In the first official episode of “Your Mental Health First,” Dr. Mel shares 8 ways new mental health professionals can have better mental health when starting a practice. Here are some of the things that Dr. Mel has learned since completing her psychiatric residency in 2008.
Summary of Episode 1: Tips & Pointers for New Mental Health Professionals
Give yourself time between patients/clients. This will reduce your stress level and give you time to jot down a few notes.
Think about how patients will reach you. Is it really the best model to be available to your patients 24/7? Make sure you establish clear boundaries up-front and be sure to advise patients to call 911 in the event of a psychiatric emergency.
Think like a patient. Are you providing an experience for your patients that you would recommend to a family member?
Ask for clarification. If you aren’t sure what a colleague (or patient) means, repeat back what the other person has said and ask for clarification.
Remember that your time is your most important daily asset. Some tasks are not a good use of your time. If you would not pay someone your own hourly rate to do the task, it’s a good idea to delegate it.
It’s important to show up at staff events—even if you only stay for a few minutes. This helps demonstrate that you’re a team player.
Get good at casual small talk with colleagues and co-workers. Connections are very important. Ask people about their families and interests.
Never eat in front of patients or clients. Never.
Learn the ground rules for meetings, especially if you hate them. There will be some meetings where your presence is not actually required. Ask your supervisor which meetings you really need to attend and whether cell phones are permitted.
The longer you stay, the longer you stay. There’s always something to do. If you don’t set clear boundaries about when your work day ends, you’ll be there until midnight.
Always be nice to your colleagues. They may be having a bad day, or you might, but if you behave badly, it will come back to you.
Before you loan something out, put your name inside it and consider what would happen if you never saw it again. If you’re not willing to lose it forever, don’t loan it out.
Transcript of Episode 001: Tips & Pointers for New Mental Health Professionals
Welcome to the podcast. Today, I’ll be talking about general mental health tips and pointers for when you’re starting out in your practice. This podcast episode is primarily geared towards helping therapists, therapists in training, psychologists, psychiatrists, graduate students, and psychology, psychiatric residents, or anyone else who wants to learn more about mental health training and how they can take better care of themselves as they take care of others.
I finished my psychiatric residency training in 2008, and I’ve been in private practice since 2010. I’ve also had a lot of experience working inside the hospital, what we call inpatient psychiatric care. That’s working with patients who have significant psychiatric concerns such that they require being in a facility or a hospital unit for a certain period of time to receive intensive treatment before being able to be discharged from the hospital and return to their lives. There’s a lot that I’ve learned along the way as a psychiatrist.
One of the things I learned is when you’re seeing patients, give yourself some time in between patients. When you’re first starting out, you just want to power through and see as many patients as you can. You’re trying to build up your practice and you’re reluctant to say no to new patients and you want to try to make the most of your time that you have at the office or at the clinic, but I think it’s very, very important to take time in between patients. You can use this time to breathe, just take a few deep breaths. You can go for a walk around the building or the clinic. You can make yourself some tea, and you can also prepare some tea for your next client or patient. This can reduce your stress level overall and give you some time in between patients to process what happened with the previous patient before seeing the next patient.
Sometimes I like to jot down a few notes in a journal. I had a patient who recently told me about Bulletproof Coffee. I’d never heard about that. She told me a unique way in which she makes her coffee in her Vitamix, and I thought that was pretty interesting and I wanted to see if I might want to try that out or learn more about it online. After our session, I spent a few minutes jotting that down and thought about when I would go over to Whole Foods to get some of the ingredients and try it out.
By the time I saw the next patient, I felt ready for the next patient and I had wrapped up my thoughts about the previous patient. If you go, go, go from patient to patient to patient, then at the end of the day, you’re spending time and catching up on notes and stressed and feeling tense and overwhelmed. One of the pieces of advice that I give new trainees is to always factor in some time for yourself in between patients. This is a great gift to yourself and also something that you can model for your patients.
Now I’ll be using the term patients and clients interchangeably. Psychologists and therapists tend to call the folks that come in to see them clients, and psychiatrists tend to call the people who come in patients, but I’ll use these terms interchangeably. Basically, these are the people that have come to us requesting services and who we’re trying to serve and help them out in their daily lives, so teaching them how to deal with stressors or conflicts in their family, how to work through depression symptoms, anxiety, overwhelm, bipolar disorder, substance use. Even though we might call those people who are seeking our services different terms, whether that be patient or client, I’m going to use those terms interchangeably throughout the podcast.
The next tip is to think about how patients will reach you. There are so many ways nowadays for us to be contacted. People can e-mail us, text us, use voice mail, Skype, FaceTime, social media, Periscope, Twitter, et cetera, and I want you to think about it. Is it really the best model to be available to your patients twenty-four/seven? I don’t think it’s a really good idea. Sometimes it can be very convenient for a patient to text you, but you don’t want to make it so convenient that they’re texting you frequently or that they might abuse that, and that can happen.
If they’re going to be using a certain means of communication such as text messaging or emailing, you need to have some good boundaries around that. I think it’s important to lay out some ground rules when you first see the patient. You might want to talk about this on the first visit and say something like, “You can reach me via text, but only for emergencies,” or, “I only check e-mail two times during the day, so if it’s something more urgent, then you need to reach me on my cell phone or the office line,” or letting patients know that you might do Skype sessions if they’re not able to come in or that you don’t do Skype sessions or you don’t do telephone sessions. That’s really important, because you don’t want the patient to feel frustrated or upset if down the road you decide that you don’t like the fact that they’re texting you at 11:00pm needing a refill.
I think it’s important to set those boundaries up front, and most people get it. They know that their mental health provider is not available twenty-four/seven, but sometimes it can be abused. Also, you don’t want to get into any legal or sticky situations where the patient is needing some acute or urgent help and you’re not available. For that reason, many mental health professionals will have a message on their voice mail greeting basically saying that in case of emergency, please call 911. That’s a bit of a legal disclaimer and letting patients know that you’re not available twenty-four/seven and that if there is a true psychiatric emergency, they need to call 911 or go to their closest emergency room and receive psychiatric treatment.
I’m happy to talk more about this on my website, YourMentalHealthFirst.com. You’re welcome to reach out to me and let me know if you want to talk more about this, because this comes up pretty often, especially as you’re starting your practice. You may want to be available in many different ways because you want your patients to be able to reach you if they need you, and you want to appear as being approachable and warm and open, but you have to put your mental health first and you have to have some good boundaries around that.
The next tip is to think like a patient. Okay? When we’re in training, we’re not really taught about the business aspect of having a mental health practice. One of the things that I’ve learned is that you really need to think about what the patient is looking for in terms of mental health treatment, what they want from their provider. The term provider, professional, again, I’ll use those terms interchangeably as well. Basically, the patient has a choice usually in terms of who they want to provide their mental health treatment. Sometimes they might be restricted to the people that are on their insurance panel, but even within that insurance panel there might be some options.
You want to create a good experience for the patient, so my personal gauge is that if this person was a family member, what would I want for that person’s care? That’s what I’m saying when I say, “Think about the patient and the patient’s experience of you and with you and the environment.” If you have an aunt and your aunt was going to see someone like you, what would her experience be like? Would it be very difficult for her to interact with you? Would the environment be warm and inviting to her? Would there be too much paperwork that would be potentially off-putting to your aunt? Just think about if this was a family member and they were seeking mental health treatment or services, is what you’re providing reasonable and practical and warm and inviting?
The next tip is specifically for psychiatrists and psychiatric residents. One of the things that people learn early on when they’re in medical school and studying to become a physician is that nursing staff are very, very important people. Nurses can make your life great or make your life miserable. You always want to be respectful to nurses because they’re on the front lines, and I feel very protective of the nurses that I work with. I want to make sure that they feel safe and that they feel taken care of and that they feel empowered to make the decisions for the patients, and that they can talk with me as a colleague so we can work together to ultimately provide the best care for the patient that we can.
When in doubt, ask for clarification. Nurses are trained to get clarification, and I never mind these requests because it ensures that we are on the same page regarding patient care. When talking with nursing staff, you want to make sure that you’re on the same page, and if you’re not sure in general about what someone has communicated to you, repeat back what they’ve said. This isn’t just in talking with nursing staff, but this is talking with occupational therapists and physical therapists and your medical colleagues and so forth. It’s always a good idea to get clarification. Oftentimes, when I’m not sure if I’m really hearing what the other person has to say, I will just repeat what they said, and I speak up.
As a student, given what I know now, I would have asked for clarification about some things that I was a little bit unsure about. I think in the past when I was a student, sometimes I was a little bit intimidated or reluctant to ask for clarification because I would question myself, “Why don’t I get it or why don’t I understand this?” Now, as an adult with much more experience, I’m very quick to say, “I need some clarification on this.” This is something that nurses are very, very skilled at doing, at making sure that everyone is on the same page. When in doubt, ask for clarification, repeat what the other person has said so you can both be on the same page.
Something else that’s very important is remembering that your time is your most important daily asset. Much more than the amount of money in your pocket, your time is the most important daily asset, so delegate effectively so that you can have more time to do what you want to do. Other professionals will talk about their hourly rate and they think about how much money they make in an hour and tasks that need to be done. They might say, “Hmm, is it really the best use of my time, given what my hourly rate is, to do these other tasks?” One of the things that I learned was to delegate. I have eight women … Yes, that’s eight, eight women who I affectionately call my survival sisters, and I delegate a lot of tasks to them.
I have a personal assistant who is like my gal Friday. I have a virtual assistant who’s online, and she lives in Las Vegas and she helps me with all my research. I also have a bookkeeper. I have my receptionist for my practice. I have my social media gal who helps me stay on top of things with my Twitter account and Facebook and Periscope and such. I have a transcriptionist that I work with. I have several different women who help me out so that I’m able to provide the care that I want to be able to provide for my patients and also I can do the things that strictly require my education and my ability to do.
Coming up with this content for this podcast, I was the person who decided to jot down my thoughts about what I wanted to share with you and that I have that information transcribed, and now I’m able to talk with you about these important topics. It’s not the best use of my time for me to actually sit down and type out everything I want to say, because I’m not the fastest typist in the world. Someone else can do that job much more effectively and easily than I can, so I happily pay her money to do that for me.
Having people that you can delegate tasks to can work wonders. You really have to think about what your hourly rate is and would you pay someone else that amount of money to do a task that is pretty straightforward and easy to do, such as transcription or running errands. For me, I’m very happy to pay these women to do some of these other tasks for me, because it’s generating income for them. They don’t mind doing these tasks and they feel like they’re really helping me and also helping themselves and they’re able to work from home and they have flexibility. It’s definitely a win-win. I’m happy to be able to delegate tasks to others.
Something that comes up from time to time when you are early on in your training, perhaps you’re a graduate student or you’re a postgraduate student or you’re a psychiatric resident or maybe a new attending, there’ll be special events or occasions that come up on the unit or at the clinic. I remember early on in my career, I would go to so many of these events and then I just didn’t want to go anymore, because it seemed like everyone was having a birthday all the time and there was work that I needed to do and there was always something. There was a retirement breakfast or a birthday luncheon or a new hire celebration, and I would get so frustrated because I was constantly asked to go to these events.
What I realized is that it’s actually very important for you to show up, so do show up. I know, I know, everyone is busy and yes, does there really need to be yet another event to go to on the unit? This is an opportunity for staff to connect and feel cohesive and to have celebrations, and it’s really important for overall morale, so do show up. You can stay maybe just a few minutes, that’s okay. You can offer to bring in a goodie. If you don’t have time to make homemade cookies, which many of us don’t have time to do that kind of thing, you can bring in a goodie. This helps everyone overall, let’s them know that you’re a team player.
You don’t want to be that person who never goes to any of the special events on the unit or at the clinic. Do show up. You’re not expected to stay there the whole time, but just say a few kind words and share a goodie and munch on a few of the snacks that some of the staff have provided for you and just be an overall good team player. Trust me, you won’t regret that. What you don’t want to do is be that person who is in their office the whole day and they never come out and socialize with staff. There is a way that you can maintain your professionalism and have good boundaries. You don’t have to get into some of the small talk or even any gossip that might come up. You can just stay for a few minutes and then you can get back to your work, but definitely do show up.
The next tip is a follow-up on that one. Get really good at casual small talk with new colleagues and coworkers. Be really, really interested in what others have to say. It makes the workday more fun, and it’s nice to be connected with your colleagues and coworkers. One of the things that I really prided myself on was that I always knew a few things about each nurse. I could tell you whether the nurse was married or single, if he or she had children, roughly how old the children were, knowing where they lived, if they lived close to the hospital or if they had a commute.
This was very sincere. I wanted to know about them, and they also got a chance to know a bit about me. They knew that I was a single parent and that I had a son in high school and that I was new to that area. Those connections are really important. You don’t want to have a big wall up or a barrier where people feel like they can’t really connect with you. It’s okay to share a few bits of information about your background and your interests, and that will also open others to share a bit about their lives as well. I think that really helps to make the work environment so much more pleasant and enjoyable, and should there be an emergency or an issue that comes up, you know that you have people who will have your back. Take the time to establish these good relationships with your colleagues and your coworkers.
The next tip, never eat in front of patients or clients. Do I really need to say anything else about this one? It’s pretty self-explanatory. Okay.
Meetings, I hate meetings. I hate meetings about meetings. I hate meetings that are thirty minutes. I hate meetings that are two hours. I hate all types of meetings, and I hate surprise meetings where you’re going about your day and then all of a sudden, the supervisor says, “Let’s have a huddle about this.” That just drives me up the wall. One of the things that you want to know about are the ground rules for meetings and how often meetings will occur. You want to be as prepared as you can for the meeting and know if you really actually do need to show up for the meeting.
Sometimes there would be meetings that would take place and I was invited to come to the meeting, but it wasn’t really required. I think that sometimes some of these meetings, they thought, “Oh, it would be nice to have Dr. Watkins join in,” but it really wasn’t the type of meeting where I was asked to provide any significant input, or it was a meeting about some larger issue that I really wasn’t directly involved with but they just wanted to give me a heads-up, so to speak, but it was not the best use of my time. You really want to think about the meetings that will be taking place at your clinic or on the unit and if you do need to attend.
Of course, if your supervisor expects you to be there, if it’s a peer review, of course, of course you have to be there, but I found that there were several department meetings that sometimes I really didn’t feel that I needed to participate in. Over time, I learned to ask my supervisor if he or she expected me to attend the meeting, and sometimes my supervisor would say, “No, it’s optional.” I didn’t even know that some meetings were optional. Check in with your supervisor on this one, because there may be meetings that are taking place that you might be invited to but they’re not really expecting you to be there. They just want to let you know generally what’s going on.
If that’s the case, of course, you can always have access to the minutes or the notes from the meeting or meet with the meeting coordinator and just let him or her know that you would like to just get an overall sense of what occurred in the meeting so that you can be up to date, because that time that you’re spending in that meeting, if it’s not really crucial that you be there, that could be time for other things that are really important for you to take care of, like direct patient care or working on your notes, or arranging family meetings, or discharge planning, or other things that need to take place in a busy inpatient unit or at the clinic. Maybe it really isn’t the best use of your time to be in a meeting when you could be providing direct patient care.
Something else to ask about before going to a meeting is if there are cell phones allowed, because sometimes I will see colleagues who are frantically texting during meetings and I wonder if they are really paying attention to what’s being said in the meeting or are they jotting down notes about the meeting. You kind of want to know what the standards are for the meeting. Is it expected that people can bring their cell phones or is that frowned upon?
Personally, what I would do when you’re first starting out in training and you’re going to meetings, don’t have the cell phone out at all unless your supervisor is asking you to pull it out of your bag for a particular reason. If it’s not being requested that you bring your cell phone out for any particular reason, do not have your cell phone out. It sends a bad signal to the other meeting attendees, because, like I just said, you don’t know if the person is distracted, if they’re updating their Facebook page or they’re taking notes about the meeting. It’s just unclear. Definitely know what the policy is about cell phones when you’re first starting out. Don’t have your cell phone out.
Also, too, another good question to ask is how long you’re expected to be there. Maybe you don’t have to be at the entire meeting. Maybe it’s just really important for you to be there for the first thirty minutes of the meeting or the last thirty minutes of the meeting. Something that I have done when I’ve had meetings with families and let’s say it’s a really busy day, I’ll ask the social worker to get the meeting going, and then I’ll jump in at the end of the meeting, like the last fifteen minutes or so.
The social worker can answer a lot of the general questions about how the patient is doing, and then I can come in as the doctor and talk about any particular medical or psychiatric concerns that come up. Sometimes it’s not necessary for two mental health professionals to be there at the meeting at the same time. Oftentimes, family members are reassured in knowing that the doctor will be coming in, and they get it. They understand that the doctor can be pretty busy during the day, but they do like the idea that the doctor will be joining in on the meeting. Sometimes having that structure can really be helpful.
Also, too, some of the nurses will really help me out of meetings going longer than expected. They will page me. They will page me out of the meeting, and that’s really nice because sometimes a meeting can go over, yet there’s other things that need to be done and they’ll just send me a page and that will be an alert or reminder to me that I need to wrap up because there’s other things that I need to take care of. I’d be happy to talk with you more about how to have the most effective meetings on an inpatient unit or at your clinic. Feel free to shoot me a message on YourMentalHealthFirst.com. I’d be happy to talk with you more about that.
One of the things we have in medicine is the longer you stay, the longer you stay. I remember when I was first trying to describe this concept to someone outside of medicine, basically the message is there’s always something to do. You have to have really good boundaries for when the workday will end. If you’re thinking that you’re going to leave work at 6:00pm, chances are something’s going to happen around 5:45. There’ll be an acute issue with a patient or with a client and you may end up having to stay longer. Now when I was first starting out, it was very difficult for me to have that good boundary because, let’s say, 5:45 something would happen.
Let’s say a family member would show up and wanted to know about what was going on with their loved one, and I’d really want to talk with them, but then I’m thinking, “Oh, my gosh, I have to get home to my son, Jonathan. I promised him I’d be coming home, but then it won’t take me that long to talk with the patient’s family member. Maybe I can squeeze this in real quick.” Then I’d feel rushed and tense and so forth or something would come up with a patient and I would be reluctant to hand off the patient’s care to the doctor who would start covering at 6:00pm, the nighttime doctor.
I found myself with this big struggle, so over time I learned that I really need to have good boundaries for when the workday would end. It’s not fair to my son for me to stay in the hospital longer and longer and longer, because he can’t advocate for himself and say, “Mommy, I really need you to come home.” I need to be a good model, too, to my patients and also my patients’ family members and telling them that I really do want to be there for them and help them out, but I also have to be respectful of other commitments that I have. Usually, what I do then if something comes up later in the day, I’ll let them know that I want to help them out and it’s best for me to find a time to work with them and talk with them about the issue in the morning, because at that time, I really need to get home and I do try to pass it along to my colleague.
In medicine, we really try to do everything we can to be responsible for our patients and finish up everything that needs to be done for our patients, but sometimes what can happen is you’re so involved with the care of the patient that it’s very difficult to have those good boundaries. It is okay to sign out to the covering doctor at the end of your shift. There will always be a reason to stay late, so I don’t want you to make that a habit.
The next tip is to be good to your colleagues, yes, even when they have a bad day. It will come back to you, so even if your colleague is snippy or just irritable and they’re not being their usual nice, collegial self, just still be nice to them because you also want that break, too, if you have a bad day. If you loan something to someone, consider putting your name on it or inside of it and consider what will happen if you never see it again. This can happen with books, pens, and money. If you do loan out an item to a colleague or a patient, just consider this fact, that you may never see this item again. Also, it becomes awkward to ask for your item back months later, and you might even forget that you loaned it to someone. Be very conscientious about what you choose to loan out to a colleague, because it does become kind of awkward later on.
Also, too, with money, just consider it a gift. Even if someone asks, “Hey, Bob, can I borrow five dollars from you?” unless you’re willing to just let that five dollars go, don’t loan out the money. Usually, if I have it and I’m feeling generous, I will give that money to a colleague, but I just kind of consider it a gift and I never expect to get it back, because it would just be too awkward to ask for it back. You don’t want to be seen as petty, and you never know, you might run out of money and you might need to borrow a few bucks from somebody. Just think about it being in a general pool of funds and don’t worry about asking for that back. Be very aware that if you loan something that’s pretty valuable or expensive, like a textbook, let’s say, you have to think about what may happen if you never get it back.
All right. This completes this part of the tips and pointers for mental health professionals. I hope that you learned some things about how you can put your mental health first and how to work effectively with colleagues and with patients when you’re starting out in your career. I would love for you to say in contact with me. That’s all for now. Thank you for listening.