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Crisis in the Mental Health Care Workforce Are Advanced Practice Nurses Part of the Solution?

Crisis in the Mental Health Care Workforce Are Advanced Practice Nurses Part of the Solution?. Nancy P. Hanrahan, PhD, RN, CS Assistant Professor Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing. Objectives. Trends: Mental Health System

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Crisis in the Mental Health Care Workforce Are Advanced Practice Nurses Part of the Solution?

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  1. Crisis in the Mental Health Care WorkforceAre Advanced Practice Nurses Part of the Solution? Nancy P. Hanrahan, PhD, RN, CS Assistant Professor Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing

  2. Objectives • Trends: Mental Health System • System: Frayed and ineffective for SMI • Workforce: Inadequate • Are APNs a Solution?

  3. Comparing Inpatient and Outpatient Trends Percent Change from Previous Year 1976-2000 INPATIENT n=2,329-2,478 OUTPATIENT n=1,151-2,068 Source: Published and unpublished inventory data from the Survey and Analysis Branch, Division of State and Community Systems Development, Center for Mental Health Services

  4. Mental Health WorkforceTrends 1972-1998 Source: Published and unpublished inventory data from the Survey and Analysis Branch, Division of State and Community Systems Development, Center for Mental Health Services

  5. Need a Workforce Competent in Medical And Psychiatric Care for Quality Outcomes Individuals with Serious Mental Illness • Only a third with SMI receive treatment • High incidence of physical comorbidities that are overlooked by CMHCs. • Inadequate follow-up • Higher mortality rates

  6. SERIOUS MENTAL ILLNESS S/ HIV A SERIOUS PUBLIC HEALTH PROBLEM • % HIV Positive • .9 • 2.8 • 4.6 • 3.7 • Group • General Population • Schizophrenia • Affective Disorder • Serious Mental Illness (SMI)

  7. 2,055,561 individuals 15.7 million claims 9% (185,403) mental disorder diagnosis 47% had more than one mental disorder diagnosis 83% had more than one major medical problem (CVD, Diabetes) 7% (709,606) mental disorders 93% (14.9 mil) medical problems Older Adult Utilization of Mental Health Services5% National Sample >65 yearsN=185,403 Data Source: Medpar File, Outpatient File, Carrier File

  8. Distribution of Claims for Medicare Beneficiaries with a Mental Disorder Diagnosis

  9. Distribution of Claims by Diagnosis and Provider

  10. Are APNs a Solution to Rural Mental Health Workforce Shortages? N=8642 Certified APNs • Purpose: • Examine the rural and urban distribution of certified APPNs and determine the potential for APPNs to be a solution to the rural mental health workforce shortage. • Survey of 50 states: • Scope of practice, state regulation (Rx authority) and curriculum for psychiatric mental health nursing programs • Findings: • APNs have a higher distribution per population in the rural areas than psychiatrists (13% vs.6.6%) • 20 states have at least 20% rural APN practice • Despite low numbers of APNs, training and scope of practice fit an urgent need in rural areas

  11. APNS WHAT WE KNOW • EDUCATION: Masters degree and PhD • N=16,606 CNS/NP Psychiatric Specialty (8,654 cert) • N=88,000 Nurse Practitioner, Primary Care Specialty • Scope of practice: Integration of bio-psycho-social • Expertise: Surveillance (comorbidity, medication/SE) • SETTINGS: Institution, Community, and Home • Trends • Rate of growth will be the same for psychiatrists by 2010 with 300 new nurses per year • Restricted scope of practice, lack of reciprocity • Education Changes: Psychiatric Nurse Practitioner • Prescriptive Authority • Nurse Practitioners 50 States • Clinical Nurse Specialists 34 States

  12. Major Trends In The Mental Health Workforce • Fewer trained professionals with an increase in the use of MHW • How does the substitution affect outcomes, access, and quality? • What is the evidence that a particular competency level is associated with better outcomes? • Poor workforce data • Reimbursement incentives drive the type of provider and the intervention

  13. Recommendations • Any meaningful reform of mental health care delivery will have to overcome current barriers to effective utilization of providers • These barriers serve no useful purpose and in fact contribute to our health care problems by preventing the full deployment of competent and cost-effective providers who can meet the needs of a substantial number of consumers. • Practice acts should ensure that they are based wholly on competency • Fund interdisciplinary training • Revise payment and practice laws to allow all demonstrably competent providers to diagnose, treat, and prescribe on their own licenses.

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