What do Mental Health NP's do?

[SnowShoeRN]

Hi all!

I've been looking at NP programs and am in the process of applying to programs for MSN/FNP.

However, I recently started a new thread in the general forum asking if I should quit nursing to pursue my long-ago dream of being a psychologist (I have a BA in psychology and an AAS in nursing). The general consensus seems to be that I should be a mental health NP.

I've wanted to explore working as an FNP in impoverished areas and rural areas both here and abroad and love the idea of working relatively autonomously. But now I'm wondering if I should look into being a psych NP instead.

I always said that I didn't want to go into psych nursing because what interests me more is the counseling aspect not the throwing-meds-at-people aspect. (Although of course I know that some conditions can only be managed by meds or a combo of meds/counseling.) But I've never worked on a psych floor, so I can't really know. Maybe I would love it.

Exactly how much counseling do psych NP's do? Is there a way I could still work in a family kind of practice treating other medical conditions (colds, flus, infections, etc) as well as mental health issues? Would pursuing an FNP cover mental health stuff too? Would I have as much freedom to travel and offer my skills to other areas as a psych NP as I would as a FNP?

Any input would be appreciated. Thanks! :)

[lucianne]

First of all, psych NPs DON'T throw meds at people. They prescribe appropriate medications for disorders that cannot be treated by therapy alone, for people who are not good candidates for therapy, or for whom therapy is not available. If you pursue an FNP, you can certainly prescribe psych meds but will most not likely have the training to handle complicated patients and if you are working in an underserved area you will most definitely encounter those patients and will be pressured to prescribe for them because mental health care is even less available in rural areas than primary care. You will not be qualified to provide psychotherapy as an FNP. There is no way to predict if you will be able to provide psychotherapy as a psych NP, it depends on where you work and who you work for. If you are working for a community mental health agency, you will probably not be doing much therapy because therapists are more available than NPs and can be paid less. However, even when I was working for community mental health, I did manage to provide a certain amount of therapy for my patients during their med checks (that was because I treated children and adolescents and was able to get 30 minute instead of 15 minute appointments). A lot of FNPs return to school to get post-masters' psych/mental health certification.

[zenman]

I agree. Therapy plus meds works the best. I personally use meds as little as possible but sometimes you have to load someone up. Today, on one person, I changed the time of one antidepressant from HS to AM plus doubled the dose, increased the HS dose of an antipsychotic med while keeping the am dose the same, added another antidepressant with different actions, and added a mood stabilizer. I know what you meant by "throwing meds" but you see how much thought you sometimes have to put into helping a person.

I've interviewed for jobs where they wanted you to see 20 plus patients a day, and at places where they thought the same was an inhumane way to treat a person and they preferred therapy to handing out meds.

It's hard to get bored with psych!

[Smitty08]

I agree with the above 2 posters. There are many different practice sites and philosophies of treatment. I typically do a great deal of medication management ("Throwing meds - NOT!") In fact I would go so far to say I have saved lives by careful medication management. I do some therapy - not much - but enough to keep my hand in and my skills up. Its a great advance practice role, very gratifying.