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Nursing the Mentally Ill
by Sandra Kennedy, RN, as told to Mary Ann Littell

I was introduced to mental illness at an early age — when I was only five. My mother suffered from depression so serious that she was hospitalized several times. No one ever explained anything to me. I had to figure things out for myself. One thing I knew: What happened to my mother did not happen to other mothers. It was somehow “bad” and not to be talked about.

I’m fairly certain that my early experiences with mental illness steered me toward a career in psychiatric nursing. But the route I took was indirect. After getting my associate’s degree, I went to work in the surgical ward of a large hospital. However, any psychiatric patients on the ward were always assigned to me. I had a special rapport with them. So eventually I decided, ‘This is where I need to go,’ and pursued psychiatric nursing as a career.

I’ve been at both private institutions and state hospitals caring for the mentally ill before coming to work at UMDNJ 14 years ago. Now I have my “dream job.” I’m a psychiatric nurse at the New Brunswick Partial Hospital Program, which is part of UMDNJ’s University Behavioral HealthCare. “Partial hospital” means it’s in between hospital and out-patient treatment. Patients attend the program by day and go home at night. There are 200 patients in the program, all chronically mentally ill — with depression, schizophrenia, bipolar disorder, and other illnesses. Some have multiple addictions as well.

Our goal is to help people be independent and responsible for themselves. To that end, our patients participate in group learning sessions. I run many of these groups, and also meet with patients individually. The groups are aimed at weight control and smoking cessation and are designed to teach people how to live independently: to care for themselves at home, take their medications and manage their illness, perhaps go to school or enter the workforce, and participate in family and community life.

Our patients have medical as well as mental health issues. While the newer psychotropic medications have been of great help, many of them contribute to chronic obesity. So on top of all their other problems, our patients have to deal with weight gain and all that comes with it, including hypertension and diabetes. As a result, mortality rates for this group are high.

These medical problems make it harder to help those who need it. We take a holistic approach, rather than just focusing on the mental illness. For example, I run a group for people with both mental illness and diabetes. Many are also obese; some are heavy smokers. For diabetics without mental illness, monitoring blood sugar levels and administering insulin is challenging. For our patients, these tasks can seem overwhelming. What we try to do is form a support group where people learn and share experiences. I also work with patients who have addictions, focusing on the physical effects of alcohol and drug use.

I’ve always been very curious about people and what makes them tick. My job is about forming relationships with people and helping them improve the quality of their lives. In turn, patients are very grateful and trusting. They appreciate your efforts. Our goal is to graduate everyone to full out-patient status. Sometimes, that’s not possible. While many go on to jobs, some do not. The most severely impaired may be able to spend less time at the program, but some are not able to leave it behind completely.

Our program has had many successes, but a few remarkable recoveries stand out. One woman came to us from the state hospital, where she’d been for a year. She was depressed, anxious, and disorganized to the point of confusion. Over a two-year period we worked with her and held up a vision of hope for her future. Gradually she lost weight, quit smoking, resumed her role in the family as grandmother and babysitter, and found a part-time job. Her family and friends are thankful that she has made such a good recovery. She has been discharged from the program, but returns frequently to stay in touch.

Through “Partners in Excellence in Psychiatry,” fully funded by Eli Lilly and Company, we help train mental health professionals from more than 60 community-based organizations across the U.S. By using teleconference media, we give the participants a way to observe a group being run in a Team Solutions format. This joint effort is designed to give those being trained a realistic experience of how it is done.

I’ve found that the more education you have, the broader your view and the more you understand. So I am now working on my master’s degree at UMDNJ-School of Nursing. I’m on the psychiatric mental health track, which means I’ll take all the general courses required, but specialize in adult mental health. When I finish, I’ll be an advanced practice nurse, able to prescribe certain psychotropic medications.

My experience with my mother’s depression has given me a strong desire to help patients and their families understand mental illness. I feel honored to know my patients and their family members and help them cope with such a challenge.