Photo by Ash Daniel
Kathy Tierney remembers well the experience that piqued her professional interest in mental health. As a nursing student in the 1970s at the University of Virginia, clinical rotations took her to Western State Hospital in Staunton, where Tierney worked with a young woman — “who was right around my age at the time,” she says — in the midst of a manic episode. “She was psychotic and really in a fragile emotional state,” Tierney recalls. “I looked at her and realized that there’s a very fine line between health and mental health. I thought to myself, ‘Why did she develop this illness, and how is it being treated?’ ”
Examining and answering those questions would shape Tierney’s life work as a registered nurse and psychiatric nurse practitioner. Now, she is director of crisis stabilization at the Richmond Behavioral Health Authority and has mentored scores of nurses throughout the years.
Tierney came to Richmond Behavioral Health in 2005 and had previously been director of psychiatric services at Rubicon, a nonprofit that was later acquired by RBHA in 2015. Tierney initiated Rubicon’s crisis stabilization program in 2002, following then-Gov. Mark Warner’s budget allocation for the development of crisis stabilization services across the state. Today, Richmond Behavioral Health offers a range of mental health services, as well as programs to people with developmental disabilities and those dealing with substance abuse disorders, reaching more than 12,000 adults and youth each year. The authority also provides a 16-bed crisis stabilization unit and around-the-clock crisis intervention and stabilization services to people in emotional or psychiatric emergencies, according to the agency’s website.
“Kathy has such a passion for serving a population of patients that’s often underserved and don’t receive the type of care they deserve. Seeing that sparked the same passion in me.” —VCU Health’s Lyons Hardy
Thirty years into her career, Tierney says her goal now is imparting as much wisdom and support as she can to those following in her footsteps. “Right now, I’m kind of heading down the mountain,” says Tierney, who earned a master’s in psychiatric mental health nursing from Virginia Commonwealth University and a doctorate in nursing practice from the University of Virginia, among other degrees. “My role now is to work with those nurses coming out of school and taking on these vital roles.”
As Tierney steps back, one of her mentees, Lyons Hardy, is stepping forward. Hardy is a clinical instructor at the VCU School of Nursing and concentration coordinator for the psychiatric mental health nurse practitioner program at VCU.
“I got to know Kathy when I was doing clinical rotations,” Hardy says. “I was working with Richmond Behavioral Health Authority as part of my graduate school studies, and Kathy was my preceptor.” Hardy earned a bachelor’s in nursing from VCU in 2003, followed by a Master of Nursing Science degree from the University of Virginia in 2008. She, like Tierney, chose to specialize in psychiatric nursing and says Tierney helped her find her career calling.
“Kathy has such a passion for serving a population of patients that’s often underserved and don’t receive the type of care they deserve,” Hardy says. “Seeing that sparked the same passion in me, and in others as well.”
Tierney also helped her understand unique aspects of being a nurse practitioner.
Inside and outside the medical field, “There can be confusion about … the difference between a nurse practitioner and a physician,” Hardy says. “One of the key things I learned from Kathy is understanding who I am as an advance-practice nurse, and what is unique and special about my role.”
Tierney explains that often, nurse practitioners’ medical education and training differ in focus from that of physicians.
“Instead of an illness-focused medical model that many physicians are trained under, [nurse practitioners] develop a more holistic approach to care,” she says. “We meet patients where they are; we examine what a patient needs differently. … [Nurse practitioners] are unique because we develop that therapeutic relationship to the individual, which is much different than [the relationship] many physicians have.”
Nurse practitioners may prescribe medications and design patient treatment plans, the same as physicians. “But we do much more than just provide medications,” Tierney says. “We don’t want to be deemed just an extension of a physician; we are a team with the physician.”
Hardy counts Tierney’s lessons as critical to her development as a psychiatric nurse practitioner. “A lot of people, even within the nursing profession, don’t understand the different aspects of the role. Someone to guide you through the process is very helpful,” she says.
Kathy Tierney (center) talks with her mentee Lyons Hardy (right) and Jackie Van Dao at the VCU School of Nursing. (Photo by Ash Daniel)
Unique Challenges and Change
There are several hurdles present in Virginia’s current mental health care system, Tierney believes.
“Resources and funding are always challenges,” she says.
“In Virginia, and this is my opinion, we often are more reactionary than proactive, in that we don’t focus on preventative care as much as we should. So that’s one of the biggest challenges, having resources allocated to get ahead of things before they happen.”
Citing it as “dysfunctional, uncoordinated and underfunded,” the editorial board of the Washington Post lambasted Virginia’s mental health system in a 2016 column highlighting various ways the state has failed to provide “adequate and humane services to the mentally ill.” The Post’s editorial board cites the death of Sen. Creigh Deeds’ mentally ill son, who stabbed his father before taking his own life in 2013, as a glaring example of these failings.
Deeds had taken his son, Austin (“Gus”), to a mental hospital for an evaluation, but the younger Deeds was released because there were no psychiatric beds available in hospitals near their Bath County home. The next day, Deeds’ son attacked him and then killed himself. The state has introduced several measures since that time to combat the bed shortages facing mental health patients.
“With the very unfortunate situation involving Creigh Deeds and his son, lawmakers looked at bed issues across the state, and we kind of jumped on that [issue] to put things in place,” Tierney says. “That’s what I mean about reactionary — we need to have things like that in place before tragedies happen.”
Another advance was the recent mid-March announcement by Gov. Ralph Northam and the Virginia Department of Behavioral Health and Developmental Services that all 40 Community Services Boards in the state, including RBHA, can now provide same-day mental health evaluations. This means that a person in need of a mental health assessment can now get one immediately, instead of waiting days or even weeks. According to the governor’s announcement, this marks a dramatic shift from addressing mental health needs only when a crisis occurs to utilizing preventive care to help avoid emergencies and hospital admissions.
Progress has been made, if slowly, regarding the role of the advanced practice nurse over the years, according to Tierney. Among the most recent of the many changes she’s witnessed is Virginia’s new autonomous practice law. Under the new legislation, enacted in January of this year, nurse practitioners with five years of clinical experience can apply to have full practice authority, or full autonomy. This means more nurse practitioners may soon treat patients in their area of specialty, independently of physicians; this could also mean more people, like the psychiatric care patients Tierney and Hardy treat, get the help they need.
Tierney, who was born and raised in Petersburg, recently welcomed a new, furry “baby” into her life: a labradoodle puppy born near her home in the Tri-Cities area. “Chester from Chester,” as Tierney calls the pooch, now lives with Tierney and her husband of 37 years, Bob. Chester takes his place in the family beside the Tierneys’ human children, an adult son and daughter, as well as their two grandchildren.
Between her job, home life and Chester, “I’m staying busy,” she says.
