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Combatting Agism in Behavioral Health with Dana Ebeling, PMHNP

Agism in Mental Health with Dana Ebeling, PMHNP

Agism in Mental Health
with Dana Ebeling, PMHNP

Dana Ebeling is a psychiatric nurse practitioner who advocates for better mental health care for aging and elderly and works with Heading a mental health provider with locations in Austin and Dallas-Fort Worth. 


With over 30 years of healthcare experience, including working as a medical director of a nursing home, her work has taught her the importance of resilience and valuing the unique life experiences of each individual. 


In this article, we explore Dana’s expertise in psychiatric care for the elderly, including the unique challenges faced by this population, supporting anxiety and depression especially when they cooccur with physical diagnoses, and the importance of collaboration between mental health professionals and primary care providers.


The heart she brings to care is coupled with a passion to ensure that mental health is not overlooked as people age. Good care of wellbeing and emotional landscape of a person’s life cannot be overshadowed by physical health, and Dana discusses how they go hand in hand. 


Resilience and Time


Dana has a deep appreciation for the resiliency of the elderly population. She believes that time on Earth and lived experiences shape who we are, and that the elderly have a unique perspective on life. The wisdom of her patients is something Dana felt blessed to witness when she started her career as a young nurse. 


To kick off the interview, Dana shared a story about one of her patients, a woman she calls Jewel, to illustrate this point:


“Jewel was one of the first patients I ever worked with as a young nurse. She suffered multiple fractures from a head-on motor vehicle accident. She was determined to get well and worked hard every day, despite chronic pain, nausea, fatigue. Yet, she was always so concerned about me, her nurse. ‘Was I working too much overtime?’ ‘Did my family need me at home?’ She was so kind and also so determined. She made a full recovery and was discharged to home.”


Dana noted that she would meet Jewel again over the years, as her husband became ill and he eventually passed away. Then, Jewel herself became ill and moved to a nursing home. Despite her own struggles, Jewel always focused on others. Dana shares one of their conversations:


“[Jewel and I] would sit together and chat about growing old, what it was like to give up your home and move to a nursing home, struggles with living with chronic illness and kidney disease. Yet, in all this, I noticed she continued to focus on others even as her own health was failing.”


When asked what she learned from this experience and what she wished more mental health care providers would consider to better serve the elderly, Dana went back to why she began to specialize in this area in the first place. 


Unique Challenges in Psychiatry and Therapy for the Elderly

In her experience as a nurse, Dana found mental health to be a crucial aspect of aging that is often overlooked. In fact, it was her experience as a medical director at a nursing facility, as well as her time spent in acute rehab facilities, that inspired her to seek the mental health route as the next phase of her career. 


“Mental health focuses on aging as a normal part of life. We can experience loss, trauma, symptoms of depression, anxiety at any age. Mental health professionals should value the individual, not the ‘age’.”


Dana stressed that an assumption of life experience, including adverse life experience, as part of the norm – in addition to physical illnesses often becoming more prevalence – the care aging patients are provided heavily focuses exclusively on their physical decline and often ignores their emotional wellbeing. 


This brings up one of the biggest challenges in mental health care for the elderly –  the increased prevalence of medical conditions and chronic illness in older adults. This requires providers to maintain close collaboration with other members of a patient’s medical team. Dana explained, “Often with aging, there is an increase in medical conditions that may require close collaboration and consideration when prescribing psychiatric medications.”


“Chronic illness and depression, and pain and depression are like bad marriages. It doesn’t mean these things aren’t linked, but that also doesn’t mean the depression shouldn’t be addressed for what it is – and that’s what’s important. We can’t chalk their depression up to ‘just getting old.’ We have to dig in and really get concerned about quality of life,” Dana suggested.


Generational Stigma


Dana also notes that there is often a stigma around mental health in older adults. She shared, “Mental health care providers need to consider that their patients may have grown up in a society where mental health was not discussed or considered at all.”


However, she did note that she has seen a shift in attitudes over her 30 years in healthcare, with adult children often encouraging their parents and grandparents to seek help.

Dana added, “I think the most important thing is to listen to their story, to be compassionate, and to meet them where they are at. It’s really about building that relationship, building that trust, and being a partner with them in their healthcare journey.”


In terms of specific approaches to working with older adults, Dana suggests taking the time to understand their cultural backgrounds and how that might impact their attitudes toward mental health. “There’s a lot of diversity and generational differences within the older adult population,” she says, “and it’s important to recognize that and to approach each person with an open mind and an open heart.”


Combating Agism in Healthcare and Mental Health Care


“I think ageism is fairly present across all medical disciplines in some capacity,” Dana shared. “Ageism is also prevalent in society. American culture tends to idolize the physically young and strong. Growing old is considered a weakness because, well, our bodies do age – but that doesn’t mean life is over. If you read stories by centenarians, you find commonalities like a continual interest in life, learning, socializing, and engaging in the community. A continued pursuit of life!”


Research confirms Dana’s findings too. In fact elderly populations living with mental health conditions report feeling age discrimination twice as often as their counterparts without mental illness.  Additionally studies have shown that people 60 years of age and older who have previously experienced agism are more likely to develop signs of negative mental health and more likely to experience depressive symptoms, and anxiety. 

They also may begin to anticipate agism occurring in their interactions which could impact the quality of relationship built with their providers – especially as advances in technology continue to change the delivery of care, and as provider shortages continue to stress and already pressured medical community. 

Continued education, research, and proactively seeking feedback can be helpful for providers to address any gaps in care or blindspots they may have when it comes to offering care to those in later stages of their life. Opportunities exist in virtual care as well including finding ways to support older patients as they navigate technology. Virtual care can improve access for those who live rurally or are less mobile, but the technology and care team support must be there as new systems are learned.


“This work is incredibly rewarding for healthcare providers. Working with patients who have wisdom and life experience is an honor. We should offer extra support, and consider it a privilege not only to provide care but also to learn from them,” Dana concluded.


Wise words, indeed.

Blog depression Ketamine spravato Uncategorized

Who Is Not a Good Candidate for Ketamine Therapy?

Who is and is not a Good Candidate for Ketamine Treatment?

Ketamine treatment is a breakthrough for people who have not experienced relief from traditional modes of treatment or medications, or the effectiveness of these methods of care has diminished. Unlike traditionally prescribed medications which can take several weeks to show effectiveness, patients receiving ketamine often report a reduction in symptoms within the first few sessions.

Research shows that Ketamine  may be suitable for people with various mental health conditions such as depression, anxiety, PTSD, OCD, and chronic pain, who have not responded to traditional treatments such as therapy and antidepressant medications. Specifically, Ketamine treatment has shown promising results in treating treatment-resistant depression, suicidal thoughts, and chronic pain. FDA approved drug Spravato® is approved for the treatment of treatment-resistant depression, and has changes the lives of many who have received this line of care.

There are many reasons why a traditional medication may stop working, or is otherwise not suitable for someone with treatment-resistant depression, or chronic, long-standing stress disorders like anxiety, or PTSD. For example some patients cannot tolerate the side effects of traditional medications. However, it is important to note that each individual’s circumstances are unique, and it is recommended to consult with a qualified medical professional to determine if Ketamine treatment is a suitable option for their specific condition and medical history.

Ketamine and Spravato® are breakthroughs for many, but are not right for everyone.  In this article we look at some factors that may play into Ketamine candidacy and important safety considerations.  

Factors to Consider for Ketamine Candidates

It is important to consult with a qualified medical professional to determine if Ketamine treatment is appropriate for an individual’s treatment of depression, anxiety, or PTSD. At Heading we conduct an intervention treatment Q&A with a care coordinator as well as a 60 minute psychiatric consultation session to establish a personalized care plan and also to determine candidacy prior to a patient receiving treatment.


It’s important to note that candidacy works hand in hand with outcomes and patient goals. Both of these should be monitored continually through the process, and the process is not ‘one-and-done’. Prior to every in-center ketamine or Spravato® appointment several factors are monitored before treatment. Keeping optimal outcomes, and safety in mind patients have access to their care-team during treatment sessions, immediately after treatment sessions, and throughout the course of a treatment protocol. 


Ketamine is becoming more well known as an interventional treatment for depression and anxiety that have not responded well to other treatments. Ketamine offers rapid relief for many people, especially when other medications have not worked.


That said, the results for any depression treatment method are not the same across the board, because every patient’s individual needs are different. That’s why it is important that a mental health care-team always consider the best course of treatment for an individual.


As a patient considers ketamine treatment there are factors to keep in mind.


Ketamine may not be the right choice for someone if:

  1. They have uncontrolled high blood pressure or heart disease. Ketamine can cause an increase in blood pressure and heart rate, which is why it is important for prescribers and care teams to be aware of a patient’s cardiovascular health history prior to receiving treatment.

  2. A patient has a history of schizophrenia or schizoaffective disorders. Ketamine may have adverse side effects and worsen symptoms of these conditions.

  3. A patient has a history of substance abuse or addiction. Ketamine has the potential for abuse and care teams are careful to ensure that treatment will not trigger relapse. 

  4. They are pregnant or breastfeeding. There is limited research on the safety of ketamine use during pregnancy and breastfeeding, and it is not recommended.

  5. They have certain medical conditions, such as liver or kidney disease.

  6. They are unable to participate in the requirements for the protocol such as payments or co-pays, the time-investment is not suitable for that moment in life, or making arrangements for care such as getting a ride to a center if they are receiving treatment at a medical office or making time for the length of treatment is not feasible with their schedule. 

It’s also important to note that this is not an exhaustive list, and a thorough consultation under the direct care of a psychiatric medical professional is crucial.  Since the goal of ketamine therapy is to experience relief from long-standing and hard-to-treat mental health disorders, if the protocol isn’t working for a patient – that’s ok! There are always changes that can be made, and other treatments.  Personalized approaches including combination therapies, and a team of mental health care providers working together can make all the difference – as mental health care is not one-side-fits-all. 

Ketamine In Center Care and Safety

The two most important goals of determining candidacy are:

1) patient safety, and 

2) the best possible outcome for feeling better and healing.



Methods of receiving ketamine vary, and patient preference, insurance coverage, and access plays a large part into whether or not they seek treatment in a center, or through another means.  However, in-center treatments, under a doctor and medical team’s supervision, have added benefits to meet high standards for safety and outcomes.



“Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. These are also the same medical professionals you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience,” shared Dr. Arif Noorbaksh M.D. a leading psychiatrist at Heading who practices out of Dallas, Texas and offers virtual psychiatric services and medication management to patients statewide.


In addition to having medical professionals immediately available to monitor physical metrics before a treatment such as blood pressure and weight, some patients receiving Ketamine also feel more comfortable receiving treatment knowing that they are in a safe medical center with nurses and doctor’s just a few steps away as the medication takes effect.  Ketamine can induce a dissociative state, sometimes this is referred to as a ‘trip’, and the patient may feel out of body, like they are flying, or experiencing a range of sensations outside of their normal state of being.  In-center treatment options provide a patient with immediate options for assistance, and a team of medical professionals determining when a patient is ready and able to leave treatment. At Heading a ride to and from an appointment is required as it is not advised to drive or operate machinery until a patient has had a good night sleep after treatment. 


Thoughts When Considering Ketamine

  • Ketamine is an effective medication offering rapid relief for depression, but not everyone is a good candidate for treatment.
  • Safety is a top priority. Work with providers who offer thorough screenings and care throughout the process
  • Effectiveness is key. There’s no point in starting or continuing a treatment protocol if it is not proving to be effective. Select a psychiatry provider who will offer a holistic assessment of your needs, including honest feedback about whether or not Ketamine is a good choice for you, as well as what additional treatment protocols they might recommend such as additional medication options, lifestyle changes, or the addition of psychotherapy which can be important in both behavior change as well as integration of the Ketamine experience.
  • Consider your own personal preferences for set and setting. How would you feel in a center with medical professionals steps away versus another method?
  • Ask a lot of questions in your intake and consultations. No question is dumb or unnecessary. You deserve care coordinators and psychiatric professionals who take time to answer all your questions, and ensure your needs are being met throughout the process.
  • Become aware of insurance, payment, and coverage options. There may be expenses related to your care. Ask questions up front, and consider how investing in your mental health impacts your wellbeing and life overall.