We can do better for the mentally ill

Giving nurse practitioners greater scope would ease the shortage of providers

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The recent anniversary of the Newtown school shooting, which was marked by yet another school shooting in Colorado, again brought the need for improved mental health care into the news.

According to the National Institute of Mental Health, approximately 57.7 million people in the United States suffer from mental disorders, yet the Substance Abuse and Mental Health Services Administration reports that only 38 percent of adults who need treatment receive it. Approximately 7.4 million children and adolescents in the United States have mental or behavioral health issues, but only one in four children and adolescents get the psychiatric care they need, according to the Health Services Resources Administration’s “National Survey of Children’s Health.”

Rarely do people who have mental illnesses engage in violent acts against others. Still, the effects of mental illness can be devastating.

People with untreated mental illness are at a higher risk for suicide, alcohol and drug abuse, self-harming behaviors and violence, and for becoming victims of violent crime. Physical health is an issue, too. Incidence of chronic illnesses, such as diabetes, hypertension, stroke and heart disease, is high among those who have mental illness, especially those with depressive disorders. Finally, according to the NIMH, the economic cost of serious mental illness in the United States is high, around $317 billion in lost wages, disability payments and medical expenditures.

More than 89 million Americans live in federally designated areas with shortages of mental health care providers, according to HRSA. That means a great many people cannot find psychiatrists to treat their mental illnesses, which is a critical problem in the Pittsburgh area, as was well-explained last fall in an excellent Post-Gazette series on mental health. About one half of those being treated for mental health conditions are being treated by their primary-care physicians, according to SAMSA.

This is far from ideal. According to the Journal of the American Medical Association, primary-care physicians spend, on average, 12 minutes with patients. Often they do not have time to do the in-depth assessment that diagnosing mental illnesses necessitates nor are they equipped to provide the psychotherapy that patients with mental illness require. Even with primary-care providers treating mental illness in their practices, many people who suffer from mental health conditions go untreated.

One way to increase access to mental health care for those who need it is to allow Psychiatric Mental Health Nurse Practitioners to practice to the full scope of their profession. These nurses are advanced-practice registered nurses certified by the American Nurses Credentialing Center to assess, diagnose and treat patients — using both medications and psychotherapy — who suffer with mental illnesses. They are able to assess a patient’s mental health and general medical needs, thus providing the patient with a comprehensive plan of care.

Numerous studies over four decades show that nurse practitioners provide high-quality care to patients in a cost-effective manner. Robert Morris University is working to address the mental-health provider shortage by training PMHNPs here and throughout the country to provide quality care throughout the lifespan of those who have mental disorders.

There is an obstacle, however. Many states, including Pennsylvania, prohibit nurse practitioners from practicing independently. In Pennsylvania, PMHNPs must have a collaborative agreement with a physician in order to practice. Other states require direct supervision of nurse practitioners or limit the prescribing authority of nurse practitioners. Such limits make it more difficult for PMHNPs to see patients and to diagnose and treat them in a safe, cost-effective manner.

Nurse practitioners provide high-quality mental health care. Limits on their scope of practice hinders access to care for patients who need help, particularly in rural areas where the need is great and where it may be difficult for nurse practitioners to secure a collaborating physician. To address the shortage of mental health care providers, states need to allow nurse practitioners to care for patients to the full extent of their education and skills.

Kirstyn Kameg is a practicing psychiatric mental health nurse practitioner and coordinator and faculty member of the PMHNP program at Robert Morris University School of Nursing and Health Sciences. Linda Raimondi is the coordinator of the Access to Interprofessional Mental Health Education program at RMU.

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