Psychiatric-Mental Health Nurse Practitioner Specialization Guide - 2022

Last Reviewed: September 30th, 2022

Any mental health illness is defined as a mental, behavioral, or emotional disorder. Serious mental illness is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to a serious mental illness. In the United States, nearly one in five adults live with a mental illness.

With these statistics, it is vital that there are medical professionals that specialize in the care of individuals experiencing mental illnesses.

What does a Psychiatric-Mental Health Nurse Practitioner do?

Psychiatric-Mental Health Nurse Practitioners (PMHNP), also known as psychiatric nurse practitioners, psychiatric NPs, or mental health nurse practitioners, focus their work on a range of mental health services. These roles are similar to that of a psychiatrist. These services can include patient assessment, psychiatric diagnosis, and medication management.

PMHNPs have the opportunity to work in many different settings and see patients that experience many different mental health issues such as anxiety, panic attacks, ADHD, ADD, psychosis, depression, schizophrenia, bipolar disorder, dementia, alcohol abuse, drug use, PTSD, trauma, or postpartum depression. Settings that PMHNP can work at include primary care units, private practice, outpatient clinics, hospitals, or community health centers. PMHNPs are also able to provide services in substance abuse programs, high-risk pregnancy centers, schools, or trauma centers.

Different Types of PMHNP Sub-Specialties

  • Child and Adolescent Psychiatric-Mental Health Nurse Practitioners are trained to assess and treat behavioral disorders in children and adolescents. These disorders can include ADHD, autism spectrum disorders, and mood disorders. Other disorders can include depression, anxiety, and eating disorders such as anorexia and bulimia.
  • Geriatric PMHNPs specialize in the assessment, diagnosis, and treatment of mental health conditions in older adults. Disorders for this population can include Alzheimer’s, dementia, working through emotions such as isolation, grief, fear of dying, or other experiences that can be associated with anxiety or depression.
  • Addiction Disorder PMHNPs specialize in the treatment of addiction disorders. Addictions can include alcohol, drug, or substance abuse, addictive behaviors such as food, gambling, sex, etc. PMHNPs that work in this sub-specialty assess, diagnose, and treat patients with these addictive behaviors. NPs that are in this specialty can work at hospitals, outpatient addiction centers, detoxification centers, halfway houses, or addiction recovery centers.

Psychiatric nurses (while not NPs) are experts at evaluating complex psychiatric, substance abuse, and physical health needs and problems of their patients. Psychiatric-mental health RNs are certified by the American Nurses Credentialing Center. Psychiatric nurses can work under medical orders from an advanced practice specialist such as a medical doctor or nurse practitioner. Responsibilities of a psychiatric nurse can include providing emotional support, administering medications and assessing responses to those medications, maintaining communication with doctors and other members of the patient’s healthcare team, follow treatment plans made by a medical doctor or nurse practitioner, educate patients and families, and provide physical and mental assessments.

Psychiatric Nurse vs. PMHNP

Some differences between a psychiatric nurse and a PMHNP are that PMHNPs need a broader range of knowledge in comparison to psychiatric nurses. Psychiatric nurses must be familiar with the characteristics of a disease, whereas nurse practitioners should be familiar with the pathophysiology of disorders at the cellular level.

Another difference between PMHNPs and psychiatric nurses is the level of autonomy in each position. PMHNPs have the ability to work independently from doctors or with minimal supervision, dependent upon the state they are working in, whereas psychiatric nurses must work under the supervision of a doctor or a nurse practitioner.

Additional differences between PMHNPs and psychiatric nurses are that PMHNPs can maintain prescriptive authority, have advanced assessment skills, can create and order treatment plans, can diagnose conditions or diseases, and can serve as a counselor or provide psychotherapy to individuals or groups.

A Typical Day as a PMHNP

A typical day as a Psychiatric-Mental Health Nurse Practitioner can vary from educating other nurses on mental illnesses to working directly with patients in the field. If working directly with patients, tasks can include:

  • Discussing with the patient’s health team and creating a treatment plan
  • Diagnosing patients and communicating information about their condition to the patient, family, and other team members
  • Educating their local community on mental health concerns
  • Conducting and interpreting mental health assessments for their patients
  • Performing and giving psychotherapy for the treatment of their patient’s conditions
  • Performing exams and checkups for their patient’s physical and mental health
  • Prescribing medications and consulting with other members of the patient’s care team
  • Adjusting medication and treatment plans for patients based on their assessments
  • Maintaining patient records and making appropriate referrals to ensure proper care of their patients
  • Provide emergency psychiatric care if needed
  • Continually learning about new medications and treatment modalities

Career Stability and Projections

According to the U.S Bureau of Labor Statistics, Nurse Practitioner jobs are the fourth fastest growing occupation projected for 2020-2030. Nurse Practitioner jobs are projected to grow 28.2% from 2018 to 2028. This is 5.6x faster than the national average for other jobs. The median average wage for Nurse Practitioners was $118,040. The lowest 10% of earners was estimated at $79,470 annually, with the top 10% of earners making $163,350 annually.

Industries with the highest levels of employment of nurse practitioners included offices of physicians, general medical and surgical hospitals, outpatient care centers, colleges, universities, and professional schools, and offices of other health practitioners. Top paying industries for nurse practitioners included community food and housing, and emergency and other relief services, religious organizations, residential intellectual and developmental disability, mental health, and substance abuse facilities, social advocacy organizations, and outpatient care centers.

States with the highest employment levels for nurse practitioners included California, New York, Texas, Florida, and Ohio. Top paying states for Nurse Practitioners included California, New Jersey, Washington, New York, and Massachusetts, respectively. California’s average annual wage for a nurse practitioner was $151,830, while Massachusetts was $129,540.

As of 2019, there are at least 19.6% or 51.5 million Americans living with a mental health issues. Of those 19.6% Americans living with mental health issues, 4.91% are experiencing severe mental illness. This means that there will always be a need and demand for Mental-Health Psychiatric Nurse Practitioners.

Psychiatric-Mental Health Nurse Practitioners also work with individuals dealing with substance abuse. Currently, 7.74% of Americans reported having a substance use disorder within the past year, 2.97% of Americans reported having illicit drug use disorder in the past year, and 5.71% of Americans report alcohol use disorders within the past year.

The estimated number of adults with serious suicidal thoughts is over 11.4 million, which is at an increase of 664,000 people in comparison to the year prior. As of 2022, approximately 10.6%, or 2.5 million youth of youth deal with severe major depression. In comparison to 2021, the number of youths experiencing severe major depressive disorder increased by 197,000. These shocking statistics highlight the importance of having highly trained medical professionals in the field of mental health in order to assist and take proper care of both adults and youth. With these statistics, there is clearly a need that results in significant job stability for Psychiatric-Mental Health Nurse Practitioners.

Career Satisfaction

Individuals considering a job as a Psychiatric-Mental Health Nurse Practitioner may find this career very rewarding if they have a genuine passion for helping those with mental health issues. Although career satisfaction levels will vary depending on each specialty, there are a few factors that the majority of job satisfaction levels rely on for nurse practitioners. A study conducted in 2005 surveyed 147 nurse practitioners and found that the overall job satisfaction of NPs was minimally satisfied to satisfied.

Nurse Practitioners were most satisfied with intrinsic factors and least satisfied with extrinsic factors from their jobs. Nurse Practitioners were most satisfied with their sense of accomplishment, challenge in work, level of autonomy, patient mix, and ability to deliver quality care. Nurse Practitioners were least satisfied with factors such as having time off to serve on professional committees, reward distribution, amount of involvement in research, and opportunity to receive compensation for services outside of normal duties, and monetary bonuses available in addition to salary.

Nurse Practitioners with zero to one year practice experience felt the most satisfied with their jobs, but satisfaction scores fell with each additional year of experience, with a plateau between the eighth and eleventh year of practice. Another study conducted in 2010 assessed job satisfaction levels as a nurse practitioner and found that 27% of NPs indicated an intent to leave their current position, with a significant correlation of being dissatisfied at their job in relation to their intent to leave.

There was also a significant negative relationship between job satisfaction and anticipated turnover. This highlights the importance of ensuring that facilities and administration are properly compensating nurse practitioners and creating positive work environments to reduce turnover, ultimately leading to an increase in job satisfaction and quality of care for patients.

Most Common Complaints as a Nurse Practitioner

Although work as a Psychiatric-Mental Health Nurse Practitioner can be very rewarding, there are a few cons to consider before pursuing this career path.

One large complaint of PMHNPs is high burnout rates. When working with patients with mental disabilities and mental illnesses, there is high potential for physical or verbal abuse. It can also be mentally exhausting taking care of patients that are unable to take care of themselves.

Another con of working as a PMHNP is that it can be perceived as less prestigious in comparison to other nursing sectors. This can add to the feeling of burnout as individuals may feel that their work is not valued as it should be.

Psychiatric nurse practitioners also complain about their jobs being understaffed, leading to work exhaustion. Another con in being a Psychiatric-Mental Health Nurse Practitioner was that some NPs felt that they had to work in a high-risk setting. This is due to the nature of the job, where Psychiatric-Mental Health Nurse Practitioners will have to work in settings such as psychiatric wards or recovery centers. Over time, this work environment can lead to burnout.

How To Become a PMHNP

** This is a broad overview. Pick your state for specific requirements. **

In order to become a Psychiatric-Mental Health Nurse Practitioner, one must first become a Registered Nurse by earning an associate’s degree or a bachelor’s degree and sitting for the NCLEX-RN exam.

Next the candidate will need to acquire 500 hours of clinical experience at a faculty-supervised program. This a requirement to apply to a Master of Science in Nursing or a Doctor of Nursing Practice degree, which is the next requirement to become a PMHNP. These degrees can have specializations in psychiatric mental health care.

Next, individuals will pursue certification, where professionals will sit for a board certification exam from the American Nursing Credentialing Center (ANCC). This certification must be renewed every five years.

Recertification can be accomplished by combining professional development with either 1,000 clinical hours or by retaking the certification exam. A current RN license is also required to recertify, which individuals must complete 75 hours of continuing education to maintain it.  It is important to note that laws for nurse practitioner certification and licensure varies state to state. It is important to research all requirements for each state to ensure proper licensure.