Why Are Our Mental Health Nurses Located in Northeast USA?

Introduction

In a shocking time of international and national distress, with a global coronavirus pandemic in full swing, the physical and emotional toll on U.S. citizens has been staggering. For nurses, either those working at the frontlines with severely ill patients, or those answering questions, sewing masks/securing PPE, and providing support at home, the mental anguish has been unlike anything we have witnessed in this lifetime.

According to ABC news, calls to U.S. hotlines requesting assistance for emotional distress have increased 891% in March of 2020, compared to a similar time in March 2019. Where are the experts to aid our Americans in distress, and how are they equipped to deal with this crisis?1

Mental Health Expertise

According to the WHO (World Health Organization), the majority of those with mental health needs do not receive appropriate care. This has been documented well prior to the Covid-19 pandemic.

Mental health has been described as a fundamental human right in which individuals “realize their own abilities, cope with the normal stresses of life, work productively, and are able to contribute to their communities.” While communicable disease or physical illness is recognized as a global burden and treated as such, mental or behavioral illness is often poorly understood or diagnosed. Yet, much of the burden of treating behavioral health, unfortunately, falls to primary care providers or walk-in clinics or ED’s, where minimal knowledge of the process is identified.4

A shortage of professional expertise, especially psychiatrists, psychiatric nurses, psychologists, social workers, and psychiatric-mental health nurse practitioners exists in rural counties and lower income sections of the United States. This creates a heavy burden on rural and poorer sections of the country where mental health needs may be unmet by those without the educational background to treat them or provide ongoing support.4

Additionally, poor mental health is attributed to a risk for poor physical health, not only suicide (50% among men) but also a 40-60% risk for premature death, related to years of dealing with complex medical problems that may be compounded by untreated depression or schizophrenia. Imagine dealing with the complexities of diabetes and blood sugar management while coping with an underlying mental health issue!3

Geographic Inequities

Where are mental health resources located? According to an analysis completed in 2016, the New England, NE metropolitan United States has the highest per capita supply of three provider types: psychiatrist, psychologist, and psychiatric nurse practitioners. The west and south-central U.S. had the lowest per capita supply of the same three providers, resulting in significant variation across the breadth of the United States, at a time when needs in the field were growing exponentially. Why the discrepancy?

The answer could be simple. This geographic area provided the most reward for prescribing professionals. Of the three, psychiatrists and psychiatric NP’s prescribe medications. Jobs in the metropolitan NE USA are plentiful and higher paying. NP roles offer greater autonomy plus prescriptive authority as opposed to NP roles in southern and rural areas of the geographic U.S., where preceptors, research, and mentoring roles may be scarce.3

As early as 2015 it was estimated that 43.4 million Americans 18 and older “suffered from a behavioral health issue,” nearly one-fifth of their population group. Although research has long indicated that early recognition and treatment of behavioral health issues is needed for treatment, this may prove difficult when mental health and behavioral health resources are not only seriously underfunded but also geographically strained in the United States.3

In 2001, a group called the Annapolis Coalition was formed to identify workforce challenges, including potential solutions for improving the behavioral health workforce, and the distribution of resources across the country. As the Annapolis group discovered, providers with prescribing capabilities; psychiatrists and psychiatric NP’s, tended to be employed in metropolitan areas in the Pacific or regional NE, leading to a vast discrepancy in resources throughout the United States. The Annapolis Coalition worked to change the future of mental and behavioral health.

A Solution?

As behavioral and mental health needs expand, it has become obvious the United States cannot rely on resources that are distributed unevenly across the country. Enter the broadened universe of telehealth.

Telehealth may connect primary care physicians with the behavioral and mental health providers patients need, no matter where they are located throughout the geographic United States. Plans can be formulated for patients in need, particularly those with acute symptoms who arrive in ED’s or walk-in clinics.3

In a wider approach, BHA (behavioral health aides), psychiatric nurses, and psychiatric-mental health NP’s can collaborate to establish nursing curricula that identifies educational needs for rural communities to assist in recognizing the patient with behavioral or mental health needs that requires support. 

Although resources may be scant, the mental health needs of patients cannot be ignored, especially during times of enormous physical and emotional stress. The rise in patient violence is merely one issue that must be addressed by a nursing curriculum, where bedside nurses learn skills for safety and de-escalation that may ultimately save lives.

In providing for the holistic needs of patients in trying times, it may indeed take a village.

References

  1. Abcnews.go.com “Calls to US helpline jump 891%, as White House is warned of mental health crisis.” Levine, M., April 7, 2020, ABC news.
  2. Acu.edu.au “Critical shortage of mental health nurses’ looms stress and high workloads take a toll.” June 13, 2019, Australian Catholic University.
  3. Ajpmonline.org “Geographic variation in the supply of selected behavioral health providers.” Andrilla, C., Patterson, D., & Coulthard, C., Volume 54, Issue 6, Supplement 3, S199-S207, June 1, 2018, AJPM, American journal of Preventive Medicine.
  4. Ncbi.nim.nih.gov “Promoting access through integrated mental health care education.” Kverno, K., April 30, 2016, Open Nursing Journal, John Hopkins University School of Nursing.

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