VNA is finding more ways to care for the mental health needs of Cape Codders
The public health arm of the Visiting Nurse Association of Cape Cod (VNA) has ramped up efforts to address the mental health crisis on Cape Cod. Each year, Cape Cod Healthcare does a Community Health Needs Assessment, and once again, one of the main findings is that more “access to care” and specifically access to mental healthcare for both adults and children was listed as one of the top concerns.
The health division of the VNA also serves as the town public health nurse for 15 towns, providing both clinical and nonclinical services and the lack of access to mental healthcare also comes up at the town level. According to Meg Payne, MBA, director of public health, provider relations and telehealth at the VNA.
“We try to do our own grassroots assessment annually with our towns, and the number one thing that always pops up is ‘what are you doing about mental health?’” she said. “We are trying to address mental health in a really unique way.”
In order to incorporate mental health screening into the programs they already run, several of the nurses and employees have completed advanced training to better help local residents with whom they interact who might be struggling with mental health issues.
Recent Certifications and Training
Rana O’Loughlin, RN, a maternal child public health nurse, received a Perinatal Mental Health Certificate from Postpartum Support International (PSI). Jane Bollin, RN, also completed the training and is preparing to take the exam to become certified.
For the Perinatal Mental Health Certificate, O’Loughlin and Bollin had to attend a 20-hour virtual training session. O’Loughlin did that in June and then passed a certification test in September. In order to qualify for the training, she had to have at least two years professional experience working with the women who had recently given birth.
“It really helps me gain the knowledge that I need to be able to care better for my patients,” she said. “And the other thing it does is that I am able to find the resources that are needed that maybe don’t exist through our program or our community. I can really tap into the Postpartum Support International website and use that organization to get the services that our clients need.”
For example, PSI has 53 different support groups for parents who suffer from postpartum mental health issues. The topics range from postpartum depression to birth trauma to postpartum anxiety and OCD. PSI also has a hotline new parents can call. There they can talk to someone who will quickly triage the caller and help them find a mental health provider.
“One of our big things that we focus on as nurses in prenatal and postpartum is mental health,” O’Loughlin said. “We’re screening and if we’re getting high screens then we’re notifying the OB offices, but then we’re doing our part as well. We’re helping them to access the support groups that are in person in our community and the virtual support groups through PSI and if they want a therapist/psychologist or someone to talk to them that we’re helping them get that done. So, this certification has just made the pathways easier for me.”
Getting to Know Moms
As maternal child public health nurses, O’Loughlin and Bollin spend time in people’s homes, helping new mothers with wound care, blood pressure checks, breastfeeding support and mental health screenings. They do weight checks and assessments of the babies to make sure they are thriving. They also visit families who have had an unexpected loss of a baby.
“We don’t always have the answers, but we’ve become really well-versed in what our community has today and how we can help serve families better,” O’Loughlin said.
All mothers who live in Barnstable County are eligible for a postpartum visit from a maternal child public health nurse, regardless of whether they deliver the baby on Cape Cod or not. Cost is not an issue. If the family doesn’t have insurance, the VNA draws from other funds.
Usually, postpartum check-ins occur in the first four to five days after birth, which is before postpartum depression usually sets in. New motherhood can be overwhelming and baby blues are extremely common after childbirth.
“Postpartum blues affects 60 to 80 percent of postpartum people,” O’Loughlin said. “That’s a really high number and we know it is fueled by hormones and lack of sleep. That’s what the data shows. But at that two-week mark, the blues usually disappear. So, if something changes and their mood doesn’t brighten or they’re not feeling like ourselves, then we know we have something else going on.”
Typically, signs of postpartum depression or anxiety begin at around the one-month mark, although it can be much sooner or later than that. Since that is after O’Loughlin visit and Bollin visit, they leave mothers with information about three local support groups, and a phone number they can call to talk to a live person in our community that specializes in perinatal mental health.
They also include information about virtual support groups from PSI, so new mothers can attend without leaving their home. It explains that PSI can help them find a mental healthcare provider and the pathway to do that. It also has O’Loughlin’s and Bollin’s phone numbers so they can call if they need help going through the steps.
The written materials are available in English, Portuguese, Haitian Creole and Spanish. The nurses also carry interpreter phones, so if they are going in for a visit with a family that is non-English speaking they dial a number and get a live person to translate.
In addition to postpartum visits, certain birthing parents qualify for a prenatal visit. They include:
- People who are 24 years old or younger
- People who are on MassHealth or don’t have insurance
- People whose primary language is not English
- People in military families
- People with a history of substance abuse or mental health concerns
A Different Population
Molly Ives, a communicable disease investigator and health educator, received a Mental Health First Aid Certificate from the National Council for Mental Wellbeing. Exercise physiologist Nicole Christensen also received the certificate.
Ives and Christensen earned the Mental Health First Aid Certificate by attending a full-day workshop made available by the Cape and Islands Area Health Education Center of Cape Cod Community College. They have an adult course, a youth course, a teen course and a course for first responders. Ives took the adult course because she does a lot of work at senior centers and she leads walking groups in Eastham and Falmouth.
“I think about it as being a first responder in a mental health crisis,” she said. “It’s a training program that’s designed to equip individuals in the community with knowledge and skills to provide support to somebody who might be experiencing a mental health challenge, struggle or crisis. They say it is similar to traditional first aid training for physical health emergencies but for mental emergencies.”
The program teaches how to apply the Mental Health First Aid Action Plan, called ALGEE:
- Assess for risk of suicide or harm
- Listen non-judgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
“I spend a lot of time out in the community, so I do get to see all different kinds of people and all different ages, and the training is good to have,” Ives said. “I’ll be able to recognize if someone’s in a situation where they may need help. We also run programs in the community where you have repeat customers so you can say, ‘Hey, you’ve been a little bit off lately. You want to chat about it?’”
More Mental Health Support
Last year, another VNA clinician, Lauren Forziati, RN, completed Youth Mental Health First Aid training for her work with that population. She also offers depression screenings for both adults and youth in the community, which is aimed at connecting people to local resources that can help.
“No matter where people in the community are touching our department, no matter where the interaction is, we have someone who is equipped to identify and help facilitate the next steps for anyone experiencing mental health issues,” Payne said. “We’re trying to work with the tools that we have in order to address the needs that we see in the community.”
