TRACEY MACKLE - PERINATAL MENTAL HEALTH NP
Born in NZ in the South Island, Tracey has always been interested in health care and was a volunteer in St John Ambulance as a teenager. After leaving her small town of Kaikoura, Tracey went to Nelson to study nursing in 1993.
After graduating Tracey worked in an acute mental health unit for 11 years as a staff nurse and then as a clinical nurse co-ordinator. Tracey moved to Brisbane with her family in 2007 and within 12 months Tracey was a nurse unit manager in a busy acute care team. She completed her Masters in Mental Health Nursing, followed by a Masters in Nursing Science (NP) and is credentialed with the Australian College of Mental Health Nurses.
Tracey is driven to provide the highest standard of mental health care and now works as a Nurse Practitioner in the Metro North Perinatal Mental Health Service which covers three birthing hospitals in Brisbane’s North.
Can you share a little about the community you are working in and the nursing you are providing to patients?
I work in the northern corridor of Brisbane which has a younger than national average maternal age and a low socio-economic demographic. Along with high prevalent disorders like depression and anxiety, many of our woman present with extensive histories of trauma and substance use.
In my role, I provide a specialist mental health assessment and recommendations to optimise maternal/paternal mental health and well-being during the perinatal period. The first 1000 days are vital for an infant’s development and we are aiming to support parental mental health to promote strong relationships and improve future outcomes for these children.
Many women still have unintended pregnancies and if they are on medication for their mental health, they can be advised to cease or stop medication because they are scared about risk to their unborn. I support women early in the pregnancy, to provide evidence-based information about choices in treatment, so they know they have options and can make informed decisions about their mental health care.
Our team tries to educate women and other health care professionals where issues like depression and anxiety are common and don’t just go on hold or disappear when you are pregnant or have a new baby. It’s a time of great change and a vulnerable time for all women, even if they have not had a pre-existing mental health problem.
We need to talk about mental health issues openly and challenge the perception that you cannot take medication in pregnancy or when you are breast-feeding, as for some women that is not an option without placing themselves at risk. If they do stop, or are advised to stop and their mental health deteriorates we want to detect that early and get appropriate treatment underway.
As a NP, I complete a comprehensive assessment and can start and/or re-commence women on medications for their mental health issues. If a woman needs medication, I can arrange this then and there without them needing to attend another appointment. This can be a huge relief for women who are struggling and have been seeking help and told this is not an option.
I work across the community, provide appointments in the antenatal clinics at the hospital, community clinics and home visits in the postpartum – our team is focused on offering flexible, timely and accessible care.
What is unique about your role in the community?
I think my role provides the community with access to a specialist perinatal mental nurse who has knowledge and understanding of best practice principles, current guidelines and up to date evidence about medication safety and use in pregnancy and breastfeeding. I can provide assessment, treatment, indirect counselling and continuity, seeing patients when they need it in both antenatal and postnatal care.
We are a publicly funded service, so there is no cost having this care and this makes us accessible and is attractive to women as often the family income has been halved, there are financial constraints, and this may help them seek support for their mental health.
Physical complications can be attributed to mental illness and I keep an eye on this, as physical issues are common in pregnancy and early postpartum and will mimic symptoms like those in anxiety and depression. I have time to spend with patients to complete a comprehensive assessment, not just focus on the presenting problem and this guides a holistic treatment plan.
Why did you decide to become a nurse practitioner?
As a nurse unit manager, I lost clinical contact. I enjoy being able to help/support people. I wanted to fully use my skill set, work a little more autonomously and to be able to extend my scope.
In a NP role I can use my clinical judgement, make decisions in patient care and treatment and be confident and accountable for those decisions. I had years of clinical experience in a variety of settings that provided a solid foundation so completing the NP training extended what I could offer as a clinician.
What are you hoping to achieve in your current role as an NP?
I am hoping to implement tele-health as an option for care to improve accessibility for parents that cannot attend a clinic appointment. We need to increase our knowledge around women who find their pregnancy and birth traumatic, complex trauma history and how this impacts on obstetric and mental health outcomes and whether we can reduce negative outcomes by providing different care options.
I would like to contribute to the development of best practice principles for women that have sexual assault histories; to better support their emotional needs in the obstetric environment.
I would love to see a second NP in our service or encourage someone in our team to undertake the training so we can capacity build. My focus is to encourage other RN’s and advanced practice nurses to broaden their horizons and become NPs.
We only have 3 other clinicians in our team to cover a huge geographic catchment so we can only do so much. With around 8,900 women birthing in our public maternity services, and depression and anxiety being common problems, we need to promote our service and look for opportunities to expand so we can adequately support the demand in our local area.
Our team would love to offer more support to dads experiencing mental health problems in the perinatal period, but it can be difficult to support dads as in most
cases they are working business hours and we only work during the day. Tele-health might be that option.
If you weren’t an NP, what would you be doing?
To be perfectly honest I wouldn’t be anything else other than a nurse - I was in St Johns Ambulance at 11 years of age, volunteered on the ambulance service from 16 years of age, worked at the local hospital at 17 years old. I was destined for health care.
If I didn’t have to work I would love to hang out at the beach all day; but I have bills to pay and I am pleased I do something I enjoy.
Becoming a NP and completing my Masters was full on. I was working full time, had a little one at home, plus teenagers and I couldn’t have done it without the support of my husband, my friends and the NP’s I trained with.
I am proud to be a NP and to offer my services to the communities I work in.