Psychiatric Mental Health Nursing
May 3, 2017 12:00 AM
Sometimes, it’s just a matter of timing.
Three years ago, the Utah Legislature changed state law to remove the prescribing barriers for new psychiatric/mental health nurse practitioners.
Up until then, new graduates with less than 3,000 hours on the job had to get their supervisor’s signoff to write prescriptions for higher-level Attention Deficit Hyperactivity Disorder (ADHD) and anxiety medications—a cumbersome restriction that discouraged companies from hiring psychiatric nurse practitioners-in-training.
As a result, most new graduates were finding jobs out of state.
The change significantly transformed the job prospects for new psychiatric nurses. And the University of Utah College of Nursing is quickly establishing itself as a hub for mental health nurse practitioners.
“Hospitals and clinics across the Salt Lake Valley know nurse practitioners provide good care,” says Sam Vincent, an instructor at the college and clinical director of the Behavioral Health Faculty Practice. “Within the next three years, we’ll see a more rapid infusion of nurse practitioners licensed to provide psychiatric care at the same time that demand is high.”
Utah’s rate of mental illness is higher than the national average, according to the Substance Abuse and Mental Health Services Administration. And the state’s suicide rate is fifth-highest in the nation. It’s not uncommon for patients to wait three months for an appointment. The state has 209 providers for every 100,000 people, compared to an average of 311 nationally, according to a 2016 report from the Utah Medical Education Council.
Every county in Utah has been designated a “Mental Health Provider Shortage Area” according to the U.S. Department of Health and Human Services.
The council estimates that Utah’s mental healthcare labor force will have to double over the next 15 years, from 5,000 in 2016 to more than 11,000 by 2030 to meet the need. Nurse practitioners are positioned to take on many of those roles.
But it wasn’t always this way. The path of psychiatric nursing has been filled with potholes.
For much of modern history, mental health care was focused on Victorian notions that favored institutionalization and Freudian analysis. Effective medications were decades from development. And caregivers often were reduced to stereotypes—from Bedlam’s harsh “attendants” to Nurse Ratched.
But as psychiatric care changed, so did the thinking about mental health nurses. The first effective psychiatric medications emerged in the 1950s, followed by antipsychotic drugs in the 1960s and 70s. When doctors started prescribing Prozac in 1986, treatment of depression and anxiety became mainstream, says Noel Gardner, a psychiatrist and medical director of the Polizzi Clinic.
Development of effective medications increased demand for mental health care exponentially, outpacing the number of psychiatrists and psychologists available.
Advanced practice nurses are an obvious alternative, Gardner says.
“They’ve worked together with us for years,” he says. “And while a number of doctors were uncomfortable for nurses to begin prescribing, very quickly we found out they were a real asset. They have a lot of background in treating people and administering medications. They were oriented in that world.”
Nurses also are economical and patient-centered, says ElLois Bailey, a psych/mental health nurse practitioner and instructor.
“My patients tell me all the time that they have a different experience with a nurse practitioner,” she says. “They feel cared about.”
Many nurse practitioners use integrated medicine—therapy combined with nutrition and lifestyle and medications—Vincent adds.
“Many patients want therapy at the same time they’re getting their prescriptions. Very few patients want just a prescription,” he says. “That’s what nurse practitioners are trained to do.”
Now, with the changes for entry-level psych nurse practitioners, college administrators are working to meet the pent-up demand. The college currently has three part-time psychiatric nurse practitioners working at University Health’s South Jordan clinic. College faculty provide care for uninsured patients at Gardner’s Polizzi Clinic two days a week. Three staff care for adolescent patients through the college’s Juvenile Justice Services contract with the State of Utah. Two see patients at the Veterans Affairs Hospital. One runs group therapy sessions at the Skaggs Patient Wellness Center.
At the same time, Professor Gwen Latendresse is studying the use of mindfulness-based cognitive group therapy through telehealth technology for pregnant and postpartum patients who have mild depression or are at risk of developing it. Three faculty members and students facilitate those groups.
Meanwhile, the college has expanded its capacity — doubling the psychiatric nurse practitioner cohort this year from 11 in 2014 to 24 students in 2016. The graduating class of 2019 will be the largest ever.
“Nurse practitioners are filling a very large part of the access psychiatric care,” Gardner says. “The future for advanced practice nurses with prescribing privileges is very substantial.”