Posted: April 24th, 2025

Individual and family psychotherapy

1- What can we do as PMH-APRNs to close the existing disparities in Mental Health?

2- Do you consider there is a stigma associated with specializing in PMH?

Psychiatric-Mental Health Nurses
Are Key to Addressing the Nation’s
Mental Health Crisis

New Data Sheds Light on Solutions to
Address Surging Demand & Provider Shortages

Executive Summary:
Escalating demand and increasing gaps in equity
and access to quality mental health care in the
United States have been exacerbated by the
impact of the COVID-

pandemic. Psychiatric-
mental health (PMH) nurses can help fill these
critical gaps in the mental health care system,
but an aging workforce and restrictive policies
continue to clash with the need to expand access
to care. This report explains the surging mental
health crisis in the U.S., barriers to addressing
the crisis, and the latest findings about under-
recognized health care professionals whose skills
and expertise make them essential to addressing
this national mental health emergency.

www.APNA.org

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

THE U.S. IS EXPERIENCING A
MENTAL HEALTH STATE OF EMERGENCY

W hen tornadoes, hurricanes, and other natural disasters
occur, the devastation and long-term impacts are
readily visible. In contrast, over the last 2 decades, the

nation’s mental health crisis has quietly gained momentum with
equally devastating results to individuals, families, schools, and
communities in rural areas, small towns, suburbs, and large cities.
In recent years, the COVID-

pandemic added more fear, stress,
isolation, depression, financial concerns, and mental exhaustion
on top of already rising rates of mental health and substance use
challenges in our communities.

Exponentially rising rates of mental health and substance use
disorders are significant challenges, even more so in the context of
a significant shortage of mental health professionals that impedes
access to care. As a result, each year, millions of Americans do not
receive the mental health and substance use treatment they need.

What does this mental health crisis look like? The lack of access
to mental health care and resulting health inequities have per-
meated nearly every area of American life and broadly increased
negative outcomes. (Health equity is defined as the right to access
quality health care for all populations regardless of the individual’s
race, ethnicity, gender, socioeconomic status, sexual orientation,
or geographical location.)

Whole health begins with mental health. Mental health is foun-
dational to overall health and therefore vital to the health of the
nation. Policymakers and health care stakeholders must come
together to take the actions needed to deliver substantially more
accessible, high-quality care to all people with mental health and
substance use challenges in all communities across the country.

The following report details the rising rates of patients in need;
documented shortages of professionals needed to provide
adequate treatment; the ongoing impact of the lack of access
and equity in treatment; and recommendations to allow for the
expanded use of psychiatric-mental health (PMH) Registered
Nurses (RNs) and Advanced Practice Registered Nurses
(APRNs) to fill these growing gaps in mental health care.

WHOLE HEALTH BEGINS

WITH MENTAL HEALTH.

MENTAL HEALTH IS FOUNDATIONAL

TO OVERALL HEALTH AND

THEREFORE VITAL TO THE

HEALTH OF THE NATION

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

State of the Nation:
MENTAL HEALTH URGENCY
AMONG ADULTS
Even before the COVID-19 pandemic, the U.S. health care system
struggled to meet the needs of an escalating mental health crisis.
Increasing demand for mental health services has grown annually,
overwhelming available mental health professionals.

Access to comprehensive mental health services is an essential
precursor to the delivery of equitable, high-quality mental health
care. Unfortunately, both access to care and equity in mental
health care have been steadily decreasing for decades.

Americans consistently lack the same access to mental health
providers as they have to other health care providers, all while the
prevalence of mental health challenges continues to exponentially
increase.

Prior to COVID-19, one in ten adults reported symptoms of an anxi-
ety and/or a depressive disorder. However, during the COVID-19
pandemic, that number rose to

adults. The latest Sub-
stance Abuse and Mental Health Services Administration (SAM-
HSA) data further provide a snapshot of current rates of mental
illness in the U.S.:

•

million Americans are experiencing mental illness or
substance use disorders.

•

2.9 million American adults are experiencing any mental
illness (AMI*).

•

.2 million are experiencing serious mental illness
(SMI**), with percentages highest among adults younger
than age 49.

Additionally, the CDC recently reported concerning increases
in suicide rates among young adults, American Indians, Alaska
Natives, Black Americans, and Hispanic Americans – populations
that previously had much lower rates of suicide – expanding ongo-
ing concerns about mental health equity and access to care in the
U.S.

PMH nurses are key to addressing this mental health urgency
among adults.

SYSTEMIC
DISPARITIES
WITHIN MENTAL
HEALTH CARE
BY RACE, SEXUAL
ORIENTATION,
GENDER, & INCOME

Black and Latinx Americans
are more likely to experi-
ence persistent symptoms
of emotional distress than
White Americans.

Despite this:
Just one in three Black
adults who need mental
health care receives it.

Among Latinx Americans,
just 33% receive mental
health care, compared with
43% of White Americans.

LGBTQ+ individuals are
more than twice as likely as
non-LGBTQ+ individuals to
experience a mental health
disorder.

Transgender individuals are
nearly four times as likely to
experience a mental health
disorder than cisgender
individuals.

Those living in high-poverty
neighborhoods have been
shown to experience signifi-
cantly greater symptoms of
emotional distress.

“How to Transform the U.S. Mental Health
System” McBain et al.,

p. 27

*Any Mental Illness (AMI) is defined as individuals having any mental, behavior, or emotional
disorder in the past year that met DSM-5-TR criteria (excluding developmental and substance use
disorders).

** Serious mental illness (SMI) is defined by someone older than

having within the past year a
diagnosable mental, behavior, or emotional disorder that causes serious functional impairment
that substantially interferes with or limits one or more major life activities.

https://www.nami.org/support-education/publications-reports/public-policy-reports/the-doctor-is-out

https://www.cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealth-508

Adults Reporting Symptoms of Anxiety or Depressive Disorder During COVID-19 Pandemic

https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102

https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121

https://www.nbcnews.com/health/mental-health/suicide-rates-declined-2020-not-groups-cdc-report-shows-rcna43

https://www.nbcnews.com/health/mental-health/suicide-rates-declined-2020-not-groups-cdc-report-shows-rcna4363

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

State of the Nation:
MENTAL HEALTH URGENCY
AMONG CHILDREN & ADOLESCENTS

Before COVID-19, the CDC reported mental
health challenges were the leading cause of
disability and poor life outcomes in young people,
with up to 1 in 5 children ages 3 to

in the U.S.
experiencing a mental, emotional, developmen-
tal, or behavioral disorder.

A recent U.S. Surgeon General’s Advisory
highlights the urgent need to address the
nation’s mental health crisis among young
people after the initial onset of the pandemic.
The number of high school students reporting
persistent feelings of sadness or hopeless-
ness increased by 40% to more than 1 in every
3 students. And the rate of suicide among those
aged of 10 to 24 years increased by 57%.

In November 2021, the American Academy of
Pediatrics, American Academy of Child and
Adolescent Psychiatry, and the Children’s
Hospital Association declared a national state
of emergency in child and adolescent mental
health.

The pandemic impacted nearly every aspect
of the lives of youth, and the Surgeon General
reports that our most vulnerable youth popula-
tions – those with disabilities, racial and ethnic
minorities, LGBTQ+, low-income, those in rural
areas, those in immigrant households, those
involved with the child welfare or juvenile justice
systems, and/or homeless – were impacted most
severely.

PMH nurses are key to alleviating this
mental health urgency among children
and adolescents.

“Mental health challenges in
children, adolescents, and young
adults are real and widespread…
The COVID-19 pandemic further
altered their experiences at home,
school, and in the community, and
the effect on their mental health
has been devastating. The future
wellbeing of our country depends
on how we support and invest in
the next generation.”

— U.S. Surgeon General
Vivek Murthy

“

https://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su6202a1_w

https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

A NATIONAL EPIDEMIC
OF SUBSTANCE USE DISORDERS

A substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior,
leading to a person’s inability to control their use of substances such as legal or illegal drugs,
alcohol, or medications. And, approximately half of those who experience a mental illness during
their lives will also experience an SUD, and vice versa.

In 2017, the Department of Health and Human Services (HHS) declared a public health emer-
gency and implemented a plan to address the nation’s devastating opioid crisis. More recently,
in a June 2020 CDC survey,

% of American adults reported new or increased substance use due
to COVID-19-related stress. Early 2020 data also show that drug overdose deaths were particularly
pronounced from March to May 2020, coinciding with the start of the COVID-19 pandemic-related
lockdowns.

SAMHSA reports demonstrate the continued growing impact of SUDs on American adults and young
people. The latest data show:

• 40.3 million Americans aged 12 or older experienced a substance use disorder (SUD) in the
past year.

• 6.5 million experienced both an alcohol use disorder and an illicit drug use disorder.
• 5.1 million adolescents aged 12 to 17 had either a SUD or a major depressive episode (MDE)

in the past year, while 644,000 adolescents had both an MDE and an SUD in the past year.

All Americans who experience SUDs must have equitable access to mental health providers with
expertise in SUD care and treatment, including Medication for Addiction Treatment (MAT) options.

A 2021 Psychiatry Online
report urgently called for a
“rapid and substantial” scaling
up of access to effective
SUD treatment to address
the ongoing opioid crisis
and continually rising rate of
overdose deaths. For example,
more than 100,000 overdose
deaths occurred in the
12-month period that ended
in January 2022.

PMH nurses are key to
tackling the national epidemic
of substance use disorders.

12 Month-ending Provisional Counts of Drug
Overdose Deaths: United States

2017 2018 2018 2019 2021 2022

60,00

120,000

REPORTED
PROJECTED

Based on data available for analysis on: June 5, 2022
Source: CDC

https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health#:~:text=A%20substance%20use%20disorder%20(SUD,most%20severe%20form%20of%20SUDs.

https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health#:~:text=Researchers%20have%20found%20that%20about,mental%20disorder%20and%20vice%20versa.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm?s_cid=mm6932a1_w

https://emergency.cdc.gov/han/2020/han00438.asp?ACSTrackingID=USCDC_511-DM44961&ACSTrackingLabel=HAN%20438%20-%20General%20Public&deliveryName=USCDC_511-DM44961

https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.202000565?journalCode=ps

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

MILLIONS OF AMERICANS
ARE LEFT UNTREATED EACH YEAR
The rates for adults and young people experiencing mental health and substance use challenges have
continued to trend upward, while the percentage of those who report an unmet need for treatment
has also increased every year since 2011.

Americans continue to find it difficult to access mental health and substance use care for several
reasons:

• Provider Shortages: People lack the same access to mental health providers as they have for
other health care providers – more than one-third of Americans live in areas with a shortage
of providers. In some states, more than 80% of the population live in a mental health provider
shortage area.

• Health Insurance Does Not Cover Most Treatment: If a patient is able to find a mental
health professional for treatment, they are often forced to go out-of-network. A 2019 report
found that a mental health office visit is more than five times more likely to be out-of-network
than a primary care appointment.

• High Out-of-Pocket Costs: Because many available providers rarely accept Medicare,
Medicaid, or private insurance, ongoing mental health care often requires a patient to make
a financial commitment to pay significantly higher out-of-pocket costs than other types of
primary or specialty care.

Increased demand generated by the impacts of the COVID-19 pandemic has caused the treatment
gap in the U.S. to increase. The National Institute of Mental Health (NIMH) reports that in 2020,
fewer than half of American adults with a mental illness (46%) were able to receive the mental
health services they needed.

Data from SAMSHA further illustrates the enormous numbers of Americans with an unmet need for
mental health and substance use support. In 2020

• Among the 67.1 million American adults experiencing mental illness, only 41.4 million
received mental health services.

• Only 41.6% of American adolescents experiencing a major depressive episode received
treatment.

• Only 1.4% of Americans aged 12 or older experiencing a SUD received any substance use
treatment.

https://www.mhanational.org/issues/state-mental-health-america

https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/

https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/

https://www.nami.org/blogs/nami-blog/march-2020/health-insurers-still-don-t-adequately-cover-mental-health-treatment

https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/Out-of-Network-Out-of-Pocket-Out-of-Options-The#:~:text=Out%2Dof%2Dpocket%20costs%20were,ten%20for%20general%20hospital%20care.

https://www.nimh.nih.gov/health/statistics/mental-illness

https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

Within this widespread unmet need for mental health and substance use care, 77% of counties
across the U.S. are experiencing severe shortages of mental health professionals. Reports
published annually by the Kaiser Family Foundation provide a deeper view into these mental health
provider shortage areas. As of September 2021:

• 41 states are reported to meet less than 40% of the mental health need in their state.
• 27 states are reported to need more than 100 additional mental health care providers just to

reach a ratio of 30,000 patients to 1 mental health provider in those communities.
• 25 states have more than 100 designated mental health professional shortage areas in their

state.

PMH nurses are key to expanding access to care across the country.

Location Percent of
Need Met

Total Mental
Health Care HPSA

Designations

Population of
Designated

HPSAs

Practitioners Needed
to Remove

HPSA Designation

Arizona 8.5% 233 3,478,236 227
Delaware 11.6% 13 289,347 25
Alaska 12.1% 321 414,461 21
Missouri 12.2% 270 2,311,813 159
North Carolina 13.0% 204 3,917,688 221
West Virginia 13.0% 110 788,226 90
Hawaii 14.1% 32 496429 28
Washington 16.2% 179 3,206,169 154
Tennessee 16.3% 73 3,464,471 261
New Mexico 18.2% 94 1,619,974 86
New York 18.8% 202 6,369,714 411
Connecticut 19.0% 44 1.542.562 84
Maryland 19.4% 63 1,709,025 101
Maine 19.7% 68 399,337 31
Florida 21.0% 235 8,703,183 509

10 – 70

72 – 126

152 – 242

250 –578

Mental Health Professional
Shortage Areas by State

Source: Kaiser Family Foundation, Mental
Health Care Professional Shortage Areas
as of September 2021.

https://lancasteronline.com/news/local/report-shortage-of-mental-health-care-professionals-already-severe-is/article_3fe14b42-1620-11e7-8690-874abbc86969.html

Mental Health Care Health Professional Shortage Areas (HPSAs)

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

WE MUST EXPAND
THE MENTAL HEALTH WORKFORCE

W ith each passing year, the need to attract and train an
expanded workforce of mental health professionals
to address patient access and equity becomes more

urgent. The ongoing demand for care has significantly outpaced
the impact of efforts to address problems of access, leaving
millions of Americans without the help they need.

Untreated mental health challenges have set the nation on a
precarious trajectory – linked to social risks, including home-
lessness, low/poor education, and increased rates of substance
use. The need to expand the workforce of qualified mental health
professionals has never been greater.

To help address the nation’s shortage of mental health
providers, SAMHSA reports the need for more than half a
million additional psychiatric-mental health (PMH) nurses
to reach “merely adequate access” to mental health and
substance use disorder care.

It’s clear that the future well-being of the country rests on the
shoulders of how well we address this ongoing and expanding
mental health emergency. PMH nurses are crucial players in the
psychiatric-mental health workforce; expanding their numbers and
roles will expand patient access to quality mental health care.

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

The APNA Workforce Survey:
THE VITAL ROLE OF PSYCHIATRIC-MENTAL
HEALTH NURSES

For 20 consecutive years, nursing has been consistently rated the most trusted health care profes-
sion, according to an annual Gallup Poll. Americans greatly value the expertise, commitment, and
professionalism that nurses provide.

Psychiatric-mental health Registered Nurses (PMH-RNs) and Advanced Practice Registered Nurses
(PMH-APRNs) represent the second largest group of mental health professionals in the U.S. PMH-
RNs and PMH-APRNs play pivotal roles in advancing health equity and providing access to profes-
sional mental health and substance use services to diverse patients across the nation.

All PMH nurses, whose practice is guided by nursing theory and process, are rigorously educated to
provide mental health and substance use care to patients. They are trailblazers in new and emerging
models of inter-professional care that place the patient at the center of the care delivery system to
drive positive outcomes and foster recovery from mental health disorders.

To address the expanding gaps in mental health care outlined above, stakeholders in nursing and
mental health must come together to recruit a new and more diverse PMH nursing workforce. We
must also ensure the deep skillsets and vital roles of PMH nurses are fully utilized to provide Ameri-
cans increased and equitable access to mental health and substance use care.

As a first step, to more accurately understand the characteristics of the current PMH nursing
workforce, identify areas in need of growth, and expand initiatives to help address the shortage of

mental health and substance use professionals, the American
Psychiatric Nurses Association (APNA) conducted the first
comprehensive research into the PMH nursing workforce.

Developed by an APNA PMH Nursing Workforce Task Force, the
APNA workforce survey was administered to PMH-RNs and PMH-
APRNs from 10/21/2020 to 5/13/2021. The PMH-RN survey was
completed by 4,088 professionals and the PMH-APRN survey was
completed by 5,158 professionals. The combined response rate for
the surveys was 12.1%.

Past national-level analyses of the mental health workforce have
failed to appreciate or incorporate the full scope of PMH nurses’
role and capabilities within psychiatric-mental health care. This
robust report should inform future analyses with reliable and

https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx

https://www.apna.org/2022-workforce-survey/

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

comprehensive data, granting
a full picture of the scope and
impact of the PMH nursing
workforce.

The lack of understanding of
PMH nursing among policy-
makers and stakeholders
has hampered the profession
from making its full impact
on the state of mental health
care. Today, more than 148,000
PMH nurses are providing
high-quality mental health and
substance use services across
the U.S.

While PMH-RNs and PMH-
APRNs have the skills and
qualifications to expand access
and equity in mental health
care all across the U.S., more
practicing PMH nurses are
needed, and they must be
utilized to the full extent of
their education and training.

Current Numbers of Some
Key Mental Health Providers

Psychiatrists 38,381 (by 2024)

Psychologists 106,000

Physician
Assistants

2,235

Psychiatric
Pharmacists

996

PMH Nurses
109,000 PMH-RNs

39,354 PMH-APRNs

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

WHAT DO PMH NURSES DO?

PMH nurses are psychiatric-mental health care professionals
who practice according to rigorous licensing and credentialing
standards. Their nursing training emphasizes preventive
person-centered care and recovery. PMH nurses form strong
therapeutic relationships with people experiencing mental
health and/or substance use disorders, and often work closely
with patient families as well.

Working broadly within health care systems with an orientation
toward innovation, PMH nurses consistently seek new oppor-
tunities for growth, development, and creative solutions to
improve the delivery of care and meet the unique needs of the
communities they serve.

Two Types of PMH Nurses:
RN & APRN

Psychiatric-Mental Health Registered Nurses (PMH-RN)

PMH-RNs work with diverse individuals, families, groups, and communities to
assess mental health, and develop a diagnosis and an individualized plan of care.
PMH nurses maintain current knowledge of advances in genetics and neuroscience
and their impact on psychopharmacology and other treatment modalities.

PMH-RNs engage in a broad array of nursing activities including health promotion
and maintenance; intake screening, evaluation, and triage; case management;
teaching self-care activities; administration of psychobiological nursing interven-
tions and the monitoring of medications and effects; crisis intervention and stabili-
zation efforts; psychiatric rehabilitation; and culturally appropriate interventions that
assist in a patient’s recovery. PMH-RNs also work to educate patients, families, and
communities and coordinate care between other needed health care professionals
and the caregivers for the patient.

PMH-RNs are licensed by state boards of nursing and may be certified in psychiat-
ric-mental health by the American Nurses Credentialing Center (ANCC). According
to the ANCC, the requirements for the PMH-RN certification include an RN license,
2 years of practice as a full-time registered nurse, and a minimum of 2,000 hours of

Definition of Psychiatric-Mental
Health Nursing

Psychiatric-mental health (PMH)
nursing promotes integrated
and comprehensive health and
wellness through prevention and
education, as well as assessment,
diagnosis, care, and treatment of
the full range of PMH disorders,
including substance use disorders,
across the life span. PMH nurses
provide care at the individual, fam-
ily/relationship, community, and
societal levels to promote well-be-
ing and quality of life, as well as to
sustain positive health outcomes.

– Psychiatric-Mental Health Nursing: Scope
and Standards of Practice (2022)

!
11

Scope & Standards

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

clinical practice and 30 hours of continuing education – both in PMH nursing and
within three years.

PMH-RNs are essential to ensuring patient access to mental health care as they
actively provide patient care in inpatient, outpatient, and community health clinics
–at the bedside and in management.

Psychiatric-Mental Health Advanced Practice
Registered Nurses (PMH-APRNs)

PMH-APRNs provide the full range of services that constitute psychiatric-mental
health care and treatment. They hold advanced master’s or doctoral degrees,
national certification, and additional licensure (based on their state board of nursing
requirements). The additional education, clinical experience, and training enables
PMH-APRNs to assess, diagnose, and prescribe medication for mental health
disorders; provide psychotherapy, consultation and liaison services; oversee case
management; and more.

PMH-APRNs practice as Clinical Nurse Specialists (CNS) or Nurse Practitioners
(NP), though their titles can vary by state. Some PMH-APRNs obtain doctoral
degrees in psychiatric-mental health nursing.

The role of a PMH-APRN often complements that of a psychiatrist, psychologist, or
social worker as part of a mental health care team.

PMH-APRNs work in a wide variety of settings – outpatient, ambulatory, emergency
departments, and hospitals. Others own private practice businesses that see
patients and consult with local communities, corporations, and local government.

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

Average Age
51 Only 20% of the PMH-RN

workforce are in their 20s or 30s

Profile:
THE PSYCHIATRIC-MENTAL HEALTH
REGISTERED NURSE

87+13
87%

Female

27% identify as a
racial or ethnic minority.

77%
Caucasian

PMH-RNs work within
the same scope of

practice regulations
across all U.S. states.

PMH-RNs make up the largest professional workforce in inpatient psychiatry, with more than 109,000 active in
the field today. The findings of the APNA workforce survey offer a useful snapshot of today’s PMH-RN.

The majority of PMH-RNs (61-71%)
report that for most patients they:

Assess physical health status

Assess mental health status

Educate patients and families

Approximately 40% of PMH-RNs
report they are providing counseling
and therapeutic relationships to most
patients, a key component historically
of the PMH-RN role.

80% of PMH-RNs in their 20s and
57% of PMH-RNs in their 30s have
earned a Bachelor of Science in
Nursing (BSN)

of PMH-RNs are currently enrolled
in a formal education program.25%

report earning a salary in the range
of $50,000-$99,00065%
report they provide telehealth services
and three-quarters of those report
providing telehealth services to patients
in rural areas.

41%

52+48
52.2%

staff
nurses

13+87
13.1%
nurse

educators

9+91
8.9%
nurse

managers

7+93
7.3%
nurse

administrators

6+94
6.4%

nursing
supervisors

PMH-RN Roles

89% work in hospitals

9+91

89+11
22+78 22.4% work in a mental health clinic

9.4% work for the Veterans Health Administration

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

PMH-RN FINDINGS OF NOTE:

• The PMH-RN workforce is aging; young professionals are needed to join the profession.
Nearly half of PMH-RNs report a plan to retire over the next 10 years, with an additional 13%
reporting they are undecided. We must attract many more people to pursue a career in PMH
nursing. Currently, the 20-29 age range makes up the smallest percentage of PMH nurses.

• The PMH-RN workforce has become increasingly well-educated. 82% of PMH-RN
respondents ages 20-29 indicate their initial nursing degree is a BSN – which is a higher level
of education than in the general RN population.

• PMH nursing is a great career opportunity for racial/ethnic and gender minorities in the
field. The PMH-RN workforce has a different racial/ethnic and gender composition than the
general RN population, with double the number of Black or African American nurses and a
greater proportion of multiracial nurses and male nurses among the PMH-RN population.

• Few PMH-RNs work in rural locations, which contributes to the service gap and challenges
with access in these areas of the country. PMH-RN respondents overwhelmingly work in
metropolitan counties. Of the 2,069 responding PMH-RNs, only 12 report working in rural
counties.

• PMH-RNs work in settings that accept a diverse payment mix. Because PMH-RNs
predominantly provide care within hospital and clinic settings, their care is often covered by
Medicare, Medicaid, and private insurance – unlike many other mental health care providers.

PMH-RNs have the potential to significantly transform the delivery of mental health and substance
use care. We must therefore advance efforts to attract more young professionals to careers in
PMH nursing across all areas of the U.S., with particular effort to expanding the numbers of those
working in non-hospital-based settings and underserved and rural areas.

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

Profile:
THE PSYCHIATRIC-MENTAL HEALTH
ADVANCED PRACTICE REGISTERED NURSE

70% practice in outpatient settings

2+98

70+30
15+85 15% practice in hospitals

2% practice in correctional facilities

PMH-APRNs…

Prescribe medications (76.3%)

Conduct diagnostic evaluations (66%)

Order lab tests and diagnostic studies (41.5%)

Provide education (81.5%)

Provide care coordination (43.5%)

Average Age
54 Just 25% of the PMH-APRN

population is under age 45

20% identify as a racial
or ethnic minority.

80%
Caucasian

90%
Female

PMH-APRNs possess additional education and training that qualifies them for advanced practice certification and
licensure. Recognized as one of the fastest growing Nurse Practitioner (NP) fields in the U.S., currently more than
39,000 PMH-APRNs provide mental health and substance use services in a wide variety of settings. Based on data
from the APNA PMH nursing workforce survey, here is a view of today’s PMH-APRN.

work in metropolitan ar-
eas of the country. Just
1% work in rural areas.

88%

47% of PMH-APRNs earn $100,000-150,000/yr
13% earn $75,000-99,000
11% earn $150,000-200,000$

70% of PMH-APRNs provide psychotherapy in
combination with medication management.

42% of PMH-APRNs completed Medication for
Addiction Treatment (MAT) waiver training to pro-
vide buprenorphine for opioid use disorders.
72% of those went on to apply for a DEA X-waiver.

88% of PMH-APRNs report having prescriptive
authority.

36% completed their PMH-APRN
preparation during the last decade.
DOUBLE the previous decade.

provide telehealth services.
On average, providing tele-
health services in 2 states
to 25 patients per week as
part of their practice.

85%

70+30
17+83
68+32

82% earned a Master of Science
in Nursing (MSN) degree.

17% earned a doctoral degree.

68.5% have graduated since 2000.

ANCC certification
among PMH-APRNs. 2013
(13,393 PMH-APRNs) to
2020 (26,690 PMH-APRNs)

2X
MORE

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

PMH-APRN FINDINGS OF NOTE:

• PMH nursing is one of the fastest growing fields among new nurse practitioners. PMH-
NP programs have nearly doubled over the past 8 years (114 programs in 2015, 208 programs
in 2021). In addition, PMH-NP lifespan certifications have increased 30% since 2019. Continu-
ing this expansion of preparation for and practicing PMH-APRNs is critical to addressing the
nation’s shortage of psychiatric-mental health professionals.

• PMH-APRNs provide two key primary mental health functions. 70% of PMH-APRNs
provide psychotherapy in combination with medication management.

• PMH-APRNs increase equity and access to mental health and substance use disorder
services. Nearly 70% of PMH-APRNs indicated that most of their patients use insurance.
Providing services to this patient population is critical as an estimated 45% of psychiatrists
and 30% of psychologists do not accept any form of insurance.

• Most PMH-APRNs expand access to mental health and substance use disorder care by
providing telehealth services. It’s important to note that since the APNA study was con-
ducted at the beginning of the COVID-19 pandemic, the telehealth data may represent only a
fraction of those services, as PMH-APRN regulations and ability greatly expanded during the
last 2 years. (Some states only temporarily enabled PMH-APRNs to provide these services
during the Public Health Emergency.) Future research and policies will continue to look at
expanding the availability of telehealth services.

• PMH-APRNs are one of just three other professions licensed to provide the full range of
mental health services, including prescribing medications in most states. As the number
of practicing PMH-APRNs expand, the current lack of hospital admitting privileges may
become a significant barrier to patients in acute distress who need access to mental health
services.

• PMH-APRNs are a vital resource for closing disparities in opioid treatment. A significant
and growing percentage of recent PMH-APRN graduates have gone on to complete Medi-
cation for Addiction Treatment (MAT) training, which allows them to obtain a DEA X-waiver to
prescribe buprenorphine for opioid use disorders.

PMH-APRN Workforce
Numbers by Certification

2004 2006 2008 2010 2012 2016 2018 2020 2022
0

15,000

30,000
NP
CNS

Total

26,680

22,023

4,657

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/1785174

https://www.theatlantic.com/health/archive/2016/06/the-struggle-of-seeking-therapy-while-poor/484970/

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

OBSTACLES TO EXPANDING PMH NURSING
TO IMPROVE ACCESS & EQUITY IN
MENTAL HEALTH CARE
More PMH nurses are needed to address the nation’s shortage of qualified psychiatric-mental health
professionals.

Interestingly, the importance of the growth in PMH-APRNs was recently documented in a new study
led by researchers at the Harvard T.H. Chan School of Public Health, which found that the number of
PMH-NPs increased 162% from 2011-2019 – to providing nearly 1 in every 3 mental health prescriber
visits to Medicare patients nationally in 2019 – while the number of psychiatrists billing Medicare
dropped by 6% during that period. The study determined that without this growth in the PMH-NP
workforce, there would have been a steep 30% decline in mental health specialist visits for
Medicare patients. Instead, the drop was just 12%.

These findings put a direct spotlight on the vital role PMH nurses play within the mental health
workforce and illustrate the positive impact these professionals can make in helping to address the
ongoing mental health crisis.

While PMH nursing is a rapidly expanding profession with strong career trajectories and compensa-
tion, nursing educators, policymakers, state regulators, and those within the profession must
come together to find ways to attract, mentor, and empower more PMH nursing professionals
to increase access to mental health care.

To accomplish this, two key ongoing challenges

must be addressed:

1) Nursing Education has not kept pace with the demand for PMH nurses.

While there has been strong expansion of PMH-NP programs to help grow the next
generation of PMH-APRN practitioners, very few undergraduate nursing schools
are able to offer students exposure to PMH nursing-specific education delivered
by an expert in the field; PMH nursing mentors; or opportunities to learn about the
profession.

Students enrolled in general nursing programs continue to report an overall lack
of defined, testable mental health care content and competencies included within
current nursing school curriculum. This ongoing shortage of PMH nursing faculty at
the undergraduate and graduate levels blocks the development of a pipeline of PMH
nurses needed to expand the workforce.

https://www.hsph.harvard.edu/news/press-releases/growth-of-psychiatric-mental-health-nurse-practitioners-helped-offset-drop-in-psychiatrists-treating-medicare-patients/

https://journals.sagepub.com/doi/10.1177/1078390318777873

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

In addition, when surveyed by APNA, PMH-RNs report that one of the barriers they
encounter in pursuing a career in PMH nursing was nursing school faculty members
misrepresenting the experience required prior to becoming a PMH-RN. These
findings are consistent with research that suggests there is a stigma associated
with specializing in PMH nursing and a negative view of PMH nursing persisting
within nursing schools.

2) Many States Still Unnecessarily Restrict the Scope of Practice of PMH Nurses

Currently, 26 states and the District of Colum-
bia fully allow PMH-APRNs to diagnose, treat,
order diagnostic tests, and prescribe medica-
tions to patients without physician oversight.

Despite the rapidly expanding mental health
crisis, 13 states continue to limit PMH-APRN
scope and practice and an additional 11 states’
regulations severely restrict PMH nursing scope
of practice.

PMH nurses must be permitted to work to the
full extent and authority of their education
and training.

If the goal is increasing patient access to quality
mental health and substance use care, the
important role of PMH nurses must be fully
employed in both education and in practice.

Full Practice

Reduced Practice

Restricted Practice

Map Source: AANP

Eliminating restrictions on the
scope of practice of advanced
practice registered nurses and
registered nurses so they can
practice to the full extent of
their education and training will
increase the types and amount of
high-quality health care services
that can be provided to those
with complex health and social
needs and improve both access
to care and health equity”

— National Academies of
Sciences, Engineering & Med-
icine The Future of Nursing 2020-
2030: Charting a Path to Achieve
Health Equity

“

https://www.psychiatricnursing.org/article/S0883-9417(15)00132-6/pdf

https://www.aanp.org/advocacy/state/state-practice-environment

https://www.nap.edu/read/12956/chapter/1

https://www.aanp.org/advocacy/state/state-practice-environment

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

A Call to Action
TO ADDRESS THE MENTAL HEALTH
STATE OF EMERGENCY

PMH nurses play a pivotal and expanding role within the U.S.
mental health workforce. In addition to consistently holding the
top position of public trust within the field of health care, nurses
working in psychiatric-mental health are rigorously educated,
clinically trained, and provide a wide range of evidence-based care
and treatment.

PMH nurses actively expand access and health equity by working
in a wide variety of care settings, accepting most forms of govern-
ment and private insurance, and leveraging telehealth services to
reach patients in underserved areas.

The nation needs more PMH nurses to reduce the shortage of accessible mental health professionals
and expand health equity across under-resourced communities.

As mentioned previously, SAMHSA called for more than half a million additional PMH nurses to reach
“merely adequate access” to mental health and substance use care. To create a trajectory towards
addressing the shortage of qualified mental health professionals, key national stakeholders
and policymakers must consider the following opportunities:

• The deep skillsets and vital role of PMH nurses must be fully understood by policymakers,
government regulators, and industry influencers so the number and roles of PMH nurses
can be intentionally expanded in light of the widespread shortage of mental health providers
and the high rate of retirements forecasted among practicing mental health professionals.

• Leaders at top health and mental health organizations should include the full picture of
the PMH nursing workforce in discussions about the nation’s mental health workforce
and leverage PMH nurse expertise in efforts to design solutions to our nation’s pressing
mental health challenges.

• Mental health stakeholders should use data from the APNA workforce report to inform
studies and decisions about the mental health workforce and access to funding.
Comprehensive information about PMH nurses and their skillsets must be included in these
national-level discussions about mental health treatment, access, and health equity.

SAMHSA reports the need
for more than half a million
additional Psychiatric-Mental
Health (PMH) nurses to reach
merely adequate access to
mental health and substance
use care.

https://journals.sagepub.com/doi/abs/10.1177/1078390321995518?journalCode=japa

https://www.apna.org/2022-workforce-survey/

https://journals.sagepub.com/doi/abs/10.1177/1078390321995518?journalCode=japa&

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

• Policymakers in states that currently limit PMH nurses’ scope of practice should be
better informed about the full range of services in which PMH nurses are educated and
trained, and their potential to broaden access to mental health and substance use care.
PMH nurses must be utilized to the full extent and authority of their education and training
within health care systems across ALL states.

• Schools of Nursing can embrace their role in helping to solve the psychiatric-mental
health provider shortage by recruiting and educating more PMH nurses. Nursing edu-
cation institutions can ensure that their curriculum promotes an understanding that mental
health and substance use disorders should not be stigmatized – they are illnesses from which
recovery is possible. Nursing schools can broaden students’ access to PMH nursing-specific
education; provide information about careers in PMH nursing; recruit more PMH nursing
faculty; offer students psychiatric rotations in a variety of settings; and connect students with
experienced PMH nurses.

• All stakeholders in mental health care must recognize and prioritize the need to recruit
and train a more diverse PMH nursing workforce, as PMH nurses are uniquely equipped
to advance health equity across circumstances, communities, and abilities. Strengthening
the number of PMH nurses will further align public health, health care, and social services to
eliminate health disparities and achieve health equity in all communities.

• Solutions must be developed to help attract more PMH nurses to work in and expand
the reach into rural and underserved areas of the country. The previously mentioned
Harvard study found that in states where PMHNPs have no restrictions on prescribing
medication, they account for 50% of the mental health prescriber visits in rural areas. To
further bolster the reach of mental health care in rural areas, we must increase awareness,
availability, and the effectiveness of telemental health services there. Currently, telehealth
services are out of reach for 21 million Americans who still do not have access to broadband
Internet in their communities.

• U.S. health care stakeholders must prioritize the integration of substance use and
mental health screening within primary health care visits nationally to educate patients
and effectively guide them to treatment resources. In addition, increased resources and
funding for substance use treatment both long and short term, including tobacco use are
needed to more effectively address the nation’s rising rates of substance use disorders.

• Ongoing research is needed to study the impact and growth of the PMH nursing work-
force to adequately represent this field to government decision-makers and stakeholders.

https://www.hsph.harvard.edu/news/press-releases/growth-of-psychiatric-mental-health-nurse-practitioners-helped-offset-drop-in-psychiatrists-treating-medicare-patients/

https://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2019/07/21-million-americans-still-lack-broadband-connectivity

Psychiatric-Mental Health Nurses Are Key to Addressing the Nation’s Mental Health Crisis www.APNA.org

CONCLUSION

An expanded workforce of highly skilled PMH nurses has the potential to meet gaps in access and
equity within mental health and substance use care throughout the nation.

Therefore, it is vital that national-level mental health stakeholders fully understand the important im-
pact and contributions of the PMH nursing workforce; support efforts to allow PMH nurses to practice
to the full extent of their education and training in all states; and help attract young professionals from
diverse backgrounds to pursue careers in PMH nursing.

PMH nurses have been the unrecognized solution in most national-level discussions of access and
equity within mental health and substance use care. As a result, this comprehensive PMH nursing
workforce report aims to fuel national stakeholder understanding and help identify key trends to
inform future policy and funding decisions impacting mental health care.

APNA is committed to advancing PMH nursing and has stepped forward to provide research, educa-
tion, and resources to continually strengthen the skillsets of PMH nurses.

For example, APNA provides:

• 24 hours of MAT education
• Access to free undergraduate faculty resources
• Expanded suicide prevention education
• Free opioid education and resources
• Curriculum to help nurses transition into the psychiatric-mental health field

APNA is also working to inspire nursing students to pursue careers in PMH nursing by:
• Encouraging increased student exposure to PMH nursing
• Providing annual student scholarships,
• Facilitating avenues for students to connect with career mentors
• Offering discounted student memberships with numerous benefits

Through this ongoing workforce development initiative, APNA continues to communicate essential
data and information to decision-makers and stakeholders to ensure that, as policies and systems are
constructed to expand access to mental health care, psychiatric-mental health nurses are utilized to
the full scope of their roles.

The core of any national effort to address the shortage of mental health professionals and
reduce the number of Americans in need of treatment must be an expansion of the PMH
nursing workforce to practice within the full scope and authority of their education and training
in all states.

APNA looks forward to contributing vital PMH workforce data to the national conversation and part-
nering with key mental health stakeholder organizations to address shared goals of improved access
and equity in mental health care.

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