Psychiatric Mental Health Nurse Practitioners (PMHNPs) are board-certified advanced practice nurses who diagnose and treat mental health and substance abuse issues. PMHNPs work in outpatient and inpatient settings, providing assessment, therapy, and medications. PMHNPs are critical in any disaster, providing emergent mental health care and psychosocial support to new patients and continuing outreach and support to established patients. Most recently, the COVID-19 pandemic has initiated a global mental health crisis.
The pandemic mental health crisis is unique in its influence on millions impacted by isolation, job loss, financial strain, and grief. Approximately half of Americans feel that the pandemic harmed their mental health. In addition, millions of healthcare workers that cared for COVID patients are expected to suffer mental health issues for up to a year after the pandemic ends. This increase in mental health issues post-COVID will create an additional cyclical mental health strain on the healthcare system.
To meet the increasing and expected mental health and substance abuse issues, the practice landscape for PMHNPs has changed. Recognition of emergent and forecasted needs combined with a national shortage of psychiatrists has led to dramatic changes in the PMHNP role.
1. Expanded scope of practice
Many states aligned with the Centers for Medicare and Medicaid Services (CMS) to expand Advanced Practice Registered Nurse (APRN) practice flexibility, including relaxing physician supervision mandates. These changes allow the PMHNP to practice to the full extent of their certification—independently counsel patients, prescribe medications, and consult —without physician oversight.
2. Further defined patient populations
In addition to the traditional patient groups, COVID-19 defined the patient population into focused groups to monitor pandemic effects and needs. In the beginning, the elderly population were quickly identified as an at-risk group. Then, the pandemic revealed the health disparities among underserved populations, shedding light on this chronic problem in health care.
Throughout the pandemic, additional patient populations were identified and assessed for risk of increased mental health needs or substance abuse. These groups included: health care workers, school-aged children and teens, university students, the homeless population, and the institutionalized. The expansion of these societal groups provides a detailed assessment of physical, emotional, and support needs.
3. Lowered access barriers
Pre-pandemic barriers to psychiatric care included:
- Limited access to care
- Stigma associated with mental health care services
- Cost of seeking treatment
Although telehealth was available, this service was limited due to insurance reimbursement and the cost of HIPAA-protected technology. During the pandemic, CMS expanded approval for telehealth services. Also, the Department of Health and Human Services (HHS) waived penalties for HIPAA violations associated with the use of technologies such as FaceTime, Skype, or WhatsApp.
Some mental health practices delivered care through drive-up clinics. These clinics continued pre-pandemic care to psychiatric patients by administering long-acting injectable medications, and safely participating in socially distant face-to-face appointments if telehealth was not an option. These drive-up clinics improved treatment and follow-up compliance throughout the pandemic.
Telehealth allowed better access to mental health services, and also allowed patients to be seen in their homes. This view into the patient’s home life provided valuable information about their surroundings, lifestyle, and support systems.
4. Innovative practice opportunities
COVID-19 created a need for PMHNPs to consult with school administrations. Children and teens transitioning from the traditional school day to a virtual day struggle with isolation, depression, and anxiety. A school-aged child with a pre-existing diagnosis (such as ADHD or other behavioral and learning disabilities) may struggle with changes in routine and environment. PMHNPs can offer consulting services to the school and to parents to help children through these challenging times. PMHNPs are also needed for the post-pandemic period for readjustment back to daily in-person school.
Many patients initially reported depression and anxiety to primary care providers (PCP). The PMHNP is a valued consultant for the PCP to initiate holistic therapies, medications, and follow-up for these patients.
During the peak of the COVID-19 assault on New York City, a pair of Yale DNP graduates quickly identified that the city was in crisis. They responded by offering Lavender, an online psychiatry office employing 14 PMHNPs to provide counseling services. (Also an ANA 2021 Innovation Winner). Lavender offers same-day inquiry response, and transparent pricing that is approximately 30% less than existing psychiatric practices.
The pandemic revealed gaps in the current healthcare system and created a mental health emergency. However, PMHNPs are prepared to provide needed services through an expanded scope of practice, telehealth services for patient counseling, and consulting services to schools and medical practices.
Andrew Penn, RN, MS, NP, CNS, APRN-BC, an adult and psychiatric nurse practitioner, is exploring how COVID-19 has changed humanity. Society transitioned from overscheduled bustling lives in society, to adapting to the isolation of working from home, home-schooling children, and a nonexistent social life. These unexpected changes have left us exhausted and wary of the future. He cautions us to slowly emerge from our isolation, give attention to self-care, and look forward to a promising, and transformed future.