The Role of Psychiatric Nurse Practitioners in the U.S. Mental Health Landscape
The United States is grappling with a significant mental health crisis. With rising rates of anxiety, depression, and other mental illnesses, the demand for mental health services has never been higher.
In this context, nurse practitioners, particularly Psychiatric Mental Health Nurse Practitioners (PMHNPs), are stepping up to fill the critical gaps in care. Their unique position in the healthcare system allows them to offer accessible and affordable mental health services to their diverse populations.
In this article, we discuss the U.S. mental health crisis and spotlight the role of PMHNPs in mental health care delivery.
Understanding the Mental Health Crisis
The mental health crisis in the US is multifaceted and complex. According to the National Institute of Mental Health (NIMH), nearly one in five adults in the United States lives with a mental illness.
Despite the high prevalence of mental health issues, access to mental health care remains limited due to a shortage of mental health professionals and a range of societal and systemic barriers. This gap in care results in many individuals not receiving the treatment they need, exacerbating the severity of their conditions and leading to a cascade of negative social, economic, and health outcomes.
Societal factors such as economic instability, social isolation, and the ongoing impacts of the Covid-19 pandemic have further strained mental health resources. In addition, a stigma surrounding mental health continues to be a significant challenge, preventing many individuals from seeking help.
Public education and advocacy are essential in changing perceptions and encouraging more people to access mental health services, thus addressing the crisis more effectively.
The Role of Psychiatric Nurse Practitioners
What is a PMHNP?
A Psychiatric Mental Health Nurse Practitioner (PMHNP) is a registered nurse with advanced practice training in psychiatric and mental health care. PMHNPs work in various settings, including hospitals, clinics, private practices, community health centers, and telehealth.
According to the American Association of Nurse Practitioners (AANP), the role of the PMHNP is to assess, diagnose and treat the mental health needs of patients. Many PMHNPs provide therapy and prescribe medications for patients who have mental health disorders or substance abuse problems. PMHNPs may also provide physical and psychosocial assessments, emergency psychiatric care and treatment effectiveness evaluations.
PMHNPs are also trained to understand the complex interplay between physical and mental health. This dual focus enables them to provide care that addresses the holistic needs of their patients, considering both psychological and physiological aspects of mental health conditions. This comprehensive approach is particularly beneficial in managing chronic conditions that have both physical and mental health components.
Scope of Practice
PMHNPs can play an important role in the mental health landscape. Their scope of practice includes:
Assessment and Diagnosis: Conducting thorough assessments to diagnose mental health conditions. This involves taking detailed patient histories, performing mental status examinations, and utilizing diagnostic tools.
Treatment Planning: Developing and implementing individualized treatment plans that may include medication management, psychotherapy, and lifestyle modifications. PMHNPs work collaboratively with patients to create tailored plans that address their unique needs and goals.
Crisis Intervention: Providing immediate care and support during mental health crises. This can involve de-escalation techniques, emergency medication management, and coordination with other healthcare providers.
Education and Advocacy: Educating patients and their families about mental health conditions and advocating for mental health awareness and resources. PMHNPs often engage in community outreach and public health initiatives to promote mental well-being.
Additionally, PMHNPs can engage in research and policy advocacy to advance the field of mental health care. Their insights from clinical practice inform evidence-based practices and contribute to shaping mental health policies that better serve populations in need.
Nurse Practitioners and the Mental Health Care Landscape
Nurse Practitioners, along with psychiatrists and modern virtual care services, offer a range of solutions for improved health care delivery.
For deeper insight into their role and the mental health care landscape, we spoke to the leadership team at UpLift, a virtual mental health care company that aims to increase access by removing barriers between therapists, psychiatrists, and payers.
We also received insight from Dr. Yavar Moghimi, Chief Psychiatric Medical Officer at AmeriHealth Caritas District of Columbia.
Increased Access to Care
One of the most significant benefits of PMHNPs is their ability to increase access to mental health care. With the shortage of psychiatrists, PMHNPs help bridge the gap, especially in underserved areas. They can work independently in many states, providing much-needed care in both rural, non-urban, and urban communities.
By offering services in diverse settings, from community clinics to telehealth platforms, PMHNPs can make mental health care more accessible to those who might otherwise face barriers to receiving treatment.
Nurse Practitioners and the Healthcare Workforce Shortage
There are over 300,000 licensed nurse practitioners in the U.S. NPs are the fastest-growing occupation in the country, and their numbers are expected to increase by 45% by 2032.
This fact makes NPs well-positioned to fill some of the gaps created by an ongoing shortage of healthcare professionals.
Dr. Yavar Moghimi, Chief Psychiatric Medical Officer at AmeriHealth Caritas District of Columbia, is a collaborating physician in the Zivian network and frequently meets with nurse practitioners to “review cases, offer guidance, and share studies and educational materials.” He views psychiatric NPs as a necessary and important part of mental health care delivery.
Regarding the healthcare worker shortage, Dr. Moghimi says that, given the current state of the healthcare workforce, there are only a few viable solutions to the physician shortage.
“There are only a few different types of providers with the necessary training to address this shortage, and psychiatric nurse practitioners are one of them,” said Moghimi. “With the right supervision and mentorship, they can certainly be part of the solution. I often tell psych NP students that they should have no problem finding employment after they graduate, as the need for behavioral and mental health services is immense.”
Nurse Practitioners and Collaboration
Kathleen Coughlin, Senior Director of Clinical Services & Quality Assurance at UpLift Health, a virtual mental health care company that aims to increase access, says that PMHNPs can certainly play a role in increasing access to care. At UpLift, NPs provide support as a critical element of care teams.
“Nurse practitioners commonly play an important role in our patient care teams,” said Coughlin. “They can help meet the needs of our patients in regard to diagnosis, assessment and treatment. If a patient meets with a psychiatrist, they may then move on to being treated by the nurse practitioner that is working with the psychiatrist.”
Julian Cohen, UpLift’s Chief Clinical Services Officer, adds that psychiatric nurse practitioners can also help solve some of the difficulties of staffing psychiatrists.
“Psychiatrists can be difficult to recruit for and maintain long-term, and psychiatric nurse practitioners have stepped up to fill some of that void. Psychiatrists have additional skill sets, but NPs and psychiatrists working together as a care team make a big difference in our ability to support the entire continuum of patient acuity.”
“Now patients can virtually visit with their family doctor, their psychiatrist, a nurse practitioner — telehealth offers a more comfortable and private environment for them.””
Telehealth
Telehealth is the use of technology to deliver remote healthcare services and improve healthcare. This includes virtual consultations, remote monitoring, and other digital healthcare solutions.
Telehealth services have dramatically expanded since the Covid-19 pandemic – according to the Global Wellness Institute, the global telehealth market is expected to reach $559.52 billion by 2027. Nurse practitioners are often on the front lines of these services.
The expansion and normalization of telehealth services empowers psychiatric nurse practitioners, physicians, and other providers to extend their reach beyond traditional clinical settings. By offering virtual consultations, they can provide services to patients who might otherwise struggle to access health care. This proactive approach can lead to early detection and management of chronic conditions, enhanced continuity of care, and timely intervention in emergencies, ultimately improving health outcomes.
Regarding the benefits of telehealth services, Cohen said, “Telehealth provides an overarching additional access to services that can often be difficult to reach. But besides just access, it also allows the patient the opportunity to potentially find a provider that is a better fit for them than what might be available within a reasonable driving distance.”
In fact, UpLift pride themselves on providing their patients an additional layer of flexibility in selecting the right provider.
“One of the things that UpLift does really well is the matching process,” added Cohen. “We try to understand what the patient needs up front and help to give them choices of providers that are likely a good fit for them.”
In fact, UpLift’s reported “rematch rate” – the frequency at which a patient requests a different provider than the one they were originally matched with – shows that the patient-provider matching process afforded by virtual care reliably results in very satisfied patients. UpLift’s rematch rate is “well under two percent” according to Cohen.
In addition, Coughlin mentions that as telehealth services have become more common, more patients have become comfortable with the notion that they can receive adequate care through virtual platforms.
“The comfort and privacy of receiving care at home has removed barriers for those who may not have sought mental health services in the past,” said Coughlin. “As these services have become more normal — now patients can virtually visit with their family doctor, their psychiatrist, a nurse practitioner — telehealth offers a more comfortable and private environment for them.”
Efficiency and Cost-Effectiveness
Cost-effectiveness and efficiency is a critical element of effective healthcare service. It is particularly important in the current landscape, where budget constraints, rising costs, and difficulties with insurance payers are significant concerns.
Generally speaking, NPs provide care at a lower cost compared to physicians. A 2024 study in the American Public Health Association (APHA) journal Medical Care found that the average primary care physician cost of care is 34% higher than a primary care nurse practitioner in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum.
The affordability of PMHNP services can reduce the financial barriers that prevent individuals from seeking mental health care. By offering cost-effective care, PMHNPs can contribute to the overall sustainability of the healthcare system, ensuring that more people can receive the mental health services they need without financial strain.
The World of Health Insurance
Health insurance is often another barrier to cost-effective mental healthcare.
Dr. Yavar Moghimi also cites a study by the Journal of the American Medical Association (JAMA) that found the percentage of psychiatrists who accept private insurance is significantly lower than the percentage of physicians in other specialties (55.3% vs 88.7%). Similar disparities were also found for public insurance programs like Medicare and Medicaid.
Companies like UpLift Health strive to ease the difficulties associated with insurance. By leveraging virtual care services, patients can easily see a nurse practitioner or psychiatrist of their choice without overpaying.
“Something that is sometimes overlooked is that a large percentage of mental health providers have historically not taken insurance,” said Cohen. “Everything from getting in the network, all the paperwork, credentialing – we provide patients with an easy way to find providers in their network, and we offer providers an easier path to see those patients without the hassle of dealing with the paperwork, claims, etc.”
It is clear that there is not just one solution to the current mental health crisis – a variety of solutions must function together to produce a more efficient, cost-effective, and patient-centered mental health care system.
Challenges Faced by Nurse Practitioners
Regulatory Barriers
Despite their extensive training, PMHNPs face regulatory barriers that limit their practice in some states. These barriers include restrictions on prescribing medications and the requirement for collaborative physicians.
Moreover, regulations across states can vary widely, creating challenges for PMHNPs who wish to practice in different regions or provide telehealth services across state lines.
Companies like Zivian Health exist to guide nurse practitioners through the complex landscape of state regulations and collaboration compliance, providing them with the collaborative agreements and compliance tools they need to deliver care to populations in need.
Stigma and Misconceptions
Stigma surrounding mental health and misconceptions about the role of nurse practitioners can hinder their ability to provide care. Public education and awareness campaigns are essential to address these issues and promote the acceptance of PMHNPs as primary mental health care providers.
By challenging stereotypes and increasing awareness, we can create a more supportive environment for individuals seeking mental health care.
Additionally, educating other healthcare providers about the role and capabilities of PMHNPs can foster greater collaboration and integration within the healthcare system. Building a more inclusive and understanding healthcare environment benefits both providers and patients, enhancing the overall quality of care.
Real-World Impact
Rural Mental Health Care
Rural America has arguably been affected most by the mental health crisis – rural areas often deal with a wider range of social, economic, and workforce challenges than urban areas.
In a piece for the Journal of the American Psychiatric Nurses Association titled “Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges,” Brooke A. Finley, PMHNP-BC, says, “general rural communities’ problems like poverty, homelessness, social stigma, low health insurance rates, long travel distances, and lack of public transportation services make these populations difficult to serve, creating low incentives for rural clinics to provide mental health services.” According to Mental Health America (MHA), 65% of rural counties do not have a psychiatrist, and 81% of rural counties do not have a psychiatric nurse practitioner.
It is in rural America, however, that PMHNPs have perhaps the largest opportunity to make an impact. PMHNPs increased by 134.1% compared with 14.9% for psychiatrists between 2013 and 2019, and they are beginning to establish mental health services in these underserved areas in increasing numbers – nurse practitioners constituted 25.2% of providers in rural practices in 2016, compared to 17.6% in 2008, according to a study published by the National Center for Biotechnology Information.
The potential of PMHNPs in rural areas is transformative. With appropriate resources and policy support, PMHNPs can significantly address disparities in rural mental health care access.
Integrating PMHNPs in Schools
Some schools have integrated nurse practitioners to address the mental health needs of students. For example, New York Public Schools have offered School-Based Health Centers within New York City since the 1990s.
In school-based care, nurse practitioners provide on-site health services, reducing the barriers to care for students and helping to create a supportive school environment.
Furthermore, integrating PMHNPs into school settings can provide early intervention for mental health issues, preventing them from escalating into more severe conditions. Early detection and treatment are crucial for promoting long-term mental health and academic success among students.
Future Directions and Recommendations
Expanding Education and Training
To meet the growing demand for mental health services, it is essential to expand education and training for PMHNPs. Increasing the number of training programs and providing incentives for students to pursue careers in psychiatric nursing can help address the shortage of mental health professionals. This expansion can include opportunities for continuing education and specialization to ensure that PMHNPs remain at the forefront of mental health care advancements.
Additionally, fostering partnerships and preceptorship programs between academic institutions and healthcare organizations can enhance the training and clinical experience of PMHNP students. These collaborations can create a pipeline of well-prepared practitioners ready to address the mental health needs of diverse populations.
Collaborative Care Models
Promoting collaborative care models that create less friction for NP-Physician collaboration and integrate PMHNPs with other healthcare providers can enhance the quality of mental health care. In states with restrictive regulatory structures, collaborative models encourage teamwork and communication among providers, leading to comprehensive and coordinated care for patients, many of which live in underserved areas. By working together, healthcare providers can address the multifaceted needs of patients more effectively.
Collaborative care models also facilitate the sharing of knowledge and best practices among providers, contributing to continuous improvement in mental health care delivery. Implementing these models can create a more integrated and patient-centered healthcare system, ultimately improving mental health outcomes.
Conclusion
Nurse practitioners, particularly PMHNPs, play a vital role in addressing the mental health crisis in the US. Their ability to provide high-quality, cost-effective, and holistic care makes them indispensable in the current healthcare landscape.
By expanding their education and training, advocating for policy changes, and promoting collaborative care models, we can leverage the full potential of PMHNPs to improve mental health outcomes across the country.
As we continue to confront the mental health crisis, it is clear that nurse practitioners are not just filling gaps—they play an important role in shaping the future of mental health care. Their dedication, expertise, and patient-centered approach are essential components in the ongoing effort to create a more accessible and effective mental health care system for all.
How Zivian Health Supports Psychiatric Nurse Practitioners
Zivian Health connects nurse practitioners to a team of reliable physicians to form long-term collaborations. Finding you an excellent collaborator is where we begin, but we also manage all the elements of collaboration compliance and quality so that you can focus on patient care.
The Zivian platform offers collaboration agreement storage, secure messaging and chart review features, a continually updated database of state regulations for Physician-APP collaborations, and creates an audit trail for all collaboration activity.
Don’t navigate the landscape of healthcare compliance alone. Connect with our team and get started today!
