America is suffering a mental healthcare crisis. The Steinberg Institute reports that two-thirds of primary care physicians are unable to find mental and behavioral health specialists to accept their patient referrals. In addition, the research reveals that 77 percent of US counties face a severe shortage of psychiatrists—and 55 percent have none at all.
In some states, the decrease in the number of working psychiatrists has been especially rapid, a trend that predates the COVID-19 pandemic. Maine, for one, experienced a 50 percent decline in the number of psychiatrists from 2015 to 2020, leading to a critical shortage of providers and leaving patients waiting up to a year and a half to see a clinician.
With an already stressed healthcare system, the US also faces both a large and aging Boomer population. This group may increase its demand for psychiatric services as it ages, but, more alarmingly, the trend portends the imminent loss of the 70 percent of practicing psychiatrists who are aged 50 and older. Without a significant increase in the number of psychiatry students completing their training and entering the workforce, the demand for psychiatrists could outstrip supply by 25 percent by 2025.
A greater reliance on psychiatric mental health nurse practitioners could mitigate these challenges. "In the context of our current untenable access to and delivery of mental health services in the United States, psychiatrists need to embrace, support, and collaborate with psychiatric-mental health nurse practitioners (PMHNPs), who already provide a significant percentage of psychiatric treatment here," says John J. Miller, MD, editor in chief of Psychiatric Times. Expanding state approval of full practice environments and utilizing the skills of psychiatric mental health nurse practitioners in a variety of settings—including traveling PMHNPs and those providing telehealth services—will help ensure that people seeking mental healthcare, particularly in rural areas, have the access they need.
If you’re interested in addressing the mental healthcare crisis in America and wondering about the types of psychiatric mental health nurse practitioner jobs now available, this article provides some answers. It also covers:
A psychiatric mental health nurse practitioner (PMHNP) is an advanced practice registered nurse (APRN) who provides mental health services and has earned state licensure and ANCC certification to practice. PMHNPs assess, diagnose and treat patients with chronic and acute mental health problems. Many PMHNPs also offer therapy and prescribe medications for patients with mental health disorders or substance abuse issues.
Psychiatric mental health nurse practitioners are healthcare professionals who offer behavioral health patient care. They are licensed to provide psychosocial and physical assessments, design treatment plans, prescribe and oversee medication management, and direct wellness and patient care for the duration of treatment. PMHNPs also can provide educational services to families and communities and offer individual and group therapy to patients in both inpatient and outpatient settings.
Some states allow these advanced practice nurse practitioners to operate autonomously, while others require the supervision of a psychiatrist. Specific certification requirements and practice restrictions vary by state.
From 2021 to 2031, the US Bureau of Labor Statistics (BLS) forecasts a 46 percent growth in the employment of nurse practitioners (there are approximately 355,000 NPs and 4.7 percent of them have their primary certification in psychiatric/mental health). PMHNP jobs command high salaries, too (there’s more on that below).
PMHNPs practice in clinical settings like psychiatric hospitals, substance abuse treatment facilities, and health centers or in non-clinical settings like schools and correctional facilities. Job types include positions as full-time and part-time employees, independent contractors in both inpatient and outpatient settings, and clinicians in private practice.
During the height of the Covid-19 pandemic, many psychiatric mental health nurse practitioners utilized telehealth to provide services and found that using telemedicine not only helped them reach patients they couldn't visit in person but also gave practitioners a better work/life balance by allowing a more flexible schedule. As a result, some now work exclusively as remote psychiatric mental health nurse practitioners and provide their services through telepsych therapy sessions.
The national average salary for the psychiatric mental health nurse practitioner job title is around $147,000. Salaries in all states exceed six figures.
Some states pay PMHNPs better than others. ZipRecruiter lists the top ten as:
The lowest paying states include Alabama, Kansas, Mississippi, Florida, Georgia, and Louisiana, with salaries ranging from around $119,000 down to $105,000.
Traveling psychiatric nurse practitioners report pay similar to their fixed-location colleagues, particularly in some states with difficult to reach rural populations, such as:
Psychiatric mental health nurse practitioners are needed everywhere, but some cities offer PMHNP salaries high above the national average. This list includes:
Of course, the cost of living is high in many of these cities and metropolitan areas, so these expenses are reflected in the higher pay.
Since PMHNPs must closely observe patients with complex mental health disorders to appropriately and effectively treat them, they’re required to be skilled in social perceptiveness and the workings of human emotions and development. They must possess high-quality listening and interpretive skills and be able to focus on a patient's unique symptoms and concerns. Their heightened problem sensitivity and inductive and deductive reasoning skills help them diagnose complex physical and mental symptom presentation. PMNHPs are keen critical thinkers and creative problem solvers, enabling them to monitor and rework treatment plans and medications as a patient's needs change.
PMHNPs also possess excellent reading comprehension and writing skills to interpret and contribute to written records and documentation. They’re good at time management and use their work time efficiently, and their sharp communication skills keep clients and their families current with treatment plan updates. And they have to be organized to meet their varied work schedule, particularly for traveling mental health nurse practitioners who work in multiple locations with a diverse roster of clients.
Each state imposes specific licensing requirements, but all require PMHNPs to hold a Master of Science in Nursing (MSN) and an APRN license. They also mandate undergoing at least 500 supervised clinical hours in an accredited PMHNP nursing program, completing required licensing-specific coursework (advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology) and training in at least two areas of psychotherapy. There are MSN programs, like the one offered at Yale's School of Nursing, that specifically prepare students for a career as a psychiatric mental health nurse practitioner.
PMHNP certification is called the Psychiatric Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) and is administered by the American Nurses Credentialing Center (ANCC). The certification exam assesses PMHNP clinical skills and knowledge, and must be renewed every five years.
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