Wagner to add mental health services to clinic practice

North Big Horn Hospital Clinic provider Ali Wagner is currently immersed in a program offered through New Mexico State University that will expand mental health services in her practice in the future. Wagner already has one Master’s of Science degree in nursing from the University of Colorado in Colorado Springs. For six years, she was a pediatric care nurse in the Neonatal Intensive Care Unit (NICU). Her current focus is on family health.

Once she completes her mental health training this summer, she will have essentially earned two master’s degrees and will have dual certification as a family health nurse practitioner and a psychiatric mental health nurse practitioner.

According to the National Alliance on Mental Illness (NAMI), 88,000 adults in Wyoming have a mental health condition. For 21,000 Wyomingites, it’s a serious mental health condition. About 7,000 Wyoming youth ages 12-17 have experienced depression, and 44.3 percent did not receive treatment for their depression. Wyoming continues to have one of the highest suicide rates in the country, and like other states across the country, drug and alcohol addiction rates continue to grow, outpacing the limited resources available for treatment.

In North Big Horn County, community assessments conducted by North Big Horn Hospital have consistently shown a need to increase mental health services. Wagner said she has seen that need reflected in her practice. 

“We’re going to take it one step at a time,” explained hospital CEO Eric Connell. “We know there are mental health needs in the Big Horn Basin, and having a provider trained to meet those needs is a first step toward meeting those needs. We believe that this will grow over time, adding more providers and counselors and maybe some other services to support it. We will respond to what our community tells us they need.”

Wagner expects to complete the program at New Mexico State in August. Since most of her classes are online, she’s still able to maintain a robust practice at the clinic. For her clinical requirements, she has been working alongside experienced mental health professionals in Cody. That experience included mental health therapy, addiction recovery and rehab at Cedar Mountain Center (CMC) in Cody. She said the experience at CMC provided her with new insights regarding drug addiction and rehabilitation.

“CMC gave me a new perspective on drug addiction and recovery,” she said. “I hadn’t really had a chance to explore that sector in nursing before. I have a better understanding of it now. I think I can be an ally for people within our community who are either in the throes of addiction or have days, weeks or years in recovery. I think being able to acknowledge the challenge and the success in every day of recovery is important.”

Wagner said she always had an interest in mental health, but her interest grew when she worked with families in the NICU. 

 “In neonatal we are working with the baby and the mom and postpartum issues and helping the dad find his place and the roles of siblings and grandparents,” she explained. “I saw a need to treat the whole family. I think that is where my interest in mental health really started to grow, because I enjoyed all of those different perspectives and being a part of that.”

She said she will still have a few days per month to see patients and will keep some patients, especially some of her older patients who have a medical history under her care. As Wagner’s mental health patient load increases, some patients may need to re-establish relationships with other providers who are more readily available to meet their needs.

“Eric (Connell) and I have been working very hard to plan how I will transition from primary care to more of a mental health role,” Wagner explained. “We have other providers who can take over most of my primary care role, if necessary.”

Connell said he expects the transition to be gradual as demand for services will determine how Wagner will divide her time. 

Wagner explained that psychiatric nurse practitioners can provide both counseling services and medication management. Her plan is to do both.

“My goal would be to provide a 20-minute section of a one-hour appointment dedicated to medication management and 40 minutes of talk therapy,” she said. “That would be ideal.”

Though the final plan is far from in place, Wagner said the mental health appointments will most likely be conducted in a different area of the hospital, since mental health conversations typically require a certain amount of privacy.

“In the realm of life, we all experience ups and downs,” she said. “Anxiety and depression is experienced by both males and females, with males finding it more difficult to ask for help. What’s difficult is men don’t feel supported to talk about it or to get the medication they might need. Sometimes it’s hard for males to come out with that and still feel they can maintain their masculinity.”

Wagner pointed out that one of the issues in rural health is the availability of providers.

“Very rarely do we have a provider available that can field calls involving mental health concerns, like the need for medication,” she said. “Oftentimes feelings come up out of the blue and we end up having to send people somewhere else for treatment. I think having someone here in the community who can take those urgent calls will be really helpful.”

Wagner said she already talked to law enforcement officials, who are often the source of referrals of patients with mental health needs, and the idea of having these services available in the community has been well received.

Wagner said, since she’s already a nurse practitioner, she can utilize some of the things she is learning in the program right now, like medication management and treatment modalities. 

“After I graduate, we’ll look more carefully at my transition (from family practice to mental health practice),” she explained. “Eventually that transition will lead to more of a mental health role. I think we’re expecting that transition to go pretty fast, since we’ve established that the need is here.” 

Wagner said one of her goals is to be sure that the new mental health services are utilized by people in the community. To that end, patients will be required to be under the primary care of a North Big Horn Hospital Clinic provider in order to seek mental health services with her.

“Since so much mental health overlaps with physical health, it will be a more holistic approach to have continuity of care,” she explained. “It will also be better if I’m able to directly communicate face-to-face with the patient’s primary care provider about preexisting conditions and that sort of thing. I think this system would also encourage people to have a primary care provider, which is critical to maintaining overall health.”

Wagner added that she is looking toward offering pediatric crisis management to her practice, too.

“My background in pediatrics and NICU has made me very comfortable working with kids,” she said. “Because of that background, I think I can provide a holistic approach to mental health care for the children in our community, as well.”

Wagner has been a provider at the North Big Horn Hospital Clinic since April of 2020. In that time, she’s helped some of her patients with their mental health needs. Her new certification will allow her to help even more.

“Our most recent community assessment showed mental health near the top of our community needs,” said Connell. “It’ll be nice to be able to finally make some real, meaningful progress toward fulfilling an obvious health need in our community.”