- Hi everyone and welcome back
to "Living Well with Schizophrenia".
I'm really, really excited to introduce today's video
because we are going to be speaking with Carlos Larrauri,
who is a nurse practitioner
who is also living with the diagnosis of schizophrenia.
And so I'm really excited
because this is kind of the beginning of a new series
that we're trying out where we are going to be interviewing
mental health professionals in the field like psychiatrists,
nurse practitioners, psychologists, pharmacists,
you name it, just to kind of communicate
their knowledge and expertise to you, our audience
and to kind of figure out how the work they do
relates to people who are living with schizophrenia
and schizoaffective disorder.
So we're going to be talking with Carlos today
about what exactly being a nurse practitioner
or being a psychiatric nurse practitioner is like,
what that entails for him
and how it relates to people
or how he can help people who are living with schizophrenia.
And also about what changes he would like to see
in the mental healthcare system.
He has a really, really unique perspective,
as someone who is a psychiatric nurse practitioner
and also someone who is living
with the diagnosis of schizophrenia.
So I'm really excited to kind of learn more
about his insights into what changes he would like to see
in the mental health care system.
Carlos is a psychiatric nurse practitioner
based out of the United States.
So all of his perspectives are kind of contingent
on the systems that are at play within the United States
but I think they do speak to larger issues
in other countries as well.
If you would like to help support this project,
as well as other projects that we're working on
with the Living Well channel,
please make sure to check out our Patreon page.
The link is in the description below.
We're really working hard to grow the channel
and to keep producing new and valuable resources
for you, our audience.
So if you would like to help support us in this endeavor,
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Any support is so appreciated. Thank you.
Okay, so hi everyone.
So today I'm here with Carlos Larrauri,
who is a psychiatric nurse practitioner.
And so hi, Carlos,
thank you so much for being here today with us.
- Of course, it's my pleasure.
- So can you tell the audience a little bit
about yourself and what you do?
- Sure, again, my name is Carlos.
By education and training,
I'm a psychiatric nurse practitioner.
I'm also secretary for the National Alliance
on Mental Illness.
And most importantly,
I'm someone living well with schizophrenia.
As far as what I do, my day job consists
of taking care of patients, these days, primarily
through tele-medical services.
I also teach occasionally for a local university and college
and otherwise I just try to stay healthy and enjoy my life.
Playing music and exercising and traveling
are parts of my hobbies that I enjoy doing as well.
- Great, so you're very busy
and it sounds like you are doing a fantastic job
like living well with schizophrenia,
which is great to hear.
So I guess diving into some questions for you.
So can you tell us a little bit
about what being a psychiatric nurse practitioner entails?
- Sure, well being a psychiatric nurse practitioner
entails several years of education, first and foremost.
Usually you have to become a registered nurse first,
which you can do through a diploma program
or through an undergraduate associate's
or bachelor's program, after which you have to pursue
a Master's education to become
a graduate level nurse practitioner.
And depending on the education you pursue,
you can specialize in different settings or populations,
such as psychiatry or acute care
or anesthesiology, for example.
And as far as the day-to-day work functions
of being a nurse practitioner,
I do a combination of medication and therapy.
I manage my patient's medications,
make sure they have side effects that are nominal,
that they can live with.
I also do some therapy,
engage my patients in what their goals are,
have them reflect on the interpersonal relationships
and things like that and that's most of what
a psychiatric nurse practitioner does.
- Great. So kind of like a holistic care model.
- That's right, that's right.
- Okay, so did you diagnosis affect your decision
to pursue this career?
- Sure, I thought to myself after my diagnosis
that I wanted to give back to the population I'm part of.
Once I got back on my feet, I thought to myself,
I wanna help other people
who have been through similar experiences like myself.
And I thought to myself,
I also want to work in the mental health field
as a clinician and the nurse practitioner model
was the most accessible and affordable model.
It allowed me to work part time and pay my way
as I was going through school and it took a number of years.
It took about four to six years
but it was still more accessible than other paths
to becoming a clinician, which take longer.
So yeah, I was very much drawn to the mental health field
and to the path of becoming a clinician
because of my lived experience
of overcoming psychosis and schizophrenia.
- Right, so how does your experience
living with schizophrenia inform your work
as a psychiatric nurse practitioner?
- I think my experience grounds my work
in a strong sense of purpose.
I feel very much that I get a strong sense of meaning
and identity from the work I do,
providing for this population.
And I think it also allows me to have a certain degree
of empathy also for the population.
I very much have struggled with the same things
my patients have struggled with,
whether it's depression or anxiety
or psychosis or substance use,
these have all been part of my experience
and I bring that to the table
when I see patients and that hopefully
will allow me to understand
where my patients are coming from.
- Do you share with your patients
about your diagnosis or your lived experience?
- It depends. Sometimes I do, sometimes I don't.
Sometimes patients look me up on the internet
and they come to the table ready to ask questions.
Sometimes I meet young adults
and especially because they're in a very similar situation
to what I've been through, I wanna break through to them
by telling them, you know, look,
I've gone through the same experience
and I've been able to manage with medication
and with staying sober and things like that.
Other times, patients kind of want
a traditional doctor-patient relationship
and they just want you to help them
and figure things out for them.
So it's one of the many tools, I think, in my toolbox
that I use when I feel it's appropriate.
- Right, I think the empathy piece
is really, really important
and that really helped me in my professional role.
Like as a social worker too,
is just having that empathy for people
who are going through even something similar
or just similar struggles and whatnot,
that's really helped me.
So that's really great to hear that you utilize that
in your work as well.
So how can a psychiatric nurse practitioner
help those who are living with schizophrenia or psychosis?
- I think a psychiatric nurse practitioner
can help those living with schizophrenia or psychosis,
much like they can help any other patients.
They're there, most importantly,
to help the person get back on track
and work towards their goals.
And in that sense, we work within a holistic framework.
Of course, technically speaking,
we tend to manage medications and prescribe
and refer to specialists and do therapy and other tools.
And we use other tools such as those
but the important thing is helping the person,
especially if it's a young adult with psychosis
or schizophrenia going through a first episode
get back on track with their lives
and working towards their goals.
- Right, so what kind of team do you work with
in terms of supporting somebody
with schizophrenia psychosis?
- So I usually work in a team based model
or team based care.
I work with case managers and counselors
that handle different functions.
A counselor might specialize more
in the therapeutic component and delve
into deeper therapeutic and longer therapeutic sessions.
Case managers may help the patient
access resources in the community,
whether it's accessing citizenship,
or housing, or government benefits, whatever may be.
And of course, I also work with specialists
such as psychiatrists who oversee part of the care as well.
- Great, okay, so you are kind of like,
do you facilitate all of these team members
in terms of treatment for these people
who are living with psychosis?
Or how does that work?
- I think at the center of it is the patient
and then the patient is kind of surrounded
by these various professionals with different disciplines
and different backgrounds
and it just depends on the patient's needs.
Whatever the patient's needs are,
they will have access and an ability
to get support from the appropriate professional.
- Right, okay.
So do you have any advice then for patients
who need to kind of like do this self-advocacy
or self-navigation of the system or whatnot?
Do you have any advice for them about doing that?
- I think you nailed it on the head.
As much as in an ideal world would work in a system of care
that is team-based and that creates a clear pathway
for people to getting better.
You know, the system, including the care
that I work within is still fragmented
and is far from perfect.
So it's important for patients to self-advocate
for themselves to be the drivers of what they wanna see,
whether it's making sure that they get the right medication
or making sure they get the right help with school,
or whatever it is.
It's very important that the patient
is able to communicate what they need
with the support of their family,
to the people that are there to help them.
- Great, okay.
So you have a really unique perspective
on kind of the mental healthcare system,
as both someone who's working
in a professional capacity within it
and somebody who had to navigate it on a personal level too,
as a mental healthcare patient.
So as someone both living with schizophrenia
and working as a psychiatric nurse practitioner,
can you tell us about your experience
in both of these capacities,
going through the mental health care system?
- Sure, well, I think you kind of hit the issue on the head,
which is that navigating the system
has been the key part of it all,
whether it's been as a patient or as a provider,
it's a system of care that isn't perfect
and requires active advocacy to make sure
people get their needs met.
As a patient, I was very fortunate to have family support
and they were really the drivers of my care
when I was going through my forward psychotic episode.
And it was my mom who was making me go to doctor.
The doctor and navigating the insurance system
and trying to make sure that I got care quickly
and trying to get me back to work in a school.
As a patient, I mean, as a provider,
I try to make sure my patients feel well
by managing their medications,
so that they can stay out of a hospital instead of crisis,
so then they can move forward with their goals.
But sometimes they run up into the challenges
or run up against the challenges
of a system that is fragmented,
where people don't always have insurance
or care is not communicated between primary care,
specialty care and other issues such as those.
- Right, okay.
So really like trying to navigate
the fragmented care system, both as a professional,
trying to help your patients
and also, as someone who's trying
to navigate it themselves at times.
- Exactly.
- So what changes would you like to see
in the mental healthcare system?
- I think there's three key changes
from a policy perspective
that would make a profound difference
in the care that all individuals receive,
regardless of their diagnosis, which would be one,
ensuring access to affordable healthcare.
We still have millions of people in the United States
that are under insured or uninsured
and ensuring everyone has access to health insurance
would go a long way to making sure that people
live healthier and safer lives.
The other would be ensuring
that we have adequate community-based treatments.
So often the point of care
for people with mental health issues is a cop car
or a crisis stabilization unit,
instead of a professional in a specialty setting,
or an academic research setting.
And aside from access to insurance and community care,
I think the other critical component,
which is certainly not the least important,
maybe the most important, is early intervention.
We need to ensure that people get an intervention
as soon as the onset of these symptoms occur,
because the longer it goes untreated,
the more difficult it is to manage the condition
for many patients.
- Right, okay.
Yeah, I completely agree with all those.
So early intervention, community supports
and affordable healthcare.
- that's right.
- Yep, okay, great.
So are there any changes particularly
to the care provided for those who are living
with schizophrenia or psychosis
that you would like to see happen?
- I think the last component is particularly critical
for people with schizophrenia and psychosis,
which is the early intervention component.
Often in the literature you hear,
or you read that people can go years,
six, seven years between the onset of psychotic symptoms
and getting access to care and much like any condition,
if someone had diabetes and they had their diabetes
unmanaged and out of control for several years,
there are gonna be complications and problems
as a result of that.
It's very much the same with schizophrenia,
where if you go several years without medication,
there could be consequences for one's abilities,
cognitively or otherwise, down the road.
So it's important that we get care early
and once we get care at the first episode
and continue care, I think it's very much possible
with time for people to resume a fairly normal life.
- Great. Okay.
So how are you working toward these changes in your work,
as a psychiatric nurse practitioner?
Is it possible to even work towards these changes
within your capacity?
- Sure, as a psychiatric nurse practitioner,
I mostly work in direct care with patients
but one of the many cool parts about being a nurse
is that you wear many hats,
whether it's as an educator or as an advocator,
or as a clinician or so forth and so on.
So one of the roles I most identify with as an advocate
and the organization that I've affiliated
most with professionally thus far,
has been the National Alliance on Mental Illness and NAMI,
which is the largest grassroots organization
for advocacy for mental health conditions
in the United States,
allows me to engage in advocacy
at both the national and the local level.
At the national level, we engage in making policy
and working along with federal organizations
like the National Institute of Mental Health.
And at the local level, we offer
other direct services to people,
whether it's free support groups
or free education classes and things of that nature.
- Great, okay.
And so you have let me know that you are also interested
in pursuing a law degree.
- That's right.
- So how do you see that factoring
into advocating for these system changes?
- Sure, I think a legal education
will give me further tools to advocate for populations
with mental health conditions.
I think it'll allow me to further specialize
in hopefully the legislative process
and understand how laws are passed
and laws are made and their impact,
the consequent health of individuals.
That's my hope with attending law school,
is to specialize in healthcare law and policy
and work ultimately in the policymaking
or legislative arena and help make systemic
and population level change through rules
and regulations or laws that impact
people's health and wellbeing.
- Yeah, great.
So you mentioned your work with NAMI
and being like a grassroots organization
being very important, as well as your work
or trying to pursue addressing policy issues
at a more systemic level.
So where do you kind of see the most change
being affected, or do both need to happen,
or what are your thoughts on that?
- Well, as is the case with many policy level issues,
a lot of the changes happening at the state level
and, you know, in the United States,
we have 50 States and they kind of experiment
with different methods.
Some states expanded Medicaid, for example
and we've been able to see how Medicaid expansion
has saved money and saved lives.
Other states have adopted coordinated specialty care,
which is a system of care that provides people
with first episode psychosis,
with very intensive wraparound services
and has provided to be a better than stand of care loan.
And at the state level, where we see the action
and depending on the issues that the state has taken up,
we've seen different advancements in the care of people
with mental health conditions.
- Well thank you so, so much, Carlos for joining us today
and answering some of our questions
and talking about what's changes
you'd like to see in the mental healthcare system.
Your insights are really valuable, so thank you.
- Of course, anytime.
- It's always so nice talking to you.
Hopefully we'll get to talk again soon
but thank you so much again for joining us today.
- Sounds great. Thank you.
- Take care and thank you.
So I hope you enjoyed that interview with Carlos
and found his insights and experiences interesting.
Big, big, thank you to Carlos
for appearing in our first interview episode
in this new project that we're trying out.
It was so wonderful chatting with you
and I know I learned a lot.
So if you enjoyed this video, please make sure to like it
and don't forget to subscribe too
so that you don't miss out on any of the future videos
we put out in this series.
And don't forget if you want to help support
the creation of future videos like this one
to please make sure to check out our Patreon page.
The link is in the description below.
Thank you so much again for watching and as always,
wishing you and your loved ones good health.
See you in the next video. Bye
(cheerful music)