Expanding Mental Health Care Services in America:

Expanding Mental Health

Care Services in America:

e Pivotal Role of Psychiatric-Mental Health Nurses

An Informational Report Prepared by

The American Psychiatric Nurses Association

April, 2019

The Expanding Need

The need for qualiﬁed mental health professionals in the United

States (U.S.) has never been greater.

Today, approximately 56 million Americans experience mental

illness or substance use disorders and nearly 17 percent report

comorbid mental and physical health challenges. Ultimately, 1 in

every 5 adults in the U.S. experiences a mental health condition

in a given year.

Similarly, the 2016 National Survey on Drug Use and Health

(NSDUH) revealed that 7.8 percent of Americans (20.1 million

people) ages 12 years and older experienced a substance use

disorder that year. Thirty-seven percent of those individuals strug-

gled with illegal drugs, 75 percent with alcohol, and 12 percent

with a combination of drugs and alcohol. Opioids, speciﬁcally,

are misused by 11.8 million people annually in the U.S.

Mental illness and substance use disorders also impact the lives

of young people across the U.S. – 40 percent of youth age

13 to 17 experience a behavioral health problem by the time

they reach the seventh grade. Young adults also have some of

the highest rates of alcohol and substance use disorders: 10.7

percent (3.7 million) of young adults experienced an alcohol

use disorder and 7 percent reported (2.4 million) using illegal

substances in 2016.

The dramatic shortage of qualiﬁed psychiatric pro-

fessionals to treat persons with mental health and

substance use disorders threatens our nation’s abili-

ty to provide timely and effective treatment.

Ongoing consumer education efforts and celebrity disclo-

sures are beginning to decrease the stigma related to seeking

treatment for mental health and substance use disorders. These

efforts are moving the needle to help Americans understand that

mental disorders are illnesses just like diabetes or heart disease.

Likewise, treatment and support for people struggling with mental

illness or substance use greatly improves millions of lives each

year. As a result, more people are beginning to seek mental

health and substance use treatment to improve their health, hap-

piness, and quality of life.

Today, we know that mental health is absolutely foundational

to overall health and wellness. Mental illness and substance

use is linked to community issues such as homelessness, lower

educational achievement, and legal problems. Addressing these

expanding gaps in care for mental illness and substance use

disorders should be a top national priority.

As the Need Grows, the Nation Struggles with a

Shortage of Mental Health Professionals

Mental illnesses are illnesses

just like diabetes or heart

disease.

It’s important for people to know that treatment works

and greatly improves the lives of those struggling with

mental health and substance use disorders.

Help Wanted: A Shortage of

Mental Health Professionals

The supply of skilled, educated, and trained mental health pro-

fessionals has not been able to keep up with growing demand.

Far more individuals are in need of care and support for a wide

range of mental health conditions – including depression, anxi-

ety, acute grief, drug or alcohol addiction, personality disorders,

and psychoses – than can access a mental health professional.

Currently, only 44 percent of adults and 20 percent of chil-

dren and adolescents receive the mental health and substance

use care they need. And, even if a mental health condition is

identiﬁed, treatment is often delayed from 6 to 8 years for mood

disorders and 9 to 23 years for an anxiety disorder.

In fact, less than half of those affected by the most common

mental health conditions – co-existing major depression and

substance use – ever receive any form of mental health or sub-

stance use treatment. The lack of treatment signiﬁcantly contrib-

utes to an increasing suicide rate, which is one of the leading

causes of death in America today.

According to a report released by the U.S. Department of

Health and Human Services (HHS) Health Resources and Ser-

vices Administration, the ﬁeld of mental health will be 250,000

professionals short of the demand projected for the year 2025.

More than 75 percent of all U.S. counties have a shortage of

any type of mental health worker and 96 percent of all counties

have an unmet need for mental health prescribers.

This care gap is most profound in rural states where 111 million

Americans live in mental health professional shortage areas.

The national need for increased access to mental health care is

further exacerbated by the disproportionate impact on racial,

cultural, and ethnic minorities who have higher levels of unmet

mental health needs. Even with targeted efforts addressing

minority populations, data indicates there were no reductions in

racial-ethnic disparities between 2004 and 2012 and African

Americans and Hispanic Americans experienced an increase

in unmet mental health treatment. The stigma related to seeking

mental health and substance use treatment is higher in minority

populations, and further complicated by the dearth of minority

mental health professionals.

Medical professionals also have a difﬁcult time referring patients

for mental health and substance use care and support. Two-

thirds of primary care providers report difﬁculty referring patients

for mental health care – that’s twice the number reported for

any other health specialty. And, with nowhere else to turn, the

number of patients going to hospital emergency departments

seeking psychiatric services increased by 42 percent over a

recent three-year period.

Young people entering college also face signiﬁcant challeng-

es in receiving care or maintaining the care they previously

received at home. For example, at James Madison University’s

counseling center the number of clients has grown 191 percent

since the year 2000. The center has just one psychiatric nurse

and one psychiatrist so it can only provide short-term services.

Once a one-time prescription is issued, students are referred out

to one of just a few private practices in Harrisonburg. Students

then have to wait several months to get a psychiatric appoint-

ment.

The lack of access to effective mental health treat-

ment has created a crisis that is negatively impact-

ing every American community and every family in

some signiﬁcant way.

In Washington State: Jess Calohan, a Psychiat-

ric-Mental Health Advanced Practice Registered Nurse

(APRN), leverages his own 20+ years of military expe-

rience through three overseas deployments to provide

psychiatric care to veterans in the underserved, rural

parts of the state. Leveraging tele-psychiatry, Jess, an

expert in combat-related trauma, provides innovative

care to patients in need of psychiatric services via two

area hospital systems.

Jess applied his personal experience to develop the

Nightmare Reduction Initiative (NRI). This program sig-

niﬁcantly expands access to care and directly supports

veterans experiencing combat-trauma nightmares. His

work is also helping to overcome the stigma attached

to seeking mental health care within the military by

targeting sleep challenges to help treat patients strug-

gling with PTSD. This important work has opened doors

around innovative treatment strategies for veterans – an

often forgotten population in our nation.

Mental Health Professional Shortage Areas

Improving access to professional mental health care

and substance use treatment will not only transform

the lives of millions of individuals, it will also have a

positive impact on the nation as a whole.

Shortage of Mental Health Care Providers: Impacts and Consequences

Our society faces grave consequences from the lack of available mental health treatment. The entirety of American society is

impacted by untreated mental illness and substance use disorders preventing people from completing their education, working and

supporting themselves, building relationships and contributing positively within their communities.

Serious mental illness costs America

$193.2 billion in lost earnings per

year.

75 percent of chronic mental health

conditions begin by age 24, yet the

delay between the ﬁrst appearance

of symptoms and intervention is an

average of almost a decade.

The U.S. Department of Veterans

Affairs estimates that each day 18-22

veterans lose their lives to suicide.

More than a third (37 percent) of

students with a mental health condition

drop out of school—the highest

dropout rate of any disability group.

More than 72,000 Americans died

from drug overdoses in 2017, including

illicit drugs and prescription opioids—a

2-fold increase in a decade.

And, overall, persons living with

serious mental illness have higher

mortality rates than the rest of the

American population due in large part

to preventable medical conditions.

Who are PMH Nurses?

Psychiatric-Mental Health (PMH) registered nurses (RN) and

advanced practice registered nurses (APRN) represent the sec-

ond largest group of behavioral health professionals in the U.S.

Both PMH RNs and APRNs play a pivotal role in providing pro-

fessional mental health services to patients all across the nation.

PMH nursing intervention is both an art and a science – em-

ploying a wide range of nursing, psychosocial, and neurobio-

logical expertise to produce effective interventions and positive

outcomes for patients facing mental health or substance use

disorders.

PMH nurses are trained mental health care professionals that

practice according to high quality licensing and credentialing

standards. Psychiatric nurses form strong therapeutic relationships

with people experiencing mental illnesses and/or substance

use disorders, and often with their families as well. PMH nurses

also work to educate patients, families, health care peers, and

communities to understand that whole health begins with mental

health – actively working to shatter the stigma associated with

mental health care and treatment.

There are several kinds of PMH nurses

Psychiatric-Mental Health Registered Nurses (PMH-

RN) work with individuals, families, groups, and communities

to assess mental health, and contribute to the development of

a diagnosis and a plan of care. PMH nurses maintain current

knowledge of advances in genetics and neuroscience and their

impact on psychopharmacology and other treatment modalities.

Services Provided by Psychiatric Mental Health

Registered Nurses

1. Health promotion and maintenance

2. Intake screening, evaluation and triage

3. Case management

4. Teaching self-care activities

5. Administration and monitoring of

psychobiological treatment regimens

6. Crisis intervention and stabilization efforts

7. Psychiatric rehabilitation and intervention

8. Educating patients, families and communities

9. Coordinating care

PMH RNs and APRNs: Ready to Fill the Gap

The role of PMH nurses must be acknowledged and

their utilization expanded to increase patient access

to quality care for mental health and substance use

challenges.

Psychiatric-Mental Health Advanced Practice Regis-

tered Nurses (PMH-APRNs) provide the full range of spe-

cialized services that constitute mental health and psychiatric

care and treatment. They hold advanced master’s or doctoral

degrees, national certiﬁcation, and additional licensure (based

on their state board of nursing requirements).

The additional education, clinical experience, and training

allows APRNs to assess, diagnose, and prescribe medication;

provide integrative therapy interventions, psychotherapy, consul-

tation and liaison services; oversee case management; under-

take policy development for programs and service offerings; and

actively engage in comprehensive advocacy education and

research efforts.

PMH APRNs practice as Clinical Nurse Specialists (CNS)

or Nurse Practitioners (NP), though titles vary by state. PHM-

APRNS may hold a doctoral degree, including either the Doctor

of Nursing Practice (DNP) or the Doctor of Philosophy (PhD).

PMH-APRNs work in a wide variety of settings – outpatient,

ambulatory, emergency department, and hospitals.

Others own their own private practice businesses that see

patients and consult within local communities, with corporations,

and even with local government.

All 50 states permit APRNs some level of prescribing authority.

21 states and the District of Columbia allow APRNs to diagnose,

treat, order diagnostic tests, and prescribe medications to pa-

tients without physician oversight under the licensure authority of

the state board of nursing. Seventeen states limit APRN scope of

practice and 12 states severely restrict nursing scope of practice

regulations.

Services Provided by Psychiatric Mental Health

Advanced Practice Registered Nurses*

1. Educate patients and families

2. Provide psychotherapy

3. Prescribe medication for acute and

chronic illnesses

4. Diagnose, treat and manage chronic illness

5. Diagnose, treat and manage acute illness

6. Provide care coordination

7. Make referrals

8. Order, perform and interpret lab tests, X rays,

EKGs and other diagnostic studies

9. Provide preventative care including screening

and immunizations

10. Conduct physical examinations

11. Manage medical problems

12. Perform procedures

* PMH-APRN scope of practice is determined by each state’s nurse

practice act and there is therefore variability from state to state. States that

do not grant PMH-APRNs full scope of practice may limit one or more of the

above services.

PMH RNs and APRNs: Ready to Fill the Gap

Highly Trained, Certiﬁed and Diverse in Practices

Certiﬁcation for PMH nursing at all levels is provided by the

American Nurses Credentialing Center (ANCC). According to the

ANCC, the requirements for the PMH-RN include an RN license,

two years of practice as a full-time registered nurse, and a minimum

of 2,000 hours of clinical practice and 30 hours of continuing edu-

cation - both in PMH nursing and within three years

PMH nurses have degrees in nursing – which means that the nursing

process informs their overall approach. However, often the role of

a PMH-APRN with a master’s or doctoral degree will overlap with

that of a psychologist, social worker, or psychiatrist. For example,

all of these professionals perform psychotherapy. And, both APRNs

and psychiatrists can prescribe medications to patients.

Psychiatric nurses work across the full lifespan, engag-

ing patients over the long-term – becoming familiar

with their personal stories and challenges – to trans-

form lives in a positive way they can see every day.

For example, PMH nurses:

• Help children exposed to traumatic and adverse events.

• Work with soldiers returning from combat operations.

• Help older adults struggling with Alzheimer’s Disease and

dementia.

• Support teens and adults confronting anxiety and depression.

• Treat and counsel those ﬁghting to recover from opioid, alcohol

and other substance use disorders.

• Develop safety plans for those experiencing suicidal thoughts.

Additionally, PMH nurses have a wide variety of career

choices and can work in a variety of different settings

including:

• Hospitals

• Primary care

• Clinics

• Schools

• Telemedicine

• Public health facilities, and

• Private practice (PMH-APRNs only)

All PMH nurses are rigorously trained to provide mental health

care to patients and play an important role in the articulation and

implementation of new models of care and treatment that place the

patient at the center of the care delivery system.

Therefore, the role of PMH nurses must be acknowledged and their

utilization expanded to increase patient access to quality care for

mental health and substance use challenges. For example, PMH

nurses are positioned well to further integrate care for mental health

and substance use into primary care settings. PMH nurses are also

increasing access by providing patients with ongoing services and

support via telecommunications technologies.

PMH nurses are poised and ready to help expand ac-

cess to mental health care across the United States.

Common PMH Nursing

Areas of Focus:

• Child & Adolescent Mental Health

• Emergency Nursing

• Gero-psychiatric Nursing

• Military Mental Health & PTSD

• Substance Use

• Collaborative Care/Integrated Care

• Addictions

Call to Action: Build a Larger Mental

Health Workforce

Our nation must develop a well-educated, trained and well-dis-

tributed behavioral health workforce to meet the rising demand for

mental health services. The workforce must be diverse to meet the

needs of the nation. Additionally, all Americans must understand

that whole health begins with mental health, treatment is effective,

and people can and do recover from mental health and sub-

stance use disorders.

PMH-RNs and APRNs have the skills and qualiﬁcations to step

forward and expand access and the quality of mental health care

across the U.S. – we just need more of them.

According to a 2016 American Psychiatric Nurses Association

(APNA) survey, there are 15,911 active PMH nursing certiﬁcations

held by PMH APRNs – 10,345 PMH nurse practitioner certiﬁ-

cations and 5,566 PMH clinical nurse specialist certiﬁcations.

And, it’s predicted that by 2025, there will be 17,900 active PMH

APRNs. Past workforce surveys show that only 4% of licensed

registered nurses (RNs) work in psychiatric-mental health. If

that percentage is still consistent, then there are approximately

154,000 RNs working in psychiatric-mental health, which is not

nearly enough to meet the demand.

PMH RNs and APRNs currently face incredibly high demand for

their services. There has been a 58 percent increase in psychiatric

RN job openings and a 17 percent increase in psychiatric APRN

job opportunities from 2014 to 2015. PMH nurses are the fast-

est-growing non-physician specialties in health care.

While there is a clear need for more professionals entering the

ﬁeld of PMH nursing, a variety of state reports are effectively

demonstrating how PMH APRNs are stepping forward to help

address the nation’s shortage of mental health practitioners. And,

a growing group of PMH RNs are taking on innovative new roles,

demonstrating their commitment to improving the ﬁeld of mental

health care.

For example, at Parkview Behavior Health – youth inpatient ser-

vices in Indiana, a team of PMH Registered Nurses (RNs) sought

to determine if bullying or cyberbullying played a signiﬁcant role

in contributing to youth admissions for mental health care and if

parents were aware of their child’s bullying/cyberbullying experi-

ences. To guide unit programming and patient treatment, the team

added new patient and parent forms asking for information about

the patient’s experiences with bullying or cyberbullying. Initial

results show a signiﬁcant relationship between patients presenting

with depression or suicidal ideation who have experienced a

form of bullying. Treatment strategies at the center are now more

targeted, a new emphasis is placed on support for the effects of

bullying, and staff can ultimately better measure a patient’s comfort

with returning to their home environment upon completing their

inpatient treatment.

In New York City a team of PMH APRNs established a center for

individuals who were homeless and dealing with serious mental

illness. The center was staffed exclusively by PMH APRNs who

provided both comprehensive mental health services and inter-

ventions to address social needs, such as housing. Data available

on two years of outcomes indicate low levels of inpatient hospi-

talization of clients served and that none were incarcerated. The

practitioners provided the full range of mental health services to

their patients.

And, over the past 15 years, New Hampshire has worked to

revise previous legislation and pass new legislation signiﬁcantly

expanding the ability of PMH APRNs to treat patients with mental

illness and began integrating them into clinical leadership roles.

The changes have allowed APRNs to demonstrate their signiﬁcant

clinical effectiveness as practitioners treating patients. This effort

serves as a very successful model for other states needing to

expand access to mental health care.

These and numerous other initiatives clearly speak to the ways in

which PMH nurses can effectively address a wide range of mental

health needs and serve as a successful solution to our nation’s

mental health provider shortage. We must therefore attract more

PMH nurses into the ﬁeld to expand access and improve mental

health care.

More PMH Nurses Are Needed to Expand

Access to Mental Health Care

In Illinois: Suicide is one of the top causes of death among all Americans aged 15 to 35. At

Linden Behavioral Health, a team of PMH Registered Nurses (RNs) sought approval from Hospital

administration to train the center’s multidisciplinary RNs according to the APNA Competency Based

Training for Suicide Prevention. This protocol requires safety planning to be completed with all pa-

tients upon admission and during any transitions in care. As a result, nurses are better able to assess

warning signs and provide patients with support and coping strategies to mitigate suicide risk. As a

result of this program, nurses have been trained and report feeling better equipped to assess po-

tentially suicidal patients and plan for their care. Patients are complying in working on their personal

safety plans and developing coping strategies. Ultimately, the risk of suicide for patients at all level of

care in the facility will decrease due to the implementation of this proactive approach.

Qualities of a Successful PMH Nurse

PMH nurses must have exceptional communication and relation-

ship development skills coupled with a deep knowledge of the

sciences.

You can enter the ﬁeld of PMH nursing in a variety of ways.

Science, liberal arts, and nursing undergraduate or master’s

students are all fantastic candidates to work toward a career in

PMH nursing. Similarly, licensed practical nurses working in other

areas of health care are also excellent candidates for educa-

tion, training, and licensure in psychiatric-mental health nursing.

PMH nursing demands signiﬁcant compassion, sensitivity, and

communication skills to assess the ongoing needs of patients and

help them navigate ever-changing life challenges. PMH nurses

are educated and receive clinical training to deliver effective

psychotherapeutic interventions, such as behavioral activation

which guides patients to feel more empowered. It’s not only

important for PMH nurses to deliver the right response to a pa-

tient, but also to deliver it in the right tone of voice, volume, and

body language necessary for that particular patient. Therapeutic

communication is an important part of numerous PMH nursing

tools, including teaching coping skills and problem-solving tech-

niques. This nurse-patient relationship has a signiﬁcant impact on

healthcare outcomes.

PMH nurses also must have command over multiple bodies of

knowledge including medical science, neurobiology of psychi-

atric disorders, treatment methods, and relationship science in

order to fulﬁll their role of promoting optimal mental and physical

health and wellbeing.

Ultimately, those who are passionate about working in behav-

ioral science or nursing and ﬁnd inspiration in helping patients

access healing and recovery will thrive in a psychiatric-mental

health nursing career.

In North Carolina: Connie Mele, a Psychiatric-Men-

tal Health Advanced Practice Registered Nurse (APRN),

spent her more than 30 years in the ﬁeld working to

advance the treatment of addiction. Among her numer-

ous accomplishments providing treatment to patients

and teaching new PMH nursing students, Connie also

stepped forward to address the challenges facing

inmates struggling with mental health issues.

Connie formed a Task Force of criminal justice ofﬁcials

to work together and develop an algorithm to identify

appropriate jail diversion steps – from what police

personnel can do when they encounter a person with

mental illness or substance use disorders all the way to

helping people struggling to ﬁnd permanent housing. A

new Crisis Intervention Team(CIT) Training Program was

developed for police ofﬁcers and detention person-

nel to better support those they encounter struggling

with mental health, substance use and developmental

disabilities. To date, more than 1,000 ofﬁcers have

been trained. This effort is another great example of an

experienced PMH practitioner using the nursing process

to identify a population in need and getting the right

stakeholders to the table to successfully address a need

in the community.

PMH Nursing Provides Flexibility

and Strong Compensation

PMH nursing provides great career ﬂexibility and job security

due to the rising demand. The wide variety of work settings and

specialty areas allow professionals to choose the type of work

they want to do and the setting that best ﬁts their lifestyle.

For example, a signiﬁcant proportion of mental health care is

provided in the community setting – with patients living in their

own homes and receiving care in local clinics, private practices

and mental health facilities. PMH nursing roles in those communi-

ty settings more typically follow regular business hours, so if you

are interested in a PMH nursing role with a more predictable

daily schedule, community-based mental health facilities and

clinics may be the settings for you.

PMH nursing jobs in hospitals have other advantages. Hospital

hours are often based on covering needed shifts and can be

less predictable. But a hospital setting provides PMH nurses with

the ability to work weekend or overnight shifts that allow a full-

time schedule to take place over the course of just a few days

each week, with the other days off.

Overall, PMH nursing is a ﬁnancially rewarding nursing role due

to the career requirements and rapidly expanding demand.

Obstacles to Growing the Field

of PMH Nursing

While it’s clear that more PMH nurses are needed to address the

shortage of mental health providers, initial growth may be limited

by the relatively small number of PMH nursing programs and

their insufﬁcient distribution across the United States. For exam-

ple, three states do not have any schools that offer PMH APRN

programs and 15 states have only one such program state-wide.

In addition to the small number of nursing schools offering PMH

APRN nursing programs, students enrolled in general nursing

programs are reporting an overall lack of deﬁned, testable

mental health care content and competencies within nursing

school curriculum. It is also rarely emphasized that mental health

is foundational to whole health, even in the face of evidence

indicating that care that addresses both mental and physical

health is essential to recovery from mental illness.

As career opportunities for PMH nurses expand and the ap-

plicant pool continues to increase, nursing programs will face

increased pressure to quickly build more education options

while ensuring that they maintain the quality of the program and

faculty.

Unfortunately, there is also a pervasive lack of understanding of

the impact of mental health on whole health within nursing edu-

cation that has built a generation of professionals that devalue

psychiatric mental health care.

Non-psychiatric nurses often view patients with mental illness

negatively – as problematic, disruptive, more complex, and

unpredictable. Non-PMH nurses often share that they even fear

and dislike patients with mental illness; disparage the important

work of PMH nurses, and perpetuate damaging myths and

misperceptions about people suffering from mental illnesses.

As a result, nursing students often report that when they interact

with nursing school teachers and non-PMH nursing profession-

als, they are actively discouraged from entering the ﬁeld of

PMH nursing – an important ﬁeld of health care that desperately

needs skilled professionals.

Those who are interested in a career in PMH nursing have a

very difﬁcult time ﬁnding mentors who will support them through

their education and embarking on this chosen career.

More work must be done to help those outside the PMH ﬁeld

better understand that mental illnesses are no different than other

illnesses like diabetes or heart disease – they are illnesses of the

brain. Treatment for mental illness and substance use disorder

are very effective and people can and do recover.

If mental health care was better represented throughout the

entirety of nursing education, the population of nurses across the

board would be better prepared, more compassionate, and feel

more conﬁdent in their ability to successfully work with patients

suffering from mental health and substance use challenges.

In Ohio: A team of PMH Registered Nurses (RNs)

working in an outpatient psychiatry clinic that began

seeing rising levels of patients diagnoses with Autism

Spectrum Disorders (ASD). Patients with ASD often

exhibit aggressive behaviors when distressed and the

facility space was not conducive to this patient popula-

tion. The team brought a multidisciplinary group togeth-

er to determine new protocols to ensure the safety of

patients, family members and staff. Several new policies

were put in place, along with infrastructure changes,

additional training for staff, and fresh workﬂow and

clinical processes to identify at-risk patients prior to their

clinical appointments.

As a result of this new paradigm at the clinic, staff are

now able to provide more effective individualized care

and prevent behavioral escalation in many situations.

The team continues to collaborate to make adjustments

and identify areas for expanded policies to beneﬁt this

new patient population.

If mental health care was better represented through-

out the entirety of nursing education, the population of

nurses across the board would be better prepared, more

compassionate and feel more conﬁdent in their ability to

successfully work with patients suffering from mental health

and substance use challenges.

Implications for the Future

We must attract more nurses into PMH specialty areas and ensure rigorous PMH clinical education for all

nursing professionals to increase nationwide access to mental health care. We therefore must consider:

To Improve PMH Education and Clinical Training:

• Nursing schools are missing an opportunity to help solve our

nation’s mental health provider shortage. Schools must teach

that whole health begins with mental health; expand PMH

nursing program offerings; integrate psychiatric nursing into

the general curriculum and provide students with access to

psychiatric rotations to gain experience.

• Stronger standards must be developed that require mental

health clinical training as a basic tenet of all nursing curricu-

lum to assure that graduates can demonstrate performance

competencies in this important area of health care.

• The general nursing profession must actively work to embrace

the fact that mental health is absolutely vital to physical health,

support efforts to break down stigma and begin to help recruit

more professionals into the ﬁeld of mental health care.

• Nursing curricular models would beneﬁt from a shift away

from exclusively hospital settings to provide PMH clinical

experience for nurses in integrated care settings – opening

the door to a wider array of real world experiences and

providing more professionals with opportunities for training

placement.

• American undergraduate colleges and universities have the

opportunity to increase student’s awareness of psychiat-

ric-mental health nursing as a career option for those studying

in the sciences or liberal arts.

To Improve Mental Health Care in America:

• The deep skillsets and vital contributions of PMH nurses must be

acknowledged and and their utilization expanded to provide

Americans with increased access to qualiﬁed mental health

and substance use treatment to improve the whole health of the

nation.

• PMH nurses must work to deﬁne and standardize PMH nursing

performance competencies and integrate those values into

general healthcare.

• The scope of practice for PMH nurses is determined by state

nursing boards and current state legislative statutes. We support

nurses working to the full extent and authority of their education,

as has been done successfully in 21 states across the nation, to

allow PMH nurses to step forward and ﬁll the gaps in mental

health care.

• More robust research is needed to provide deeper detail on

the PMH nursing workforce to adequately represent this grow-

ing ﬁeld and demonstrate to government organizations and key

stakeholders the important contribution the profession.

• Data collected must be used to further PMH nursing workforce

development efforts, including improving education and region-

al practice guidelines while informing public policy decisions.

• PMH nursing leadership must work more proactively to

advance the visibility of the profession and advocate for the im-

portant role PMH nurses play in America. PMH nurses must step

forward to serve as mentors, advocates, policy, and curriculum

advisors and conduct research to advance the profession.

• Leaders at our nation’s top health and mental health organiza-

tions – Health Resources and Service Administration (HRSA),

Substance Abuse and Mental Health Services Administration

(SAMHSA), National Institutes of Health (NIH), National Insti-

tute of Mental Health (NIMH) and the Centers for Medicare

and Medicaid Services (CMS) – must better understand the

importance of mental health, treatment and recovery, and allow

PMH nurses a seat at the table to partner in efforts to design

solutions to our nation’s top health care issues.

Click to Learn More:

Learn about a career as a psychiatric-mental health RN

Learn about a career as a psychiatric-mental health APRN

PMH nurses play a pivotal role within the mental health

workforce. They are rigorously educated, clinically

trained, very experienced and provide a wide range of

effective support and treatment to those with mental health

and substance use challenges in a variety of settings.

Visit www.apna.org to learn more.