When Bailey Nissen, CMA (AAMA), graduated from a medical assisting program in 2018, she kept her options open while job hunting.

“I was looking for jobs in my area, and I came across a medical assisting role that was the only one I had seen in psychiatry,” says Nissen. “It sparked my interest.”

To her delight, Nissen was hired by Broadlawns Medical Center in Des Moines, Iowa, to work at their outpatient behavioral health clinic soon after she applied.

Nissen’s days are filled with caring for patients who have various mental health disorders, such as anxiety, depression, bipolar disorder, and substance use disorder. When she first took the position, she traveled back and forth between the clinic and its affiliated psychiatric urgent care unit.

“It was great to help patients in need [during a crisis],” she says. “I never knew what [situation] was coming through the door.”

However, her time in urgent care was limited, and before the COVID-19 pandemic began, Nissen mainly worked in the clinic, assisting physicians who met with 10 to 15 patients per day. She roomed patients, took their vital signs, and recorded medi­cal histories.

“I would ask questions that pertain to mental health—such as whether they had symptoms of depression, suicidal thoughts, or changes in eating habits for those with an eating disorder—as well as other general questions medical assistants would ask about medications the patients take and allergies they have,” says Nissen.

At the start of the COVID-19 pandemic, the clinic turned to telemedicine. Nissen calls patients the day before their appoint­ments to ask whether they have any changes to their medications or pharmacy location and gathers information related to their medical history.

“I really miss seeing the patients,” says Nissen. “But we have noticed that we have a lot more patients showing up for their appointments—whether over the phone or via [computer]—since they don’t have to come in.”

Overall, patients are displaying increased anxiety and depression symptoms, notes Nissen. “A lot of people can’t get out of the house like they could before, and a lot of people have anxiety about contracting the coronavirus. We definitely notice an increase with our substance use disorder patients, and more people are asking to get help,” says Nissen.

Unlike typical primary care or specialty practices, Nissen’s work involves the unique challenge of being unable to immediately see patients’ symptoms.

While stigma and preconceptions about who might have a mental illness abound, anyone can be affected. “With mental health, you can’t really see it, so being able to talk with patients and find out what’s going on in their head is crucial to understanding their struggles,” says Nissen.

Nissen finds that working with sub­stance use disorder patients is most gratify­ing. The clinic offers a medication-assisted treatment program in which patients visit with their health care provider once or twice a month. Some patients are referred to Broadlawns Medical Center after being discharged from a residential treatment program. Others are seeking care for with­drawal from opioids or methamphetamine.

“A patient might come in initially not doing well,” says Nissen. “As their recovery journey progresses, it is rewarding seeing them staying sober, attending their appointments with the provider, going to therapy, and taking medication as prescribed.”

While Nissen plans to stay in mental health for the long term, she believes the skills she has gained will benefit any practice.

“No matter where I work, there will be patients with mental health issues, so everything I’ve learned in this setting will help end the [associated] stigma no matter where I go,” says Nissen.