Deep Dive with Lindsay Hill, DNP, PMHNP - Psych NP Mentor - PMHNP Mentor

Lindsay Hill
  • 3.7 (9)
  • Mental Health

Welcome to my podcast. I am Lindsay Hill, DNP, PMHNP BC, and this show is my space to slow down and really unpack what psychiatric care looks like in real life. Each episode is built from the learning that shapes our work in mental health: lectures, clinical meetings, medication updates, webinars, books, and the conversations that make you stop and think. We will dig into the details that matter, like diagnostic clarity, treatment planning, psychopharmacology, side effects and monitoring, comorbidities, therapeutic approaches, patient communication, and the practical judgment calls that rarely fit into a tidy script. My goal is simple: take complex topics and make them feel understandable, usable, and grounded. Whether you are a student, a clinician, or someone who loves learning about the mental health field, you will leave with clearer frameworks, helpful reminders, and takeaways you can bring back to your practice and your life. Thanks for being here. Let’s dive in. This podcast is for education and discussion only and is not medical advice. Lindsay Hill, DNP, PMHNP-BC, founded the Psych NP Fellowship, a 12-month online mentorship for psychiatric nurse practitioners: https://psychnpfellowship.com/

  1. 20h ago

    S3E8: PMHNP Sliding Scale Fees: A Private Practice Playbook

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A sliding scale can widen access or invite a payer audit. How PMHNPs build a written, income-based fee policy using 2026 federal poverty guideline numbers. In this Deep Dive episode, two hosts walk through “PMHNP Sliding Scale Fees: A Private Practice Playbook” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • A sliding scale is safest for uninsured and true self-pay patients. Federal guidance says discounted care for uninsured people is legal. • For in-network patients, the copay and deductible belong to the insurance contract. Routinely waiving them can break that contract and, with federal programs, raise Anti-Kickback concerns. • Tie the scale to the federal poverty guidelines. In 2026 that is $15,960 for one person and $33,000 for a family of four in the 48 contiguous states. • Cap the number of reduced-fee visits. Three reduced slots out of 24 weekly follow-ups costs a practice $14,400 a year at most in the example below. • Put the policy in writing, verify income the same way for everyone, and review each patient's tier every 12 months. • The risky discount is the informal one made up in the room, not the one in a written policy. Read the full article: https://psychnpfellowship.com/pmhnp-sliding-scale-fees-private-practice-playbook-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E8: PMHNP Sliding Scale Fees: A Private Practice Playbook

  2. 2d ago

    S3E7: Duty to Warn: A PMHNP Confidence Script

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A patient names someone they want to hurt. Here is how PMHNPs check state duty-to-warn law, size up the threat, talk with the patient, and document the call. In this Deep Dive episode, two hosts walk through “Duty to Warn: A PMHNP Confidence Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Duty-to-warn law is set by each state. Carlat counts mandatory Tarasoff laws in 26 states plus Puerto Rico; others only permit disclosure, and a few have no statutory duty. • The usual trigger is a serious threat of violence against a reasonably identifiable person. Angry venting and intrusive OCD thoughts usually don't meet it. • HIPAA already permits disclosure to prevent a serious and imminent threat (45 CFR 164.512(j)). The real constraint is your state law. • Warning the victim is the last rung, not the first. Intensified treatment, means restriction, and hospitalization often protect better and keep the alliance intact. • Tell the patient what you are doing and why, when it is safe. Then document verbatim quotes, your reasoning, your consults, and every contact attempt. Read the full article: https://psychnpfellowship.com/duty-to-warn-pmhnp-confidence-script-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E7: Duty to Warn: A PMHNP Confidence Script

  3. 3d ago

    S3E6: Precepting PMHNP Students: What It Pays You Back

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Precepting PMHNP students can earn state tax credits of up to $10,000 a year and fill an ANCC renewal category. Here is the math, the time cost, and the rules. In this Deep Dive episode, two hosts walk through “Precepting PMHNP Students: What It Pays You Back” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • U.S. nursing schools turned away 6,496 qualified master's and 10,359 doctoral applications in 2025, and AACN lists a shortage of preceptors and clinical sites among the reasons. • Maryland gives NP preceptors a $1,000 tax credit per student (90+ hours), up to $10,000 a year. Georgia gives APRNs $750 per 160-hour rotation, up to $7,500. • 120 hours of precepting APRN, medical, PA, or pharmacy students fully meets Category 5 of ANCC certification renewal. • Taking a school's teaching stipend can make you ineligible for a state credit worth more than the stipend. • The real cost is clinic time. Get protected time or adjusted productivity targets in writing before you say yes. Read the full article: https://psychnpfellowship.com/precepting-pmhnp-students-tax-credits-ancc-renewal-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E6: Precepting PMHNP Students: What It Pays You Back

  4. 4d ago

    S3E5: Switching Antidepressants: A PMHNP Cross-Taper Protocol

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Direct switch, cross-taper, or washout? A step-by-step PMHNP protocol for switching antidepressants safely, with half-life math and MAOI washout rules. In this Deep Dive episode, two hosts walk through “Switching Antidepressants: A PMHNP Cross-Taper Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Switch when the first antidepressant gave no meaningful response after an adequate trial or caused side effects the patient won't tolerate. Augment when it gave a partial response. • There are three switching strategies: a direct switch (stop today, start tomorrow), a cross-taper (overlap over 2 to 4 weeks), and a taper plus washout (roughly five half-lives off before starting). • Half-life sets the pace. Fluoxetine tapers itself, while paroxetine and venlafaxine are the drugs most likely to cause discontinuation symptoms. • MAOIs have their own hard rules: wait 5 weeks after fluoxetine, about 2 weeks after most other serotonergic antidepressants, and 2 weeks after stopping an MAOI. • Most day-3-to-day-10 complaints during a switch are discontinuation symptoms, not relapse. Name them for the patient ahead of time. • In STAR*D, about 1 in 4 patients who switched after citalopram reached remission. A switch is a real second chance, not a consolation prize. Read the full article: https://psychnpfellowship.com/switching-antidepressants-cross-taper-pmhnp-protocol-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E5: Switching Antidepressants: A PMHNP Cross-Taper Protocol

  5. 6d ago

    S3E4: Lethal Means Counseling: A PMHNP Confidence Script

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Lethal means counseling for PMHNPs: when to ask about firearms and medications, word-for-word scripts, storage options, and how to document it with confidence. In this Deep Dive episode, two hosts walk through “Lethal Means Counseling: A PMHNP Confidence Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • In 2023, firearms accounted for 27,300 of the 49,316 suicide deaths in the US, about 55%. • About 90% of suicide attempts with a firearm end in death, compared with a few percent for most overdoses. • One in four survivors of near-lethal attempts in a Houston study acted less than 5 minutes after deciding to. • Lethal means counseling is a short, voluntary conversation about putting time and distance between a person and a method. It is not confiscation. • Ask everyone with elevated risk, use the same calm tone you use for sleep and appetite, and write down who holds the key. • Your own prescriptions count as lethal means, so quantity, packaging and who holds the bottle belong in the plan. Read the full article: https://psychnpfellowship.com/lethal-means-counseling-pmhnp-confidence-script-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E4: Lethal Means Counseling: A PMHNP Confidence Script

  6. Nov 5

    S3E3: SSRI Sexual Dysfunction: A PMHNP Management Protocol

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Most patients on SSRIs have sexual side effects but few say so. A PMHNP protocol to screen, wait, lower the dose, switch, or augment without risking relapse. In this Deep Dive episode, two hosts walk through “SSRI Sexual Dysfunction: A PMHNP Management Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Sexual side effects are among the most common reasons patients quietly stop an SSRI, and most will not mention it unless you ask. • Screen at baseline and at every follow-up with a short scale like the ASEX or CSFQ-14, so you can separate depression-related problems from drug effects. • Paroxetine carries the highest risk among SSRIs. Bupropion, mirtazapine, and vortioxetine carry lower risk. • The protocol runs in order: confirm, wait one follow-up, lower the dose if the patient is in remission, then switch or augment. • Bupropion add-on has the strongest adjunct evidence. Sildenafil helped both men and women in randomized trials. • Never trade remission for sexual function without a plan. Relapse is the bigger risk. Read the full article: https://psychnpfellowship.com/ssri-sexual-dysfunction-pmhnp-management-protocol-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E3: SSRI Sexual Dysfunction: A PMHNP Management Protocol

  7. Nov 4

    S3E2: Pharmacogenomic Test Results: A PMHNP Confidence Script

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A patient hands you a pharmacogenomic report and wants only green-column meds. Here's what the evidence really shows, plus a word-for-word PMHNP script. In this Deep Dive episode, two hosts walk through “Pharmacogenomic Test Results: A PMHNP Confidence Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • In the 1,944-patient PRIME Care trial, pharmacogenomic testing changed which antidepressant patients got far more than it changed whether they reached remission at 24 weeks. • Only CYP2D6, CYP2C19 and CYP2B6 have CPIC dosing guidance for antidepressants. SLC6A4 and HTR2A results should not drive decisions. • A "red" column usually means adjust the dose or monitor more closely, not "never prescribe." • Read the report against the current med list, because strong CYP2D6 inhibitors like bupropion and fluoxetine can override the genotype. • Use the four scripts below to validate the patient's effort, explain what the test can and can't do, and make a shared plan. • Never stop a working medication because a report flags it. Observed response beats predicted metabolism. Read the full article: https://psychnpfellowship.com/pharmacogenomic-test-results-pmhnp-confidence-script-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E2: Pharmacogenomic Test Results: A PMHNP Confidence Script

  8. Nov 3

    S3E1: PMHNP Quarterly Estimated Taxes: A 1099 Playbook

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A 1099 PMHNP netting $160K owes about $10K in federal tax each quarter. The deadlines, safe harbor rules and set-aside system that keep your April calm. In this Deep Dive episode, two hosts walk through “PMHNP Quarterly Estimated Taxes: A 1099 Playbook” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • 1099 PMHNPs have no employer withholding, so the IRS expects tax paid in four installments: April 15, June 15, September 15 and January 15. • Self-employment tax alone is 15.3% on 92.35% of net earnings, about $22,600 on $160,000 of net income, before any income tax. • You avoid the underpayment penalty if you pay 100% of last year's total tax (110% if last year's AGI topped $150,000) across the four dates. • The penalty works like interest, currently 7% a year on the shortfall, so the bigger danger is a cash crunch in April, not the penalty itself. • If you also have a W-2 job, raising your W-4 withholding can cover your side income, and withholding counts as paid evenly all year. • Move 25% to 30% of every deposit into a separate tax account the day it lands, and pay each quarter from that account only. Read the full article: https://psychnpfellowship.com/pmhnp-quarterly-estimated-taxes-1099-playbook-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

    S3E1: PMHNP Quarterly Estimated Taxes: A 1099 Playbook
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3.7
out of 5
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About

Welcome to my podcast. I am Lindsay Hill, DNP, PMHNP BC, and this show is my space to slow down and really unpack what psychiatric care looks like in real life. Each episode is built from the learning that shapes our work in mental health: lectures, clinical meetings, medication updates, webinars, books, and the conversations that make you stop and think. We will dig into the details that matter, like diagnostic clarity, treatment planning, psychopharmacology, side effects and monitoring, comorbidities, therapeutic approaches, patient communication, and the practical judgment calls that rarely fit into a tidy script. My goal is simple: take complex topics and make them feel understandable, usable, and grounded. Whether you are a student, a clinician, or someone who loves learning about the mental health field, you will leave with clearer frameworks, helpful reminders, and takeaways you can bring back to your practice and your life. Thanks for being here. Let’s dive in. This podcast is for education and discussion only and is not medical advice. Lindsay Hill, DNP, PMHNP-BC, founded the Psych NP Fellowship, a 12-month online mentorship for psychiatric nurse practitioners: https://psychnpfellowship.com/

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