SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I'm Sarah Hexem Hubbard, Executive Director of the National Nurse-Led Care Consortium.
This is Part 1 of what will become a longer series on emerging models and mental health care. We're learning directly from our client services here in Philadelphia, specifically the Philadelphia Nurse-Family Partnership and Mabel Morris Family Home Visit Program.
Starting in 2021, we worked closely with a partner organization, Joseph J. Peters Institute, to integrate two therapists into our nurse-home visiting programs. This integration allows the parents working with our nurses to directly access professional counseling through us.
While COVID-19 highlighted mental health needs across the U.S., this project has actually been years in the making. It emerged from our home visiting nurses who were frustrated with the behavioral health system that was repeatedly failing to give their clients the support they need, and who advocated for resources that would change that.
The demand for services within our programming, which on the whole serves about 800 families a year reflects only a portion of the pregnant and parenting families who struggle to access professional mental health care. So, as we’re learning from the experiences of our clients and providers to improve our own model, we’re also building the case for more innovative models of mental health care that meet people where they are.
On this episode, we’re going to hear from two different mothers currently receiving therapy through this initiative. They’ll share what their experience has been like, including interactions with their therapists and the impact so far. In the next episode, we’ll talk about the systemic barriers to care, like the ongoing shortage of mental health providers and outdated payment models, as well as potential solutions to help close those gaps.
First, we’re going to hear from Mercedes Nesmith. Mercedes started counseling this past spring and took a day off from work to talk with us for this episode.
MERCEDES: Before I had Makhiyah, my one driving force for me to have her was I was in a prior relationship with a person who I helped take care of their child. We were kind of getting kind of Rocky, we broke up, because I moved on in another relationship. And I kind of had a mental crisis, like I was going through depression. It was my first time ever experiencing suicidal thoughts. I felt incomplete. And I really thought I was never going to get over it. I was in a new relationship with a new partner, and my partner was just upset, you know, from me being upset. And she was just one day like, you know, ‘I'm sick of seeing you upset and I'm sick you crying like you can have your own child, like, I will be here, I will help you, I will support you.’ Around that time, I couldn't really see it. But you know, December 26 2018, when I had my daughter, my whole life changed all over again. And she's three now about to be four. On the go. She's very independent, very want to do her own thing. I love watching her grow and just being her support. As a child, I really didn't have that from my mom, my mother was a really strong person, she was a provider. She wasn't really good like showing her emotions. So we really didn't have, oh, I love you or give me a hug. It wasn't really that. It was kind of like that tough love. But as I'm experiencing motherhood, I try to be the mother that my mother wasn't to me, even now as being 36 years old. I'm just learning how to express my emotions. And that's just with the help of the program. And of course, in the beginning, I had so much going on and I was trying to make time for me, make time for my therapy sessions. I was trying to make excuses. But when I really took a step back and said, This is for my well-being, this is for the good of me I need to do this. This is important. Because I can't be a good mom or good provider or good mate if my mental status or my mental is not good. So I say you know what, ok.
In the beginning, it was like every week, every week, because she said, you know, if you're in a program, we got to meet every week for at least an hour. So yeah, it was every week we met on Thursdays. But it was like so crazy. My schedule, when I went back to work was so crazy that I had to. I only had time to talk on my lunch breaks. So in my lunch breaks are only 30 minutes. So I would do Thursdays and Fridays for a half hour to just make that hour just so I could stay in the program like this, how dedicated I was to it. Because I felt like she cared about me. And we were breaking down boundaries. And I was finally understanding why I act the way I act, or you know why I'm afraid to express my emotions. You know, we went through a lot of my childhood traumas. We went through a lot of things, talking about it, and just interacting with her, just I connected because I know she cares, she understand. And she made me understand. But it will make me feel so much better to the point where some of my employees, even managers like, well, what's her number, like, I need to talk to someone you know what I mean? And I felt like that made me open up my mind to there's a lot of people struggling with mental illnesses, but are afraid or afraid to talk about it or afraid of what people might think. But I feel like, if you need to talk to someone, if you're feeling overwhelmed, go talk to someone. No one's perfect. No one has this thing called life figured out. And sometimes, if you're talking to someone who knows what they're doing, or in those types of ways, they can help you understand yourself and just make you more comfortable to believe that it's not you you're not, you know, something weird or nothing's crazy wrong with you is just we're human. We're going through the motions. So when you talk to someone who's been there and understands, makes you not feel as like this is I'm a weirdo or something like that, you know? So yeah, and I know it's a lot and I feel like maybe because it's taboo, or people are afraid of what people might think. But once you sit down and you talk to a person, and they're understanding you and you’re understanding your ways and your traumas and your triggers and things like that, it helps you in life. It helps your day go by you understand, or you try to avoid certain triggers or certain things that are going to trigger you, certain people that you shouldn't have around you that are triggers, including family members, lovers, friends, whatever. Just help you protect your energy around you. It’s very important.
I almost had another mini break down and she got me through it, she really did get me through it. And sometimes you just you don't even just need the professional help. I feel like it's a combinational thing you need the professional help and you need to acknowledge your own self happiness and things that you need to do to pour back into yourself so you can be happy. If you don't find that within yourself, you'll never be happy with anything. So I feel like me finding myself and taking some self-reflection and just taking some time away from everything and just put back into me and doing the things that I wanted to do like go skating, sit down by Delaware Avenue just on the rocks by the water just me in the water me in the water just talking me in the water just becoming one. You know me having a self-reflection time to heal. A lot of times I feel like us as adults, we don't heal from prior things that we go through. We carry this stuff on our shoulder. You know, being a parent, working every day, you know, and I'm one of those parents who, unfortunately, I don't have a lot of hope with my daughter, you know, it’s only me and my co-parent partner. But I do realize that sometimes I do need a break. I can't take it all my own. My co-parent partner will, you know, ask me like, you know, are you doing you want to do something this weekend or I'll take her, you know, you want to do something today, or she'll say “Go, go go, I gotta right now”. And it's kind of like it forces me to put that time back into me so I can be on point to be her mother because if I'm worn down, how can I be the best mom I can be? So you know, that's also something with the parents and thing that I'm learning and working on, allowing myself to have breaks without feeling guilty.
I did go through some life-damaging and things. I went through some traumatic things, and I need to talk about it. A lot of times in the African American communities, when things happen to us as children, we might go and say something to a family member, and they're going to say, just keep it in the family, or what goes on in this house stays in this house. So what goes in our family stays in our family, but no one from the family is trying to help those individuals at all. We're just sweeping things under the rug, or we're still left to live with predators and have to see them every day. You know, that's traumatizing. It's not healthy at all, you know, so once you become an adult, I gotta say, like, 21 Or maybe 25,26, and your late 20s, you should start seeing some of those effects in your every day and you should say, Okay, I need to go talk to someone I need, I might need some help. You know, I've been holding this secret and for years, and I feel ashamed of it. Let me go talk to someone they might, can connect with me and just helped me get over this obstacle because it just might be you just need to talk to someone and they can just give you some advice on you know, how you should move emotionally after that, you know, I mean, it might not be that bad. But I suggest anyone who's dealt with a childhood trauma, a definite family, losing them, parent, losing a child, talk to someone, you know, because most of the time if it goes untreated, you're going to end up harming someone else or yourself. So, talk to someone, never feel afraid. Never feel like something's wrong with you.
SARAH: Now, we’re going to hear from JaiLynn Carter-Wilson. JaiLynn’s child is almost a year old now and she started weekly counseling sessions with us this past summer. She made time to talk with us after getting off the night-shift and before heading off to the classes she’s taking in order to apply to nursing school. JaiLynn first describes how her home-visiting nurse helped her connect with therapy.
JAILYNN: We had a meeting almost immediately after I gave birth, I think it was like in like that same week, because we've already been meeting pretty regularly by then every two weeks. So we just kept it, you know, and I told her, I was like, I had the baby and I was telling kind of like, how, like how the birth went and I just started crying. And so she was just like, you know, you know, that sounds pretty traumatic. And so like, you know, she's just empathizing with me and like really helping me like work through it and then so she kind of like was giving me like the screenings like the postpartum screenings, you know, the kind that they gave you at the pediatrician too. And she like referred me to my therapist now that I have. She's amazing but it was a crazy long waitlist, but when I finally got on, I've been forever grateful.
It's been a lot like. It's been great like, but just realizing like, you know, how much you actually have to work through is can be like. Therapy is like hard work. It's actually really hard work people don't really like, think about that when you think about therapy, like, you know, but actually having to, like, you know, going through the process to improve is arduous, but she's amazing. Like, I, like come to really, like really realized a lot of things about myself when I talk to her so. And then I think the hardest part is like, like, talking about all the things that you talked about in therapy and then having to like, then go eat lunch or like then go like go to work and it's just like, wow, I just kind of had a breakthrough. And I don't know if it’s going to turn into a breakdown, but I guess I'll do this right now. [LAUGHS]. Cause I went to therapy, like mainly because I was just focused on being a good mom, like, I didn't want my mental health to affect my parenting. And so I really just went through like, you know, just for guidance, looking for tips to make sure that I was on the right path when it comes to like my motherhood but that's not even what I got out of it. I got a lot of a lot of about myself. I went in there, you know, for the service of another person, but like I came out, like learning that I need to serve myself more. And yeah, it's a crazy revelation, man. I'm still working through it.
Definitely like check in with yourself. Because it's very easy to just like go in on autopilot like and just react because you're just trying to like, it's kind of like you're in like this of like survival mode. I don't know if you ever heard but people call postpartum the trenches. So it's just like, you know, you're just head down trying to get through it, you don't really you're sleep deprived, your your hormones are all out of whack, you don't really take time to really like, focus on where you are mentally and like, you know, even you know, anyplace. So that's why I just feel like, definitely just check in with yourself, see where you are, and like, you know, go from there.
It's definitely counterintuitive, but like when you say you can't pour from an empty cup, you don't realize what empty is until you're empty, and you can't do anything about it. And you're wishing that you like, you know, you took the time to take care of yourself now, but you can't get that back. And, you know, people a lot of people think like, not taking care of yourself is like, you know, like the pinnacle of motherhood, like they call like motherhood, like martyr, like could, you know, and so, it's, it's really, it's, I really found like the best parents like have like a healthy like balance. Because they don't, they don't like have to project everything onto the kid because he's going to need an outlet. And so if you don't have the outlet, your outlet ends up becoming your child.
Yeah, so that's, that's something that I feel like, you know, I tried to do at least every Sunday to like a restart to my crazy week. Yeah, like, you know, just giving myself like, you know, taking a bubble bath and painting my nails and giving myself a facial and, you know, just staying home with my husband and watching movies and not doing anything, not doing homework. Not stressing about work.
I really like especially like just learning about myself and just trying to give yourself the same empathy that you would give your child you know, kind of re-parenting yourself is really important, especially when you've like, you know, been through any type of trauma, like it's like, whether it's like, from birth or anything like you know, really just taking being easy on yourself and realizing that, you know, if you were if you had a broken leg right now, you wouldn't be expecting yourself to run a 5k. You know, you would you would be worrying that you will be using crutches, you know, so it's the same thing.
I don't even know how long I'm going to be in therapy. I'm just I've just started. I feel like probably I'll always be therapy. But I feel like I don't think that's a bad thing. I definitely do feel like therapy is something that you kind of like want to do. It's kind of like going like to school or starting a diet. If someone's forcing you to do it, it's not going to be effective. So it's something that you have to go into with an open mind. Because even some questions, I'd be like, we're actually going with this. And then we get there. And I'm like, oh. So yeah. And some things people just aren't ready to face and ready to talk about. And I don't know, sometimes I feel like maybe I wasn't ready for therapy, either. I feel like I should have did therapy-lite before I did therapy, like, you know, there's some therapy warmups or, you know, something because we'd be going in there and I leave my head be hurting and I want to take a nap. I don't want to leave the house. But it's like, after like I've processed that and I'm over it. I'm like, that was good. I might have needed that cry.
SARAH: Keep listening for our special coverage on access to mental health services. In the next episode we’ll be having a broader conversation (with Ivan Haskell, executive director of the Joseph J. Peters Institute) about the ongoing shortage of mental health providers, issues with accessing care, outdated payment models, and some proposed solutions to help close those gaps.
Thank you so much to Mercedes and Jailynn for sharing your stories.
Support for this episode comes from the van Ameringen Foundation and the Pennsylvania Action Coalition.
You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at paactioncoalition.org.
And if you or someone you know would be a good fit for our home visiting programs that serve low-income pregnant and parenting families, check out our program pages at https://nurseledcare.phmc.org/.