While mental health care has become a full-blown crisis in the United States, a new study finds that psychiatric nurse practitioners are helping to fill the gap.
The researchers discovered that the mental health system in the United States has become increasingly reliant on this particular category of specialists to meet the needs of Medicare patients as the numbers of psychiatrists accepting Medicare has dropped.
“We were surprised by the degree to which PMHNPs [psychiatric mental health nurse practitioners] are the de facto mental health prescribers in parts of the country,” said corresponding study author Michael Barnett. He is an associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, in Boston.
“In the states where PMHNPs have no restrictions on prescribing medications, these providers account for 50% of all mental health prescriber visits in rural areas, which was much greater than we had anticipated,” Barnett said in a Harvard news release.
To study the issue, the researchers analyzed fee-for-service Medicare claims from 2011 to 2019. The team was focused on the number of PMHNPs and psychiatrists who were billing Medicare, as well as the volume of outpatient and psychiatric services delivered by those provider groups. They also looked at how the numbers varied by rurality and also by regulations that can restrict whether a psychiatric nurse practitioner can prescribe medications.
The investigators found that in 2019, nearly one of every three mental health prescriber visits to Medicare patients were done by psychiatric nurse practitioners. Psychiatrists billing Medicare dropped by 6% between 2011 and 2019, but numbers of psychiatric nurse practitioners increased by 162%.
The researchers estimated that there would have been a 30% decline in mental health specialist visits among Medicare patients during these years without the growth of the psychiatric nurse practitioner workforce, but instead there was a drop of only 12%.
“This work puts the spotlight on PMHNPs as a critical part of the mental health workforce,” Barnett said. “This is so important because we desperately need new solutions to address the current mental health crisis in this country. Policy that targets the PMHNP workforce could be a key part of the national effort to expand mental health access.”
The findings were published in the September issue of Health Affairs.
The U.S. National Institute of Mental Health has more on mental health in older adults.
SOURCE: Harvard T.H. Chan School of Public Health, news release, Sept. 6, 2022