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How Nursing Schools Are Contributing to America’s Mental Health Crisis

James Madison University’s counseling center has just one psychiatric nurse and one psychiatrist. Meanwhile, the number of students seeking care has grown 191 percent since 2000. That means that once students receive a one-time prescription, they’re referred out to one of just a few local private practices—and then they often have to wait months for a psychiatric appointment.

Across the U.S., only 44 percent of adults and 20 percent of kids currently get the mental health and substance use care they need, and that care can be delayed by up to 23 years. That’s a huge problem, since an estimated 56 million Americans experience mental illness or substance use disorders every year.

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As the stigma around mental health is decreasing, more people are seeking treatment. Yet the number of trained mental health professionals hasn’t kept up with the growing demand. Over 75 percent of U.S. counties face a shortage of mental health workers. In fact, the U.S. will be short on an estimated 250,000 mental health professionals by 2025.

Ultimately, lack of treatment leads to more deaths. People with serious mental illnesses are more likely to die than the average American, and the suicide rate in the U.S. is on the rise.

Nursing schools aren’t training students on mental health

Despite the clear need for care, past surveys show that only 4 percent of licensed registered nurses (RNs) work in psychiatric-mental health. Why? For starters, there simply aren’t enough psychiatric-mental health (PMH) nursing programs across the United States, and mental health is rarely emphasized in general nursing programs, according to a new report from the American Psychiatric Nurses Association (APNA).

What’s more, nursing students also report there’s not enough mental health care content in the curriculum. They say teachers often discourage them from entering the psychiatric field and that they have a hard time finding a mentor. (Non-psychiatric nurses often view patients with mental illness as problematic and even fear or dislike them.)

To address this issue, the report says, schools should focus on mental health training as part of the all general nursing curriculum and provide students with access to psychiatric rotations. This would help new nurses better understand that mental health is absolutely vital to physical health.

If general nursing focused more on mental health, the report concludes, nurses across the board would be better prepared, more compassionate, and more confident in their ability to treat people with mental health conditions.

What psychiatric mental health (PMH) nurses do

PMH nurses are licensed mental health care professionals who are filling the gap in mental health care. In fact, there are more PMH nurses than any other mental health professional in the U.S.

PMH nurses work in hospitals, clinics, schools, and private practice. They help children exposed to trauma, soldiers returning from combat, older adults struggling with cognitive decline, teens and adults confronting anxiety and depression, and people recovering from substance abuse.

There are two types of PMH nurses:

  • Registered nurses (PMH-RNs) assess mental health conditions and develop care plans. They screen people for mental health conditions, teach self-care, intervene in crises and psychiatric rehabilitation, coordinate care, and educate the public about mental health conditions to reduce the stigma of seeking care.
  • Advanced practice registered nurses (PMH-APRNs) hold advanced master’s or doctoral degrees, national certification, and additional licensure depending on their state’s requirements. This allows them to provide a variety of interventions. They can assess, diagnose, and prescribe medication; provide psychotherapy; develop policies; and participate in research. A PMH-APRN’s role often overlaps with that of a psychologist, social worker, or psychiatrist.

There are growing job opportunities for PMH nurses: From 2014 to 2015, there was a 58 percent increase in PMH-RN and a 17 percent increase in PMH-APRN job openings.

How to become a PMH

The American Nurses Credentialing Center (ANCC) certifies PMH nurses. Requirements for a PMH-RN include:

  • An RN license
  • Two years of practice as a full-time RN
  • At least 2,000 hours of clinical practice and 30 hours of continuing education in PMH nursing within three years

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Requirements for PMH-APRN include:

  • A bachelor’s degree in nursing
  • Working as an RN in various areas of health care, including mental health
  • A 16-24 month program that teaches pathophysiology, advanced health assessment, brain and behavioral correlates, advanced psychopharmacology and psychotherapeutic techniques; followed by clinical rotations in outpatient mental health settings, hospitals or residential care settings

PMH-APRNs have one of the following degrees: may specialize in treating a particular population such as children, adolescents, geriatrics, substance use disorders, forensics, or the LGBTQ community.

Mental Health Myths and Facts,
Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication, JAMA Network.
Using Celebrities in Abnormal Psychology as Teaching Tools to Decrease Stigma and Increase Help Seeking, SAGE Journals.
County-level estimates of mental health professional shortage in the United States, NCBI.
National Projections of Supply and Demand for Selected Behavioral Health Practitioners:2013-2025, US Department of Health and Human Services.
Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis, NCBI.
Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015, Centers for Disease Control and Prevention.
The Current Psychiatric Mental Health Registered Nurse Workforce, SAGE Journals.
Blueprint for development of the advanced practice psychiatric nurse workforce, NCBI.
Expanding Mental HealthCare Services in America: The Pivotal Role of Psychiatric-Mental Health Nurses, American Psychiatric Nurses Association.
Healthcare Industry Facing Severe Psychiatrist Shortage, Health eCareers.

Last updated on 10/3/19.

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