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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-19 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-19 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.

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WHOLE HEALTH BEGINS

WITH MENTAL HEALTH.

MENTAL HEALTH IS FOUNDATIONAL

TO OVERALL HEALTH AND

THEREFORE VITAL TO THE

HEALTH OF THE NATION

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

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 4 in 10 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.:

• 73.8 million Americans are experiencing mental illness or substance use disorders.

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

• 14.2 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., 2021 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 18 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.

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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 17 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

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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, 13% 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

2015 2016 2017 2018 2018 2019 2021 2022

60,000

120,000

REPORTED PROJECTED

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

0

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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.

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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.

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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.

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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 N