I became interested in becoming a psychiatric mental health nurse practitioner (PMHNP) after suffering a serious accident in 1992. Extensive injuries and complications greatly affected my sense of control and my view of the world. During my 8-year recovery, the only health care professionals who regularly inquired about my psychosocial functioning and acknowledged my frustrations were my nurses.
When I inquired about mental health counseling, my primary care providers said it was normal to be a little down after a serious injury and that feelings of sadness and frustration would pass. The gap between this assessment and my own experience of how physical illness was affecting my psychological well-being sparked my interest in mental health and nursing. Eventually, I decided to pursue a PMHNP degree so I could give patients integrated care.
The PMHNP graduate program I chose focused on evidence-based psychiatric care delivered in both psychiatric and primary care settings. The program focused on using mental health screening tools, diagnosing and managing mental illness, and providing psychoeducation, cognitive behavioral therapy, and psychotropic drug therapy.
Primary mental health care is an essential role of the PMHNP, who can also help manage coexisting physical conditions with physical assessment, differential diagnosis, and drug assessment. Although most PMHNPs work in psychiatric settings, PMHNPs are beginning to provide mental health intervention in primary care settings.
A PMHNP can provide significant benefits to patients in the primary care setting. Even though in 2002 the President's Commission on Mental Health documented that primary medical providers deliver about half of the care for common mental disorders and prescribe most of the psychotropic drugs, they aren't specifically trained to assess and treat psychiatric conditions and they may be limited by time constraints. The onsite support and collaboration offered by a PMHNP can address both of these problems.
The interventions of a PMHNP in a primary care setting can increase patient participation in treatment plans. Of medical patients referred to mental health services, up to 50% don't follow through with their referrals. Typical barriers to seeking mental health treatment include inconvenience, transportation problems, stigma, and cost. Scheduling appointments in the same facility is more convenient and has less stigma attached. Early detection of mental disorders and evidence-based treatment approaches delivered by PMHNPs increases recovery rates, can improve physical health, and in turn, reduces overall health care costs.
A PMHNP can also help integrate medical and psychiatric care. Patients with chronic mental illness are at high risk for multiple physical problems. Prolonged mood, anxiety, and psychotic disorders often result in detrimental health behaviors, such as a sedentary lifestyle, poor eating and sleeping habits, strained personal and professional relationships, and poor lifestyle choices and coping skills (smoking, substance abuse, physical or emotional abuse, and anger outbursts). In addition, common newer antipsychotic drugs (called atypical antipsychotics) have a lower risk of some adverse reactions than older drugs, but they put patients with chronic mental illness at greater risk for obesity, cardiovascular disease, and diabetes. Some examples of these newer drugs are clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa). Psychiatric mental health nurse practitioners in the primary care setting can implement evidence-based interventions. With immediate access to medical records, onsite labs, and primary care providers, they can easily screen for coexisting problems.
Finally, certain diagnoses, medications, and treatments can compromise a patient's mental health.
Medical and psychiatric care can be fragmented because there isn't enough collaboration. A PMHNP in the primary care setting can bridge this gap. By addressing the interplay of physical and mental health and providing an integrated approach to care, the PMHNP can help restore psychological health and speed healing.
SELECTED WEB SITES
American Psychiatric Nurses Association (APNA) http://www.apna.org
College of Nursing, Medical University of South Carolina PMHNP program http://www.musc.edu/nursing/academics/mastersprograms/mp_index.htm, then click on Psychiatric Mental Health Nursing
Oregon Health & Science University http://www.ohsu.edu/son/academic/ms-pmhnp.shtml
President's New Freedom Commission on Mental Health http://www.mentalhealthcommission.gov/reports/reports.htm
McDevitt J. Primary care update for mental health nurses: Evidence-based guidelines for nursing assessment, intervention, and follow-up. Journal of Psychosocial Nursing & Mental Health Services.
42(10):22–35, October 2004.
Reich L, et al. A new frontier: Psychologists practicing in primary care settings. Behavioral Healthcare Tomorrow
. 13(6):28–32, December 2004.
Stuart GW, Laraia MT. Principles and Practice of Psychiatric Nursing, 8th edition. New York, N.Y., Elsevier, 2005.