Dr. Joanne McDougal-Patterson stands in front of her mobile mental health clinic, "Nurse Practitioners on Wheels," a pioneering initiative aimed at providing accessible maternal mental health care.
Joanne McDougal-Patterson, born and raised on St. Croix, was recently recognized on a national talk show for her pioneering work in bringing mobile mental health services to struggling new mothers. In an interview with the Consortium, the doctor of nursing practice discussed her work, as well as the gaps in the territory's legal framework which prevent professionals like herself from providing services in the V.I.
“During the pandemic…the virtual clinic…was necessary to take care of patients across the country,” McDougal-Patterson said. “Once the pandemic lifted, I knew that I didn’t want to go back to business as usual.”
That sparked the idea for a mobile psychiatric clinic – the first of its kind in the state of Georgia, where “Dr. Joanne”, as she is known, lives. “I purchased a tiny house on wheels and converted that into a mobile mental health clinic,” she said, explaining that she sought to create “a clinic that would mimic a homey feel.”
The clinic's focus on maternal mental health comes from McDougal-Patterson's many years of experience in obstetrics. “I practiced here for many, many years at Emory and saw a lot of women struggling in the postpartum period,” she notes. “There really wasn't a whole lot of resources at the time to refer these patients to.”
Her own personal experience giving birth to a premature baby also influenced her decision to focus on this important specialty. “Most providers [are] focused on the pregnancy,” she explained. “They're not focused on the mental health aspect of delivering a preterm baby, being on bed rest for 10 weeks – it's a lot. So I set out to become that provider,” McDougal-Patterson declared.
Her qualification as a doctor in nursing practice means that in Georgia, as well as other states in which she is licensed – Nevada, Florida, Maryland and Washington D.C. – McDougal-Patterson is able to offer patients a full suite of services. “Sometimes it's therapy, sometimes it's medication, sometimes it's both, depending on the severity of their symptoms.” She treats patients grappling with depression, anxiety, even postpartum obsessive compulsive disorder; those who have had a traumatic birth or who have delivered a premature baby, as well as patients who have delivered a stillborn baby, or a child who passed away shortly after birth. McDougal-Patterson also supports women who may be struggling during the transition back to work. “That seems to be very anxiety-producing,” she said.
McDougal-Patterson's mobile clinic, Nurse Practitioners on Wheels, began attracting attention since its launch late last year, including from prominent national attorney Benjamin Crump, leading to millions of views for her “cozy mental health care” practice. All the buzz and positive feedback, McDougal-Patterson says, is proof that “the country really wants something very different in terms of mental health care.” Earlier this year, she received a message from producers of the Kelly Clarkson show, which led to her appearance on the program last week. At the end of the 11-minute segment, after speaking about her goals to acquire a fleet of mobile clinics and expand her services across the country, McDougal-Patterson was surprised with a $10,000 donation by virtual mental health service provider BetterHelp to further that dream.
However, despite her desire to bring that kind of service back home to the Virgin Islands, McDougal-Patterson is currently unable to do so due to legal restrictions. “The U.S. Virgin Islands is a reduced practice state,” she explained. “There are laws that prohibit us from practicing at the fullest extent of our training.” Because she is a nurse practitioner and not a physician, the Virgin Islands requires McDougal-Patterson to have a “collaborative or supervising physician” in order for her to practice in the territory. “It's a bottleneck to providing accessible care to the territory,” she argued. “There's not enough providers…there isn't a psychiatrist for me to partner with.”
Further, health officials have not seemed eager to assist McDougal-Patterson with her efforts to provide access to much-needed mental healthcare services in the territory. “I've actually tried to establish telehealth provisions there, and it's sad to say I have never gotten a response,” she disclosed. “I have reached out to psychiatrists…it's just an unfortunate situation.” McDougal-Patterson argued that Virgin Islanders are underserved when it comes to psychiatric care. “A lot of times the psychiatrists are providers who are not full-time in the territory either,” she said. This leaves many Virgin Islanders in need of care without access to the necessary psychiatric support.
McDougal-Patterson is calling on the Virgin Islands government to make the necessary changes to address that gap. “I really would like the politicians to pay attention to what it means to not have full practice authority or advanced practice registered nurses in the territory,” she said. “There are not enough providers [to] take care of all these people that are in the territory, [and] there are nurse practitioners willing, able, ready to stand in that gap – be on the front lines, diagnose and treat patients – but there are not enough medical doctors to collaborate with nurse practitioners,” she reiterated. “I am encouraging the politicians to really take a look at full practice authority and how we can make that a reality, just like it's a reality in states like Maryland, Arizona, Nevada, District of Columbia.”
As she continues to lobby for legislative change in the Virgin Islands, McDougal-Patterson has some advice for women in the territory who may be struggling with their mental health during pregnancy or soon after childbirth. “You have to speak up,” she urged, encouraging women to take their concerns to their primary care provider. “They should be able to plug you in with the resources that's available.” However, while she encourages women to be more vocal about their struggles, she cautions them to be careful about who they choose to confide in. “The unfortunate truth is that mental health is still stigmatized; there are some people who will use that against you.” Women, McDougal-Patterson says, “have to be really smart about who you share with, and who you share with is a licensed healthcare professional.”
