Unmet needs for mental health care is creating opportunities for nurses, both new and experienced, in multiple care settings. With the demand for mental health nurses, the possibilities are wide-open, well-paying -- and impressively diverse. You can choose from a surprising array of care settings: inpatient psychiatric hospitals, outpatient clinics, emergency departments, schools, long-term care centers, or even correctional facilities. You can care for pediatric patients, students, adults, or geriatric patients. You might decide to specialize in a certain condition -- addiction, trauma, disaster recovery, or mood disorders. Demand for psychiatric nurse practitioners and mental health nurses in all these settings is surging. At the same time, there's a national shortage of qualified providers and "a behavioral health workforce shortage, causing significant barriers to care for Americans," said Megan Simmons, DNP, PMHNP-BC, assistant professor and director of the Psychiatric Mental Health Nurse Practitioner (PMHNP) Program at Vanderbilt University's School of Nursing.
Nurses are filling the gap
There is a "stark contrast" between the number of behavioral health providers currently available versus the number actually needed to address mental health issues, according to a Behavioral Health Workforce report from the Substance Abuse and Mental Health Services Administration (SAMHSA). For nurses, it means a world of opportunity for new roles. An additional 304,541 psychiatric or behavioral health nurses are needed to care for individuals with serious emotional disturbance/serious mental illness, estimates the report. The demand for mental health nurses is clear. According to Simmons, PMHNPs can assess, diagnose, and treat patients (including psychopharmacological interventions, psychotherapy, and crisis intervention) in the following settings:
- Inpatient psychiatric hospitals
- Inpatient hospital units
- Corrections facilities
- Skilled nursing and long-term care facilities
- Substance use disorder rehabilitation facilities
- Outpatient private practices
- Outpatient community mental health centers
- Veterans Administration Psychiatric Facilities (both inpatient and outpatient)
- Schools
- Integrated care clinics with both primary care services and mental health services
- Home health agencies
- Domestic violence shelters
Demand for Mental Health Nurses
"Psychiatric-mental health (PMH) nursing is one of the fastest growing fields among new nurse practitioners," reported Leslie Oleck, MSN, PMHNP-BC, president of the American Psychiatric Nurses Association (APNA). PMHNP programs have nearly doubled over the past eight years (with 208 programs in 2021, up from 114 programs in 2015). "We have seen increased demand for professionals in all levels of PMH nursing - from RN to APRN and across settings," reported Oleck. The mental health system is increasingly relying on PMHNPs. In 2019, PMHNPs provided nearly one-third of mental health prescriber visits of Medicare patients, found a recent study. "Mental health access is a public health crisis, only worsened by the COVID-19 pandemic," said study author Michael L. Barnett, MD, MS, associate professor of health policy and management at the Harvard T.H. Chan School of Public Health. While demand for mental health treatment is soaring, provider supply is actually dropping among psychiatrists. The problem is particularly acute in rural areas. "We need new solutions. PMHNPs are an important part of the mental health workforce that has received relatively little attention in mental health policy," asserted Barnett. The findings are a big step towards putting PMHNPs more squarely in the spotlight as a critical part of the mental health workforce. "They could be a key part of expanding access to mental health in the future. Our paper can inform workforce policy and workforce development," said Barnett. Lack of access to mental health care is of particular concern in rural areas. Demand for mental health nurses is only expected to increase in the near future. "Nearly half of current PMH-RNs report a plan to retire over the next 10 years," said Oleck. If you're a licensed nurse working in another area of health care, you're an excellent candidate for PMH nursing. To transition into psychiatric mental health, Oleck recommends getting an APNA membership to learn about the profession and free training opportunities, access to job postings and connections to peers currently working in the field, and taking the 16-hour APNA Transitions in Practice Certificate Program. Students with science, liberal arts, or nursing undergraduate degrees, and students currently in master's programs should all consider mental health nursing, urged Oleck: "We hope that more nursing students consider careers in PMH nursing."
"Upstream" health care
There's growing awareness of the social determinants of mental health. As a mental health nurse, you can address issues that typically get overlooked during a typical health care appointment. "Childhood adversity and trauma can have an undesirable impact on a person's life across the life course. Mental health and substance abuse abound. Poverty and systemic racism are critical factors that must be addressed," said Faye Gary, EdD, RN, FAAN, professor of nursing at Case Western Reserve University. Ideally, nursing curricula covers the social determinants of mental health so students can consider working in this field. "More focus on 'upstream' health care is needed -- on health promotion and disease prevention -- and less on treating diseases, which is too costly and ineffective for improving the health status of the nation," said Gary. As a front-line nurse, you are well-positioned to fill the nation's need for mental health care. "Nurses have their fingers on the pulse of America. They are well-informed researchers, educators, health policymakers, and outstanding clinicians," said Gary.
Mental health nursing offers flexibility
PMHNPs are some of the most highly paid advanced practice nurses. "This makes the career desirable for nurses seeking to advance their education," said Simmons. Some nurses who apply to the program already have a background working as a PMH-RN, while others come from a variety of other nursing backgrounds. "Many indicate that they are returning to school because of the great need they saw for mental health care, which they are seeing across all settings in healthcare," said Simmons. Multiple PMHNP students started their nursing careers during the peak of the pandemic in the ICU setting. These new nurses saw the importance of addressing the mental health of patients and families. "That began their interest and passion in exploring and pursuing a career as a PMHNP," said Simmons. PMHNPs also add further value by prescribing medications and provide psychotherapy. "PMHNPs are needed in a variety of settings to fill the continually growing need for qualified mental health professionals," said Simmons.
Meeting the demand for mental health nursing
Once you've set a goal of obtaining certification as a PMHNP, a good first step is to obtain a master's degree and/or doctoral degree in nursing. PMHNP certification allows you to work with patients in a variety of settings -- inpatient (in both medical and psychiatric hospitals), outpatient (in community mental health or private practice settings), emergency departments, or substance use disorder treatment centers. "This gives flexibility for a career that is in high demand," said Simmons. Consider these courses to learn more about mental health nursing: Mental Health and Older Adults (1.0 contact hours) Healthcare clinicians will have contact with older adults in increasing numbers. Treating these patients will require a fundamental knowledge of healthy aging, so it is paramount to know the effects of aging on the mind and body. Common psychosocial challenges, such as loneliness and loss of independence, will be reviewed. Further, a review of common age-related physical changes will be provided. Helpful strategies that healthcare providers can use to support their patients during late adulthood will also be provided. Psychosis, Mood, and Anxiety (5.8 contact hours) Neuropsychiatric disorders have surpassed cardiovascular conditions worldwide in causing disability and premature death. As healthcare professionals, nurses often encounter people with mental illness. This module discusses the etiology of severe mental illness as well as current treatment guidelines and general nursing recommendations for various psychiatric disorders. It specifically describes care for depression, anxiety, schizophrenia, and bipolar disorder.
