When people think of careers in mental health, they usually think of psychologists or psychiatrists. But did you know that you can get the best of both worlds without having to undergo a residency by being a nurse practitioner? Yes, a nurse practitioner can specialize in mental health and Dr. Richard Marn has got one to humor you in this episode. Dr. Kojo Sarfo, DNP is a board-certified mental health nurse practitioner who also happens to have a 700,000-strong following on TikTok, where he posts short videos about mental health awareness. In this conversation, he shares how one gets a career as a mental health nurse practitioner, what his typical day looks like in a forensic psychiatry institution, and what qualities make for good candidates in this little-known career that is gradually making itself seen on social media.
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The Career Of A Psychiatric Mental Health Nurse Practitioner And Spreading Mental Health Awareness On Social Media With Dr. Kojo Sarfo
We have an awesome episode with another wonderful guest who is genuinely excited about what he’s doing and how he’s helping people. We’re going to talk with someone who is in the mental health field. His name is Dr. Kojo Sarfo. He’s a Nurse Practitioner who specializes in Psychiatry, specifically Forensic Psychiatry. We’re going to learn how he’s having not only a notable impact on people clinically, but also a profound impact on social media. In fact, Dr. Kojo Sarfo, as of April 2021, has over 700,000 followers on TikTok. He has a lot of people following him because his message has resonated with a lot of people and he tries to educate a lot of people about mental health through social media. That’s a fantastic and important thing to do. I’m lucky that he came onboard, wonderful guest, respectful, professional, and insightful person as well. Without further ado, let’s jump into this episode.
Welcome, another great episode here. I have Dr. Kojo Sarfo.
Richard, how are you doing? Thank you for having me on.
It’s a pleasure. I’ll let you jump right into it, Kojo. Can you please give me a quick bio of yourself, something in about 30 seconds or so, so people know a little bit about you?
My name is Kojo. I’m a Board-Certified Psychiatric Mental Health Nurse Practitioner. I got my degree from Augusta University as a DNP, Doctor of Nursing Practice degree with a specialty in Psychiatry. Prior to that, I got my Bachelor’s from Western Governors University, which is the online school in Utah, Salt Lake City. I did my nursing training at the University of West Alabama. I got my Associate‘s Degree in Nursing in 2013. That was what propelled me in this whole career and started my nursing journey.
As a nurse practitioner, what do you do clinically? What exactly are you doing in healthcare?
It depends on the specialty, whether it’s acute care, geriatric, psychiatry. A nurse practitioner assesses, diagnose, and treat patients within psychiatry. They also provide supportive psychotherapy as well. You do this either with a Master’s degree or a Doctorate, but you need at least a Master’s degree. Sometimes, the requirements are different. In some states, it varies like in Georgia where you have to have a collaborating physician. The physician had to review at least 10% of your charts. In Virginia, where I started my career, you have to have five years of having a collaborator before you can be independent.
In other states like Arizona and Washington State, from the moment you graduate, you can be independent as a nurse practitioner. You are a clinician in healthcare similar to your colleagues who are physician assistants or your colleagues who are physicians, but the training is different. The main difference between the nurse practitioner and the physician route is that the residency, which is required for physicians. It’s not required for nurse practitioners. It’s optional. They do have residency programs. It’s not required where physicians have to mesh into a certain program. That’s one of the biggest differences.
Since we’re talking about steps to get to your degree, what are the initial steps to achieve your professional degree? After high school, what do you usually have to do?The best part of being a nurse practitioner is that you get to be a clinician while being in a position where you can learn from physicians. Click To Tweet
After high school, the most linear path on what you want to do is you want to go into a four-year program and get your Bachelor of Science in Nursing. After you do that, you can get experience if you want. It’s a good thing to gain experience if you’re going to be a nurse practitioner because you’ll have the requirements of that residency that physicians have, so you’re going to be drawn on your experience as a nurse when you were working with the charge nurse, the residents, and attendings, all those things are helpful.
You can get the Associates then get the Bachelor’s, but to keep it straightforward, get a four-year Nursing degree and then after that, you get a Master of Science in Nursing for your nurse practice. That’s a two-year degree. If you want to go the extra year for your Doctorate, you can. For a high school student, you can graduate, do a four-year program in nursing, and then you can do a two-year Master’s level graduate program to receive a Nurse Practitioner degree. You can do it in six years.
What is the best part of your career?
The best part of my career is the versatility. For me within psychiatry, the fact that I got to go to the nursing ground and spend so much time with the patients and then working on a unit as an RN, I got to learn from the charge nurses, psychiatrist, and I got to ask all these questions which prepared me for my schooling as a nurse practitioner. Once I got into the profession, the best part is that you get to be a clinician, you get to have your own patients, assess, diagnose, treat, refer out, provide, and supportive psychotherapy. At the same time, you’re in a position to where you can learn. Most states require you to have a collaborating physician.
Even in states where it’s not a requirement, it’s always a good idea to have buddies who have been nurse practitioners for many years or to have a psychiatrist or a physician in whatever specialty you’re in that you can talk to. The path I have to take requires you to go through so many hoops and then you meet so many people. Getting to meet different people in different specialties is helpful for when you start to practice. You can ask questions because you’re going to have a lot of questions when you start. It’s going to be confusing. The fact that you’ve gone through the nursing path, you have so many people you can ask questions and get help from.
What’s your least favorite part of your career?
The least favorite part of my career is probably the fact that you can go from being a nurse carrying out the orders to being a provider but at the same time, when you started off as a nurse and then you switched to being a provider, it’s difficult to turn that switch on, especially if you’ve worked as a nurse for so long because you’re used to getting the orders to the physician. You become so good at executing it and then you have to tap into a different part of your brain to be the person who is calling the shots, putting the orders, and making the diagnosis. It was difficult for me, at first, to flip the switch and go from the RN to the provider. For some people, it’s easier or harder, but it was as difficult having to adjust from going to carrying out the orders to now I have to be able to explain the medication, the side effects, and why we chose this over that.
It’s a different mindset. Kojo, is there a part of your job that is the least part that you like doing or the least favorable part that you don’t look forward to?
Within psychiatry, as a nurse practitioner and as somebody who’s worked in an inpatient setting, one thing that I don’t like is when you have someone who comes in and they’re aggressive either towards themself or other people and yet to force medications. A lot of times, you have to do that for their safety or for the safety of other people. You have to go through a process. We have to get a second opinion. Forcing medications on somebody can be quite difficult. It could be traumatic. I hate doing it, but working inpatient, I had to do that a lot.
Give them a shot physically or overriding their desires, what do you mean by force?
If somebody is coming in or having a psychotic break and they’re trying to harm himself or other people, if it’s a situation where it’s emergent and there’s a crisis on your hands, you have to go ahead and put them in the chair, administer anti-psychotics and things of that nature. We do that frequently in psychiatry. That’s something that I don’t particularly like to do. To take your question from a different angle, for nurse practitioners as a whole, one thing that is frustrating about the profession is having to explain the role of a nurse practitioner. The funny thing is that sometimes you have colleagues who are nurse practitioners but let’s say their FNP, Family NP. Sometimes, they don’t know the scope of practice of a psychiatric nurse practitioner.
Even within the nurse practitioner profession, different specialties oftentimes don’t know how to explain what each does. You’re going to have PAs who don’t know the role of nurse practitioners. PAs, to my knowledge, can bounce from specialty to specialty, whereas the nurse practitioner route, you specialize in a certain thing. You have physicians who don’t know what the role is. When you go to a new hospital, you may have to let them know this is what you can do. You would think that they would know, but it’s 2021, we still have to do more education about what each career does. This show is a fantastic way of doing that to let everybody know what we all do.
Since we’re talking about that, there seems to be some misunderstanding. What are some misconceptions that people have of maybe not only nurse practitioners but also psychiatric nurse practitioners?
For psychiatric nurse practitioners, a lot of people are now aware that psych NPs can provide psychotherapy, or there’s some form of CBT or motivational interviewing. People don’t see psych NPs as psychotherapists and you can provide therapy. Also, for nurse practitioners as a whole, some people don’t realize that they can assess patients and diagnose because people know it to be an advanced practice degree, which it is but sometimes people will focus in and key in on the nurse part and say, “A nurse can’t diagnose. A nurse can’t assess. A nurse can’t prescribe medications.” Every nurse practitioner can do that. It just depends on the State Laws. In some states, you can’t prescribe a schedule to stimulants but in some states, you can, but every nurse practitioner can assess, diagnose, and treat. A lot of people don’t know that.
It’s important to highlight that depending on where you live. It can determine your scope of practice. I’m glad we went over that. As a nurse practitioner, what is your typical day like? How would you describe that? Start to finish. What time did you get up in the morning? What is the day like? How many patients do you see? What type of patients you’re seeing? What you’re doing for them, and then when you leave?
I was working in Forensic Psychiatry in Southern Virginia. A typical day for me, I will come in. I will check the emails and I would go in and see if I had any admissions overnight. If I had any admissions overnight, the social worker was on top of things. She would send emails and I would have collateral information on the patient. I’ll read about the patient and see what’s going on. “Is this somebody who needs to be seen right away?” If they had been in the chair overnight or if they’re having a crisis, you go and you see them, make sure that they’re stable, then you review and get some collateral information. I would do my best to knock that up first thing in the morning, so when I go into the morning report and I get the report from the nurses, I know exactly what’s going on and not clueless as to what’s going on in the unit.
After we get more on report then we’ll have treatment team meetings. Some days, we have the treatment team meetings around 1:00 PM or so or some days, we’d have after morning report. The treatment team meetings are where you would bring the patients in and you would do it after they had been there for 72 hours, two weeks, or a month. You would bring them in and you would discuss the game plan. You would review the diagnosis. You would see how the patient has been doing. See if they’ve been refusing medications, are they getting better, or are they feeling like they need more time to be in the hospital? Sometimes you have to make the executive decision and say, “Even though this patient wants to go home, we still need them to be more compliant with medications. We want them to be free of self-harm for at least 7 days or 2 weeks.” We will go over the goals and objectives of what we want to see. This is where we would call the family members and get their input.
Pre–COVID, we’d had the family members come in sometimes and talk with the patient. That was helpful because these guys and girls were stuck in an inpatient hospital for sometimes months to years. Within the forensics setting, a lot of them were stuck for a long time. If somebody came in, they had a psychotic break, and they needed to be placed on meds, they could leave much earlier than that. It was helpful to have family coming in and giving their input. Family is also great for collateral information. They can let us know how the patient was like at home. We would do that.
Assuming it was a day where we had the treatment team meetings in the morning, after that, then I would see my other patients on the unit. I would start off with the patients who had recent medication changes. I’ll see them and I would see the stable patients less. More so to see, “Are you doing good? Any issues.” I’ll go to lunch. After lunch, I would have to get some coffee, make sure that I’m not falling asleep, and then I would do charting. The charting could take me from 1:00 PM to 5:00 PM. At the same time, working in an inpatient hospital, you could have a code. Every hospital is different, but sometimes you’ll have a code gray.
What does that mean?
You’d have a psychiatric emergency like a patient fighting. You have to address the situation. If they go in restraints, you have to see them within an hour. That could throw off the whole flow of the day. You never know when those things happen, but you have to take care of it quickly. They get back to your day-to-day routine.
Are you, yourself, physically restraining these patients when you need to?
You are not. Sometimes, it’s difficult for us because you’ve been a nurse so you’ve been helping the techs restraint the patient sometimes but when you go into the NP role, you become the provider. You’re not physically restraining the patient, but you’re given the orders to the nurses and the techs to say, “This patient needs to go on the chair.” Maybe they’re banging their head. You would call out the orders and they would follow, but you’re not physically restraining them yourself.
What is forensic psychiatry? You mentioned that before.
It’s psychiatry within the forensic setting. It’s complex because you have patients who have a legal history. A lot of them have committed crimes anywhere from petty theft to homicide and arson. It’s psychiatry but you have to add the forensic component in there. You have to think about the patient’s charges and how safe they are to go back into the community. If they’re a registered sex offender, you have to keep those things in mind when they go out in the past. You have to take into account so much more. You have to figure out the legal situation.
If it’s a high-profile case, you might have to go to court, you might be subpoenaed. The judge might want to know what type of care you’re providing for a patient. I was on NGRI unit. That means Not Guilty by Reason of Insanity. My unit was pretty unique to where they will come from a maximum-security psychiatric facility to my hospital. What I would do is I would assess the patient, check the diagnosis, make sure I agree with it if I change it, provide a rationale as to why I changed it, continue medications or put them on something else.
We would work on something which we call the conditional release plan because they’re NGRI, they’re Not Guilty by Reason of Insanity. If they didn’t have a mental condition, they would be incarcerated. We worked with the psychologist closely with them and the social workers to make sure that they go through a graduated privileging system. As they become more and more stable, as they demonstrate that they are safe to go back into the community, the conditional release plan will allow that person to go back into the community but they have to be, in some way, in a control environment to make sure that they’re still taking their medications, they’re not going to be harmful towards themselves, or anybody else in the community. It’s pretty unique.
Forensic psychiatry relates to people who have had issues with the law. Part of your job is to assess how and when they can be put back into the general population.If a psychiatrist and a psychologist had a baby, then you’ve got a psychiatric mental health nurse practitioner. Click To Tweet
For the patients who are an NGRI, Not Guilty by Reason of Insanity, some patients, but depending on the crime or what happened, may never be in the community as we know it. They may have to go into a special housing, especially if they’ve had a crime that was quite egregious or if they’re a sex offender. You have to find specialized homes for them. It depends on the patient.
Are all the patients you take care of typically have been through jail?
Can you tell us a story of some of the patients that you’ve taken care of where you had an impact on their care or their life?
One patient comes to mind. He went to jail for an offense and he was deemed to be not guilty by reason of insanity. He had issues to where he would go to the privileging system and he would do well. Right before he would get out, something would happen. He would decompensate or stop taking his medication. You have to start back over again. He had been in the hospital for at least five years. He has spent the majority of his twenties in the hospital. When I transferred his care to a different provider, the last I heard from him, he was almost ready to get out. He had had a job in the community. He was stable. He didn’t like the oral medication. We transferred him to a long–acting injectable. Some patients prefer that because there’s a stigma associated with taking pills every day. If you’re able to put them on a shot, once every two weeks or once a month, sometimes that boosts their confidence. You have to make sure that they’re stable and that they’re following through with therapy and medications.
This guy became stable. He wasn’t hearing as many voices. His mood was much more even. He got a job in the community. He was working and doing well. I would see him sometimes ride his bike around the city when I was driving home and it was good to see. When I first met him, he was aggressive, amped up. He had his angry affect to him. After I worked with him for a couple of months to see him in a better place and that much closer to going back into the community. When you’ve been in the system for the majority of your twenties, it’s tough to transition back to the life that we live. It can be scary.
That’s a great story of how you’ve helped one person, especially when they’ve gone through the legal system, and they have a rap sheet and such. That’s awesome that you’re able to do that. In terms of the outlook for this type of career, what do you think that looks like?
The outlook is fantastic. As you can see with COVID, there’s a growing mental health crisis for everybody. COVID has not discriminated, whether you’re a healthcare professional or you’re an individual. It’s been tough to adjust. We’ve had to go from working in a hospital to working at home. Some people have lost their jobs. Some people have lost family members. With this career being one of the careers that are better suited for the Telemedicine setting, we’re going to see a lot of people pursue psychiatry.
If not, through the psychiatrist route or the PA route through their nurse practitioner route. You have a lot of people, especially nurses. There are some programs that allow people to get into a nurse practitioner track without having been a nurse before. It’s a controversial program. I don’t know too much about that because I went through the nursing track. The outlook is encouraging for anybody who wants to do psychiatry from a nursing background. You’re never going to be out of a job. You can work inpatient and outpatient, set up your practice, and collaborate with other providers. There’s always going to be somebody who needs someone to talk to and somebody who needs medication. If you’re an empathetic person and you want to be part of the solution, the outlook is promising.
Occupations come to mind of people that work in mental health with a professional degree, graduate degree, nurse practitioner, PA, psychiatrist, which is a physician, but also psychologists where they get their PsyD or PhD. Those are the main ones, at least, that I can recall that would have a graduate degree that works in mental health. What are the types of students that will best flourish in a nursing practitioner career especially in this psychiatric realm?
The people who would like best flourish in this environment are individuals who have concerns about what they want to do, but they know that they want to be in the mental health field. People who pursued the psychiatric nurse practitioner track have to ask themselves whether they want to be a psychologist or a psychiatrist. Sometimes some people on TikTok think of it as if a psychiatrist and the psychologist had a baby because you cannot get the best of both worlds. To pursue a PsyD track, you’d have to either go to graduate school for at least 3 or 5 years. A psychiatrist, four years of med school, four years of residency, maybe extra fellowship after that. The fact that the training is more concise as a psychiatric nurse practitioner, it is shorter.
Provided that you have a good support system around you, that’s the thing. You have to have people that you trust. Other providers that you admire how they go about their day-to-day activities. Provided you have that, you can do a nursing degree and before your nursing degree you can do two years. You don’t even have to get your Doctorate. You can do a two-year Master’s degree program. You can go ahead and start to see patients and you can prescribe medications. That’s the difference between the PA, NP, MD, DO, the society, and then the PhD. As a nurse practitioner, you can prescribe medications, which is big for a lot of people.
It’s being able to prescribe medications and administer therapy. Let’s do some rapid-fire questions. A little bit about you. I noticed you were wearing a Lakers outfit before. What are your favorite sports teams?
My favorite sport in basketball is the Lakers. In football, it’s the Tennessee Titans football team. My favorite baseball team is the Atlanta Braves, and my favorite soccer team would be Chelsea.
What are your favorite types of books you like to read?
The God of Small Things. I read that book in high school. I thought it was a fascinating book. The Alchemist is a good book. Those two come to mind. In general, I like to read nonfiction books. I remember we didn’t have video games growing up. I couldn’t afford it. There was a little mobile library that would come by when we’re growing up as kids. I would go in there and I would read autobiographies about people like Martin Luther King and Bill Clinton. That was a hobby of mine as a kid. I still like reading nonfiction stories.
What’s your favorite musical instrument that you play or like to listen to?
If you’re stuck in an island and could bring only two things with you, what would you bring?
I will bring my acoustic guitar and I’ll bring my electric bike.
From a scale of 1 to 10, how hot do you like your shower water?
Eight and a half.
Do you remember any advice or comments that had a significant impact on how you live your life so far?
“Whether you think you can or you can’t, you’re right.” It was an advisor somewhere along the way. That phrase motivated me to believe in myself and know that I can do the things that I want to do.
Kojo, what do you most value in friendship?
Respect and loyalty.
What leaders do you most admire and why?
I admire Martin Luther King, Gandhi, and Nelson Mandela. I admire people who were able to be dominant without having to exert. They never have to over speak or do anything aggressive, but their presence was felt by who they were.
What would you consider to be the top 2 or 3 qualities that have made you successful?
Empathy, desire to learn, flexibility, and being able to adjust on the fly.
Finally, if you were told you only had one week left to live, what would you do?
I would spend as much time with family members and friends as possible. I would put all my money into making memories and spending time with them.
Time is awesome. Time is important. I would agree too. That’s it for our questions. Thanks for participating. Some readers do not know it, but you have a great following on TikTok. You’re doing a lot of wonderful stuff in TikTok and helping people understand mental health. Where can readers learn more about you and reach you and understand what you’re doing? What are you doing and how can people learn more about it?
I’m using TikTok as a platform to promote mental health awareness and break down complex mental health conditions in a way that’s clear and concise for people to understand anywhere from 7 to 12 seconds and different little skits in music video content ideas that make people more comfortable talking about mental health and being open. On TikTok, you can find me, @Dr.KojoSarfo. On Instagram it’s, @DrKojoSarfo. Those are the two main platforms where I post content. If I posted there, it can be seen anywhere else. Those are my two main channels.
You’re also on other social media as well, not just that.
I’m on Twitter, @DrKojoSarfo. Facebook, @DrKojoSarfo, YouTube and also Twitch. I started Twitch streaming, which is a gaming platform where you can play different games and also talk to people. My goal with Twitch is to get the guys. I feel like there’s an issue with male mental health and guys not being comfortable to be vulnerable enough. I figured that by playing games. I have a controller here and I have my whole Twitch setup. To be able to play Rocket League or Madden and talk about mental health, it’s going to provide a safe space for a lot of guys who wouldn’t otherwise talk about these things. Looking back to myself in high school, I wasn’t the most forthcoming with how I was feeling. I’m trying to be who I needed when I was younger.
You’re bringing mental health closer and make it more tangible in their environment. You also have a website too.
Kojo, thank you so much for coming on board and be part of this episode. I appreciate it. When people hear about what you’re doing, they‘ll be inspired as well. Thank you so much.
Thank you for having me on.
It’s my pleasure.
- Dr. Kojo Sarfo
- The God of Small Things
- The Alchemist
- @Dr.KojoSarfo – TikTok
- @DrKojoSarfo – Instagram
- Twitter – Dr. Kojo Sarfo, DNP
- Facebook – Dr. Kojo Sarfo
- Twitch – Dr. Kojo Sarfo
About Dr. Kojo Sarfo
Dr. Kojo Sarfo, DNP, PMHNP-BC is a Ghanaian-American Psychiatric-Mental Health Nurse Practitioner, entrepreneur, and writer. He graduated from The University of West Alabama with his Associate’s Degree in Nursing and then obtained his Bachelor’s in Nursing from Western Governors University. He went on to obtain his Doctorate in Nursing Practice degree from Augusta University with a specialty in Psychiatry.
He has three years of teaching experience as an adjunct faculty professor with the College of Nursing at his alma mater, Augusta University. He has a passion for treating and caring for persons with severe mental health conditions. He is also the CEO and Co-Founder of Abrantie & Signora, LLC, which is a clothing company dedicated to spreading positivity and mental health awareness for teenagers and college students.