Welcome to the Reality Check podcast. Psychosis is Real, so is Recovery.

On this episode, Serena Chaudhry speaks with Registered Mental Health Nurse Christy Boudreaux, who works for the independent pharmacy, Patio Drugs.

Join us as we find out more about Christy and her dedication to her local patients and to ensure they have access to long-acting injectables (LAIs) in the local community.

For more information about Clear Answers to Louisiana Mental Health (CALM) and their Early Intervention Psychosis Program (EPIC NOLA), visit the website: www.calmnola.org

Find out more about Patio Drugs here: https://patiodrugs.com/

Podcast produced by Red Rock Branding – www.redrockbranding.com

Serena: Welcome to the Reality Check. Psychosis is real. So is Recovery podcast.

Ashley: I'm Dr. Ashley Weiss. I'm a child adolescent psychiatrist. And I'm Serena Chaudhry. I'm a clinical social worker and we are the co-founders of Epic Nola, which is the Early Psychosis Intervention Clinic in New Orleans, and also the co-founders of Calm, clear answers to Louisiana mental health.

Serena: Great. Good afternoon. We have Christy Boudreaux with us today on Reality Check. I've been so excited about this moment and talking to you about having you on the podcast, and I'm so excited that we made it happen. Thank you. I'm so

Christy: excited to be here. Yeah.

Serena: So if you could just start, Christy, I know you and I know what you do on a daily basis to make the world better for our patients at Epic, but I'd like you to introduce yourself to our listening audience and tell us a little bit about the history of patio drugs, where you work and how it came to be.

Christy: Okay. So Christy Boudreaux. I'm a registered nurse. I've been a registered nurse for 30 years. For I guess the last 15 or 20 years I've been a mental health nurse. I work for an independent local pharmacy, PET drugs that's been in business 65 plus years now I lose track. Part of what we do is we have injection clinics to.

Christy: Administer long acting antipsychotic injections that are ordered by the different providers in the area. They become in need of maybe 15 years ago, we were approached about this because we had done a few other specialty injections and just that there was a need in the community, and so that's how it started with just a few patients.

Christy: And now quite a few where we, I manage them, do the injections. I have a couple other pharmacists that do the injections with me and I just work really hard to try to, to help them be compliant and get their, their treatment so they can live better lives. And

Serena: I'm gonna piggyback on what you just said about working really hard to help people, people be compliant.

Serena: And I am going to throw accolades your way because you go above and beyond really. You do, to help people be compliant. And Christie has been a nurse for our patients for the entirety. I think of the 10 years that Epic has been around, if not the entirety, almost the entirety. And I remember meeting you at an injection clinic at the church around the corner from the clinic, which the name I'm forgetting.

Serena: Um, yes. First Grace United Method. Yes. First Grace, who does a lot of community facing work and providing services and food and. Long acting injections for community members in need, and you were doing an injection clinic there. And I think we took some of our patients by there to get their injections.

Serena: And I think what struck me is, first when I met you and interacted with the clinic at First, grace was just the calm way in which you approach the patients, the beautiful bedside manner you have when with them and. The rapport that you form and getting a long acting injection injection as a young person with a newly diagnosed in our situation, psychotic disorder could, can be a terrifying thing, and no young person really wants to be going to do this once a month.

Serena: But somehow in your own way, you help people to feel comfortable. They show up because right. They have this relationship with you and this comfort level with you. They show up at First Grace, they show up at the pharmacy, they show up, and what we know from data is that the more the adherent young people are, the better.

Serena: Prognostically they're gonna do in terms of their recovery from psychosis. And so that is all, all so, so important. And the other thing I wanna highlight is that you work for an independent pharmacy, and I really think pharmacies like patio drugs are at the heart and center of the medication management for coordinated specialty care clinics.

Serena: You all put the human. Component into the care that our patients get when they leave our doors, right? We can provide the psychiatry appointments, the therapy appointments, but we, in order for those to continue, they need to be able to stay adherent to their meds, and you all do that. So tell me a little bit about practicing at patio and how, how, yeah.

Serena: What that experience is like for you.

Christy: So. I mean, it's not just me. I feel like we have a really great team in place. You do. Some of our pharmacy techs have gone through mental health training. The mental health ccp. Is it mental health CP or Mental Health First Aid. Thank you. Uh, first training. I was at a loss for a second of the name, just to help them have a better understanding, and so I think that makes them.

Christy: Just better able to talk to patients as they call in and, and work with them to get them them, you know, medication. We do the oral meds as well and they do packaging and everything. What I like about it that I think we're blessed, that we have is that, like you said, being an in. Able to focus each on each patient individually and what they need and what would work better for each.

Christy: And I've just, you know, watched through the years. I, I think they do a dynamic job with that. We have our little satellite clinic so that we can try to cover, you know, patients who might live or work in a different area and find something that's more convenient. And that's something that I work with the patients.

Christy: Find the best location for them. And sometimes that changes mostly. Mm-hmm. Might be gonna stay with a family member or work in a certain day, but I'm just, I feel like the more flexibility that I can have and give to the patients, the better chance that they will be compliant with getting their injections.

Christy: Mm-hmm. And then I call a lot

Serena: right. Yes, you work with a dynamic team who makes all of this happen and I, I think the flexibility is what I think I found as a provider and, and being at Epic NOLA for 10 years. The flexibility that patio has allows our patient, allows us to work with you and our patients to work with you, right?

Serena: Because we're working with young people who right lives are dynamic and whose diagnoses are dynamic and. In order to provide really quality care, I think there is a necessary level of flexibility. Like you gave a great example. If someone has gonna visit a family member, you know, for a time and they need to have their, uh, medication pickup switch, do you work with them?

Serena: You all do a, uh, home delivery service, which for many of our families is, you know, an essential part of their care. Back and forth to the pharmacy for the multiple medications that some people are on is an onerous task. You know, when you in some instances have parents that are unwell or parents that are aging, this, um, helps to facilitate and ensure that people are able to adhere to their medication regimen.

Serena: Um, I'm curious from your perspective, what are some of the barriers that you see existing to care for young people? With mental illness and in

Christy: art of, of course, you know, I do feel it, as long as I've been in this field that I do feel it's improving drastically. But of course there is still, you know, the stigma that they feel.

Christy: They're embarrassed. You know, when you're young, you wanna be like all your friends. Feeling like you're different in any way. I think for some of them is a challenge and sometimes that may affect compliance. You know, I tried at first appointment with somebody specifically. I really try my best to break down any stigma and just discuss how if you had high blood pressure, you'd have to take that medicine.

Christy: Mm-hmm. And it's a little spiel. I always try to give them, if you have diabetes, you have to take your diabetic medicine. This is just a, you know, a chemical that needs to be regulated and mm-hmm. That's why now we're, we're lucky to have these medications and, and if you, you know, do your best to stick with it and discuss anything side effects with your provider and that kind of thing mm-hmm.

Christy: Then hopefully, you know, it helps them feel better about it and realizing that they're not different. It's just. It's just, you know, medication to help 'em feel bad. So that, that would be a, a big barrier. And then just sometimes I see with some hospital discharges I get where they might discharge a new patient from a hospital.

Christy: And even that again, I feel like has improved. I'm not, you know, tearing the hospital staff, but sometimes they might give one refill and then say, follow up with the provider. And in some cases, you know, it might take a little while. To, um, to get that appointment, then they might, you know, not have a refill after that.

Christy: But finding more and more I've been expressing that concern. So I'm finding more and more they're sending them home with at least, you know, a couple, just to give 'em a chance to give on board with their provider outpatient. So, I mean, those are the two of the biggest. That I can think of.

Serena: Yeah. I, as you know, 'cause you engage with us at the community level, we're, you know, working hard with calm to bust stigma and to reduce it in our community.

Serena: I think, I think we have come a long way. And I think we still have a very, very long way to go. And as I've talked to other guests about, and I talk to people in the community about right, stigma exists at all levels, right? You identify the way in which, right, an individual is embarrassed to have this diagnosis and that embarrassment, that self-stigma is exacerbated by community stigma and right inaccurate notions, inter inaccurate perceptions.

Serena: People with mental illness being dangerous, being bad, being their fault, and right. We as a community, it's essential that we as a community work together to continue to battle that stigma so that young people can get to you and get to other providers to get these medications that we know can help people function and recover.

Christy: Absolutely.

Serena: Yeah. You, I know we talked about you have these satellite pharmacies, you have these injection clinics you deliver. Can you tell our listeners what the range of your services are?

Christy: Sure. So it's not so much satellite pharmacies as much as it's satellite injection clinics. Mm-hmm. So we, oh yeah.

Christy: No, no. So we, we cover, I guess. You know, delivery wise and medication wise, we have, we do packaging, which is like individual packaging for patients to make it easier to manage their medication. Some patients like that, so they might get a month at a glance of all their medicine, or some patients do the little weekly packets, and so we do deliver that.

Christy: We deliver in a 50 mile radius. We, we do injections, we can deliver injections to providers, and then we also have the injection clinics here, and then in our satellite clinics, which is like the Mattie area, the New Orleans area. Mm-hmm. Slide to cover the North Shore and then g to cover on the West Bank.

Christy: And so. I do all the scheduling and anybody that works with me directly, because I always, I don't like to just go by the patient's address. I like to look and, and talk to them and see mm-hmm. What would work better. So we do, like I said, try to do, be flexible with that. I'm trying to, and then the delivery, like you'd mentioned, we do deliver, um, it's like a 50 mile radius mm-hmm.

Christy: That we deliver. Something else we do, I think that makes us a little unique is, um, medical bills, some of the insurance plans. I will only cover these injections under their medical benefit, where not all pharmacies can, um, medical bill. Mm-hmm. Um, because that's generally something that's done under the hospital.

Christy: Mm-hmm. Or maybe in the doctor's offices as well, but, so we can do that. We have contracts with some of the insurances to do the medical bills, so, mm-hmm.

Serena: Right. And I, I'm, I'm, thank you for explaining that. I think it's so important for listeners to know that these services are available. You don't have to just live in New Orleans or the greater New Orleans area within 50 miles.

Serena: You can, they can, you know, get served by a patio. And I think as we move, as we expand Epic, as we move into the South central and into the Acadiana regions, right, we're going continue to work with you to the, and push sort of, uh, to the limits of these, this 50 mile radius. And then, you know, our goal will be to try and find other small, independent clinics who are in these outer regions because.

Serena: Our experience with y'all has been so wonderful and I really do think it, it matters a lot. You know, I think whe when I check in with my patients about whether they've gotten their injection or not, they'll say, oh, well, miss Christie's gonna call me and she'll tell me when it's my time to come in. I think nobody would expect that call, but how wonderful one, as a young person to know that you can rely on this adult human provider to call you and remind you.

Serena: And then not only do you call, but you follow up. If they don't show right, you follow up with them, but then you follow up with us at the clinic and you let us know. If someone doesn't show and it's not, it's, it's all right. In the interest of helping people stay well and adhere to this medication plan that we know will improve their functioning,

Christy: I do.

Christy: I do definitely follow up. Sometimes I think I'm a pain, but you know, I've had some. Patients that might be just having a rough time, they don't wanna come out and get it. They'll tell outta 10 times. They'll tell me Thank you for getting back in, because that's what made me finally, you know, yes, I feel like I'm being a pain, but I think most of them appreciate.

Christy: So thanks. I thank you for telling me that too. I like to hear that.

Serena: Yeah. True story. And, and, and you know, one, I, I think the other thing is you've been at patio drugs for, you said how long now?

Christy: For, for a long time. I've always done some, I mean, of course I was in the hospital probably like my first 10 or years or so, 15 years of nursing.

Christy: So at least 15, 20 years I've been in some capacity.

Serena: Well, so I highlight that because I do think the mental health field, because of the acuity of illness and how hard it can be to manage, there's a lot of turnover. I think when you can get people such as yourself who have been, and your team who have been in the field and in similar positions for a period of time, right?

Serena: That also helps to enhance trust and build rapport. So my follow up to that point is a question and I, I'm curious, what has kept you in this for 30 years in nursing, but in 15 years of working in mental, mental health nursing?

Christy: Well, I'm gonna tell you, when I was in nursing school a very long time ago, and I did my rotations, the two, the two areas that I loved the most was mental health and pediatrics.

Christy: When I got outta nursing school, I went into pediatrics, and that's what I've done for the last, I mean, for my first 15 years of nursing, the last 15 years. I mean, this kind of happened that I got into mental health because there was a need. They approached us, but I love it better than any area of nursing I've ever.

Christy: I find it so rewarding to see patients that might come in for their first injection. I'm seeing them at their worst. Mm-hmm. Sometimes their worst point in their life. And then to see as their injections start working and they continue with that treatment with y'all, that they start, you know, all of a sudden getting back in school, getting a job.

Christy: I mean, that, that to me is just, and it's just, it, it's amazing to me and it inspires me. They inspire me every day. So that's what's kept me at it. I love it. It's a love now, and I'm just, you know. Yeah. Very important.

Serena: Yeah, no, I totally, I totally hear you on that. And it's similar on the clinic side. I think that it, it is the beauty and the privilege of being able to be with someone across their journey, right?

Serena: And to go from, yes, I agree. Probably one of the most, the hardest, most difficult moments in a young person's life too. You know, this moment where we can see them thrive and succeed and engage in the world. Like, that's a privilege and so, so super inspiring. Yes,

Christy: It really is.

Serena: Yeah. And we've had the shared privilege of, you know, treating many of the same people for almost a decade now, which is wild.

Christy: Yes, it really is. Yeah, it is.

Serena: Amazing.

Christy: It's been an amazing ride.

Serena: Yes. And we see people grow up as, right, because some people are coming in seeking care at a really, at a young age, right? We're getting people in high school, which they're getting to care soon. And that's what we want because we know the longer at the duration of untreated psychosis, the harder the recovery and the worse the prognostic outcomes.

Serena: So we see them in high school and they move up and. Through high school, graduate and out into the world, and that is, that's super cool.

Christy: It's, it really is. Yeah.

Serena: I'm curious what you would say, just from a nursing perspective, you've found this passion, you've found mental health as right, your, your love within the field.

Serena: What, what would you say to someone who's just entering the healthcare field as an MOA or moving into nursing school? What would be your pitch for pursuing mental health or psychiatric nursing? Well.

Christy: I would share my story and, and mm-hmm. How rewarding it is, I would remind them, something that I feel like I've learned is, is self care.

Christy: That's very important to take care of yourself because it, you know, it's the analogy of the oxygen mask in the plane. Mm-hmm. Put your own oxygen mask on first before you help anybody with you. And so I think to be. Beneficial in this field because it can be very draining and mm-hmm. You know, it, the, it's very important to make sure you're always taking care of yourself first as well, to stay strong to do it.

Christy: Mm-hmm. Yeah.

Serena: Yeah. No, that's, I, I, I think I, I appreciate both of those things, and I do think when you do both of those things, when you listen to your heart and you take care of yourself, I think you can really make an impact. In the lives of young people and their families. And I would be negligent if I didn't bring that.

Serena: You know, you clearly, you provide these long-acting injectables and these medications to young people, but I think your collaboration with their family members, their caretakers is essential too. And as we both know, and as many of our listeners know, this is a just a scary, disorienting. You time in a young person's life when they're first diagnosed with a psychotic disorder and to be, have a provider, a nurse, pharmacy that you can talk to.

Serena: Ask questions and as a family member, that is, that is huge. And I, I am circling back to the beginning of the conversation. You talked about the psychoeducation that you provide patients, trying to help them to understand what these medications are doing, what some of the side effects might be. You know, that might seem obvious, but it doesn't happen all the time and it doesn't happen everywhere and in all pharmacies.

Serena: And it's so essential because these meds are, they're big meds. You know, with heavy side effect profiles and to be able to help young people understand what they can do to help them and what some of the things are that they need to look out for in terms of side effects. That is, I think that's empowering.

Serena: And anyone who's brave enough to show up for an, uh, a long, long-acting injection deserves, you know, that, um, right, right. Deserves that treatment and that source of empowerment. Great. So as we move ahead and we move forward in this work in the next, you know, decade, what do you think are some of the priorities for you in the world of pharmacy and nursing?

Serena: And then I'm gonna ask what are you think some of our, what we should have our eyes on in the world of coordinated specialty care?

Christy: Wow. Okay. I think obviously what. What y'all are already doing to continue to go out there and reach everyone you can to reduce the stigma, I think is, is vital. You know, hopefully there will be a day where there is no stigma out there, right?

Christy: So I think that that is important. Another thing, I mean, this is not for me as a, as a provider, but one thing I'm seeing more is the testing that's being done on what works. Work on some patient based on their makeup, chemical makeup and, and what would work better for another patient. And I, I've seen, I think y'all might be touching upon some of that because I've, I've had the conversations mm-hmm.

Christy: Patients who are fast metabolizers, you know? Mm-hmm. That kind of thing. And I think that's very important. I think that's, you know, a breakthrough, hopefully. Treating mental health? Um,

Serena: absolutely because I think some of the hardest work is done upfront when you're first getting on these meds right there.

Serena: Most of these young people are medication naive. They're having a hard time tolerating, and if we can, um, mitigate the trial and error and get someone on something that agrees with their body, their metabolism, their makeup at the outset, it makes things easier.

Christy: Absolutely.

Serena: Yeah. And I think to that point, right knowing, and this is such an important part of the care that we give and the work we need to do, knowing about family history, having family members be honest about their history, reducing stigma within the family and speaking openly about medication.

Serena: And if you have a family mentor. Family member, excuse me. With the chronic and severe mental illness, what has, what medication has worked for them that can help Right. In treatment in the early phase. Yeah. Yeah. So the road is long, but I believe, I know our commitment is strong and so thank you so much, Christie, for coming on to Reality Check.

Serena: Thank you for the work you do in New Orleans and beyond, and I look forward to seeing you at, in my mind, in November, if not sooner. Absolutely,

Christy: yes. Thank you so much for having me. I'm honored. I really appreciate it. Yeah. Thank you so much. Take good care.

Serena: Take Care.

Serena: Bye-bye. Until next time. Thanks for taking the time to get your reality check.

Serena: And remember, psychosis is

Ashley: real, so is recovery. If you have enjoyed this episode or found it useful, please subscribe wherever you get your podcast from. And check out the website calmnola.org.