While the number of psychiatrists in the United States to manage unmet mental healthcare needs is lacking, psychiatric mental health nurse practitioners may help fill gaps in care.
Researchers at the Harvard T.H. Chan School of Public Health evaluated how the supply and use of psychiatrists and psychiatric mental health nurse practitioners changed over time, and they compared their practice patterns. They discovered that psychiatrists and psychiatric mental health nurse practitioners treated roughly similar patient populations with comparable services and prescriptions.
The study, published in the September issue of Health Affairs, reviewed Medicare claims for a 100% sample of fee-for-service beneficiaries (with an average age of 61) who had an office visit with a psychiatrist or a psychiatric mental health nurse practitioner during the period 2011 to 2019.
From 2011 to 2019, the number of psychiatric mental health nurse practitioners increased 162%, compared with a 6% relative decline in the number of psychiatrists. During this time, annual mental health office visits per 100 beneficiaries decreased 11.5% from 27.4 to 24.2. This was due to a 29% drop in psychiatrist visits being offset by a 111.3% surge in visits with psychiatric mental health nurse practitioners.
The proportion of all mental health prescriber visits provided by psychiatric mental health nurse practitioners jumped from 12.5% to 29.8% during 2011 to 2019, surpassing 50% in rural, full-scope-of-practice regions. Psychiatric mental health nurse practitioners represent “a rapidly growing workforce that may be instrumental in improving mental health care access" amid ongoing demand for health specialists with prescribing privileges, the study’s authors concluded.
Citing previous research, the authors noted that the deficiency in psychiatrists is projected to widen over time, with a projected national shortage of 14,000 to 31,000 in 2024. They added that “the deficit of mental health specialists is particularly dire in rural regions, where 80% of counties have no practicing psychiatrists.”
Although physician assistants are the other key discipline of advanced practice providers in the healthcare workforce, surveys indicate that few are employed in psychiatry practices. As a result, the researcher's analysis focuses on nurse practitioners.
“Mental health access is a public health crisis, only worsened by the COVID-19 pandemic,” Michael L. Barnett, M.D., the study’s corresponding author, told Fierce Healthcare in explaining why the researchers conducted the study. “While demand for mental health treatment is soaring, provider supply is actually dropping among psychiatrists, particularly in rural areas. We need new solutions. Psychiatric mental health nurse practitioners are an important part of the mental health workforce that has received relatively little attention in mental health policy. We wanted to address that knowledge gap.”
Until this study, little attention has been paid to the substantial role that psychiatric mental health nurse practitioners play in the mental healthcare system. “Our findings are a big step towards putting psychiatric mental health nurse practitioners more squarely in the spotlight as a critical part of the mental health workforce,” said Barnett, associate professor of health policy and management at the Harvard T.H. Chan School of Public Health. “They could be a key part of expanding access to mental health in the future.”
By 2019, Barnett and his colleagues found that almost one in three visits by Medicare beneficiaries with a mental health prescriber were with a psychiatric mental health nurse practitioner. They suspected that this trend could be fueled in part by the fact that the majority of psychiatrists do not accept Medicare insurance.
The study’s strengths, Barnett pointed out, include a decade of national data for millions of older and disabled Americans, and the identification of psychiatric mental health nurse practitioners based on the type of care they delivered rather than reliance on inaccurate administrative claims labels.
As for limitations, he acknowledged that “we only studied people in Medicare, so psychiatric mental health nurse practitioners may have a different role in other populations." He added, "Also, we did not study quality of care.”
While the findings are novel, Barnett said they aren’t expected to change clinical practice. Instead, they are useful in guiding workforce policy and development. “Healthcare leadership and policymakers may want to focus on this growing workforce to reduce mental health shortages in the U.S.,” he said.
In the report, the authors noted that the rapid growth of the psychiatric mental health nurse practitioner workforce implies that policies that facilitate their recruitment and training, “such as targeted investment in nursing programs or loan repayment, may have a greater short-term impact on increasing the mental health workforce than physician-targeted strategies, especially in rural areas.”
The authors also indicated that a significant amount of mental health care is now provided virtually. In prior work, they learned that before the pandemic, nurse practitioners were one of the largest provider groups participating in mental health telemedicine. These clinicians, the authors wrote, “may also play a key role in the rise of virtual mental health, which is a new paradigm of care likely to persist for many years.”