How Nurse Practitioners Can Offset the Psychiatrist Shortage

Several elements contribute to the shortage of psychiatrists in the U.S. Understanding these factors is essential for developing effective strategies to address practitioner shortages and ensure that individuals can access quality mental healthcare services in a timely manner.

Millions of U.S. adults experience mental health struggles. The National Institute of Mental Health reports that in 2020, 21 million people experienced a major depressive episode, and the Anxiety and Depression Organization of America reports that 40 million adults struggle with anxiety disorders each year.

Demand for treatment has continued to rise since the start of the COVID-19 pandemic, according to the American Psychological Association. Sixty percent of practitioners polled for a 2022 APA survey said they lacked the availability to accept new patients.

There has been a marked reduction in the negative assumptions previously associated with mental illnesses, a 2020 survey conducted by HealthPartners Institute found. This has helped more people feel comfortable in seeking care.

Approximately 14,100 openings for psychologists are projected to become available each year between 2021 and 2031, according to the U.S. Bureau of Labor Statistics (BLS), with many of these openings resulting from the need to replace professionals who are exiting the labor force. The American Psychiatric Association (APA) also reports that the supply of psychiatrists will continue to decline while the demand for mental healthcare services rises.

The ACA’s expansion of coverage, including offering more affordable insurance plans, allowing adults under the age of 26 to stay on their parents’ healthcare plans, and expanding Medicaid, reduced the number of uninsured individuals by 30.4 million. The ACA also requires plans to cover more mental healthcare services for subscribers, which has increased demand for mental health professionals, the Commonwealth Fund reports.

Psychiatric mental health nurse practitioners can help offset the psychiatrist shortage in a variety of ways. For example, a 2022 article published by Health Affairs found that while the supply of psychiatrists in the U.S. remains inadequate, the number of practicing PMHNPs is growing rapidly. NPs are projected to be among the fastest-growing professions between the years 2021 and 2031, according to the BLS.

Additionally, similar to psychiatrists, PMHNPs can also provide care, counseling, and mental healthcare services to patients struggling with a variety of conditions. Examples include the following:

• Anxiety
• Depression
• Schizophrenia
• Bipolar disorder
• Eating disorders
• Trauma-induced disorders, such as post-traumatic stress disorder and dissociative disorders
• Phobias, such as fear of certain animals, air travel, and fear of deep water, among others

As of March 2023, more than half of U.S. states and territories grant full practice authority (FPA) to nurse practitioners. NPs working in FPA states are permitted to evaluate and diagnose patients, order and interpret diagnostic tests, initiate and manage treatment protocols, and prescribe medication. FPA states and territories include the following:

• Alaska
• Arizona
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Guam
• Hawaii
• Idaho
• Iowa
• Kansas
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• New York
• North Dakota
• Northern Mariana Islands
• Oregon
• Rhode Island
• South Dakota
• Utah
• Vermont
• Washington
• Wyoming

The American Association of Nurse Practitioners (AANP) further reports that about a dozen other states and territories provide NPs with reduced practice authority, which limits nurse practitioners’ practice rights in at least one area. For example, NPs working in some reduced practice authority states may have reduced prescriptive authority, or they may be required to engage in career-long collaboration with another healthcare provider, such as a physician, to provide patient care. As of March 2023, reduced practice authority states and territories include the following:

• Alabama
• American Samoa
• Indiana
• Kentucky
• Louisiana
• Mississippi
• New Jersey
• Ohio
• Pennsylvania
• Puerto Rico
• S. Virgin Islands
• West Virginia
• Wisconsin

Last, the AMA notes that about 10 additional states grant NPs restricted practice authority. Nurse practitioners working in restricted practice authority states have less autonomy than NPs in reduced practice authority states, and they are required to have career-long supervision by another healthcare provider such as a physician. The primary difference between NPs practicing in reduced practice versus restricted practice states is the amount of oversight that is required. Restricted practice authority states as of March 2023 include:

• California
• Florida
• Georgia
• Michigan
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas
• Virginia

PMHNPs play an important role in assessing, diagnosing, and evaluating patients seeking care for a variety of mental illnesses, such as eating disorders, depression, bipolar disorder, and obsessive-compulsive disorder. In addition to being licensed registered nurses (RNs), PMHNPs complete additional specialized training designed to provide them with the skills needed to care for patients’ mental health struggles throughout their lifespans.

Although the exact roles and duties of PMHNPs can vary based on the facility they work for, common responsibilities include the following:

• Conducting mental health assessments and examinations
• Leading psychotherapy sessions
• Diagnosing psychiatric illnesses
• Prescribing medications, such as antidepressants, mood stabilizers, and tranquilizers
• Developing treatment plans
• Providing follow-up care to evaluate the effectiveness of various treatment plans
• Educating patients about mental health

The first steps toward becoming a PMHNP are to become an RN and earn a Bachelor of Science in Nursing (BSN). RN candidates need to pass the NCLEX-RN exam, which tests candidates’ competency to provide safe care to patients. The NCLEX-RN exam is offered numerous times throughout the year at testing centers throughout the U.S. All 50 states require RN candidates to pass the NCLEX before applying for licensure.

The next step toward becoming a PMHNP is to complete an advanced nursing degree, such as an online MSN, DNP, or BSN to DNP program. The most common requirements for MSN and BSN to DNP programs include the following:

• A BSN degree from an accredited institution
• An active nursing license
• 1-5 years full-time paid working experience as a licensed RN
• Payment of an application fee
• Submission of official transcripts from all prior colleges or universities attended
• Minimum quality point average (QPA) or grade point average (GPA) requirements

In addition to earning an advanced degree, aspiring psychiatric mental health nurse practitioners also need to complete about 500 faculty-supervised clinical hours at a hospital, clinic, or mental health facility before applying for certification from an organization such as the American Nurses Credentialing Center (ANCC) to practice as a PMHNP. Certification typically involves passing a computer-based accreditation exam.

• American Association of Nurse Practitioners. The AANP nurse practitioner certification page lists options for various credentials.
• AANP Job Center. This official AANP job board helps NPs and PMHNPs find jobs.
• American Nurses Credentialing Center. The ANCC provides certification exams for various nursing board certifications.
• American Psychiatric Nursing Center. Information about continuing education resources or PMHNPs from the APNC.
• Travel Nursing Central. This organization provides information about traveler nurse agency rankings, information about how to find housing, and listings for travel nurse jobs.
• S. Bureau of Labor Statistics. The BLS describes the job prospects and salary estimates for nurse practitioners (NPs), including NPs who work with patients struggling with mental health.
• Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). Information on the ANCC PMHNP certification exam, along with fees and credentialing requirements.

Licensed RNs interested in becoming psychiatric mental health nurse practitioners and helping to address the nation’s psychiatrist shortage must start by developing the foundational knowledge needed to help patients cope with difficult situations, such as addiction, trauma, and other types of mental health conditions.

Completing an accredited mental health nurse practitioner training program can provide graduates with the tools needed to connect with patients, educate families, and provide treatment to children, adolescents, adults, and elderly individuals seeking help.

Is there supposed to be bullets of factors contributing to the shortage in this section? If not, can we reword this sentence as it seems a bit confusing to read ‘include the following:’ and then go into separate headlines and not list this out.

Also, the previous heading has “Below are just a few of the ways that PMHNPs can help offset the mental health practitioner shortage.”

Can we perhaps just reword this sentence from “Factors that have contributed to the psychiatrist shortage is the U.S include the following:” to “Several elements contribute to the shortage of psychiatrists in the U.S. Understanding the various factors Is essential for developing effective strategies to address these shortages and ensure that individuals can access timely and quality mental healthcare services”.

Feel free to reword and I’m open to your thoughts, just want this section to flow to the other section a bit better for readers and I feel the colon is usually used to introduce lists.

We revised the text here based on your suggestions. We also revised the last sentence of the introduction (“Below are just a few of the ways that PMHNPs can help …”) to avoid confusion, since the ‘ways that PMHNPs can help’ information comes after the ‘understanding the shortage’ section. Let us know what you think, thanks!