Q and A: Becky Spencer, Psych-Mental Health NP

Becky Spencer worked for years with women who were about to give birth or who had recently given birth and saw the need for more mental health services around this time of transition for families. Almost a decade after earning a PhD, Spencer enrolled in UC's Post-Master’s Certificate in Psych-Mental Health NP program and graduated in 2021. Now, she works in a community mental health clinic, offering treatment to parents experiencing perinatal mental health illnesses.

Here's what Spencer had to say about the psych-mental health specialty, UC’s program and her current role.

I have worked in many nursing specialties over the past three decades, but my real passion is caring for families in the perinatal period. I have been a lactation consultant for 18 years and completed my PhD in 2012. My research trajectory centers on breastfeeding in vulnerable populations. My second passion is teaching nursing; I have held a faculty position for the past 12 years, and I currently teach at the graduate programs at Texas Woman's University.

When I finished my PhD, I think my family was ready for me to be finished with being a student, but I believe being a perpetual student makes you a relevant and humble teacher. Perinatal mental health was the giant elephant in the middle of my research and clinical work, and I was frustrated with the lack of resources in my area and lack of providers who were specialized in treating perinatal mental health illnesses. The incidence of depression and anxiety disorders that occur in the perinatal period has increased significantly in recent years, and untreated or under-treated mental illness has short- and long-term detrimental health consequences for parents and children. That is why, in 2020, I decided to take a leave of absence from teaching to pursue a post-master’s certificate in psych-mental health.

UC’s program prepared me quite well. I graduated in August 2021, passed the American Nurses Credentialing Center board exam, received my licensure by the end of 2021 and started working in a comprehensive perinatal mental health program in January 2022. The coursework prepared me to take board exams, and I really enjoyed learning both from my instructors in the program and my classmates. The job prospects for psych-mental health NPs are plentiful and well-paid.

I work for a community mental health clinic in Texas providing comprehensive mental health treatment to parents who experience perinatal mental health illnesses. I work with a wonderful team of therapists and nurses who are all passionate about perinatal mental wellness and clinical collaboration.

I provide medication management and psychotherapy for patients in a behavioral health partial hospitalization and intensive outpatient setting. Our patients spend three to four
hours per day, Monday through Friday, in psychotherapy, and I see our patients for medication management twice per week. I have seen great strides toward wellness in four to six weeks of collaborative and intensive psychiatry and psychotherapy treatment. I also see patients in private practice — typically once every one to three months — for medication management and psychotherapy. Another important long-term responsibility of all nurse practitioners is to support and get involved with state and national nurse practitioner associations. Our voices are stronger together and our professional organizations help to raise our voices to garner support at the state and national levels for the ability for all nurse practitioners to practice at the full extent of our license.

One of the biggest rewards of my work as a Psych-Mental Health NP is seeing patients get better. I can truly say that treatment works and it works best when medication management and psychotherapy are closely collaborated. Another reward is being able to provide the level of care that patients need. The need for mental health care greatly exceeds the number of available providers. Prior to becoming a licensed Psych-Mental Health NP, I was limited in my ability and scope of practice as an RN to provide the mental health treatment so many of my patients needed. Now, I am helping to narrow the gap in the delivery of evidence-informed mental health care.

One of the biggest challenges in Texas, the state where I practice, is insurance reimbursement and the cost of mental health care. Many insurance plans have higher co-pays or less coverage for mental health provider visits than for other medical visits, which
prices mental health care out of the reach of many patients. The complexity of insurance billing has resulted in many psychiatric providers only accepting cash pay for care, which also limits access to mental health care for many patients. Another challenge is the Texas state requirement that advanced practice nurses have a contract with a collaborating physician. States with limited practice laws continue to cause many barriers for nurse practitioners’ practice. These collaboration agreements have a high cost for nurses and do little to promote high-quality and safe patient care.