I have witnessed first-hand the effects of mental disease on family members, friends and patients. My mother battled with mental illness throughout her life. She was diagnosed with schizophrenia in her twenties as a young single mother. She was hospitalized repeatedly in mental institutions and subjected to multiple medications and treatments including electroconvulsive therapy but ultimately died from heart disease. This aligns with a current study by Rossum et al (2022) in the Journal of the American Heart Association which indicates people with serious mental illness may have increased heart disease risk at younger ages and advocates for comprehensive coronary risk assessment, identification and management to prevent early death. Even so, there remains a gap in the paradigm of treatment for those with mental disease and other health problems.

For instance, my best friend was the strongest, most outgoing, vibrant and considerate woman that I have ever encountered. She joined the military as a single mother of three children. Her decision was quixotic, but I was amazed at her courage and tenacity. She wanted to support her children and serve our country. While in the military, she was injured by an improvised explosive device (IED) in Afghanistan. Her injuries were considered minor, and she returned to work shortly thereafter. However, she returned home a broken woman. While she suffered a "minor traumatic brain injury (TBI)" by diagnostic criteria, she was tormented by nightmares and post-traumatic stress disorder (PTSD) which rendered her incapacitated and unable to remain in active military service. She lost custody of her children and ultimately committed suicide. It was inconceivable to believe that such a vital life could be so devastated by one injury.

Such is also the case with the patients that I have encountered throughout the thirty years of nursing practice. I have experienced patients ranging from mild injuries in the emergency room which required brief interactions to those who require intensive, critical care management and long-term, continuous medical care. For the past fifteen years, my practice has focused primarily on those suffering brain injury due to an acute stroke. Their lives have been disrupted abruptly and changed in a matter of minutes. Due to the supervenience of the injury, patients and family members experience difficulty coping and adjusting to this change. Moreover, the brain injury also results in emotional and behavioral problems.

The combination of neurologic injury and mental health compromise compounds the challenge of treatment since it requires both neurological and psychological intervention.

I have an intense appreciation for the limitless potential of the brain and the human body. I am intrigued by the ability of the brain to recover but also aware of the requirements and essential elements of support necessary for positive outcomes. When the brain is injured, the whole body suffers. I believe each aspect of an individual's injury must be addressed with intricate precision. I am specifically interested in the areas of trauma, coping and compensatory strategies. There is a prevalence of substance abuse among individuals with brain injury and mental health disorders as well as family members due to impaired coping ability. I have facilitated support groups for individuals suffering from traumatic brain injury, stroke, and brain aneurysm. In all of these arenas, I have found that patients and family members continue to feel overwhelmed and unprepared due to scarcity of resources and manpower as well as limited and/or exhausted foundational coping strategies.

I am pursuing a Doctor of Nursing Practice with Psychiatric Mental Health Nurse Practitioner post-Master Certification to be better equipped to address each component of this issue. It is my desire to help mitigate the heavy demands of the healthcare system, relieve the burden of access to care, provide a broad range of treatment options to address neurologic and psychologic aspects of a patient's injury and thereby improve health outcomes.