Mississippi has the second lowest rate of psychiatrists per population of any state in the country, according to Health Resources & Services Administration. That is of particular concern with the estimate that up to 20 percent of children have a behavioral health disorder, and 15 percent of people 60 and older need mental health services.
“When it comes to psychiatric providers, there is a huge need,” said Rep. Donnie Scoggin, who is a family nurse practitioner (FNP) in Ellisville. “If you look at the ratio of patients per provider, we are very low on the totem pole. Mississippi, through cuts and lack of financial support, has been very unsuccessful in maintaining a good mental health program. We need psychiatric mental health nurse practitioners (PMHNPs) desperately.”
PMHNPs are required to have a couple of years of experience working as an RN before entering programs that generally require several more years of education and extensive clinical experience before receiving their credentials. In Mississippi, in order to practice, PMHNPs are required to have a psychiatrist who will collaborate with them. Because psychiatrists are few and far between, finding a collaborating psychiatrist is very difficult.
Scoggin said House Bill 1303 to remove the collaboration agreement requirement for PMHNPs and other types of NPs overwhelmingly passed the Mississippi House this year, but did not get passed out of the Senate Public Health and Welfare Committee. However, the chair of that committee has indicated willingness to hold hearings on the topic this summer, and to support the legislation if the hearings go well.
“On the collaborative agreement, that does not mean you are not going to collaborate with physicians,” Scoggin said. “NPs have and always will collaborate with other providers. It is just part of the medical process. The contract requirement started 50 years ago before the invention of cell phones and current communications. The collaborate agreement is really outdated and hopefully this summer as we have the hearings, we will work through the process.”
There are many counties in Mississippi that have very minimal or no psychiatric providers available. Scoggin finds it extremely sad that many people facing depression, anxiety, schizophrenia and mental retardation have no access to the help that they need.
“The problem is very significant in Mississippi,” Scoggin said. “We need PMHNPs to precept with psychiatrists, but be allowed to practice independently in underserved rural areas that don’t have any mental health available.”
Carolyn Coleman DNP, FNP-BC, PMHNP-BC, coordinator of the NP program for the University of Southern Mississippi College of Nursing and Health Professions, said NPs are fighting for full scope practice in order to be able to practice at the top of their education.
“More and more states are allowing full scope practice,” Coleman said. “Currently 28 other states do not require the collaborative agreement. With all the shortages of mental health providers in the state, there is not a lot of recognition for the role of the PMHNP.”
Coleman said they often hear about how hard it is to see a psychiatrist. People may have urgent mental needs that can’t wait for several months. Some children in the Delta are having to wait several months just to get an evaluation done.
“The social workers there were overwhelmed with the wait period,” Coleman said. “Think of Attention Deficit Hyperactivity Disorder (ADHD) children in foster care. They are trying to go to school and are not being able to focus causing their grades to suffer. A lot of time ADHD students get labeled as a behavior problem. It is a mental health problem they can’t control. Here, because we don’t have full-practice authority, we are often not able to work in the field because there are a limited number of psychiatrists to contract with. I personally talked to a licensed PMHNP who wants to work in a rural area, but because she can’t find a psychiatrist to contract with, can’t do the work.”
Coleman said USM has a growing number of students in the PMHNP program, which is online and intensive with the number of hours of classroom instruction and clinical hours required.
Counselors and licensed clinical social workers can provide talk therapy to people with mental health problems, but aren’t allowed to prescribe medicine. PMHNPs can prescribe medications.
“Sometimes a patient needs medicine to get to the place where they can benefit from counseling,” Coleman said. “There is a chemical imbalance going on. Give them medicine so they can concentrate and deal with problems like being schizophrenic or bipolar.”
Coleman said lack of mental health care has an economic impact. People call in sick or sometimes leave their jobs requiring their employers to rehire and retrain others.
“It is a bigger issue than people really look at,” Coleman said. “In the schools, sometimes teachers can’t teach because of disruption. If you get medication on board, it makes it a better working environment for the teacher and their students. It also improves the quality of life for the students and their families.”
“We do have a growing dementia population right now,” Coleman said. “We need to keep these people at home as long as we can. Keeping them at home is much less expensive than the cost of a long-term facility.”
Coleman predicts that with post-COVID mental health issues, we will need every healthcare provider we have.
“We are going to have a big mental health fallout from isolation, loss of jobs and loss of family members,” she said. “There is a lot that has gone on with COVID that has really increased our mental health demand. We need all our healthcare providers ready to roll because it is coming and we need it without the hindrance of having someone to practice with.”
USM’s program requires a doctorate degree and the program takes three years. Some other programs require only a master’s degree that can be obtained in two years, although it can take longer for students who continue working full-time.
“I really enjoy it,” she said. “And I love teaching it. I really feel like I make a difference.”
The University of Mississippi School of Nursing also offers an online PMHNP program to prepare students to assess, diagnose and treat individuals with mental health problems.