The mental health care system in the U.S. is facing a crisis. With an increasing number of patients in need of care, the system is struggling to keep up. Psychiatric mental health nurse practitioners (PMHNPs) are emerging as an essential part of the solution, stepping in to fill the gaps left by a shortage of psychiatrists. In fact, the number of PMHNPs entering the field has skyrocketed over the past five years, outpacing the growth of psychiatrists and highlighting the opportunity for major policy reforms.
A recent Health Affairs report shows that the rise in the number of PMHNPs has been far more dramatic than that of psychiatrists. While the number of psychiatric residency matches has grown at a relatively slow, linear rate, the number of PMHNPs entering the workforce has surged significantly. From 2013 to 2019, the number of PMHNPs with a Medicare National Provider Identifier number jumped by an impressive 134%. In contrast, the number of psychiatrists only increased by 15%. This disparity highlights a significant shift in the landscape of mental health care, as NPs are stepping in to fill the roles traditionally held by psychiatrists.
This increase in the number of PMHNPs is particularly crucial as the U.S. grapples with a growing mental health care workforce shortage. According to the American Psychiatric Nurses’ Association, over 75% of all U.S. counties are experiencing a shortage of mental health workers, and a staggering 96% of counties face a shortage of mental health prescribers. At the same time, patients are increasingly turning to nurse practitioners to help meet their needs. As psychiatrists remain in short supply, NPs are stepping in to provide essential care during a time of critical need.
The Increasing Reliance on Nurse Practitioners
As the shortage of psychiatrists continues to impact patients, psychiatric nurse practitioners have become an invaluable resource in delivering mental health care. PMHNPs are highly trained professionals, skilled in assessing, diagnosing, and treating patients with a wide range of mental health disorders. These practitioners often have the expertise to prescribe medications, provide therapy, and offer ongoing care, making them a crucial part of the mental health workforce.
Unfortunately, despite the critical role that nurse practitioners play in the mental health field, many states still limit their ability to practice fully. Many states impose scope-of-practice restrictions, preventing NPs from practicing to the full extent of their education and training. These restrictions often require nurse practitioners to have a supervisory or collaborative agreement with a physician, even if they are fully qualified to work independently.
These artificial restrictions hinder NPs from delivering timely care, and more importantly, they prevent the mental health care system from reaching its full potential. As noted by the authors of the Health Affairs report, for NPs to realize their full potential in addressing the mental health care workforce shortage, they must be allowed to practice at the top of their education and license, free from unnecessary regulatory restrictions. States that have granted full practice authority to NPs have seen positive results, including improved access to care and no compromise in the quality of services provided. Furthermore, such changes could help retain and recruit nurse practitioners, ensuring that the workforce is robust enough to meet the growing demand for mental health services.
The benefits of allowing NPs to practice independently extend beyond the NPs themselves. Research has shown that when nurse practitioners are empowered to practice more autonomously, both NPs and physicians experience increased productivity. By expanding the scope of practice for NPs, the healthcare system as a whole can operate more efficiently, enabling both NPs and physicians to provide the care that patients desperately need.
Addressing Gaps in Education Funding for Nurse Practitioners
One of the key issues contributing to the shortage of mental health providers is the lack of funding for nurse practitioner education. While Medicare’s Graduate Medical Education (GME) system receives $15 billion annually to fund medical education for physicians, nurse practitioners are not eligible for any of these funds. The funds allocated to physicians often go to hospitals, rather than to community-based settings where most primary care and behavioral health services are delivered.
This discrepancy in funding needs to be addressed. The Health Affairs report emphasizes the need for enhanced federal funding for the education of all primary care providers, including nurse practitioners. The report advocates for funding that prioritizes community-based programs, particularly those in rural and underserved areas. By investing in the education of nurse practitioners, we can ensure that they are well-equipped to meet the mental health needs of their communities. Additionally, expanding educational opportunities for NPs can help ensure that the workforce is prepared to address the growing mental health care workforce shortage.
Rethinking Shortage Measures
Another issue highlighted in the Health Affairs report is the way the federal government currently measures healthcare provider shortages. The government determines Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs) based solely on the number of physicians in a given area, completely excluding nurse practitioners and physician assistants (PAs) from these assessments. This outdated methodology fails to account for the increasing role that NPs and PAs are playing in providing care, especially in underserved areas.
As research from the USC-Brookings Schaeffer Initiative for Health Policy points out, the notion of a widespread shortage of behavioral health professionals may not be as clear-cut as it seems. The report suggests that, while there may be shortages in some areas, the overall workforce shortage may not be as severe when NPs and PAs are factored into the equation. In fact, these professionals are increasingly filling the gaps left by physicians and helping to alleviate the burden on the healthcare system. The report asks a critical question: “Why are we willfully ignoring reality?”
The growing number of PMHNPs is a vital response to the mental health care workforce shortage, but without proper recognition of the role they play, the healthcare system may continue to underestimate the impact of this shift. By recognizing NPs as key contributors to the mental health workforce, policymakers can ensure that this growing workforce is utilized to its fullest potential.
The Path Forward: Policy Reform and Empowerment
To truly address the mental health care workforce shortage, policymakers need to take action to empower nurse practitioners and reform outdated systems that hinder their ability to practice effectively. This includes removing scope-of-practice restrictions, increasing funding for NP education, and reevaluating how the government measures workforce shortages. By supporting NPs and allowing them to practice independently, we can ensure that the mental health care system is better equipped to meet the needs of patients across the U.S.
Nurse practitioners are already playing an essential role in the mental health care system, and by removing the barriers that limit their potential, we can ensure they are able to fully contribute to addressing the growing demand for care. It is time for meaningful policy reforms that empower nurse practitioners and create a more accessible, efficient, and effective mental health care system for all.
By investing in and empowering the growing workforce of psychiatric nurse practitioners, we can begin to tackle the mental health care workforce shortage head-on, offering better access to care for patients in need and improving the overall effectiveness of mental health care in the U.S.
