I grew up in a tight-knit military family in a community struck with the stigma of mental illness. Throughout my childhood, we lost friends to the complications of untreated mental illness, including overdose and suicide. However, mental illness seeped through our town, affecting my classmates with poor attachments, financial insecurity, and family unrest. These experiences pushed me to explore mental health throughout my career as a registered nurse and, more recently, as a medical student.
While working as a Registered Nurse, I honed my skills in mental status examinations and cared for patients’ comorbid psychiatric illnesses with medical disease by communicating and building rapport. One such case was Susan, who lost her ability to speak with her family and friends after a glossectomy. When early signs of depression began to show as a result of this new communication barrier, I quickly alerted the resident psychiatrist with whom I collaborated to conduct the appropriate tests and provide the necessary care. I also worked closely with both Susan and her family on a daily basis to ensure that they felt supported as they adjusted to her new physical and mental state. Working with patients like Susan allowed me to see the impact of life-altering conditions and procedures on their mental health and helped me to appreciate opportunities for psychosocial intervention that involved other interdisciplinary team members in their management to prepare for discharge. Moreover, my experiences as a Registered Nurse encouraged me to develop strong metacognitive skills which have resulted in a reflective practice. This has allowed me to continuously strive to learn to maintain continued competence.
As a medical student, I eagerly explored psychiatry through a range of psychiatric electives, caring for patients in multiple care settings and across various socioeconomic and age ranges. During my 10-month integrated community clerkship in [removed identifier], a rural community with high rates of suicide and addiction, I partnered with my preceptors and patients to manage acute and chronic complications of mental illness such as suicide, pancreatitis, and substance withdrawal. This provided opportunities to communicate with psychiatrists in tertiary care centers for transfer of care when there were concerns regarding patient’s acute safety. Working in [removed identifier], I developed longitudinal relationships with my patients, allowing me to develop rapport and to follow them across practice domains. Many of my patients lived on reserve and experienced intergenerational trauma and struggled with substance use. As our rapport developed, I found I was better able to engage with and connect with my patients which resulted in uncovering more of their life story. Although mental health was a common issue, it was seldom addressed as many of my patients struggled to provide their daily needs including clean water, access to safe housing, and financial stability. Our efforts to provide them with mental health care was also hampered by the physicians’ large patient loads and our minimal access to many allied health services including mental health therapists, nursing, and rehabilitation. I therefore learned to adapt and find strengths in the community to involve as part of integrating and mobilizing support systems in partnership with my patients. Caring for patients with poor access to care, low socioeconomic status, and ongoing trauma has thus allowed me to approach medicine holistically and exemplifies my passion for rural psychiatric care.
These experiences have helped me to value the ability to understand my patients from a biopsychosocial framework. I view our duty in psychiatry as supporting their strengths and addressing negative thought processes on a trajectory to wellness, as well as providing guidance and resources utilizing pharmacological and non-pharmacological therapies. These responsibilities also come with many challenges such as working with structural barriers to care caused by longer wait times and personal barriers to care caused by social and occupational implications of stigma. My experiences in areas that have faced some of the gravest issues in access to care will allow me to not only work effectively under such conditions but also create innovative, community-centered solutions to increase and improve care. Additionally, the growing aging population threatens to overwhelm the current psychiatric infrastructure and will require more complex approaches due to medical comorbidities and medication contraindications. This calls for ongoing research focused on medical comorbidities of neuropsychiatric illness and treatment modalities to improve quality of care, which I am also keen on pursuing.
I am drawn to the University of [removed identifier] psychiatry program due to its resident-focused approach. As someone who benefits from a feedback-driven learning environment, I appreciate the ongoing mentorship and supervision and the preparatory endeavors, including the mock examinations. From a clinical perspective, the program has a strong psychotherapy curriculum and offers unique elective opportunities including electroconvulsive therapy. I believe this will both strengthen and diversify my skillset, enabling me to provide the best care to my future patients. Finally, your program is well-known for allowing residents to train in rural areas, which complements my career goals of providing psychiatric care to those who are underserved and marginalized. I am excited by the prospect of continuing my training in psychiatry in your program, where I will surely be challenged as I continue to explore novel approaches to treatment and uncover the physiological, neurological, and pharmacological dimensions of mental health.