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

There aren’t nearly enough practitioners to address Americans’ mental health care needs—and the problem begins in nursing school.

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

Across the US, only 44% of adults and 20% 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 massive problem since an estimated 56 million Americans experience mental illness or substance use disorders yearly.

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. As a result, over 75% of US counties face a shortage of mental health workers. In fact, the US 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 US is rising.

Nursing Schools Aren’t Educating Students on Mental Health

Despite the clear need for care, past surveys show that only 4% 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).

Moreover, nursing students also report insufficient 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 general nursing curriculum and provide students with access to psychiatric rotations. This would help new nurses better understand that mental health is 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 filling the gap in mental health care. There are more PMH nurses than any other mental health professional in the US. 

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:

  1. 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.
  1. 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, 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% increase in PMH-RN and a 17% 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 the following:

  • 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.

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: they may specialize in treating a particular population, such as children, adolescents, geriatrics, substance use disorders, forensics, or the LGBTQ community.

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