People with mental illness are some of the most stigmatized and misunderstood-and often voiceless-people in the country. In the state of Tennessee, however, four psychiatric clinical nurse specialists have taken lead roles in state government mental health services, representing and supporting this vexing population. These four special nurses are Virginia "Ginna" Trotter Betts, MSN, JD, RN, FAAN, Candace Gilligan, MSN, RN, Lynn McDonald, MS, RN, and Freida Hopkins Outlaw, DNSc, RN, CS.
"Mental health is fundamental to [overall] health, yet it's frequently overlooked. The opportunity to bring knowledge to the public is critical," says Betts, commissioner of the Tennessee Department of Mental Health and Developmental Disabilities. As a result, she has found her job to be the most complex and challenging she's ever had.
A past president of the ANA (1992 to 1996) and senior adviser to the U.S. Department of Health and Human Services (1998 to 2000), Betts argues that her background in nursing makes the scope of her current job less daunting. "So much of what I've accomplished in life I learned in Nursing 101-being a nurse gives one the absolute best perspective," she says. "If you're true to those basic principles, you come up with options and evaluate what you've done."
The biggest challenges in American health care, she says, are financial as well as social. "One out of four of us will have a mental illness diagnosis in her lifetime, but mental health is only 6% of health care dollars spent." Betts notes also that the stigma attached to mental illness "is both pervasive and unfounded-we simply don't know enough about how the brain works."
Her job is made easier by the presence of her three colleagues-Gilligan, McDonald, and Hopkins-all of whom are in top positions in the department she heads. "Nursing input is essential," she says. "Someone is going to make health policy, so it might as well be someone who knows something about it." She disagrees with the perception that nurse leaders often don't support one another. "All four of us feel enhanced by high achievers," she says. "We want others to feel successful and are encouraged by them."
Assistant commissioner Candace Gilligan agrees. "Each of us is contributing to key decisions and policy," she says. Gilligan holds major responsibility for psychiatric and substance abuse services funded through the Medicaid Managed Care program. "TennCare reform is a top priority because it was using 28% of the state's budget, and we had to substantially reduce costs," she says. "We've elevated performance all the way around for the benefit of people with mental illness."
Her nursing perspective remains vital. "It's the person we're serving, the one in need of mental health services, who matters," she says. "We're here to ensure accountable and quality services."
Lynn McDonald sees it the same way. As the chief officer of Middle Tennessee Mental Health Institute, with a $43 million budget for a 245-bed setting, she measures success by what's provided for each patient.
"It really helps me to go out and talk with the person I'm serving," she says.
McDonald also asserts that her clinical background is part of what enables her to take on such a challenging job. "Being a nurse gives me credibility," she says. "It helps inform my decision making."
Freida Hopkins Outlaw, assistant commissioner for the Office of Special Populations, concurs: "My clinical days helped me more than anything else to do this job." Her responsibilities cover many areas, from coverage for children and the elderly to forensics to concurrent disorders. With a background in research, she's already brought in $11.3 million federal dollars to the Tennessee system.
Outlaw praises the impact that a collective effort can have. "All of us have different strengths: Ginna sets policy and figures out politics, Candace knows business, Lynn is a fine administrator, and I'm a provider who knows research," she says. "We have to trust each other's wisdom-it's what we do collectively that matters." -Hob Osterlund, MS, RN, CHTP