Psychiatric nurses: Key to filling the gap in the mental health crisis?

Increasingly, employers who offer health benefits to their workers are asking their benefits advisors to help them support plan members’ mental health. Telehealth solutions that target mental health concerns evolved rapidly during the pandemic and are becoming an acceptable alternative to scheduling in-person sessions with local therapists.

Now, a national organization that represents psychiatric-mental health nurses (PMH-RNs) has launched a campaign to call attention to the role that such nurses can, and should, play in treating mental health situations.

The American Psychiatric Nurses Association recently published a white paper (Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis) that cites data supporting a growing mental health crisis in the U.S. The paper advocates for PMHs to assume greater responsibility for treating mental health patients. Part of the association’s challenge, it says, is familiarizing the public with PMHs. Their qualifications and range of services they can offer puts them in a position to treat a very wide range of mental health conditions.

Plan sponsors would welcome more resources to address mental health issues, says benefits advisor Allison De Paoli, founder of Altiqe.

“Any plan sponsor will tell you stress levels among workers are out of control. They are all looking for solutions,” she says. “If these nurses have the capacity to help, they need to be promoting themselves to the right people.”

The association acknowledges its need to accelerate outreach, especially in the face of limited access for many to mental health services even as the need has greatly increased.

How bad is the mental health crisis? The association’s report says: “Prior to COVID-19, one in ten adults reported symptoms of an anxiety and/or a depressive disorder. However, during the COVID-19 pandemic, that number rose to 4 in 10 adults.”

It cites data from the Substance Abuse and Mental Health Services Administration offering a snapshot of current rates of mental illness in the U.S.:

• 8 million Americans are experiencing mental illness or substance use disorders.
• 9 million American adults are experiencing any mental illness.
• 2 million are experiencing serious mental illness with percentages highest among adults younger than age 49.

Related: An open letter to employers: ‘Address your employees’ mental health needs’

The report further notes that the incidence among children and adolescents is even higher than among adults, and that the exploding opioid crisis has driven demand for treatment services sky high. According to SAMSHA, the unmet need for mental health and substance use support in 2020 looked like this:

• Among the 67.1 million American adults experiencing mental illness, only 41.4 million received mental health services.
• Only 41.6% of American adolescents experiencing a major depressive episode received treatment.
• Only 1.4% of Americans aged 12 or older experiencing a SUD received any substance use treatment.

With respect to employer plan members, telehealth mental health options gained considerable traction among plan sponsors, and studies indicated that member adoption of telehealth services grew rapidly during the pandemic.

Direct primacy care solution?

De Paoli and other advisors have encouraged sponsors to include telehealth in their benefits plans to address the growing need and the lack of local access in many regions. De Paoli also advises her clients to consider direct primary care as a solution.

“A direct primary care physician will not be able to prescribe certain medications, but they can find it for you,” she says. “A DPC is not the person to supervise a mental health condition, but they can help someone having a lot of stress by connecting them with a provider who can help. In that way, behavioral health could be the bridge between your primary care provider and a mental health specialist.”

A spokesperson for APNA says offering virtual mental health counseling to plan members would effectively address a range of common conditions.

“Research has demonstrated that telemental health services are equal in efficacy to those in-person, and are even preferred by some,” she says.

In the U.S., APNA reports, nearly half the states place limits on the functions that psychiatric-mental health nurses can provide. For instance, PMH nurses with advanced degrees can perform virtually all the functions of a psychiatrist. Yet in certain states, some functions can only be handled by psychiatrists. Eliminating this barrier to accessing more providers of mental health services is a key objective of APNA.

Psychiatric-Mental Health Advanced Practice Nurses (PMH-APRNs)’ prescriptive authority is largely dependent on state-specific regulations. There are 24 states that limit the scope of practice of PMH-APRNs (see the report for a link to a map designating the differences among the states). There are also controlled substances that are regulated by the Drug Enforcement Agency where the prescriber may have to meet certain requirements to prescribe. Psychiatric-mental health registered nurses (PMH-RNs) cannot prescribe medication.

The association noted that other barriers to access, such as high deductibles and out-of-pocket expenses for mental health services, should be reduced or eliminated to encourage utilization. Meantime, policymakers should take action aimed at attracting more individuals to existing psychiatric-mental health educational programs so that, as demand for their services increases, so does the number of practitioners.