How Psychiatric Nurse Practitioners Have Taken Charge Against an Unseen Epidemic
The percentage of people in the U.S. who don’t get the mental illness treatment they need continues to grow. More than half of those with mental illness – more than 27 million Americans – are going without treatment, according to the 2022 State of Mental Health in America report from Mental Health America (MHA).
Meanwhile, in the face of continued provider shortages, some are noting a surge in numbers of psychiatric mental health nurse practitioners (PMHNPs) that may be instrumental in meeting these needs.
Addressing the demand for mental health care
“Mental health access is a public health crisis, only worsened by the COVID-19 pandemic. While demand for mental health treatment is soaring, provider supply is actually dropping among psychiatrists, particularly in rural areas,” says Michael L. Barnett, M.D., the author of a study on psychiatric provider populations, in an article published by Fierce Healthcare.
“We need new solutions. Psychiatric mental health nurse practitioners are an important part of the mental health workforce that has received relatively little attention in mental health policy,” he says.
The number of psychiatric mental health nurse practitioners treating Medicare beneficiaries more than doubled from 2011 to 2019, according to the study published in the journal Health Affairs, while the number of psychiatrists declined six percent. Some experts are now advising ways to best make clinical use of these specialized professionals.
“The extent to which PMHNPs can meaningfully address the demand for mental health care depends on a variety of factors,” according to JAMA Network invited commentary by Ulrike Muench, Ph.D., M.S.N., and Taressa K. Fraze, Ph.D. They continue:
“First, the growth of this workforce in the coming years is an important factor. The analysis by Oh et al estimated that approximately 9,917 PMHNPs participated in Medicare Part D in 2019, compared with 29,711 psychiatrists, with an annual growth rate of PMHNPs billing Medicare of between 1% and 3%. Strategic investments in increasing the PMHNP workforce should be considered as an approach to improving access to mental health services.
“Second, it will be key for states to implement full practice authority for nurse practitioners. Only if PMHNPs can provide comprehensive mental health care without needing to rely on physician collaboration and supervision even for basic mental health services will the full potential of this workforce be realized. A wealth of research has assessed the quality of care provided by NPs, including PMHNPs, with studies demonstrating improved access and care outcomes when states implemented full practice authority, including improvements in access to mental health services and mental health outcomes.
“Third, it is critical that PMHNPs be optimally integrated within primary care. Careful consideration should be given to determine how primary care practices can best capitalize on the clinical expertise of these specialized clinicians.”
A holistic approach to mental health
How psychiatric mental health nurses may integrate in clinical settings depends on several factors. The scope of their practice is defined by their education and training as well as their state practice regulations, according to the American Psychiatric Nurses Association (APNA).
Psychiatric nurses may be registered nurses (RN) or advanced practice registered nurses (APRN). Advanced practice registered nurses have advanced degrees, certification and licensure that allows them to offer many of the same services as psychiatrists.
“The additional education, clinical experience, and training allows APRNs to assess, diagnose, and prescribe medication; provide integrative therapy interventions, psychotherapy, consultation and liaison services; oversee case management; undertake policy development for programs and service offerings; and actively engage in comprehensive advocacy education and research efforts,” according to an informational report by APNA.
When it comes to helping patients treat mental health disorders, psychiatric mental health nurses may take a role in:
Scheduled counseling – Psychiatric-Mental Health Advanced Practice Registered Nurses may see patients in a wide variety of settings. According the APNA report, these may include hospitals, primary care settings, clinics, schools, via telemedicine, in public health facilities, and in private practice.
Leading conversations about mental health – Since the nursing process informs a psychiatric mental health nurse’s approach, they are often well-qualified to lead helpful conversations in a patient’s best interest.
“PMH nurses are educated and receive clinical training to deliver effective psychotherapeutic interventions, such as behavioral activation which guides patients to feel more empowered. It’s not only important for PMH nurses to deliver the right response to a patient, but also to deliver it in the right tone of voice, volume, and body language necessary for that particular patient. Therapeutic communication is an important part of numerous PMH nursing tools, including teaching coping skills and problem-solving techniques. This nurse-patient relationship has a significant impact on healthcare outcomes,” according to the APNA report.
Prescribing medication – Some psychiatric nurses may prescribe medication in the course of mental illness treatment.
“All 50 states permit APRNs some level of prescribing authority. 21 states and the District of Columbia allow APRNs to diagnose, treat, order diagnostic tests, and prescribe medications to patients without physician oversight under the licensure authority of the state board of nursing. Seventeen states limit APRN scope of practice and 12 states severely restrict nursing scope of practice regulations,” according to the APNA report.
Continuing into the future
Policy will continue to shape around these issues as registered nurses and advanced practice registered nurses continue to enter the field to meet urgent and growing psychiatric mental health needs.
“PMHNPs are a rapidly growing workforce that may be instrumental in improving mental health care access’ according to the authors of Health Affairs study. They suggest that that, “PMHNPs may fill the widening gap between supply of and demand for mental health specialists with prescribing privileges.”
“People with mental health or substance use problems have the same hopes, desires, and dreams that everybody else does,” says Susie M. Adams, 2019 APNA Psychiatric Nurse of the Year, on the APNA website. “If we focus on helping people have productive, meaningful lives and being part of a community and giving them a purpose – that to me gives more satisfaction than anything.”
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