An integrative care approach to mental health with Megan Dye, ARNP, PMHNP-BC

LHC: Hey there, Welcome to Let's Make a Health Connection! In this podcast, we introduce, interview, and showcase the many healthcare providers and resources that we feature on our website, localhealthconnect.com. I'm Jennifer Barber; I'm a licensed clinical social worker in Washington and Oregon, and I'm happy to be part of the local Health Connect provider community. Today, we're talking to Megan Dye. She's a psychiatric mental health nurse practitioner with additional certification in perinatal mental health. She's been a registered nurse since 2008 and a nurse practitioner since 2012. formerly worked as an inpatient on the psychiatric consult team for Legacy Health, and she's been in private practice since 2016 and offering Telehealth since 2020. She practices in the states of Oregon and Washington, and her hobbies are swimming, wakeboarding, coaching softball, and fish keeping. I did not know about that, Megan. I also didn't know that. You're kind of an interesting person.

MD: I appreciate that, thank you; my hobbies are varied, that's for sure.

LHC: Welcome to the podcast. I really appreciate you coming on and just kind of participating in this meet and greet and allowing people to get to know you just a little bit better.

MD: It's my pleasure. Thank you.

LHC: So, tell me a little bit about your practice and if you have any specialty populations you like to work with.

MD: Sure, my private practice has been such a joy because I really do get to hone in on things that are of interest to me or holes that I see that really need attention. The start of my career really focused on inpatient and acute mental health. My original love has always been first episode psychosis, early severe depression, and anxiety in my late teens and early 20s. I think that has guided me in a lot of ways to be able to practice in an outpatient setting by seeing emergencies, but it really is a joy of mine to go in early to communicate with parents. to really try to navigate early resources for patients having emergent psychiatric symptoms, primarily those in their late teens to early 30s. As I had my own children, my interests shifted slightly to women's mental health, specifically perinatal mental health. This includes everything from pre-pregnancy planning to several years postpartum, along with all of the complications that come with treating during that time.It's not just women, but ideally, I would see someone before they were pregnant. We'd talk about medications. Throughout their pregnancy, I overheard them discussing hormone fluctuations and body changes that affect medication.I also feel very prepared postpartum to help support those patients and what can be some of the most difficult months for their families. That really is where I've put much of my effort over the last five years.

LHC: Great. I think it's really important. Let's just take a moment to talk specifically about the role that you play in mental health as a mental health nurse practitioner. Are we talking specifically about prescribing medications, or are we talking about prescribing medications and mental health therapy? Mix of both?

MD: So that's very much a provider choice. Certain institutions, I believe, prepare a little more heavily.You can then pursue continuing education for additional support. My preference for my practice is to do primarily medication management. I am certainly trained in basic therapy, but I do not consider myself a therapeutic expert, which is why I really reach out to community teams to provide that level of support because I want my patients to have the best of everything. Then, I can devote my time to studying the nuances of medication. This may seem really simple to some people, but maybe not to others.

LCH:You know, you sent me a list of questions that you were prepared to answer, and this is not one of them, but I think you can handle it. If someone were working with a primary care doctor and they were seeing this doctor and realizing, "You know, I feel like I have some depression, some anxiety, or maybe I'm struggling, with a new bipolar diagnosis.” Why would someone reach out to a mental health nurse practitioner instead of just working with their primary care doctor?

MD: That's a really great question, and I did actually get quite a bit of it. I think general practitioners are a blessing, but they are in a position where they need to know a little about a lot of things. It also is a bit dependent on their preference; some really focus on mental health, and some have had much less training or focus on this particular avenue with psychiatric medications. We can cause harm if we do not accurately diagnose when prescribing medications, so a simple case of anxiety or situational depression can be easily managed in primary care.My hope is that primary care sees when something is not very clear and that there are great nuances that really do need a specialist, like with anything I don't think primary care would take over cardiac care in the same way that it wouldn't take over psychiatric care. One disadvantage is that we have a severe shortage of mental health providers, and so, once again, I am grateful for primary care getting involved and attempting to do so, but the nuance and the education that come with a specialist really make for long-term wellness.

LHC: Great. Thank you so much for answering that question. So in the introduction, we spoke about you. Since 2020, telehealth has been available. Is that strictly all you're doing in telehealth? Are you seeing people in person as well?

MD: As of this fall, I am strictly doing telehealth, though I do have the option to use an office, and I was actually quite torn about this decision. I have seen a few patients in the last few months, and I miss the feeling in the room. I miss touching my patients, even just for vital signs. I miss the ease of not having to send things electronically. That being said, time and time again, over the last two years, I have been repeatedly thanked for the availability of telehealth, and I've been told by multiple patients that I would have never come to see you and I would have never taken this chance to get well if you did not offer this video option because of my anxiety or because of my transportation issues. So I think it is doing much more good than harm, but I do miss that direct patient interaction.

LHC: Great great. Thank you for offering to tell us a little bit about your integrative care approach to mental health.

MD: I feel really strongly about this. I actually do a lot of work outside of clinical appointments to create community resources for my patients and then professionally dialogue with other providers because this is not a one-stop shop for wellness. My patients need assistance with things like nutrition, certainly with expert-level therapists and natural paths. This is hard work. This is all stuff that, in certain ways, I'm researching on my own to offer to my patients. I think the more on the team, usually, the better. I just want to know where my limitations and specialties are versus what I can offer them that is not straight pharmacology.

LHC: Great. I have to say that in my own personal experience as a mental health professional therapist working with you as a prescriber, you have been so important, and yes, you are important. That's not the word I'm looking for, but it has been a pleasure to work with you because you are such a team player. You are available. You're easy to reach if there's—I wanted to call that out because I think that's not always the case with other team members.

MD: I really appreciate that. That feedback is very welcome because that is what provides optimal care.

LHC: That's so great. thank you. Talk to me a little bit about your passion for providing services to frontline workers and teachers.

MD: Always. Frontline workers have been on my mind because I've been there. We were there. We are there, and I feel like, as providers or anyone associated with the health care system, we need to be well, and so we need to support each other to be well. I love working with medical providers because the knowledge base is there, and we can talk about things that are very detail-oriented. But I also understand when my patients talk about caregiver burnout and talk about desperately wanting to help people but not always being able to help them, and I think it's become blatantly obvious that we have always needed more support for our health care providers. This is just when it has come to a crisis. Interestingly, I really wasn't expecting this, I had never thought of it. But I'm seeing teachers in the exact same position, and I would say they are right there on the front lines with every therapist, nurse practitioner, physician that's out working during the pandemic. Their needs are very great, and we are not even close to supporting them enough in the ways they need. They may not know how to advocate for their health in the same way that those of us in medicine do.So to me, that is a heartbreaking realization that needs attention.

LHC: Great. Thank you. So let's talk about new things on the horizon for you. What do you have that you may have just started getting into things or have things that you're looking forward to?

MD: One thing that has really been on my mind lately. I'm just so happy because I'm just so proud of some local clinics here. The Vancouver Clinic is one such example.They are changing how they monitor postpartum patients in an obstetric clinic. So these are not psychiatric providers. These are the OB-GYNs and midwives who have come together to say, "We need to intervene." earlier on women's mental health. The way that this is shifting is that they are now offering two-week follow-up visits, which I have always done in my practice. But there are very few people who have had access to that before. I mean, this is coming to the masses as opposed to waiting the full six weeks to detect crisis or advanced depression symptoms. I'm encouraged that mental health is being prioritized in postpartum care, and this is just one small step toward the many things I hope to see in the future.

LHC: Oh, that's fabulous. I didn't know the Vancouver Clinic was doing that, so how exactly will you be a part of that? Can you just explain what that looks like?

MD: So right now I'm peripheral, actually. I haven't learned this from my patients rather than directly from providers though I do work very closely with some OB-GYNs, and so even though I've offered this service to my patients already, I'm really hoping that a local clinic will get involved in making this mainstream. if not already used for postpartum care.

LHC: Great. Thank you. That's such a great service. Is there anything else you would like our community to know? Either other providers to know about you or people who might be searching for a mental health nurse practitioner prescriber in this area?

MD: I think one of the things I notice is just the great frustration and fear about not being able to get a mental health provider. I wish I had more answers to that, but what I would say for the community is to certainly start with a primary care provider. If you need referrals within the clinic system, they are increasing services like psychiatric mental health through clinics like the Vancouver Clinic and PeaceHealth. I think that most patients don't know about that; we also have access to community mental health services for those who do not have private insurance and cannot be in a private practice setting in terms of getting follow-up in the community. If you hear that somebody's full, don't leave it at that. say, "Do you know anybody else who's accepting patients?" or "Start care with a therapist and say, "Do you know a prescriber?" or vice versa. Begin by asking a prescriber, "Do you know a therapist?" because that is often the best way to get access to care from community providers as well.This has been my goal, and it has helped with my success in private practice. Communication and collaboration are gold. It is essential for good care, and it's essential for our health and our practice.

LHC: So great. Thank you. Thank you so much, Megan. I just want to say thanks again for being a part of this today. If there's nothing more, we will sign off.

MD: I appreciate you. Thank you.

LHC: Thank you, bye. Thanks again for listening to Let's Make a Health Connection. Find us online at localhealthconnect.com as well as on Facebook, Instagram, and Twitter. Links and show notes for this interview are available on our podcast page. These interviews are really fun, and I hope you made a health connection today. We'll talk again next time.

Let's make a health connection. Copyright 2022, All Rights Reserved, is the exclusive property of MBS Therapy LLC, a Washington-based company. Local Health Connect is inclusive and does not endorse any political or religious group. Thank you again for listening, and we'll see you next time on localhealthconnect.com.

By Jennifer Barber, LICSW 11-22-2022