Nurse practitioners can help increase Virginians’ access to behavioral health care

In September, Centra opened Virginia’s first emPATH (Emergency Psychiatric Assessment, Treatment and Healing) unit in Lynchburg, and last month, Riverside Health System opened Virginia’s first psychiatric emergency department in Hampton. With one in five adults receiving some kind of behavioral health care, and the U.S. Surgeon General calling youth mental health a public health crisis, there’s no question these resources are needed in the commonwealth. Yet because of current regulations in Virginia, staffing these types of facilities may prove difficult.

A 2023 study by Mental Health America ranked Virginia 34th in the nation for access to mental health care, and 128 of Virginia’s 133 localities are federally-designated Mental Health Professional Shortage Areas. In fact, according to the Virginia Health Care Foundation, 35 localities don’t have any licensed providers to prescribe and manage psychiatric medications, which are essential in treating many behavioral health conditions.

As the demand for behavioral health services continues to increase and the number of practicing psychiatrists continues to decrease, psychiatric mental health nurse practitioners (PMHNP) can help. PMHNPs are nurse practitioners (NP) who are educated, licensed and certified as primary care and psychiatric mental health providers. This is important;  the need to manage behavioral health conditions in primary care settings is increasing.

As a doctor of nursing practice and the director of behavioral health for a federally qualified health center, I work with a team of professionals who identify and address behavioral health issues in the primary care setting. Most patients with chronic diseases also have some degree of depression and anxiety, and many of these patients have more serious behavioral health issues including bi-polar disease or substance use disorder. We need health care providers who embrace the whole patient, focusing on their mind, body and spirit so patients can have better health outcomes.

A shortage of workers is hindering efforts to improve mental health care in Virginia

This approach is what encouraged me to return to school after 30 years as a primary care NP to focus on behavioral health. I am passionate about integrating primary care and behavioral health and increasing the number of NPs offering this care in Virginia. With our unique blend of clinical expertise and emphasis on disease prevention and health management, NPs are well equipped to manage the increasing demand for behavioral health services.

There are more than 16,000 NPs in Virginia including more than 500 PMHNPs. NPs are advanced practice registered nurses who have master’s, and often doctorate, degrees and extensive clinical training in the diagnosis and management of common and complex medical conditions. A part of our country’s health care system since 1965, NPs consult and collaborate with health care colleagues in a variety of settings including large hospital systems, medical offices and free and mobile health clinics. 

The evolution of advanced practice nursing continues and evidences improving access and outcomes, but inconsistencies between states have created barriers to care. More than half the states, the District of Columbia and the Veterans Administration have laws embracing NPs and allowing for full practice authority. States that have a transition to practice for NPs require two to three years. Virginia is the most restrictive state in the nation, requiring NPs with less than five years of clinical experience to maintain a practice agreement with a physician in the same specialty in which the NP is licensed and certified. For PMHNPs, this requirement can be even more challenging since many areas of our state do not have any practicing psychiatrists to manage these agreements. It can also be costly to NPs and health systems who often have to pay to maintain these agreements.

November 12-18 is National NP Week, which recognizes nurse practitioners and the valuable work they do every day. I am thankful for the individuals who trust us to care for them and their loved ones, the legislators who champion NP practice and the health care colleagues who partner with us every day. I look forward to working together to advance behavioral health in Virginia and hope you will join me in thanking Virginia’s NPs for their commitment to enhancing health care in the commonwealth.