Even before the COVID-19 pandemic, the mental healthcare service providers who manage America's psychological treatment were critically overwhelmed. An April 2022 survey by the National Council for Mental Wellbeing revealed that more than four in ten adult Americans who needed mental healthcare in the previous 12 months had been unable to access treatment (and 67 percent of adults who were able to receive mental healthcare reported difficulty accessing it).
Among the cited barriers to access (including 37 percent who lacked health insurance or could not pay the out-of-pocket costs), 28 percent of respondents could not find a conveniently located mental healthcare provider (in rural areas, providers can be hours away). 21 percent were unable to obtain an appointment immediately (and often had to wait weeks or months for one to open up).
About 50 percent of US counties lack a single psychiatrist—and the profession is contracting through 2024 to a forecast low of 38,821, resulting in a projected shortage of between 14,280 and 31,000 psychiatrists. As Elizabeth Hancq, research director for the Treatment Advocacy Center notes, "If people don’t have access to treatment when they need it, there can be tragic results at the individual and societal level".
Psychiatric mental health nurse practitioners (PMHNPs) can help fill the gap in mental health services. PMHNPs diagnose and treat people with psychiatric disorders and, in many states, can prescribe medication without an MD's supervision. These professionals operate in hospitals, health centers, schools, correctional facilities, and private practice. They sometimes specialize in specific populations—in pediatrics, with adolescents, or in adult and elder care.
A psychiatric mental health nurse practitioner tasks are many and varied. We'll discuss them in this article, as well as:
Psychiatric mental health nurse practitioners provide psychopharmacology and psychotherapy care. They diagnose mental health disorders, prescribe medication, design wellness and treatment plans for patients, treat substance abuse issues, and conduct physical and mental health assessments. Below is a list of the tasks PMHNPs perform in their practice.
Appropriate and effective mental health care begins with a patient's comprehensive health assessment followed by a careful diagnosis. PMHNPs begin treatment by documenting a patient's psychological and medical history and evaluating their behavior to assess their needs. This requires distinguishing between physiological and psychological disorders based on the patient's presenting complaints and symptoms—and designing treatment plans accordingly.
After a thorough assessment, the practitioner designs a personalized treatment plan to address a patient's physical and psychiatric conditions. PMHNPs collaborate with interdisciplinary team members who include nursing staff, psychiatrists, and psychologists to develop and evaluate patient care plans. They interpret diagnostic and laboratory tests and consult with doctors in other behavioral health specializations about complex mental health issues.
One of the more rigid competencies required for psychiatric mental health nurse practitioners is the prescription of medications to treat mental health disorders. This critical step in care can lead to effective treatment and relies on accurate medical assessment for the use of antidepressants, stimulants, mood stabilizers, antipsychotics, and anti-anxiety medications. Prescriptions are written for short or long-term care and can include medications administered by injection for inpatient and outpatient care. Practitioners also oversee the use and status of medical and pharmaceutical supplies for their facility or practice. Each state imposes unique requirements for the prescriptive authority granted to psychiatric nurse practitioners.
PMHNPs record and monitor the positive and negative effects of a patient's prescribed medications. They provide routine health screenings (as allowed by practice agreements and state regulations) to check for adverse reactions to prescribed medications and watch over patients whose physical condition might be complicated by substance use, diabetes, or a heart condition.
Psychiatric mental health nurse practitioners design, develop, implement, and monitor practice protocols around evidence-based practice and review and evaluate published research. To consistently offer the best plan of action for patients and the larger medical practice, they commit to reviewing all interventions and practices in light of new research and evidence. PMHNPs also refer patients to specialists or primary care physicians for specific treatment and care.
For many patients, family support represents a vital aspect of their healthcare. PMHNPs educate and inform patients and their family members about mental health and medical conditions, medications, preventive health measures, and the risks and rewards of treatment plans. This outreach is offered to individuals, families, and groups, and presents opportunities to teach a patient's larger support network about other mental health topics like stress reduction, healthy eating, and the benefits of sleep and exercise. Practitioners also provide community outreach to educate people about available mental health services and to help destigmatize mental health treatment.
Psychiatric mental health nurse practitioners work with individuals who experience chronic or acute mental health disorders. Part of their practice involves working directly with patients, patients and their families, or with groups applying psychotherapy and other types of psychiatric care. Therapy sessions are offered in hospitals or clinics, in correctional facilities, at patients' homes in person, or through telehealth services.
As in all forms of therapy, patients change as a result of care. PMHNPs not only design and develop the initial course of treatment, but monitor the patient's progress and make evaluations and adjustments as necessary. In addition to working on individual treatment plans, they provide outreach and health promotion in communities and evaluate crisis and response activities.
All medical practitioners commit to staying up-to-date on medical news, training, and innovation. PMHNPs participate in professional growth and development activities and attend conferences and continuing education classes. They also maintain certification in child abuse clearance, CPR, and crisis intervention training. They must renew their state licensure and PMHNP certification every five years through the American Nurses Credentialing Center (ANCC) and complete continuing education classes along with that exam review work.
As with any medical position, you must complete a series of steps before you can practice as a psychiatric mental health nurse practitioner. First, you need to become a registered nurse (RN) by completing an associate degree in a nursing program or earning a bachelor's degree in nursing (BSN). Both degrees allow you to take the registered nurse licensing examination—the NCLEX-RN. Once you are an RN, you’re eligible to apply to PMHNP programs to pursue either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) from an accredited school of nursing.
A PMHNP program’s length depends on whether you've completed an associate's or bachelor's degree. But generally, most mental health nurse practitioner master's programs require anywhere between two to four years of full-time study—plus preceptorship and clinical work before you can become certified.
After completing their nursing education, family nurse practitioners (FNP) and psychiatric mental health nurse practitioners (PMHNP) must complete 500 supervised clinical hours to qualify to apply for national certification through the American Nurses Credentialing Center (ANCC). Certification requires all candidates to take the The Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) assessment exam.
Coursework for a PMHNP MSN degree program varies depending on your concentration, but the core curriculum is similar across all advanced nursing school programs.
At the Yale School of Nursing, coursework includes psychopharmacology, neurobiology, psychopathology, mental health assessment, developmental and personality theory and in individual, family, and group psychotherapy. Other advanced classes cover health assessment, pharmacology, pathophysiology, health promotion, and evidence-based practice.
Students in the program work with populations across the lifespan; clinical work takes place in several healthcare settings to cover all age groups. Field experiences include clinical work in community mental health centers, emergency psychiatric services, primary care facilities, and acute and long-term care settings.
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