Why all the insistence that as a patient you should set up your patient portal? You may be thinking that patient portals are cumbersome, complicated and technology is just too difficult to set up. Let me assure you that it does take effort, but there are many benefits to engaging with your patient portal.

At Scottsdale Mental Health & Wellness Institute, we have integrated the patient portal into our patient care. We assist our patients with setting up their portal and walk them through the initial setup of the portal. We help patients gain access to all the features and benefits available. The portal serves many functions including providing options for communication with your providers, information about upcoming appointments, the ability to complete documentation, and features that can improve your mental health functioning.

We utilize the patient portal for the entire admission paperwork process which is done through an e-signature application that gets imported directly into your chart once completed. Our admissions staff provides additional options for those who don’t have access to computer equipment or who have difficulty managing technology. We have patients complete intake paperwork in person, have patients fax documents to the practice, and send the documents in an attachment via email. We then upload all those documents into your chart.

Once your Patient Portal is set up, you have secure access to information about your care. The Patient Portal allows you to directly communicate through the messaging feature with your provider. If you are seeing multiple providers then the additional provider can start a message with you and you can communicate with your entire team.

Prior to your initial appointment, our team will send you what is called “treatment measures”. These measures are tools to help your provider evaluate your emotional condition and understand your level of functioning prior to your appointment. The measures show up in your portal two days before your session. When completed the measures are imported into your chart so your provider can review your status. Measures are very helpful to your provider because they can review your status before they even see you in session. These measures save your provider time so they can dedicate more time to listen to your issues and concerns. Over time the practice can also track progress with your emotional/psychological condition by looking at the results of your measures. So please if your portal is set up, keep an eye out for the emails that inform you that you have measures to complete. Measures are also ongoing while you are in treatment.

At SMHWI, we are rolling out many other features of the portal so patients can benefit more from using the Patient Portal which is directly linked to your Electronic Health Record. Our goal is to provide solutions for our patients which improve patient care and improve patient functioning. We understand that many people struggle with technology and we want you to know that we will support you with any technical limitations you may have. We hope you benefit from the Patient Portal in the future.

Author: Patrick Mingey, Director of Marketing

Patrick brings unique and varied skills to his position as Director of Marketing. His background includes 15 years as an addiction therapist and 41 years of personal recovery. He has dedicated his life to helping others and has worked with thousands of people who suffer from addiction and mental health disorders. He is passionate about making a difference in the lives of those he interacts with. Patrick has extensive experience in marketing and previously ran his own marketing company in which he provided graphic design, website development, and content marketing. He is very excited to offer not only his marketing expertise to Scottsdale Mental Health & Wellness Institute, but also offer his passion for helping others.

Jose A. Rodriguez, PMHNP-BC is a board-certified Psychiatric Mental Health Nurse Practitioner. Jose graduated from Oregon Health & Science University in 2013 with a Bachelor of Science in Nursing. He then received a Master of Science in Nursing with the specialty of Psychiatric Mental Health in 2021 from Frontier Nursing University. Jose specializes in treating patients throughout their lifespan and is passionate about aiding military veterans suffering from PTSD, depression, anxiety, and substance abuse. Jose’s work experience includes 9 years as a critical care nurse and crisis nurse in Boise, Idaho. Jose has a total of 18 years in the United States Army Infantry with six of those years in active duty. He is a Sergeant First Class and is currently serving in the Oregon Army National Guard. Jose recently moved to Arizona with his lovely wife and two sons and is looking forward to exploring the “Grand Canyon State”. Not only does Jose provide evidence-based pharmacological therapies to help patients struggling with their mental health, but he also utilizes a patient-centered approach that individualizes the plan of care to the patient.

Victoria Emanuelson, MPAS, PA-C, is a nationally certified Physician Assistant. She graduated from Stephens College in Columbia, Missouri, and recently relocated to the Phoenix area. Over the course of her training, she worked with diverse patient populations in a variety of clinical and geographic settings, including urban and rural underserved communities, and the LGBTQ+ community. She is a member of the American Academy of Physician Assistants and the Arizona State Association of Physician Assistants. She is empathetic and collaborative in her approach to patient care, and is passionate about patient education and improving patients’ quality of life. Victoria has a special interest in treating patients living with chronic conditions, members of the LGBTQ+ community, and patients with complex family backgrounds.

The Fall Season at SMHWI is approaching, and many of our families are decorating for Halloween and parents are assisting their children with picking special costumes, some pleasant and some frightening.

Remember how fun it was to wear a costume for the day, hide behind a mask, and present as someone you’re not for the day.

The stigma associated with mental health issues can result in having to wear masks every day. Masks can stop people from seeing what we are really feeling or from what is really going on in our lives. Many people believe that we should present as having it all together, so others won’t know our struggles. Even though most people in society deal with anxiety, depression, or other mental health issues, we are taught to cover up these problems so we can get acceptance from others and avoid judgment.We tend to smile when we are sad, deny our feelings, and when asked, How are you? state, “I’m fine”.

Our masks are varied and protect us from being vulnerable, including anger, silence, withdrawal, or intellectualizing to mask our feelings. The problem with wearing masks is that we present as ingenuine and become more isolated with our feelings.

The reason therapy works so well at SMHWI is because we provide a safe place to let yourself be vulnerable and put down your masks. At SMHWI we know your struggles and embrace you to be open about whatever you are dealing with in life. Therapy allows you to build trust and then incorporate that trust in all your relationships. Therapy also helps you normalize what you are going through, so you realize you are not alone with your struggles. Some of us are afraid to put down our masks because we feel vulnerable but to make progress in recovery, we need to learn to be open.

Deciding to seek treatment is a very scary process just like Halloween can be, but the result is usually feeling safer and more secure when you open up. The issues you are already dealing with in life are difficult enough, so don’t let your fear of sharing stop you from getting the help you need in the future.

Patrick Mingey, Director of Marketing

Patrick brings unique and varied skills to his position as Director of Marketing. His background includes 16 years as an addiction therapist and 41 years of personal recovery. He has dedicated his life to helping others and has worked with thousands of people who suffer from addiction and mental health disorders. He is passionate about making a difference in the lives of those he interacts with. Patrick has extensive experience in marketing and previously ran his own marketing company in which he provided graphic design, website development, and content marketing. He is very excited to offer not only his marketing expertise to Scottsdale Mental Health & Wellness Institute but also offer his passion for helping others.

Emina Foci PMHNP-BC

Emina Foci holds a Doctorate in Nursing Practice with a specialty in Adult Psychiatric/Mental Health. Along with that, she holds a Master’s in Science and Leadership. She is board certified as an Adult Psychiatric and Mental Health Nurse Practitioner.

She started her career as an RN in 2003 at Barrow Neurological Institute where she gained invaluable skills as a healthcare professional. In 2010, she became a Psychiatric and Mental Health Nurse Practitioner and started working for private practice. During that time, she also became a professor and pursued her passion for teaching and patient care at the same time. Over the years, she has worked in various areas of the mental health field including inpatient, crisis, outpatient, SMI, and general mental health.

With her vast experience in the field of mental health and natural ability for problem-solving, she is eager to take on the most complex of cases. With genuine empathy and understanding of the human experience, she will take on a humanistic and “down the earth” approach to help improve your quality of life. She will focus on evidence-based practice to ensure your care is safe and efficacious.

Mindfulness is a rapidly growing philosophy in the field of counseling and mental health. You may have
heard of mindfulness before, but there may not be a solid understanding of what mindfulness is. For
many people, mindfulness is synonymous with meditation. However, meditation itself can be loaded
with preconceived notions and expectations for inner peace, enlightenment, relaxation, and the ability
to slow down and think about nothing. While meditations that seek out these outcomes exist,
mindfulness makes the process much simpler.

Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction or MBSR defines mindfulness as
“paying attention, in a particular way, on purpose, in the present moment, and nonjudgmentally.” We
can simplify that definition even further. Mindfulness is being present and being okay with the present.
When we are mindful, we notice what’s happening in our world right now and we allow ourselves to say
that what is happening right now is allowed to happen. When we are mindful this way, we allow our
mind to speak with us and we learn to listen to it. Our goal in mindfulness isn’t to think about nothing
and clear our mind- quite the opposite! Our goal is to pay attention to our surroundings and our present
moment, including our thoughts, and learn to put space there and reassure ourselves that despite
everything happening in the world right now, we are okay and will keep moving forward.

One of the simplest mindfulness meditations is RAIN. It’s a practice that we can do for 30 minutes or an
hour, but it’s also a practice that can be done in less than 5-minutes. It’s a mindful practice that allows
us to check-in with ourselves and practice this new way of paying attention to, and being okay with, the
present moment.

R – Recognize. Take some time to recognize what is going on right now. What can you see, hear, smell,
taste, and touch? How is your breathing? Your pulse? What is on your mind right now? What intrusive
thoughts is your mind giving you as you give it this space? Above all else, how are you feeling?

A – Allow. Allow the present moment to just be. As you are recognizing the present, resist the urge to
change it or judge it. Tell yourself, “Everything is allowed to be how it is right now.” You may not like
how you are feeling, but you are allowed to feel that way.

I – Investigate. We’ve recognized our present moment and we’ve decided to let it be as it is. Now we can
investigate it. Why is it the way it is? What events have influenced it, or are influencing it? Is there
anything going on with you that needs to be managed? Are you hungry, angry, lonely, or tired? If so, can
we address that? What can you do to nurture yourself and take care of yourself?

N – Non-identification and Nurture. Non-Identification means that we separate ourselves from our
feelings. You can feel anxious, that doesn’t have to mean that you are anxious. Everything around us is
constantly changing, as are our emotions. You may be anxious now, or upset, or sad, or frustrated, or
happy, or excited. The one thing each of these emotional states have in common is that they are always
changing. No emotion is forever. By recognizing that, we can lower the intensity of our emotion. If I
know my stress will pass, I can lesson the burden of being stressed right now. With that realization, we
can nurture ourselves. What do you need right now? What’s something you can do after this practice to
take care of yourself? Would it help to call a friend, to read or write in a journal, to take a short break or
to go for a walk, or maybe to just sit and relax? Take this step and recognize it as you nurturing yourself
in this present moment.

Jacob Johnson, LPC

Jacob Johnson graduated from Northern Arizona University in 2015 with his Master’s Degree in counseling after receiving his Bachelor’s Degree in philosophy there prior. He started his counseling work in the field of substance use and co-occurring disorders working inpatient in Flagstaff and Prescott before moving back to Phoenix where he has worked as both an outpatient counselor and a clinical supervisor.

He is a licensed professional counselor who has worked extensively with adults, adolescents, and families in the fields of substance use, co-occurring disorders, and general mental health utilizing a combination of cognitive-behavioral therapy, mindfulness-based stress reduction, motivational interviewing, and positive psychology.

Vanessa Plumley, MSN, PMHNP-BC is a Board Certified Psychiatric Mental Health Nurse Practitioner. Vanessa received her Applied Science Practical Nursing Certificate in 2017 and then graduated with her Associate of Applied Science Degree in Nursing in 2018 from Northland Pioneer College. Vanessa then graduated from Frontier Nursing University in Kentucky in September 2021 where she received her Master of Science in Nursing/Psychiatric Mental Health.

Vanessa began her mental health journey in 2015 when she started working at Change Point, a level one psychiatric hospital in Show Low, AZ. She began to work as a paraprofessional psychiatric aid for about two years. It was during this time that her passion for mental health began. She began to further her education and move up within the company, working as a Licensed Practice Nurse and then a Registered Nurse. She then went on to work at Valley MentalHealth and Chemical Dependency Hospital in Phoenix for two years. She has worked with individuals suffering from substance abuse disorders, mental health disorders, and those diagnosed with serious mental illness (SMI).

Vanessa has a strong passion for physical health and believes that one’s mind and body are truly connected. It is her goal to holistically help others find their way to a healthy balance both mentally and physically. Vanessa believes in incorporating the latest evidence-based research to the treatment plan. Her overall approach to care is patient-centered and collaborative. She believes by collaborating as a team that the patient will gain the tools, they need to reach their personal goals. As no one’s treatment is the same, she would like to help you develop your own individualized plan.

Many times our patients don’t understand exactly how a Psychiatric Mental Health Nurse Practitioner can support them with their mental health issues and what services Nurse Practitioners provide.

One of the first questions we receive at SMHWI is, Are Nurse Practitioners qualified to treat me?

A Psychiatric Nurse Practitioner is an Advanced Practice Registered Nurse specializing in Psychiatric Care across the life span. To become a Nurse Practitioner, an undergraduate degree in nursing is required and successful completion of the state board exam to become a Registered Nurse (RN). After becoming a RN, a Master’s Degree (MSN) or Doctoral Degree (DNP) is obtained to become a Psychiatric Mental Health Nurse Practitioner (PMHNP). A PMHNP can work in inpatient, outpatient, emergency or community-based settings to provide Psychiatric Care. In Arizona, a PMHNP is able to assess, diagnose and prescribe medication to treat mental health conditions. PMHNP’s treat a wide variety of mental health conditions including anxiety, panic attacks, depression, bipolar disorder, ADHD, substance use disorders, PTSD, Schizophrenia and other mental health disorders. A PMHNP will work closely with you to help develop an individualized treatment plan that meets your specific needs.

Some of the typical, daily tasks of a Psychiatric Nurse Practitioner are:

• Diagnosing patients for mental disorders, as well as being able to differentiate if a patient is experiencing a psychological or physical-based disorder
• Documenting a patient’s past history and evaluating how that may have led to a mental disorder, such as family genetic history or past trauma
• Laying out a mental health treatment plan for recovery, including taking medication and attending counseling
• Prescribing medication and making sure a patient keeps up with their daily medication schedule
• Monitoring the effectiveness of a patient’s treatment plan
• Collaborating with a patient’s health team to potentially modify their care plan

Weekly or monthly tasks of a Psychiatric Nurse Practitioner can include:

• Meeting with patients’ treatment team to discuss developments
• Providing ongoing medication management services
• Coordinating care with outside providers

What are the benefits of meeting with a MH Nurse Practitioner?

• Most Nurse Practitioners have already done rotations of multiple placements in MH facilities and have extensive experience in the MH field
• They are under the supervision of the practice Medical Director
• Usually, they have more availability for scheduling appointments
• They are required to provide a thorough psychiatric assessment and utilize a variety of assessment tools to complete this process
• They can get reimbursed from insurance companies just as a physician can.

SMHWI currently has four MH Nurse Practitioners on our team, all of which are very qualified to treat most mental health conditions. Some MH Nurse Practitioners have certain specialties which can help you select a specific provider and SMHWI lists those specialties within their Bio’s on the Our Staff page.

Blog Contributors:
Samantha Willen, DNP, PMHNP-BC
Samantha Willen, DNP, PMHNP-BC is a Board Certified Psychiatric Mental Health Nurse Practitioner. Samantha graduated from Oregon State University in 2012 with a Bachelor of Science in Human Development and Family Sciences. She then went on to receive a Master’s in Science, Entry to Nursing in 2013 and Doctor of Nursing Practice in Psychiatric/Mental Health in 2018 from the University of Arizona.

Jose A. Rodriguez, PMHNP-BC
Jose A. Rodriguez, PMHNP-BC is a board-certified Psychiatric Mental Health Nurse Practitioner. Jose graduated from Oregon Health & Science University in 2013 with a Bachelor of Science in Nursing. He then received a Master of Science in Nursing with the specialty of Psychiatric Mental Health in 2021 from Frontier Nursing University. Jose specializes in treating patients throughout their lifespan and is passionate about aiding military veterans suffering from PTSD, depression, anxiety, and substance abuse. Jose’s work experience includes 9 years as a critical care nurse and crisis nurse in Boise, Idaho. Jose has a total of 18 years in the United States Army Infantry with six of those years in active duty.

You called the doctor’s office today to make an appointment. When you ask to see a specific doctor, the receptionist responds, “The doctor does not have any available openings for two months but we can schedule you with one of our physician assistants next week.” You think to yourself, What the heck is a physician assistant! It’s my hope that this article clears this up.

Physician assistants, better known as PAs, are licensed medical professionals that practice medicine under the supervision of a physician. As providers with full prescribing privileges, PA’s examine, diagnose and treat patients in the same way that a physician does. The
relationship between the physician and PA is a collaborative one. The oversight provided by the physician may include daily meetings, weekly meetings or they may be on an as needed basis depending on the experience level of the PA as well as the comfort level of the supervising physician. This allows for better access to care as a physician may supervise up to four PAs at a time in Arizona.

So you may ask yourself, why should I be comfortable seeing a PA instead of waiting for the doctor. The education of physician assistants is quite rigorous. The PA’s education now consists of a master’s level education. A typical PA program requires a bachelor’s degree to get in
and requires about 12 months of didactic(in class) education followed by 2000 hours of supervised clinical training. Following successful completion of a PA program, the PA then goes on to work under the supervision of a physician which usually involves a period of training in
that specialty. One very important point is that the PA education mimics that of medical school for physicians, the only difference being the duration. PAs are required to obtain 100 hours of continuing education every two years and must retake the board exam every 10 years.

Multiple studies have shown that patient satisfaction with the care of PAs is high with a number of studies also showing outcomes that were indistinguishable from that of physicians.
PAs are employed in every subspecialty of medicine including all surgical specialties.
Some interesting facts about PAs:

• The first PA training program was in 1965 at Duke University making the profession over 50 years old
• PAs have over 400 million patient interactions per year
• As of 2020, there are 148,019 physician assistants practicing medicine

As patients, I would encourage you to strongly consider scheduling an appointment with a physician assistant. It’s likely that you will be able to get in sooner, get a plan of care started and continue to see the same PA on an ongoing basis. And if you’re like one of the 93% of
respondents in one study, you’re likely to be satisfied with your treatment.

Mike Higbee, PA-C

Mike Higbee is a nationally certified physician assistant specializing in psychiatry. Mike graduated from St. John’s University in New York City in 2003 with honors. His guiding philosophy in practice is not only to alleviate the burden of psychiatric illness but also to guide his patients on where certain aspects of the disorder may be useful. Mike has experience in outpatient psychiatry, substance use treatment as well as crisis psychiatry. He is an active member of the Association of Physician Assistants in Psychiatry. He is also in the process of writing the chapters on psychotic disorders and anxiety disorders for a medical textbook in collaboration with Yale Medical.

“I meant to do it. I really thought I was going to. I’m not sure what happened. I fully intended to do it.” If you’ve ever found yourself saying statements like these and falling into negative self-judgment and self-deprecation, you’ve experienced the intention-behavior gap in your life. This gap is the concept that describes the disconnect between intention and action.

There’s a general understanding that we want to make a change to our lifestyle, achieve our goals, do something different. But there’s also frequently shortcomings in meeting our goals and feelings of failure associated with not hitting objectives we set for ourselves. Research has shown that intention only successfully predicts 30% to 40% of health behavior changes.

Mark Faries, Ph.D., in a research paper published in 2016, suggests 5 variables important to understand in the intention-behavior gap: the motivation, the trigger, the response, the capacity, and the process. These variables may help us as we look for solutions to what’s keeping us from reaching our goals

The Motivation – Is this change for you or for someone else?

The Trigger – What made you decide to make this change?

The Response – Can you find a way to facilitate positive feelings and reinforcement along the way of making this change?

The Capacity – Is this change reasonable and sustainable given your current abilities and limitations?

The Process – Have you fully identified ‘the how’ of making this change?

When it comes to motivation, we need to find ways to make goals internally motivated. Internal motivation means we’ve selected and are working on goals that really matter to us. These aren’t provided by our family or health care physicians, but rather are goals that are purposeful and that we feel an internal commitment to. There may still be pressure to complete them, but that pressure should be internal. “I want to make smoke less so that I can be healthier” is a very different sentence than “my doctor wants me to smoke less so that I can be healthier.” Thus, as we work to make goals for change, we want to ensure that our goals are coming from within and reflect a change we want to see in ourselves.

The trigger describes the actual stimulus for change. A trigger to a weight loss goal may be seeing our weight on the scale or a practitioner letting us know we fall into the obese category on the BMI. A trigger to stop drinking may be family conflict or losing our job. Triggers aren’t necessarily bad, but they are our wake-up call that a change needs to happen. A trigger works for us when it conflicts with a value and that conflict can spark action. If I don’t care about my physical health, I may not mind a dentist telling me I have multiple cavities. But if I value my health and appearance highly, that trigger may tie into that value and spark change in my brushing/flossing habits. Therefore, when making changes, we want to find changes that align with our values and beliefs and can be used to reflect on how making changes ultimately will allow us to feel better about ourselves.

The response to our trigger, goal, or action becomes an ultimate predictor of sustainability. If we are told that we are overweight, that may cause an emotionally depressing response that actually locks us into staying that way. We don’t want to be there but the emotional feedback from our brain is negative and takes our energy way. A good way to encourage a positive response emotionally is by seeking out behavioral change that makes us feel good and focusing on that positive reward rather than a negative punishment. Looking not at our weight, but at how much weight we’ve lost could reframe into a number we feel better about. Similarly, it may help our response to not even look at numbers when it comes to weight and instead find physical activity to engage in that is fun for us and seek that out as a form of pleasure. This can reframe the goal and give us a positive response to that trigger rather than a negative response or self-judgment. Ultimately the response factor varies from person to person and it’s our responsibility to look at ourselves and figure out what works best for us.

Our capacity to change is reflected by how much energy we actually have to create change in our life. Studies have shown that even in individuals with high intentionality for change there is a split on follow-through that may be related to their overall capacity for change. It’s almost like a personal battery and if the change we are trying to make is taking up too much energy, our battery will deplete before we can accomplish it and change isn’t sustainable if it’s met at all. Luckily, we have found some ways to increase our capacity: exercise, healthy eating, mediation, prayer, gratitude work, affirmations, and time outdoors have all been shown to increase this capacity. It may be worth starting with goals to increase these activities and letting that become a domino effect to some of our larger goals over time.

The process stage is where all these variables come together. It’s the action behind everything else. We need to have our large goals “to be healthy” and under that umbrella are smaller goals “to exercise” and “to eat better,” and yet again underneath those goals are even more implied goals, “to get a gym membership, to have workout clothes, to have the time to exercise, to know what exercises to do at the gym, etc.” At the same time we have to navigate challenges and barriers that arise. To work on this goal may mean less time to watch television, not eating certain meals or foods, less time to spend with our family or at work. This complexity is an important facet of the intention-behavior gap as our goals start to conflict and we must weigh pros/cons and work within our support group to find a balance and compromise. The process stage is challenging as it forces us to look not just at our goals but to truly understand them and all the moving pieces that are present within behavioral change.

There’s no easy solution to the intention-behavior gap. If we notice we get stuck here frequently, however, this can be an important hurdle to discuss with members of your treatment team. A counselor or provider may be able to help you find internal motivation, reframe negative conceptions into positive outlooks, or find a more reasonable process. Together you can look at where stuck points exist and work on creating sustainable and actionable goals that align with your values and ultimately facilitate positive and lasting change.