1.3 Psychiatric-Mental Health Nursing

What is Psychiatric-Mental Health Nursing?

Registered nurses (RNs) in a variety of settings provide care for patients with medical illnesses who may also be experiencing concurrent mental health disorders. Nurses who specialize in psychiatric-mental health nursing promote patients’ well-being through prevention strategies and patient education, while also using the nursing process to provide care for patients with mental health and substance use disorders.^[1] According to the American Psychiatric Nurses Association, psychiatric-mental health nurse specialists perform the following activities^[2]:

• Partner with individuals to achieve their recovery goals
• Provide health promotion and maintenance
• Conduct intake screening, evaluation, and triage
• Provide case management
• Teach self-care activities
• Administer and monitor psychobiological treatment regimens
• Practice crisis intervention and stabilization
• Engage in psychiatric rehabilitation and intervention
• Educate patients, families, and communities
• Coordinate care
• Work within interdisciplinary teams

Within the specialty of psychiatric-mental health nursing, there is an opportunity to become board certified. Eligibility requirements include a bachelor’s degree, two years of full-time work, 30 hours of continuing education, and passing a certification exam. The nurse earns the credential of PMH-BC (Psychiatric-Mental Health-Board Certified) or RN-BC.

Psychiatric-mental health advanced practice registered nurses (PMH-APRN) and nurse practitioners (PMHNP-BC) are registered nurses with a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree in psychiatric nursing. APRNs as defined by the American Nurses Association are professional nurses who have successfully completed a graduate program of study in advanced direct nursing practice. PMH-APRNs perform the following activities:

• Provide individual, group, couples, and/or family psychotherapy
• Prescribe medication for acute and chronic illnesses
• Conduct comprehensive assessments
• Provide clinical supervision
• Diagnose, treat, and manage chronic or acute illness
• Provide integrative therapy interventions
• Order, perform, and interpret lab tests and other diagnostic studies
• Provide preventative care, including screening
• Develop policies for programs and systems
• Make referrals for health problems outside their scope of practice
• Perform procedures

Standards of Psychiatric-Mental Health Nursing

The American Psychiatric Nurses Association establishes standards of practice in psychiatric-mental health nursing that are built on the ANA Scope and Standards of Practice (2021). These standards are published in the Psychiatric-Mental Health Nursing: Scope and Standards of Practice document.^[3] The standards are very similar to the ANA Scope and Standards of Practice, with additional activities included in the Intervention standard of care. These interventions will be further discussed in the “Application of the Nursing Process in Mental Health Care” chapter.

There are specific legal and ethical considerations that apply to caring for patients with mental illness. See the “Legal and Ethical Considerations in Mental Health Care” chapter for further information.

Treatment Settings

There are many settings where psychiatric-mental health nurses collaboratively provide services to clients with mental health disorders, ranging from outpatient settings to inpatient care to state mental hospitals.

Outpatient Services

Patients often initially visit their primary care provider when concerned about their mental health. If a patient has a more severe disorder, they are typically referred to specialized psychiatric care providers such as psychiatrists, psychiatric-mental health advanced practice registered nurses/nurse practitioners, psychologists, social workers, counselors, or other licensed therapists.

There are many different types of mental health services offered in the community:

• Patient-centered medical homes that are comprehensive, coordinated, patient-centered models of primary care.^[4]
• Community mental health centers that offer free, low-cost, or sliding scale care for those who lack funding for mental health care.
• Country programs, such as Comprehensive Community Services (CSC) or Community Support Programs (CSP).
• Psychiatric mental health care in correctional facilities.
• Psychiatric home care that provides community-based treatment for clients who are homebound.
• Certified peer specialists.
• Telepsychiatry that provides therapy and prescription services through videoconferencing.^[5]

Inpatient Care Settings

Patients with acute mental health symptoms, or those who are at-risk for hurting themselves or others, may be hospitalized. They are often initially seen in the emergency department for emergency psychiatric care. Patients may seek voluntary admission, or in some situations, may be involuntarily admitted after referral for emergency evaluation by law enforcement, schools, friends, or family members. Read more about involuntary admissions in the “Legal and Ethical Considerations in Mental Health Care” chapter.

Acute-care psychiatric units in general hospitals are typically locked units on a separate floor of the hospital with the purpose of maintaining environmental safety for its patients. State-operated psychiatric hospitals serve patients who have chronic serious mental illness. They also provide court-related care for criminal cases where the patient was found “not guilty by reason of insanity.” This judgment means the patient was deemed to be so mentally ill when they committed a crime that they cannot be held responsible for the act, but instead require treatment.^[6]

Residential Treatment Centers

Residential treatment centers are live-in facilities that provide intensive therapy for substance abuse, complex mental health disorders, behavioral disorders, and eating disorders. These centers target patients whose health is at risk in less restrictive settings such as home, outpatient care, or community. Patients receive comprehensive evaluations, individual and group therapies, integrative therapies, and medication. Stays are generally longer than inpatient settings, with one to three months being common. For youth, schooling may be continued while in treatment^[7].