Creating a mental image of better healthcare for all

This one-year Post-Master's Psychiatric Mental Health Nursing Certificate Program (PMHNP) combines online classes with on-site training at hospitals and clinics. Funded by a two-year grant from the Maryland Health Services Cost Review Commission, administered by the Maryland Higher Education Commission, the program will welcome its first 10 students in fall 2014. Later classes will likely be capped at 15 students.

"The beauty of this program is that we can train nurse practitioners that are already working with patients in rural areas in a more advanced level of psychiatric practice," says Karan Kverno, PhD, PMHCNS-BC, PMHNP-BC, Assistant Professor in the Department of Acute and Chronic Care. "The training is all online but we are developing contacts in outlying areas where the NPs are living so they work part-time and keep up their practices while they are being trained."

The program meets a pressing need for more efficient delivery of mental health services. Depression, anxiety, and substance abuse darken the lives of millions of Americans but like other mental disorders, these conditions often go undiagnosed and untreated--particularly in rural areas with few psychiatric care providers.

About one-third of people in need of mental health care received it from their primary care providers, yet very few primary care providers -- whether physicians or nurse practitioners -- receive special mental health care training.

The implementation of the Affordable Care Act in 2014 will increase access to mental and substance abuse services to an estimated 6 million to 10 million Americans, swamping an already burdened system. "Many of these people will come in through primary care providers," says Kverno. "And the workforce is very strained in terms of psych care providers."

In Maryland, approximately 62,000 children and adolescents live with serious mental health conditions, including autism, ADHD, anxiety and depression, and substance abuse. Those children are at a much higher risk of dropping out of school or becoming incarcerated.

One in five older adults also requires psychiatric services, but there is an extreme shortage of geriatric mental health care providers. Veterans too are underserved, Kverno says. "Access to mental health care in the VA health care system can be very slow."

The Hopkins program will help alleviate this problem by training NPs to screen, identify and (where appropriate) treat mental disorders in primary care settings. "You don't treat everything," Kverno says. "You screen, identify, and determine if a patient needs referral to a specialist. If it's something the provider is qualified to treat themselves, they do."

Advanced courses in the neurobiological basis of mental and addiction disorders and psychopharmacology, psychotherapeutic frameworks and modalities and psychiatric diagnosis, symptom and illness management, and health assessment and management will provide the theoretical backbone of the program. Two clinical courses in which students work under the guidance of local psychiatrists and other mental health providers will round out the accelerated one-year curriculum.

"Everyone who will be admitted to the program is already an NP, so we'll be able to streamline the program," Kverno says. "We are building on the knowledge students already have." Even so, she points out, "they'll be working really hard."

Nurses themselves recognize the need for more advanced training in providing mental health care. "I was just at a national organization of nurse practitioner faculty recently and faculty were saying that they wished we had more psychiatric training," says Kverno. She herself has worked as a psychiatric nurse practitioner since 2005.

The World Health Organization and the Substance Abuse and Mental Health Services of the U.S. Department of Health and Human Services are also focusing more on integrative health care, Kverno says. And with the expected surge of newly insured Americans, primary care providers will have a greater need than ever to screen, identify, and treat not just substance abuse but a wide range of psychiatric disorders. "We are going to have a large influx of people into the health care system with mental health needs," Kverno explains. "Every professional group needs to figure out how they can help with this big need."