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. 1d 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

  2. 3d ago

    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

  3. 4d ago

    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

  4. 5d ago

    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

  5. 5d ago

    S2E99: Antipsychotic Metabolic Monitoring: A PMHNP Protocol

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Only 28.9% of antipsychotic patients got lipid tests even after guidelines. Use this PMHNP schedule, the 3-5-7 weight rule, and clear lab action thresholds. In this Deep Dive episode, two hosts walk through “Antipsychotic Metabolic Monitoring: A PMHNP Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Order weight, BMI, waist, blood pressure, A1c or fasting glucose and a lipid panel before the first dose, not at the first follow-up. • Recheck weight at weeks 4, 8 and 12, repeat labs and blood pressure at 12 to 16 weeks, then keep checking at least annually. • Use the 3-5-7 rule: more than 3% gain raises metformin, 5% or more raises a switch, and 7% or more is clinically significant gain. • Glucose and lipids can shift within weeks, before the scale moves, so a stable weight does not clear a patient. • A nonfasting lipid panel works for most patients. Repeat it fasting if triglycerides come back at 400 mg/dL or higher. Read the full article: https://psychnpfellowship.com/antipsychotic-metabolic-monitoring-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.

    S2E99: Antipsychotic Metabolic Monitoring: A PMHNP Protocol

  6. 5d ago

    S2E98: Federal Deprescribing Push: What PMHNPs Should Do Now

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! HHS wants psychiatric medications reviewed more often, but its letter binds no one. What PMHNPs should change in consent, charting and Medicare billing. In this Deep Dive episode, two hosts walk through “Federal Deprescribing Push: What PMHNPs Should Do Now” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • HHS announced its psychiatric overprescribing action plan on May 4, 2026. The clinician letter that came with it uses the word “encourages” and sets no new prescribing rule. • Formal HHS guidance on tapering was supposed to follow a July expert panel. This review found no published version as of November 1, 2026. • The best evidence you can use today is a 2026 consensus statement in JAMA Network Open: 45 experts, 44 of 50 statements agreed, and 100% agreement on reviewing every psychotropic at least once a year. • CMS confirmed that between-visit taper work can count toward care management codes. Nurse practitioners can bill general behavioral health integration (CPT 99484) if every requirement is met. • Patients may hear the headline before they hear from you, so an abrupt self-directed stop is the near-term risk to plan for. Read the full article: https://psychnpfellowship.com/federal-deprescribing-push-pmhnp-guide-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.

    S2E98: Federal Deprescribing Push: What PMHNPs Should Do Now

  7. 5d ago

    S2E97: Patients Who Secretly Stop Meds: A PMHNP Script

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! About 1 in 5 antidepressant users stops without a prescriber's OK. Here is the question, script and restart check PMHNPs need when a patient quits meds. In this Deep Dive episode, two hosts walk through “Patients Who Secretly Stop Meds: A PMHNP Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • In a Psychiatric Services analysis of 1,411 antidepressant users, 22% stopped without a clinician's advice or approval. • “Have you been taking your medication?” almost always gets a yes. Christoph Correll, MD, suggests asking how many doses were missed since the last visit. • Fewer reported side effects can be the first sign of partial adherence, because clinical worsening may show up late. • A disclosure needs a safety check before anything else. Find out what was stopped, when, and why, then screen for risk and withdrawal. • Never say “just restart it” by reflex. Lamotrigine and clozapine both have gap rules that can require re-titration. • Check adherence before you raise a dose, add an agent or call anything treatment-resistant. Read the full article: https://psychnpfellowship.com/patient-secretly-stopped-medication-pmhnp-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.

    S2E97: Patients Who Secretly Stop Meds: A PMHNP Script

  8. 5d ago

    S2E96: HIPAA Risk Analysis: A Solo PMHNP Practice Playbook

    Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A Maryland psychiatric practice paid $40,000 after ransomware. Here is how a solo PMHNP builds the HIPAA risk analysis OCR asks to see, one step at a time. In this Deep Dive episode, two hosts walk through “HIPAA Risk Analysis: A Solo PMHNP Practice Playbook” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • A Maryland psychiatric practice paid $40,000 and accepted three years of OCR monitoring after a ransomware attack, and OCR cited the lack of an accurate, thorough risk analysis. • HIPAA has no small-practice exemption from the risk analysis requirement. Your size changes how much you need to do, and whether you need to do it stays the same. • A solo version comes down to three documents: an inventory of where patient data lives, a scored risk register, and a dated fix list. • Your EHR vendor's compliance covers the vendor. Your laptop, your phone, your email and any AI scribe without a signed agreement are still yours to assess. • Keep the documentation for six years, and redo the analysis at least yearly and after any incident or new technology. Read the full article: https://psychnpfellowship.com/hipaa-risk-analysis-solo-pmhnp-practice-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.

    S2E96: HIPAA Risk Analysis: A Solo PMHNP Practice 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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