Behavioral health physicians, especially prescribing doctors, are in short supply throughout the country. Although the number of psychiatric health nurse practitioners (PMHNPs) is quickly expanding, state constraints on the scope of practice may limit their capacity to provide behavioral health care. Behavioral health physicians, especially prescribing doctors, are in short supply throughout the country. Although the number of psychiatric health nurse practitioners (PMHNPs) is quickly expanding, state constraints on the scope of practice may limit their capacity to provide behavioral health care. The purpose of this paper is to take a close look at the potential challenges that health nursing practitioners may face, the impact on individual health patients in rural areas, and possible solutions to these challenges.
The Role Played by a Psychiatrist Nurse Practitioner
A psychiatric health nurse practitioner has been trained to care for people with illnesses throughout their lives. Nurse practitioners are trained in the assessment, diagnosis, planning, and evaluation, and they typically provide services similar to those provided by doctors (Ortiz et al., 2018). The scope of practice for nurse practitioners varies by state, with laws ranging from full practice to limited or restricted practice. Nurse practitioners are now authorized to practice in 22 states and Washington, D.C. Nurse practitioners usually work in conjunction with, or under the authority of, a physician in countries where the practice is limited or restricted.
Since health cannot exist without health, psychiatric health nurse practitioner [PMHNP] benefits all aspects of health care. PMHNPs assist the public in various ways, including preventing, detecting, and treating problems using holistic techniques. PMHNPs provide health from conception to death, including grief and end-of-life care. Through health policy, program creation and administration, practice, research, and training of both the community and the future PMHNP workforce, PMHNPs help individuals, families, and populations.
The PMHNP role takes into account all of a patient’s characteristics as well as their potential. It integrates the body’s, psyche’s, and societal knowledge arsenals. PMHNPs, like other nurse practitioners, employ biological treatments, psychotherapies, conventional techniques, and more to collaborate with individuals, penetrate problems, and establish promising advancements in people’s lives (Danielsen et al., 2018). Depressed individuals, familial disruptions, and hereditary sickness are all factors that contribute to disorders. The sick will always be among us, and societal upheavals like violence and conflict are precursors to illnesses. Psychiatrists are in short supply, primarily pediatric, geriatric, and addiction psychiatrists; these patterns imply that the United States needs PMHNPs.
The purpose of the PMHNP is to examine, diagnose, and treatment the health needs of the patient. Many PMHNPs give counseling and prescribe medicines for individuals who have health illnesses or drug misuse problems. PMHNPs may also conduct physical and psychosocial examinations, emergent psychiatric care, and medication efficacy reviews. Nurses considering this career path should be informed that most PMHNPs practicing in inpatient settings maintain typical working hours with occasional night shifts while they’re on call.
Mental Health State Challenges faced by PMHNP in the Rural Areas.
For decades, primary care physicians have been in short supply in rural communities throughout the United States, putting rural citizens at increased risk of health issues and sickness consequences. Rural communities vary, yet both rural and urban regions are growing increasingly diversified in terms of culture. For example, the Hispanic community, the quickest increasing ethnic group in the United States, has spread throughout all 50 states, affecting rural and urban areas (Andrilla, Moore & Patterson, 2019). Hispanics/Latinos, Black Americans, and other communities have different views and attitudes about health, sickness, and their capacity to get health care than the general population. In the apparent lack of culturally appropriate treatment, these variances may lead to health inequalities between the minority and the general population.
Nurses constitute the majority of the healthcare workforce. They operate in a range of locations and care for a broad range of people. The nursing profession plays a vital role in providing excellent, patient-centered, accessible, and affordable care while the healthcare system undergoes reform, thanks in part to the Affordable Care Act (ACA). The Institute of Medicine’s (IOM) study “The Future of Nursing: Leading Change, Advancing Health” presented nurses’ responsibilities in the evolving healthcare environment.
However, People in rural areas are deemed to have more enormous possibilities of utilizing primary care practitioners for mental issues. This is especially seen for the poor, the elderly minorities, problem drinkers, and seriously mentally ill individuals. Studies show that physicians who work in the rural sectors play a crucial role than even those in the urban sectors. This may be connected with the low number of health practitioners in these locations and the issue of stigmatization related to mental illness (Grant et al., 20121). Inadequate mental health knowledge in their training centers or residency, limited time for enough practise required for managing challenging cases, failure to detect a psychiatric illness, heavy patient caseload, minimal visits for patients by relatives and friends, lack of time for guidance and counselling, and lack of a specialised backup are some of the challenges that primary practitioners face when treating mental illness. When referrals for professionals are available, there still appear to be some obstacles to making such referrals. Idiosyncratic criteria are the process of selecting the appropriate timing for recommending a patient to a specialist. There are worries concerning stigma and the patients’ hesitancy to utilize providers for mental health.
Underutilization of mental health equipment has been discovered to be a setback in fighting mental conditions. Over the recent assessments, rural regions have been employing lesser medical characteristics than metropolitan places. Outpatient health services are shown to be lower in rural than urban areas (Berndt et al., 2017). Those who manage to have visited have fewer or no connected mental patients. This was estimated annually. The inconsistency in rural inpatient visits is noticeable. Another gap is that patients are more likely to get their therapy met in rural regions than in metropolitan sectors. Studies reveal that this is connected with poverty, minority status, and age, reducing the chances of accessing mental health treatment. Black individuals and rural populations under-utilize health care and seek assistance later when the problem is in its worst stage. This disparity in under-utilization between black and white indicates a cultural difference in dealing with mental illness.
Elderly persons encounter difficulty in obtaining health services. Research in River Delta county demonstrates that kids who confront depressed symptoms had fewer visits to doctors than emergency departments, public health clinics, and school-based clinics. Such sort of use asks for improved approaches of creating health sectors with well-established health providers. Nationally estimated, twenty percent of teenage children suffer from emotional and behavioral issues. About 11 percent suffered severe health impairment, 5 percent serious health functional impairment with 10-15 percent experiencing signs of depression at any moment; 9 to 13 percent of kids suffer from emotional disruption 15 to 24 are found to receive limited care for severe mental disorders.
Rural children are disadvantaged while obtaining health care. This is related to research that suggests that rural teenagers get less mental therapy than metropolitan youngsters. This might be related result of not having a psychiatrist or insufficient children psychiatrist. The significant research of kids found out that; it is in the rural regions where children with mental disorders get numerous assistance from different organizations, although they are still less likely to utilize these services. Depression, anxiety, and psychological problems are found to be connected with mental illness.
The perceived social shame and the absence of concealment may hinder one from obtaining medical assistance. Rural locations, however, have less secrecy, and this holds many people to obtain health treatments. Rural folks are likewise less likely to identify the need for medical assistance compared to urban persons. People with depression in remote locations experience decreased availability of accessibility to mental health treatment and consultation sectors. The stigma connected with mental health has been determined to be the common obstacle for rural inhabitants than the urban residents.
Possible Solutions
Relaxing constraints on ARNPs’ scope of practice might assist them satisfy the essential need for primary care services in rural (and urban) regions. ARNPs’ scope of practice and degree of professional autonomy, on the other hand, varies by state. These same 50 states are presently separated into three categories based on the ARNP’s practice rules.
Complete Practice: All nurse practitioners are allowed to screen patients, diagnose, order, and interpret diagnostic tests, initiate and manage treatments (including prescribing drugs and controlled substances), and prescribe drugs and controlled substances under the exclusive licensing authority of the state board of nursing (Pesut et al., 2017). This approach is recommended by both the National Academy of Medicine (previously the Health care) and the National Council of State Boards of Nursing.
Reduced Practice: State practice and license restrictions limit nurse practitioners’ capacity to take up one component of ARNP practice. State legislation either requires a career-long controlled cooperation arrangement with another health practitioner or restricts the context of one or more parts of ARNP practice before an ARNP may offer patient care.
When references for experts are available, there still seem to be certain impediments to making such referrals. Idiosyncratic criteria are the process of selecting the appropriate timing for recommending a patient to a specialist. There are worries concerning stigma and the patients’ hesitancy to utilize providers for mental health. The perceived social shame and the absence of concealment may hinder one from obtaining medical assistance. Rural locations, however, have less secrecy, and this holds many people to obtain health treatments. Rural folks are likewise less likely to identify the need for medical assistance compared to urban persons. People with depression in remote locations experience decreased availability of accessibility to mental health treatment and consultation sectors. The stigma connected with seeking mental health has been determined to be the common obstacle for rural inhabitants than the urban ones.
However, anxiety such as depression is stress-related to economic troubles. In the 1980s, the agricultural crisis or losing an excellent job in your field might trigger mental problems. Studies find out that depression is more widespread in agricultural communities during this era of farming crisis, and providers should pay attention to such difficulties at the community or individual level. Stressful living is an increased danger for inviting suicide.
Recommendations and conclusions
Among the challenges impacting rural health sectors, specific remedies are processed; one, there is a need to identify the deficiencies of the health facilities. Secondly, luring health professionals rely on managed behavioral health care programs. Rural mental health care personnel should get proper training for their job. There should be increasing dependence on primary care practitioners for mental health treatment. The relationship between PCPs and mental specialists should be enhanced. Finally, expanded outreach and informal assistance should be highly appreciated. There should be methods set that are focused on recruiting mental experts in remote regions. To do this, one might supply information on current supplies and the location of mental health specialists to be more precise and accessible. Local health facilities are crucial in mental health, and it remains a source of mental health treatment in most rural communities. Failure shows that services to the poor may be promoted by finance adjustments and laws.
Subsequently, the increasing availability of social workers and suitable licensing may boost the community mental health clinics’ staffing. Telehealth also plays a mental service delivery. Positive feedbacks have been offered from recent experience with telepsychiatry. The extra interpersonal contact that has arrived with it is likewise greatly appreciated by the clients and the providers. In the same numerous tele-mental health networks have thrived; this has featured direct psychiatry. Training crises, medication management. Life in rural lacks metropolis life. Despite this, research has indicated significant prevalence rates of depression and anxiety disorders that have consequently contributed to more excellent suicide rates. Treatment of these illnesses remains a severe problem nationally.
The limitations of health care have been the heart of all difficulties. Most individuals with a high incidence of depression and anxiety do not obtain high-quality therapy. This shows that the quality of health care may be a concern in both places. As noted before, mental problems and mental health are challenging in rural places. This arises mainly from the inability to notice such problems at an early stage, lack of money. Mental disease happens to individuals of all ages, men, women, and children. Some individuals look disadvantaged in obtaining such treatment, including youngsters, the elderly, groups of minorities, African Americans, and others. These components, coupled with demanding professions and a lack of understanding about mental illness, catalysis the issue further. It is also necessary that the rural practitioners obtain training in mental health periodically to meet the emerging issues.
References
American Association of Nurse Practitioners. State practice environment. 2018. Retrieved from: https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment
Andrilla, C. H. A., Moore, T. E., & Patterson, D. G. (2019). Overcoming barriers to prescribing
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Buprenorphine for the treatment of opioid use disorder: recommendations from rural physicians. The Journal of Rural Health, 35(1), 113-121.
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Grant, R., Smith, A. K., Newett, L., Nash, M., Turner, R., & Owen, L. (2021). Tasmanian healthcare professionals’& students’ capacity for LGBTI+ inclusive care: A qualitative inquiry. Health & Social Care in the Community, 29(4), 957-966.
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute.
Pesut, B., Hooper, B., Jacobsen, M., Nielsen, B., Falk, M., &O‘Connor, B. P. (2017). Nurse-led navigation to provide early palliative care in rural areas: a pilot study. BMC palliative care, 16(1), 1-10.
