28 August 2023
At first, Adejoke Adedeji’s decision to become a nurse felt like a means to an end, a steady day job that would fund her dreams of becoming a writer.
“Being the daughter of Nigerian immigrants,” she laughed, “I knew a ton on nurses.” She’d tried other careers for a few years after earning her bachelor’s degree at Concordia University in St. Paul, but eventually decided to take what she saw as a more “straightforward” approach and attend nursing school in Georgia, where she eventually became an RN with a focus in psychiatric care. The decision, she told herself at first, was simply practical: “I did not intend to fall in love with nursing. I thought I would use the nursing profession to help give me stability and I would continue with creativity on the side.”
But once she started working as a nurse, Adedeji’s perspective expanded. She saw the significant impact that she had on the lives of her patients — and her focus on psychiatric nursing felt particularly important to supporting the health of the larger community.
Adedeji had a personal understanding of the impact of mental illness. “I lost my 15-year-old cousin to suicide in May of 2010,” she said. This experience was devastating to her family. Then, just a few months later, her youngest brother died suddenly from a heart defect. The way the outside world reacted to each loss illustrated the real need for culturally informed mental health support.
After her cousin’s death, Adedeji recalled that many members of the Twin Cities’ close-knit Nigerian community steered clear of her family.
“Because it was a suicide they weren’t supportive at all,” Adedeji said. “A lot of Nigerians are traditionally religious. They talked about things like, ‘She’s going to hell.’ It was very upsetting to me and my cousins.” The experience, she explained, left a mark. “It was all very traumatizing.” Her cousin’s family, she said, “didn’t get the support that I think they should have.”
In contrast, the response to Adedeji’s brother’s death was different. “There was more outward support,” she said. “However, there were still people who attributed his death to a superstition. There were a lot of insensitive things that were said. Some people acted like it was a disease and they are going to catch it.”
This experience, Adedeji said, illustrated a clear need for more understanding in the Nigerian community about mental illness and its treatments. “I got to see how ill-equipped as a community we are to handle these things. There were very few people out there who knew the community and really understood mental health treatment.” At the time she didn’t realize that one day she would be able to fill that need.
Hanging up her shingle
Not all career paths follow a straight line. For a while after earning her nursing degree, Adedeji turned her focus away from mental health.
“While I was in nursing school,” she said, “I shadowed someone at Children’s Health Care in Atlanta and I fell in love with the NICU. I just loved taking care of babies so there was a little bit of a detour.”
But that detour was short-lived. A few years after graduation, Adedeji spoke with a former nursing school professor who said that while taking care of babies and their families had been a good break, Adedeji was likely missing her true calling.
“The professor joked with me,” she recalled, “‘Babies don’t talk. You like to talk to people. I see you having a bigger impact in a different kind of role.’”
Adedeji took the advice to heart. “I always knew I would go on to get a master’s and become an advanced practice nurse,” she said. “At one point someone asked me, ‘Why don’t you do psych?’ I was like, ‘Duh. That’s a perfect fit for me.’ After that, the work was like second nature.”
The decision to go back to school to become a psychiatric nurse practitioner felt natural, like something Adedeji should’ve been doing all along. “Because Nigerians especially value education,” she said, “I knew that the more education I had I would have more credibility when I spoke to people who had some different ideas on how to support or not support people with mental health concerns.”
Minnesota is one of 26 states that allow nurse practitioners to operate independent practices without a supervising physician. In September 2019, this designation inspired Adedeji to open Nexus of Hope, a Lakeville-based mental health clinic offering a range of services, including talk therapy, transcranial magnetic stimulation (TMS), medication management, medication assisted treatment for substance use disorder, and meditation and lifestyle change guidance.
Nexus of Hope started as a one-person office, but the practice grew quickly, despite the fact that it opened only months before the global pandemic hit. “I thought it would take a while to build up a caseload, but within a few weeks I was busy.,” Adedeji said. “I moved into a bigger space.”
The busy practice, which Adedeji said is likely the only group practice in the state run by a nurse practitioner of color, now employs four psychiatric nurse practitioners, offering a mix of virtual and in-person care. Even with this expanded team, Adedeji said she struggles to meet community need: “We would like to have more staff but as you know there is a shortage of mental health providers. We are trying to be more efficient and figure out more ways to recruit talented staff.”
Nexus of Hope’s more than 600 patients come from a range of cultural backgrounds, though its founder’s personal history means that a good number have connections to the Nigerian community.
“I do have several Nigerian patients who, because of that shared background, find working with me more effective than working with someone else,” Adedeji said. Community attitudes about mental illness impact several parts of her practice. Take patient privacy concerns, for instance: “Unfortunately, some people in a lot of immigrant cultures do not want to see someone from their own culture because immigrant communities are small,” Adedeji said. “They say they don’t want someone in the community to know about them getting mental health care, and they are afraid that a Nigerian provider might speak about their case to others, even though there are HIPAA laws.”
This perspective means that some community members resist treatment for mental illness, Adedeji said. That can lead to late or delayed treatment, and even to serious crisis. She’s trying to spread the word that seeking care for mental illness is no different than seeking care for physical illness.
“There is still heavy stigma around mental health treatment,” Adedeji said. “Many people are very secretive about it, which can be dangerous.”
She hopes that her family’s deep connections in Minnesota — and stretching back to Nigeria — will help encourage community members to get the help they need. “A lot of my parents’ friends here all went to the same Baptist church in Nigeria,” Adedeji said. “They were in the same youth group. Because of that, I’ve really been able to speak to that group of people. I am trying to connect to members of this community, normalize these conversations and open up avenues.”
Whole-person approach
To the outward-focused Adedeji, the patient-focused approach to health care taught in nursing school feels natural. Taking time to look at each patient as an individual and to collaboratively work with them to find the mental health treatment that best fits their needs made sense. To her mind, this is the best way to practice psychiatric medicine.
“I like to help people find solutions to issues in a collaborative manner,” Adedeji said. This approach also gives her the ability to use her creative brain. “In nursing I might not get to be a creative writer, but I am able to flex my out-of-the-box thinking muscles to help patients solve different issues.” Through this aspect of her work, she said, “I fell in love with being able to really address helping a person holistically, and not just be focused on the disease process.”
This individualized approach to patient care extends to treatments, including psychiatric medications, Adedeji explained. She strives to find the treatment courses that work best for each patient, rather than follow the course favored by other health care providers. One example is benzodiazepines, a common anxiety medication that has fallen under scrutiny in recent years for its risk of misuse.
“I’ve had patients who have successfully used benzos for decades, and sometimes they’ve ended up in the ER for something unrelated and a provider who doesn’t know them has said, ‘We’re going to take you off this benzo. You shouldn’t be on it,’” she said. “I am more open to listening to the patient, taking a deeper look at their history and understanding what’s working for them.”
Adedeji doesn’t think that psychiatric nurse practitioners are necessarily better than other providers at treating people with mental illness. “There are good doctors and there are bad doctors,” Adedeji said. “It’s just that nursing’s more holistic approach is different and it can work really well, especially with mental health care. I really like being a nurse. I like that approach to patient care, and I think my patients appreciate it, too.”