Nurses Are Key to Treating the Nation's Mental Health and Substance Abuse Crises

Psychiatric-mental health nurses can help fill critical gaps in the mental healthcare system.

Expanding psychiatric nurses’ numbers and roles will help solve the twin dilemmas of rising mental health/substance use disorder (SUD) and fewer mental health professionals, says a new report released by the American Psychiatric Nurses Association (APNA).

Mental health and SUD have reached epidemic proportions. Prior to COVID-19 one in 10 adults reported symptoms of an anxi­ety and/or a depressive disorder; however, during the pandemic, that number rose to four in 10 adults, the report says. According to the latest Substance Abuse and Mental Health Services Administration (SAMHSA) data:

• 52.9 million American adults are experiencing any mental illness.
• 14.2 million are experiencing serious mental illness, with percentages highest among adults younger than age 49.
• 40.3 million Americans aged 12 or older experienced a substance use disorder in the past year.
• 5.1 million adolescents aged 12 to 17 had either a SUD or a major depressive episode (MDE) in the past year, while 644,000 adolescents had both an MDE and an SUD in the past year.

Indeed, the pandemic affected nearly every aspect of the lives of youth, and the U.S. Surgeon General reports that the most vulnerable youth popula­tions— those with disabilities, racial and ethnic minorities, LGBTQ+, low-income, rural residents, those in immigrant households, those in child welfare or juvenile justice systems, and homeless—were affected most severely, the report says.

Lack of treatment

The National Institute of Mental Health (NIMH) reports that in 2021, fewer than half of American adults with a mental illness (47.2%) were able to receive the mental health services they needed. Getting treatment for mental health and SUD is difficult for several reasons:

Provider shortages: More than one-third of Americans live in areas with a shortage of providers, and in some states, more than 80% of the population lives in a mental health provider shortage area. According to reports published annually by the Kaiser Family Foundation:

• 41 states are reported to meet less than 40% of the mental health need in their state.
• 27 states are reported to need more than 100 additional mental healthcare providers just to reach a ratio of 30,000 patients to 1 mental health provider in those communities.
• 25 states have more than 100 designated mental health professional shortage areas in their state.

Health insurance does not cover most treatment: Those who can find a mental health professional for treatment are often forced to go out-of-network, which can be costly. A 2019 report found that a mental health office visit is more than five times more likely to be out-of-network than a primary care appointment.

High out-of-pocket costs: Many available providers rarely accept Medicare, Medicaid, or private insurance.

The solution: psychiatric-mental health nurses

Numbering more than 148,000, psychiatric-mental health RNs (PMH-RNs) and advanced practice RNs (PMH-APRNs) represent the second-largest group of mental health professionals in the United States and play pivotal roles in providing access to profes­sional mental health and substance use services to diverse patients across the nation, the report says.

But more than half a million additional PMH nurses are needed to reach “merely adequate access” to mental health and substance use disorder care, according to SAMHSA.

Roadblocks exist, however. “The lack of understanding of PMH nursing among policy­makers and stakeholders has hampered the profession from making its full impact on the state of mental healthcare,” the report says. “While PMH-RNs and PMH-APRNs have the skills and qualifications to expand access and equity in mental healthcare all across the U.S., more practicing PMH nurses are needed, and they must be utilized to the full extent of their education and training.”

Two key challenges must be addressed to boost the numbers and effectiveness of psychiatric nurses, the report notes.

1. Nursing education has not kept pace with the demand for PMH nurses.

Despite strong expansion of psychiatric nurse programs, few undergraduate nursing schools can offer students exposure to PMH nursing-specific education delivered by an expert in the field, PMH nursing mentors, or opportunities to learn about the profession, the report says.

This ongoing shortage of PMH nursing faculty at the undergraduate and graduate levels blocks the development of a pipeline of PMH nurses needed to expand the workforce.

Additionally, PMH-RNs report that nursing school faculty members misrepresented the experience required prior to becoming a PMH-RN. These findings are consistent with research that suggests there is a stigma with specializing in PMH nursing and a negative view of PMH nursing within nursing schools.

2. Many states still restrict the scope of practice of PMH nurses.

With Utah’s adoption of full practice authority (FPA) last week, 27 states and the District of Colum­bia fully allow PMH-APRNs to diagnose, treat, order diagnostic tests, and prescribe medica­tions to patients without physician oversight. The remaining states, however, continue to limit PMH nurses’ scope of practice.

“PMH nurses must be permitted to work to the full extent and authority of their education and training,” the report advises. “If the goal is increasing patient access to quality mental health and substance use care, the important role of PMH nurses must be fully employed in both education and in practice.”