You Cannot Prescribe Your Way Out Of Suffering with Dr Josh Waddell

You can feel it in your gut when a plan looks perfect on paper but fails in real life and rural mental health care is full of those moments. We sit down with Dr. Josh Waddell, PMHNP and host of the Mental Maps Podcast, to talk about what actually changes outcomes when depression, anxiety, serious mental illness, and substance use collide with food deserts, long drives, and limited resources. His journey from psychology and psychotherapy into medication management makes the conversation blunt, practical, and deeply human.

We dig into why psychotropic medications can be essential in acute crisis yet fall short for many mild to moderate cases, and how that frustration can open the door to integrative psychiatry. We talk nutrition, lab testing, nutraceuticals, and the careful role of herbs, not as hype, but as additional tools when patients are stuck. Along the way, we explore how to blend psychotherapy principles into brief prescribing visits so meds support the work rather than replace it.

We also get specific about the parts of care that most trainings do not spell out: countertransference with high-acuity or treatment-resistant patients, and how “baffled, frustrated, confused” can be useful data if we check ourselves and stay curious. Then we tackle a high-volume clinical scenario: how to invite psychotherapy when someone is pre-contemplative, including a simple way to ask whether their current improvement is actually “well,” and what to do when a patient has no template for wellness at all.

If you’re a PMHNP, student, or mental health clinician who wants better results and less burnout, this one is for you. Subscribe, share this with a colleague, and leave a review with your biggest takeaway or the toughest barrier you see in your own community.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Welcome And Guest Lineup

SPEAKER_02 0:10

Specific default EVP proof. Noticed to notice it.

SPEAKER_07 0:31

Welcome back, everybody, to another episode of Pep Lao's Ghost. I am so thrilled with our next guest, Dr. Joshua Waddell is here with us. And I will say with Josh, you know, usually I'm kind of inviting people that I somewhat know, or I think one of the people in the podcast know, but I just was really fascinated with Josh and his presence and also his interest in podcasts, since he has his own podcast going, Mental Maps Podcast, which again would highly recommend all and everybody who's listening here to check that out as well. But I always like this idea of cross-pollination. And so I really wanted to get another person who don't who's doing podcasts here on the podcast. And so thank you, Josh, as always, for being here. And I want to also highlight that Dr. Sean Convoy and Dr. Melissa Chapman Hayes is here as well. Also to do some cross-pollinating. I just learned that uh Melissa has her own podcast as well. So super excited about that. So check that out. Measure what matters by elevate what matters. I'm so super excited that Melissa's jumping into the podcast. Who isn't, right? It's everybody's got a podcast now these days, which is great. So that's excellent. But so again, thank you, Josh, for being here. I'll kind of kick things off. And you know, what I'd like to do as well is just kind of you know dig into your background a little bit. And if you wouldn't mind kind of sharing what is your your path, your journey to being a psych mental health nurse practitioner, you know, what kind of initially drew you to this space and you know go back as far as you'd like. And so thanks. Just let you take it from there.

From Therapist To PMHNP

SPEAKER_04 1:58

Yeah, yeah. So I have kind of an interesting space in the concept of mental health. Primarily, uh, you know, I started as a case manager, as a bachelor's in psychology, right? And so I was uh living in Tennessee at the time. I didn't really care about school when you think about it back in the day. I raced motocross my whole life, and my mom was like, You gotta go to school. And I was like, Well, that's the worst. And then finally you get to the point where you're like, I gotta be an adult, and this is not gonna make me money. And so I was always kind of drawn to drawn to the brain. And so I got into case management, and then I was I got my master's as a therapist and worked as a therapist for a while in that space of treating everything, right? Uh, adults and kids. I was in rural Appalachia, uh, I was doing in-home work, right? So we were hiked back into these caves and we'd hike back into like deep parts and kind of find people and work with them, those kind of things. And one of the things that always drew me into these spaces was that we could help them therapeutically, but there was always this concept of medicine that was there. And I didn't understand it very well. I was a therapist by trade, and I wanted to understand it very well because it kind of seemed like some people maybe needed them, some people didn't, and then I just didn't understand it. And so when the concept of psych nurse practitioner got really popular, uh Vanderbilt had created a hybrid program at that time, and so I got into that program and went there. And after that, I moved uh to a rural clinic in Florida. Rural health has always kind of been my thing, and so I end up in a very rural clinic here in Florida. It's kind of this interesting juxtaposition where you have this beach world where there's wealth and you know, all kinds of stuff, and then you just go right across the bridge and it's like a third world country and there's food deserts and it just it blows your mind. And so I got up here into that space, primarily seeing everything, you know, five to 95, serious mental illness, you know, major depressed in general anxiety, those kind of things. And then I had a Suboxing clinic as well. We had a lot of opiate problems in that. So we built that from the ground up, which was incredible, right? Doing some correctional work in that space too. But in that, one of the things I continued to find was that the medicines I had worked sometimes, you know, and sometimes it didn't. And that was very frustrating, right? You know, in our acute crises, these absolutely was helpful. But for people with these mild to moderate issues, it was it didn't work. And so I got really interested in is there something else, right? You know, there's nothing worse than you know, you tried three, four, five medicines, and they're just continuing to have these issues. And so that got me into the integrative space of both new nutraceuticals, nutrition, but then also the use of like herbs. And so that kind of opened a door for me of there's got there's so much more to this. And so that's kind of how I got into that space. I ended up leaving that clinic not too long ago. I have my own practice now and able to do a lot more lab testing and those kind of things, which is great. Uh, my passion is rural mental health, but I kind of came to a phase of life where I needed a break. And so I'm kind of excited to be in the private practice space. But that's how I ended up in the integrative concept.

SPEAKER_07 4:50

Thanks, Josh. Would you mind kind of talking a little more about kind of that rural? Because I mean, I, you know, University of Iowa here in Iowa. I mean, most people probably think it's the whole state is rural, which is inaccurate. But, you know, is that just part of your background, kind of where you grew up, or or what what other things kind of draw you to that kind of population of working for people like I loved how you kind of you know paint a picture, you have to kind of drive up on the mountains and meet them where they are and that sort of thing. And that's that's always kind of exciting too. So you mind sharing a little bit about that?

SPEAKER_04 5:16

Yeah,

Why Rural Communities Hit Hard

SPEAKER_04 5:17

I grew up kind of in the middle of nowhere in Tennessee. Like the town that I grew up in doesn't even have a stoplight. To this day, it still doesn't have a stoplight. The only thing that's there is a dollar general, you know. So, like you, and that was big when it came. You would have thought like we got a target or something that's huge. And so, like, that was big time. And so, in that space, the challenges of like rural Appalachia and the parts of East Tennessee, any any rural area really, it's just very different. You know, a lot of things are taken for granted. You know, the concept of food and good food, you know, if you're unless you're growing it, the chance of you getting it's pretty small, right? And then we've seen societally where a lot of these uh, you know, fast food and some of those things have kind of leveraged these areas because they know they can make cheap food, people need it. It's a lot easier to feed four kids at McDonald's than it is to go to Whole Foods. And so they kind of leverage these spaces, and you kind of find that there was some really great research that was done by a sociologist at Yale who she found that you know the presence of Dollar General alone would change the di the just the whole concept of your community because then you're just going to get lower level stuff, lower quality things. And so that was something that I always seen. And it hurt my heart, you know. It's like, why, you know, why do why do people just born in these places all of a sudden have to live this way? And so that's really what got me drawn into that. And it's interesting, you know, there's so many complexities and multiple, there's so many layers in it, right? Uh, but that in itself is is a is a driver.

SPEAKER_07 6:43

Thanks, Josh. Appreciate that. I'll turn it over to Sean.

The Journeyman Path In Training

SPEAKER_06 6:46

Hey, Josh. So I uh I'm looking at this more from my question is framed really kind of from an academic lens because for all of us who who spend time working with students, we recognize there's typically two kinds of students that enter psych nurse practitioner programs. There are the traditional psych nurse practitioner students who, you know, go to nursing school or jump right into graduate school or you know, spend some time in practice and they just follow that path, right? And then in my mind, there's another kind of nurse practitioner, a psych nurse practitioner that I call the journeyman or journeywoman nurse practitioner, uh psych nurse practitioner that have all different types of lived experiences professionally, personally, that provides all this texture, right? And as a as an educator, I have to teach them a little bit differently, right? I'm getting this sense from your story, uh, and knowing that you and I had a conversation a few years ago before all this, that you're probably more in line with that journeyman psycho practitioner model, right? So my question is how does your journeyman trajectory kind of inform your unique ability to deliver care?

SPEAKER_04 7:54

That's a great question, Sean. Yeah, I when I seen your name, I was like, I remember talking to you. Yeah. Yeah. I think one of the big things when you think of like being a journeyman is you get a lot of information about stuff. And so you think like, well, you know, knowledge in itself isn't always going to translate. But what it does is it informs you how to set with people. And I think that when you're in a journeyman, you get to sit with people in a lot of different ways. As a therapist, that's what you do, right? You learn to set with people. You know, if you're coming, I have students that are accountants or anthropologists or, you know, you know, whatever that is. And so they come at it in a different way. And so I think their ability to interact with people is very different. On the same time, on the same edge of that, though, we do have challenges, right? I remember getting into nursing school and having to learn about the nursing component and being like, oh my gosh, there's the human body stuff, and I got to touch people, and there's this whole thing, and I've got to deliver a baby. I mean, it was just like it was so wild, right? And so I was like, I just want to like talk to people and prescribe medicine. So that was a big shift for me in that space. But I think when you can leverage these qualities that those people have, man, they can make some really interesting providers and bring something a little bit different into those spaces. So yeah, I think that you definitely teach them differently. Many of us, I think, end up becoming very like visual learners a lot of times. So the videos and those kinds of things. I know I've had to do a lot in my own courses of just get more videos in there and get more opportunities to wrestle with this stuff that's not just reading. I think that, in my opinion, a journeyman or woman ends up being those kind of people.

SPEAKER_06 9:25

Cool. That helps me understand. And also invoking Melissa here, it kind of helps me measure what matters. So I'll pass it to Melissa.

Blending Therapy Thinking With Meds

SPEAKER_01 9:33

Yes. Well, my question is going to be a little bit on your background as a psychologist, since I was trained as a psychologist and I'm not a nurse. And part of it, you've mentioned the medication component of it, is some of the many components of training that you get when you go the nursing route. So, in terms specifically, of integrating psychodynamic principles into prescribing, often pharma psych psychopharmacology and psychotherapy, they're compartmentalized in modern systems. So, how do you integrate those principles into the work that you do or how have you and do you?

SPEAKER_04 10:12

So, as a provider, I always practiced out of glassers' work. I love wearing glassers work and choice theory. And so the concept of needs made a lot of sense. And so, as a therapist, you can spend a lot of time in that. As a med provider, especially in community mental health, I got 15 minutes, so it's time to go, you know? And so you end up using a lot of solution-focused skills. And I would find that that'd be very helpful. I enjoyed that role because there, to a point, there's less setting in it, you know. And as a therapist, you just spend a lot of time setting with people and letting them find it. Whereas a med provider, you'd spend a lot of time of what is your core issues right now? Okay, well, we need to get your food right, or maybe we need to just take this medicine, or can you get this medicine? Do you have a car? You know, you're kind of working through some of those core components. I think when you bridge them together, there's this understanding of what the medicine's actually doing, not just at a neurological level, but at a thought and an emotion level that's very different, right? You know, we see where there's so much of that in, like CBT and those kind of other modalities where this is what we believe is happening, right? By constantly challenging your thoughts, then therefore these new thoughts are going to be created. Well, what if I can give you a medicine that can help turn that emotion down so that you can actually challenge your thought? And so I think that's where you can kind of bridge them in. And so, in that, like I I have, I think I have people, you know, you never really know, but I think I have people maybe a little bit more bought in on their medicine just because it's gonna give them the ability to do this other work rather than it just being like, here's Olaf. You know, good luck, man. Hope that hope that keeps you not being depressed.

SPEAKER_01 11:43

Yeah, I mean, it sounds a lot more holistic. So here's physically how, you know, what this medication is gonna do to your body, help tone your emotions down so that we can address X, Y, Z.

unknown 11:55

Yeah.

SPEAKER_04 11:55

And there, I mean, you know, you know that in the in the psychology space. There's a lot of great work of, you know, what therapy's doing at the neuronal level, right? I know Dr. Chad Luke, he's wrote some stuff on that in the clinical mental health space, you know, of just what this has happened, right? Not just from BDNF, but all these neurotransmitters and all these neural connections. So can we help that with medicine and then bridge it together? That that's really what you're trying to do, I think, as a med provider. It's just sometimes do you have the time to explain it or not?

SPEAKER_01 12:23

Yeah, thank you.

SPEAKER_07 12:24

Yeah. This is a great conversation. I mean, I think I'm gonna kind of spin a little bit off of what uh Sean brought up, this idea of uh being a journey person will

Countertransference As Clinical Data

SPEAKER_07 12:34

say. And it's something we talked about last time or at least a couple of podcast episodes ago, about you know, people who have been practicing a while and you have all this wealth of experience. You know, and when I'm talking to students as well as or new practitioners, you know, there's always this transference, counter-transference, and it's always kind of this fear of, you know, I just need to avoid it, need to avoid it. But but I think that's something that can be really, you know, part of the process of healing that can go along with it. And so maybe if you can talk about that when you're dealing with, you know, high acuity, complex, treatment-resistant people, you're you're inevitably going to come up with people that you're gonna have some counter-transference issues with. How do you work on recognizing that and maybe even you know keeping that from derailing your work that you're doing with those people?

SPEAKER_04 13:18

We it always makes I tell my students this a lot too. If I'm feeling this emotion about this person, how must they feel being that person? Right? And at the same time, how much much their family or the people around them to feel that way, right? So of course I'm uncomfortable and I've got to check myself of being uncomfortable or just frustrated. But at the end of the day, no one wakes up and says, I want to make everyone around me uncomfortable. That sounds awesome. Like that's gonna be very helpful to me from a societal level. And so we have to remember ourselves in that. I will say one thing that I think I love about being a med provider compared to being in like a director role in some of those things is that med providers, you know, we can jump in and kind of be there for 30 minutes, an hour, whatever that looks like, and then we're out. Whereas like if you've ever been a director or have you ever done like therapy work on a unit, you're in it all day, right? The emotions there, you're kind of going through it day in and day out. So we have this ability to kind of jump in and kind of recognize where the counter transference is, not out of, hey, I need you to be nice so that everyone else is calm, or hey, I need you to do this so that my mail you looks good when the executive comes by. But I can experience the counter transference of this is what your ability to meet your needs do does for me. And I think that in alone can be very helpful, creates a lot of empathy, and then it can kind of maybe guide you into what needs they're trying to meet.

SPEAKER_07 14:36

Yeah. Yeah, I like that idea. Again, it just feeds that information. I I've always liked Dr. Marcia Linehan always kind of talked about that gris for the mill. It's it's gris for the mill, everything is grisp for the mill. And so though that stuff that brings up within you, and I really loved how you said that, you know, try to put yourself in their shoes. And they're, you know, if they're making you feel that way, how much are they getting out of bed and thinking about that or feeling that way? Or or experiencing those kind of hostilities or you know, vast emotional, intense emotionals from other people as well. So thanks, that's been great.

SPEAKER_04 15:08

So, Josh, this is a good thing. I used to have a professor who'd always say, if there's someone that makes you feel baffled, buffled, or confused, there's a reason why. And so anytime you're either baffled, buffled, or confused, it's like, okay, there's something going on here in this space that's doing that. And then I got to recognize it.

SPEAKER_07 15:24

Yeah, yeah, it's almost better to feel to recognize that than be like totally lost and confused, right? You know, it's let that let that guide you for sure. That's great.

Selling Psychotherapy With Respect

SPEAKER_06 15:33

So, Josh, you know, the podcast is is namesaked around Hildegar Peppla. So I'm gonna steer us back to some psychotherapy stuff. I'm hoping to give our listeners some practical guidance about a specific high-volume clinical scenario that we all encounter at different times uh during the day when we're seeing patients. I want to ask you to think for a second about how you would approach a patient whose psychiatric condition is not gonna get better solely with the psychotropic solution, right? You know, based upon your experience that part of this is psychotherapeutically driven, right? So, my question for you, and hopefully that you can share this to our audience, which is a pretty good chunk of seasoned clinicians and students, right? How do you sell psychotherapy to a patient who is pre-contemplative as it relates to the value of psychotherapy?

SPEAKER_04 16:20

Man, that's a good question. If I was doing if I was really good at this, I'd probably be selling something besides psychotherapy. Uh but yeah, I think that it it you know, it's such a challenge, right? One of the things that I like to highlight is that if you're taking a medicine right now and kind of looking at your scales, whatever you use, right? Whether you're using scales, you're doing numbers, whatever. If I'm at like a four when I started my medicine and I'm at a six, how does six feel? Right? Is this how you want to feel today? Is this as good as you think you can feel? And if so, who am I to say that you have to get help? But if you're not, there is something else. And I think that's kind of how you sell it as there's another ingredient in the toolbox. Do you have to do it? No. But it's kind of like someone putting something on the table and saying, I can make you feel better with some work that you can do with me. And that's kind of wild, right? To think about I don't, I'm not gonna give you something, you're not gonna wake up and all of a sudden you're better. But wherever you're at today, whatever this medicine has done for you, if you do this other thing, one of the ways that I like to tell people when I'm kind of going through my different uh options, because I love to give people options, well, say, you know, I can give you this medicine, right? And it's probably gonna be very helpful, right? You know, we're probably gonna see about 50 to 75 percent decrease in symptoms, sometimes 100. That's what we have. If you just do therapy, right, you're probably gonna have about a 50 to 75 percent, you know, sometimes a little bit less, a little bit more. And if you just done like diet and exercise and all the things, it's kind of better. But if you do all three and you attack it in all three ways, you're gonna get better. It may take some changes in medicines and those kind of things, but I think that's the selling point, is that no, I'm not saying you have to, but if you feel exactly the way you want to feel right now. Now, granted, we know we could say that there's some need concepts in that, and ultimately we could say, like, well, I don't want to get better, and those kind of people. But I think that's the the biggest thing in it, is that there is something else on the other side.

SPEAKER_06 18:17

That's really cool. So that kind of helps me in my mind, and I'm and I'm I'm kind of speaking to our students right now or listening that you know, it sounds like part of your strategy is, you know, I'm going to roll with the resistance and I'm going to continue to apply motivational interviewing techniques when they are pre-contemplative, looking for that opportunity to say, is this as good as it's going to get? Is this acceptable to you? And you just keep playing on the edge, looking for your opportunities down the road. Is that a fair way to say it?

SPEAKER_04 18:44

It is. And I think one thing we have to remember is that for some people, they don't have a template of what it looks like to be well, right? And so when we engage in these conversations, we are making the assumption that they know what wellness looks like, right? But if you have that person that sits in front of you and you're like, well, when was the last time you didn't feel depressed? And they're like, never, sometimes that is true. Sometimes they don't have a template of what wellness looks like. And so if that's the case, maybe it's stepping back and spending the time to say, like, what does wellness look like for you? Like, how would you know you're as healthy as you want to be? I was working with someone the other day where we were doing in my model, I have like body, mind, environment, spirit. And so we kind of talked about how how would you be healthy in all four of those components? Because they have no idea. They don't know what being healthy looks like for them. And so, what would it look like for your body to be healthy or your mind to be healthy, your environment to be healthy, your spirit to be healthy? And I think that can be very helpful too. If if they don't know where to go, there's probably a reason why. And we got to help them create that template.

SPEAKER_06 19:44

That's that's beautifully concordant. Thanks. I'll pass it to Melissa.

How To Learn A Community Fast

SPEAKER_01 19:49

My question is going to focus back on the rurality and working in rural settings. A lot of my focus has been in rural health as well. And I grew up in a rural area. My family lives in extended family, rural Iowa, rural Pennsylvania, rural Tennessee. And those are all rural in so many different ways, right? Rural isn't like they're they're they're different. But what I found from my work and then personal experience is navigating in those settings, as you've mentioned, I kind of operate differently than I would if I was in Minneapolis, which is where I live now. I'm wondering when it comes to something like mental health, how how you approach the folks you work with, like was is it in crisis settings, or sometimes it's like if there's resistance, maybe you don't call it what we are talking about, like in this setting. Maybe it's more of like an indirect route. Sometimes I like you meet people where they're at. And what does that look like, I guess? If you have any examples of going into a community, because I think that's that's something that if folks haven't worked in a lot of rural settings, it's unclear. Like as I'm mentoring people, like you can't come in and say, like, oh, we're gonna talk about, you know, how did you feel about it? Like, we don't do that. That would be shut down immediately in a in a lot of these settings. So, what does that look like in your work?

SPEAKER_04 21:06

Yeah, I mean, I I tell students all the time, and then used to when I was at the community clinic, we'd bring people in. When you come in, you need to get in your car, you need to drive around that entire town. You need to know what those streets are that they're talking about, you need to know what it means to go down into the holler. You need you need to know those things. You need to know where they're spending their weekends at. I mean, you need to know what life looks like. And I know for me, you know, being in Northwest Florida, driving those roads and realizing I haven't seen a store in 35 minutes. Oh my gosh. You know, let's kind of think about that for a second. Or I have not seen a single bus stop since I got on this road. Oh, there's no public transportation here. I think those are the things that you have to know. It's very easy to kind of assume that those things are there and they're not. And then I think you can learn a lot just driving back roads, be careful, especially in some areas, but drive some back roads and look at some of those things. Look. what the houses look like. Look at what life looks like. You know, are there even jobs around? You know, if you want to like see some stuff, you know, you can get up in Appalachia, but also like here in Florida, you'll go two hours without ever seeing any kind of large you know building that someone would work in. Right? What's the job situation like? I think those are very, very important. I remember when I was in East Tennessee and I was working up there as a therapist, one of the things that you kind of learned is how everything goes with the seasons. And it's very similar to here too, but recognizing that like, hey, all my people are going to make money from this time to this time. So if they don't show up for their session today, there's a reason why because they're trying to make money because their money chance is going to stop in maybe two more months. You know, and so you kind of just recognize those seasonal movements and those things. And I think all of that can be very helpful in understanding why people do what they do based on the areas that they live in.

SPEAKER_01 22:54

I love that. And I feel like you've just legitimized like I have experiences driving around Vermont and switchbacks and I was terrified because I'm like I literally I can't see around this and it's like such an arrow right it matters so much to immerse yourself in those communities so you can understand. Thank you.

SPEAKER_04 23:10

Yeah I mean you're driving in the road you're like that road's not paved and that road's not paved and so you're none of these roads are paved. Okay now I need to put into full-wheel drive a little bit because I see where I can go you know it's it's a very interesting concept but I that I think that's what makes you good providers knowing the area that you're in. I think there's a lot of people who will they'll go and you know I I always try to eat local anyways but if I can go to the local store like I try to get everything I need in the area that I'm working in just so I kind of know it. You'll see them out and about and that can kind of be a little uncomfortable but at least they know you exist and you're part of the community that can be pretty fun.

SPEAKER_07 23:48

That's awesome. Yeah I think you know it reminds me back my get my RN, we had a community nursing class and we had to go out in communities and one of the things I'll always remember is when you look at the road you look to see if there is a curb and the curb means that there is a sewer system usually attached to that so that rainwater and other things can know so if you're going through a town that doesn't have a curb that might not have a sewer system. So that's an interesting kind of you know part of that just like you were saying unpaid versus paid kind of roads.

Fixing A Broken Mental Health System

SPEAKER_07 24:15

So so this has been awesome Josh. You know we've got got kind of our last you know what we kind of we'll call our parting question but then I've got a question that uh our previous guest has for you as well. But before we get to that what are some advice that you would give to other PMH MPs currently practicing or like Sean said some students who might be listening to this as well as a journeyman as with all this experience I mean I think part of your desire and you're teaching at Yale University and other places, I think you want to pass what you've learned your your information on to others so so what is some parting information for the the profession of PMHMPs and you know where Hildegard started us off and and where we are today and what the future looks like for you man I can get on a soapbox so if you need to cut me off go preach let's go let's go yes right there.

SPEAKER_04 25:02

Shut me down man uh because I I I get on tangents all the time about stuff like this. I mean I think that you know let's look we can all get real right healthcare in America is super broken. I mean it's wildly broken. We can all talk about it's a very broken system. And so one of the things that we have a really awesome opportunity is can we help fix the brokenness of that system. Right. And I think that's where PMH and Psy all nurse practitioners really have a seat at that table, right? Is to help fix a lot of this brokenness whether it's as Sean was saying maybe many of us are journeymen that are kind of coming into this space or the training that we get is very different. It's a little bit more holistic, a little bit more integrative, especially in most uh universities it is so we have a space to be that so if you're a student, be thinking about not only can I earn myself a seat at the table, which is unfortunate it's kind of uncomfortable to say, but you have to earn your seat at the table, right? Do I know how these medicines work? Do I know how these diagnoses emerge and exist that gets you a seat at the table. And then once you're there can you change the conventional system that's there right maybe we don't do that exact thing. Like I was telling some of my students the other day each person has a specific trait that brought them to be a nurse practitioner right and many of us is investigative or empathic and those kind of things. But from that is also their way to impact their community. And so it's not only do you learn how to help people but how can you change some of the systems that are there. And I think we all forget that we have that ability to do that. That's the cool thing about being a nurse practitioner is you can you can change these systems. You know you see nurse practitioners now they're creating these community gardens in these cities where they're kind of helping people get good food or they're doing some stuff at the like the leadership level where they're trying to create integrative kind of practices where primary care and and other specialties are kind of getting involved that's cool stuff that we can do and be a part of so just know the training you're doing now as a student that's going to get you a seat at the table and get you to help people but then from that how do you find your niche if you will for that moment I love it.

SPEAKER_07 27:04

Yeah I always tell I mean and that's great way to kind of end it I think because it's you know it's one of those positive it's more of an upbeat type of thing. Because I mean you're right we could go down a rabbit's hole about how the system and you know you said the healthcare system in general but yeah the mental health system across a country is really broken. And uh but I think you're right it's a it's a great time to be a PMHNP because we have the we have the training we have the holistic approaches we've we've got all the things we need to really kind of like you said have that seat at the table. So all right I'm gonna transition into our previous guest Dr. Paula here is going to ask you a question. So let's uh let me share real quick.

Best First Job For New Graduates

SPEAKER_00 27:38

All right so we have Dr. Paula Alaka here with a question for Dr. Josh Waddell Hi Dr.

SPEAKER_03 27:46

Waddell. I my question for you is based on the immense number of practice settings that you've been able to participate in. So my question to you is do you have any recommendations for new graduates on the best setting to get started in when they're beginning their practice?

SPEAKER_07 28:07

Thank you, Dr. Paula.

SPEAKER_04 28:08

Yeah Josh take it away I'm I'm a big believer in every student getting in community mental health there is no place in the country you're gonna see more people sometimes to your demise but more people with the vast amount of diagnoses and the vast amount of medications you ever see I mean the statistical chance of you prescribing an M Ao I is really low. You get community mental health it's gonna happen. Give yourself some time it's gonna happen right and so I'm a huge believer in just getting community mental health and now the big thing you've got to know is when it starts to weigh on you, right? Because for some people a year is enough for other people they do it for their whole career. They're just kind of wired for that and so there's a lot of self-work that needs to be done a lot of mentoring that needs to be done because when it's time to go it's time to go you know when it's not serving you and you're not serving them anymore make a shift. But I'm a huge believer getting in that space. I think acute settings are great but I think it's really challenging you know and I know you guys have worked with people in this space too if all you've ever done is acute it's very challenging to know how to manage an titrate meds on the outside and in the lab work and the social concepts. So get in community mental health there's a need anyway sometimes you can get your loans paid off if you're at least lucky enough to get some of the federal loans back in the day and just get in there get do the work learn and then you know the world your oyster after that because you're seeing five to 95 every diagnosis that exists in there I'm just a big believer in that space.

SPEAKER_07 29:35

Love it. Yes exactly yeah we've talked about that before too you know it's you know I think there is some concern and in and and like you said you know for that autonomy and wanting to practice one how you want to practice there's a lot of I know I see a lot of my students kind of going into private practice and and not getting that community experience it's it's gonna be interesting how the future kind of you know shapes their worldview and in their professional outlook on things but but I think that's a a great thing to say.

Where To Find Josh And Closing

SPEAKER_07 30:00

So I want to just wrap up here by saying thank you to Dr. Josh Waddell. Thank you so much for being here this has been amazing. I'm inspired I'm my cup is fuller and uh if you want to listen to more to Josh he had does have a podcast mental maps check it out and he's got new uh episodes coming out as well but we'll have some new episodes coming out in a week or so but thank you again Dr. Josh Waddell those of you listening make sure you like subscribe send those comments please please let us know have a suggestion for a guest we don't get the guests