1.7 Psychiatric-Mental Health Nursing

What is Psychiatric-Mental Health Nursing?

Registered nurses (RNs) in a variety of settings provide care for clients with medical illnesses who may also be experiencing concurrent mental health disorders. Nurses who specialize in psychiatric-mental health nursing promote clients’ well-being through prevention strategies and patient education, while also using the nursing process to provide care for clients 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 mental functioning and behavior treatment regimens
• Practice crisis intervention and stabilization
• Engage in psychiatric rehabilitation and intervention
• Educate clients, 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. 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 “Implementation” section of the “Application of the Nursing Process in Mental Health Care” chapter.

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

Treatment Settings

Treatment settings for mental health illnesses vary based on the severity and complexity of the condition, as well as the resources available. These settings can be broadly categorized into several types:

Primary Care Settings

Mild to moderate mental health conditions are often managed in primary care settings. This includes the integration of mental health services within primary care practices, where general practitioners may provide initial assessments, prescribe medications, and offer brief counseling.

Outpatient Services

These settings are suitable for individuals who require regular, but not intensive, mental health care. Outpatient clinics provide services such as psychotherapy, medication management, and follow-up visits. Community mental health teams  often operate in these settings to offer coordinated care. Clients often initially visit their primary care provider when concerned about their mental health. If a client 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.

Day Treatment Programs

These programs provide a higher level of care than outpatient services but do not require overnight stays. They are designed for individuals who need intensive treatment during the day but can return home in the evening.

Inpatient Care Settings

Clients 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. Clients 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. This setting is for individuals with severe mental health conditions that require 24-hour care and supervision. Inpatient treatment focuses on crisis stabilization, safety, and rapid discharge planning. It is important to note that individuals with suicidal ideation who are not medically stable may be admitted to medical surgical units for care. Specialized units may exist for different populations, such as children, adolescents, and those with dual diagnoses. Read more about involuntary admissions in the “Patient Rights” section of 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 clients. State-operated psychiatric hospitals serve clients who have chronic serious mental illness. They also provide court-related care for criminal cases where the client was found “not guilty by reason of insanity.” This judgment means the client 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.^[4]

Community-Based Services

Community-based services include mobile crisis response teams, intensive in-home therapies, and therapeutic foster care. These services aim to provide support in the least restrictive environment possible, helping individuals remain in their communities while receiving necessary care.

Telepsychiatry

This modality extends mental health services to remote or underserved areas, providing access to psychiatric care through telecommunication technologies. It is particularly useful in community settings such as schools and correctional facilities.