Meet Hilary Fowler, Psychiatric Mental Health Nurse Practitioner for Eating Disorders
Hilary Fowler is a dual-board-certified pediatric nurse practitioner (NP) and psychiatric mental health NP. As a provider, she specializes in eating disorders, particularly with adolescents, and focuses on residential and day treatment (PHP) at Sanford Behavioral Health. We sat down with Hilary to discuss her role at Sanford Behavioral Health Campus and how she collaborates with others on the care team.
Limelight Interview – Meetย Hilary Fowler, MSN, PMHNP, CPNP
Unique experiences and qualifications mark Hilary Fowler’s career journey. She holds a BA in Psychology and a BSN in Nursing. After serving as an active-duty RN in the Air Force for 5 years, she specialized as a Neonatal & Pediatric RN for 8 years. Hilary then pursued her MSN as a Pediatric Nurse Practitioner from Wayne State University. Over the past 4.5 years, she has gained extensive experience in inpatient trauma/surgery, outpatient primary care/private practice, and outpatient/inpatient adolescent mental health and eating disorder treatment. For more information on Hilary Fowler, please go to her profile on Meet Our Team.
The Role of Psychiatric Mental Health NP in Eating Disorders
Sanford Behavioral Health: What is the first day like for patients in our eating disorder program?
Hilary:ย When an individual enters residential or PHP level of care on that first day, they meet a series of people. They start by signing all their paperwork with the admissions team, and then they usually meet with me, the medical provider, first. They may also meet our psychiatrist, but typically, I am the first point of contact. We meet for about an hour, and I complete their full history and physical assessment. We talk about their medical, psychiatric, and treatment history and their medications; it is a full exam.
Next, they’ll meet with their dietitian to discuss their meal plan, food allergies, and food likes and dislikes. We ask them to recall what they ate in the past 24 hours before they arrived, which gives us a jumping-off point. Then, they also meet with their clinician, who does the biopsychosocial exam, which is usually 90 minutes of talking about more in-depth traumas, their mental health history, and their eating disorder history. It is a busy first day as they meet with their whole clinical and medical team.
Sanford: Do eating disorder residents have an individual therapist who goes with them through the process?
Hilary: Yes. They are assigned a therapist and a dietitian, who are the primary providers within the multidisciplinary team. These individuals will be with them throughout their treatment care as they step down to outpatient therapy.
Sanford: How often do you see patients while they are here?
Hillary: Residential patients meet with their medical provider, dietitian, and individual therapist at least twice a week. In day programs (PHP), it is once a week for all three. During those follow-up visits, they discuss their mood, anxiety, sleep patterns, and medications, including how they’re working for them, side effects, and other related issues. Our PHP patients commute if they live close enough (day programs run Monday through Friday with a weekend break). We also have supportive housing on-site for those who live a distance away or feel the need to leave their home environment for a time.
Sanford: We are collaborating with the RightCare Clinic in Grand Rapids; how is that going?
Hilary: Great. I actually sent someone there this week. We can efficiently transport our patients to them and communicate directly. Staff at RightCare (RCC) are mindful of our clients not wanting to be weighed or bound to their weights, and they’re cognizant of all the other nuances that go along with eating disorder care. They know what we want as far as orthostatic vital signs. RCC is in between emergent care and an emergency department, so if something comes up with a client while in our care, like an asthma attack, we can control that situation. So, they’re more in tune with the needs of our clients because we have a direct relationship with them.
Sanford: We talk about being “psych-first” at Sanford; what does that mean to you?
Hilary: I would say that Dr. Bhandari, our psychiatrist, is a really important member of the Sanford multidisciplinary team. He is a great resource to have as a collaborator and my go-to person when there are more complex psychiatric medications like polypharmacy going on. However, as a psych mental health NP who specializes in eating disorders, I certainly feel comfortable managing a lot of the medical comorbidities and the psychiatric comorbidities that go along with that particular set of diagnoses.
Sanford: How did you get into this line of work, and have you always specialized in eating disorders?
Hilary: In college, I majored in psychology because I was fascinated by mental health and the way that the brain worked. I then went into nursing. When I got my first job as a nurse practitioner, I worked as a floor nurse in the pediatric unit at Beaumont in Royal Oak, Michigan. We would get all of their eating disorder patients who came in for inpatient stabilization. Because they were often in inpatient for a week or longer, I was able to build a rapport with them and their families. Working with eating disorder patients, I found out I had a passion for mental health and decided to go back to get my psych NP.
Sanford: Could you talk about the continuum of care at Sanford Comprehensive Treatment for Eating Disorders?
Hilary: The continuum is very important. It always worries me when we have patients who come to residential treatment and, because of prior obligations, do not step down to the other levels of care. Because the step-down approach is evidence-based and helps prevent relapse in eating disorders and addiction. Residential treatment gives them a great foundation to recover. However, if they are discharged home without any real simulation of how to handle stressors while managing their meal plan and attending therapy without the cocoon of residential treatment, they can relapse.
Day programs (PHP) help them assimilate a support environment while they experience the stressors and triggering experiences of home life. So, it is crucial that they go through all the steps, from residential to PHP to intensive outpatient therapy (IOP). The full continuum allows them to get support from the treatment team while living at home and dealing with the stressors. All the evidence supports that it’s important for relapse prevention. We have a flexible IOP schedule in the morning and evening. It puts structure in the day.
Sanford: From your perspective, what do we do well at Sanford?
Hilary: Well, we are the trailblazers paving the way in Michigan for adult residential treatment and eating disorders. So, of course, there will be bumps along the way as we figure out what works and what doesn’t. We have had some really successful clients leave Sanford and make significant improvements in weight restoration. I think that speaks to our ability to carefully monitor our clients and get them on their nutritional rehabilitation.
Restoration is really important for those who restrict nutrient intake. The key to recovery is rapid weight restoration as fast and safely as possible. The longer an eating disorder lingers, the more rigid the patterns of thinking and disordered behaviors become in the brain, especially as adults. At Sanford, we do a great job of monitoring the medical situation as far as their electrolytes, making sure that they are getting all the vitamin and mineral replacements that are key to preventing the refeeding syndrome, which is a very serious complication of eating disorders.
Our clients say that we do a really good job in the group setting, and I think they benefit from group therapy. The milieu can be therapeutic in a way that meets clients’ needs more than we can do as individual providers.
ย For patients with bigger bodies, we do really well at regulating their meal plans and helping them work on their relationship with food and their bodies. Our goal is not weight loss because we know that it can be really triggering if you have an eating disorder, no matter what end of the spectrum you’re on.
Sanford: What is the fun part of your job?
Hilary: I really love it here. For the first time in my career, I feel fulfilled as a nurse practitioner. Mental health is where I want to be; it’s the thing I’m most passionate about. Also, seeing clients make significant improvements in their weight and become more accepting of their bodies over time is really fulfilling. Not to be cliche, but it is rewarding to be part of that journey with clients. It is intimate and vulnerable, so I feel privileged to be able to participate in their care.
My favorite thing about working at Sanford is the team component of eating disorders. I have a multidisciplinary team where I collaborate with the dietitian, psychiatrist, and therapist. We periodically discuss patient cases in eachย other’s offices.ย We’re collaborative because we don’t all know what the clients are sharing with each of us.
Sanford Behavioral Health Campus
Sanford: The challenging part of being a psychiatric mental health NP?
Hilary: When patients cannot continue treatment because of work and family obligations, that’s a challenge because it’s disruptive to their continuation of care, and it worries me as far as relapse prevention.
Sanford: Could you speak about co-occurring disorders?
Hilary: Treating co-occurring disorders is another unique aspect of Sanford. One of the biggest issues in Michigan is access to healthcare. So, if a patient has a dual diagnosis, they get treatment for whatever is the priority at the time. Because of our campus concept, we have the opportunity to treat eating disorders and other mental health conditions. No matter what program you are in, you can step across the facility and get the secondary service. You don’t have to readmit or do research and then leave the facility and drive somewhere else. It makes treatment a lot more accessible to clients!
Sanford: Finally, what is your take on recreational therapy in eating disorder treatment?
Hilary: The recreational piece is a key component of recovery because we know that treatment can be very fatiguing, both mentally and physically. Recreational therapy is a therapeutic way for clients to take a break from talking about food and body and give their minds an opportunity to become creative. They can focus on breathing and being in tune with how their body feels, which is an important part of recovery, too.
So, mindful movement, artistic creativity, and even therapeutic screams are important parts of our treatment here. Recreational therapy contributes to a patient’s overall experience. They might look back and remember those experiences more than the topics discussed in group therapy.
Thanks, Hilary!
