practicing nurses leave psychiatrists | News

For immediate release: September 6, 2022

Boston, MA — The mental health system increasingly relies on psychiatric nurses (PMHNPs) to meet the psychiatric needs of Medicare patients, according to a new study by researchers at the Harvard TH Chan School of Public Health.

“We were surprised at the degree to which PMHNPs are the de facto prescribers of mental health in some parts of the country,” said corresponding author Michael Barnett, associate professor of health policy and management at Harvard Chan School. “In states where PMHNPs have no prescription restrictions, these providers account for 50 percent of all mental health prescriber visits in rural areas, a much higher figure than we anticipated.”

The study was published in the September 2022 issue of Health Affairs.

Access to mental health is a public health crisis that the COVID-19 pandemic has exacerbated. While the demand for mental health care is increasing, the supply of psychiatrists who accept insurance is decreasing, particularly in rural areas.

To assess how the mental health workforce and patient population have changed over time, Barnett and his colleagues analyzed Medicare payment claims during the 2011-2019 period. The team focused on the number of PMHNPs and psychiatrists billing Medicare, the volume of outpatient and psychiatric services by provider group, and how these numbers varied based on rurality and scope regulations, which can limit whether a PMHNP is able to prescribe drugs.

The results showed that PMHNPs provided nearly 1 in 3 mental health prescriber visits to Medicare patients nationwide by 2019. The number of PMHNPs also increased by 162% over 2011-2019, while psychiatrists who have Medicare revenue fell 6%. During this period, without a growth in the PMHNP workforce, there would have been a nearly 30% drop in mental health specialist visits in Medicare. The drop was instead of 12%.

“This work highlights PMHNPs as a key part of the mental health workforce,” said Barnett. “This is so important because we desperately need new solutions to address the current mental health crisis in this country. Policy targeting the PMHNP workforce could be a key part of the national effort to expand access to mental health. “

Co-author Arno Cai is also from Harvard Chan School.

This research was supported by the National Institute on Aging (K23 AG058806-01) and the National Institute of Mental Health (R01 MH112829-01) in the National Institutes of Health.

“Trends in Mental Health Care Delivery by Professional Psychiatrists and Nurses in Medicare, 2011-19”, Arno Cai, Ateev Mehrotra, Hayley D. Germack, Alisa B. Busch, Haiden A. Huskamp, ​​and Michael L. Barnett, Business health, September 2022, doi: 10.1377 / hlthaff.2022.00289.

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Harvard TH Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators and students, we work together to bring innovative ideas from the laboratory to people’s lives, not only by making scientific breakthroughs, but also by working to change individual behaviors, public policies and health practices. Each year, more than 400 Harvard Chan School faculty members teach over 1,000 full-time students from around the world and train thousands more through online and executive training courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the school is recognized as America’s oldest vocational training program in public health.

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