN, NP · Jul 2

There is a need for mental health professionals that can help first responders. One of my patients, a first responder, struggled with PTSD. He went to a retreat/inpatient program only for first responders and found it very helpful. A number of such patients have told me they were referred to talk therapists specializing in treating first responders.

My concern is that if you become a PMHNP, in most organizations you would be focused on med mgt. Those are 15 to 20 min f/u appts, not enough time to provide substantial talk therapy. There are some organizations that allow PMHNPs to set their own appointment times, but those are not common.

If you want to focus on talk therapy, you could become a PsyD or a clinical social worker. The pay may not be as high as for a PMHNP unless you have a private practice.

If you become a PMHNP, when starting out, just get as much good experience as possible and then you could specialize and perhaps set up your own practice.

Best wishes.

CuriousConundrum · Aug 20

Having followed a similar path, we know that meds can be limiting to certain career paths as can the diagnoses. Talking is not necessarily a therapy and anyone can talk. Evidenced based psychotherapy programs such as CPT, PE, et al for PTSD are meaningful. Marketing and decorating your private practice office for public safety personnel could definitely be a niche, and there are some papers addressing your topic of interest. But by only working in this capacity, you would preselect a healthier than normal (with respect to psych) population and not grow in the experiences we unfortunately need. Most likely as a newb, you'd have to work for a group, and they'll have scheduling peons who put whatever they fill like putting on your schedule. It burns me up that an uneducated, inexperienced person dictates my day, but such is life. Outside of these concerns, you'd need a population density to support a practice. Where I grew up and wore many badges, there weren't enough public safety officials in 10 counties to support a psych practice. To make a living at this, you need access to a lot of sick people. If about 20% of a municipality will seek mental health services - at some point in life - even less of a percentage of uniformed guys will seek the same.

FiremedicMike, BSN, RN, EMT-P · Aug 20

CuriousConundrum said:

Having followed a similar path, we know that meds can be limiting to certain career paths as can the diagnoses. Talking is not necessarily a therapy and anyone can talk. Evidenced based psychotherapy programs such as CPT, PE, et al for PTSD are meaningful. Marketing and decorating your private practice office for public safety personnel could definitely be a niche, and there are some papers addressing your topic of interest. But by only working in this capacity, you would preselect a healthier than normal (with respect to psych) population and not grow in the experiences we unfortunately need. Most likely as a newb, you'd have to work for a group, and they'll have scheduling peons who put whatever they fill like putting on your schedule. It burns me up that an uneducated, inexperienced person dictates my day, but such is life. Outside of these concerns, you'd need a population density to support a practice. Where I grew up and wore many badges, there weren't enough public safety officials in 10 counties to support a psych practice. To make a living at this, you need access to a lot of sick people. If about 20% of a municipality will seek mental health services - at some point in life - even less of a percentage of uniformed guys will seek the same.

I completely respect your opinion, but a few points

1. I do live in an area with a pretty significant amount of public safety personnel.

2. I think the mental health in this population is probably lower than your giving it credit for, with a huge percentage being poorly medically managed by their PCP. The level of depression and SI is far higher than what is reported.

3. I do plan on incorporating some level of peer support/CBT into my practice.

4. Observationally, there are far more than 20% of my cohort seeking mental health treatment. I started in public safety over 25 years ago when we pretended there was no such thing as PTSD, now the acceptance of taking care of our mental health has been thrust into the limelight and is much more socially accepted than ever before.

CuriousConundrum · Aug 20

FiremedicMike said:

I completely respect your opinion, but a few points

1. I do live in an area with a pretty significant amount of public safety personnel.

2. I think the mental health in this population is probably lower than your giving it credit for, with a huge percentage being poorly medically managed by their PCP. The level of depression and SI is far higher than what is reported.

3. I do plan on incorporating some level of peer support/CBT into my practice.

4. Observationally, there are far more than 20% of my cohort seeking mental health treatment. I started in public safety over 25 years ago when we pretended there was no such thing as PTSD, now the acceptance of taking care of our mental health has been thrust into the limelight and is much more socially accepted than ever before.

Addressing the #2 and #4, you're right. It is more socially acceptable, but still not completely. I think that perception is even more regionally dependent. The psychological usually testing required preselects people who don't have the typical SMI. I'm not suggesting there isn't depression, anxiety, and PTSD or related disorders, perhaps more than in the non-first responder population, but I still don't see them openly getting treatment. I even tested out a similar market by affiliating with department chaplains and never had a single referral.

Fast forward several years, I found myself staffing a VA hospital with young, hard charging OIF/OEF vets who also wanted to become cops and firemen many of which were drawing service connected disability for PTSD or MDD. Many of them I tried to discourage because I didn't deem it safe for their mental health trajectory. It was there I learned that the state north of me, doesn't conduct any psychological testing on officers. Boy, that was alarming. You sound to be in a population dense area, I'm thinking FDNY and NYPD off the top of my head, haha. Most of the US is rural, so outside those metro areas it would be hard to render a cops and firemen practice.

FiremedicMike, BSN, RN, EMT-P · Aug 20

CuriousConundrum said:

Addressing the #2 and #4, you're right. It is more socially acceptable, but still not completely. I think that perception is even more regionally dependent. The psychological usually testing required preselects people who don't have the typical SMI. I'm not suggesting there isn't depression, anxiety, and PTSD or related disorders, perhaps more than in the non-first responder population, but I still don't see them openly getting treatment. I even tested out a similar market by affiliating with department chaplains and never had a single referral.

Fast forward several years, I found myself staffing a VA hospital with young, hard charging OIF/OEF vets who also wanted to become cops and firemen many of which were drawing service connected disability for PTSD or MDD. Many of them I tried to discourage because I didn't deem it safe for their mental health trajectory. It was there I learned that the state north of me, doesn't conduct any psychological testing on officers. Boy, that was alarming. You sound to be in a population dense area, I'm thinking FDNY and NYPD off the top of my head, haha. Most of the US is rural, so outside those metro areas it would be hard to render a cops and firemen practice.

I am in a metro area, but not one of those. I'm also in an area which has openly embraced mental health resources for public safety including city and state funded operations with dedicated mental health staff and providers who work solely with this population.

I have witnessed the transition from toughing it out to seeking help in my area and have utilized these services myself.

Times are changing, and it's a good thing.

FullGlass, BSN, MSN, NP · Aug 21

Specializing in treating public safety personnel is a much-needed service. Most providers have more than one specialty. The concerns being expressed are that as a PMHNP, it is important to grow your expertise. And you may not be able to get a job or set up a practice with only this specialty immediately upon graduation. My advice is get a first job that offers the opportunity for professional growth and do that for at least 1 year, preferably 2 years. After that, then look at ways to specialize and get the word out to the community that you are available. A great psychiatrist I know told me that even in high-need areas, it takes time for a practice to get going - 2 to 3 years at least. That means very little income during that period.

I work for a very large outpatient psych practice. You could work for such a practice and make it known public safety is your specialty and get the word out in the community. That way you would have a full schedule from the start, and you can grow the number of public safety personnel your treat, over time.