One-third of all U.S. adults reported symptoms of anxiety or depression in May 2021, according to the U.S. Census Bureau. Yet the country is experiencing a shortfall of mental health providers to help them, multiple media outlets report. As USAFacts highlights, the nation needs an additional 6,398 mental health providers to make up the deficit, which currently affects 122 million people who live in areas with a shortage of mental health providers.
Meanwhile, the U.S. shortage of psychiatrists that started before the pandemic continues. However, in March 2021, President Joe Biden signed into law the American Rescue Plan, which sets aside some $4 billion for mental health services.
Psychiatric mental health nurse practitioners (PMHNPs) and psychiatrists play key roles in helping our nation address its current mental health crisis. Although the duties and responsibilities of the two roles are similar, people considering careers in mental health should understand the key differences in psychiatric nurse practitioners vs. psychiatrists and how they can work collaboratively.
What Does a Psychiatric Nurse Practitioner Do?
A psychiatric mental health nurse practitioner (PMHNP) is a nurse practitioner (NP) who specializes in mental health care. A PMHNP applies all the responsibilities of an NP to the specialized field of mental health services while also using specialized knowledge to administer diagnoses and treatment strategies.
PMHNPs treat patients of all ages, supporting them through a variety of mental health issues, including neurological diseases, difficult life circumstances and trauma. They can also distinguish diagnostically between physical and emotional symptoms. They may examine and interview patients experiencing fatigue and appetite loss, for instance, to detect signs of possible mental health issues, such as depression. They act as therapists while applying a holistic approach that combines medication, counseling and community education to mental health care.
PMHNPs most commonly work in behavioral health or addiction clinics but may also work in private practice or hospital settings. Other settings include schools, hospice care facilities and prisons. Many PMHNPs instruct fellow nurses and conduct research in higher education institutions. In typical clinical settings, they work regular hours but must be on call for after-hours emergencies.
Direct patient care is only one facet of what a psychiatric nurse practitioner does on the job. Most collaborate with fellow PMHNPs, physicians, families and the community. Some are active in shaping public policy on mental health care.
PMHNPs and Treatment Evaluation
One of the most important functions of a PMHNP is the ongoing evaluation of patient treatment plans. For example, mental health patients who have been prescribed medication need follow-up care to determine its ongoing effectiveness, such as whether the dosage needs to be adjusted or whether a patient experiences side effects. Likewise, patients receiving psychotherapy should be monitored to see whether the therapy approach is working or needs to be revisited in the light of new developments, such as changes in a patient’s life circumstances.
PMHNPs collaborate with patients in treatment plan monitoring and follow-up — making them true advocates for people in their care. They are at the forefront of diagnosing, treating and staying connected with patients who need their expertise and ongoing support.
PMHNPs and Types of Care
PMHNPs deliver mental health care to patients, families and communities by:
- Completing psychosocial and physical patient assessments
- Diagnosing psychiatric, neurological and substance use disorders
- Differentiating medical disorders from psychiatric disorders
- Creating mental health care treatment plans
- Managing patient mental health care
- Conducting mental health therapy
- Delivering emergency psychiatric services
- Serving as a mental health services consultant and educator
PMHNPs and Psychotropic Medication Prescription
PMHNPs prescribe medication under the same state-determined conditions as all NPs. They typically prescribe psychotropic drugs (“psychotropic” means acting on the mind), such as antidepressants, antipsychotics and mood stabilizers. Currently, all 50 states allow PMHNPs to prescribe medication, but several states require PMHNPs to get a supervising physician’s approval first.
PMHNPs and Types of Mental Health Disorders
One distinction in psychiatric nurse practitioners vs. psychiatrists is their availability. Increasingly, PMHNPs have become a much-needed alternative to psychiatrists for patients seeking psychiatric care. This is especially true with the ongoing shortage of psychiatrists, both before and during the COVID-19 pandemic.
Currently, at-risk patients may have long waits to see psychiatrists. However, they might be able to see PMHNPs the same day they seek treatment. Thus, part of what a PMHNP does is be available to patients to provide quick access to mental health care.
The types of mental health disorders a PMHNP diagnoses and treats include:
- Eating disorders
- Bipolar disorder
- Substance use disorders
What Does a Psychiatrist Do?
Psychiatrists are medical doctors in the area of medicine known as psychiatry — the research and treatment of mental, emotional and behavioral health disorders.
Psychiatrists’ extensive education and training equip them to serve a wide variety of patients. They can assess and diagnose both the mental and physical components of psychological problems in their patients. To do so, psychiatrists may run psychological tests, order laboratory tests and hold discussions with patients to further understand their mental states. They can then administer a variety of treatments to treat these issues, which may include medication, psychotherapy, alternative therapies and other psychosocial interventions.
Like PMHNPs, psychiatrists can work in a variety of settings, including clinics, psychiatric and general hospitals, private practice, prisons, and university medical centers. Other settings may include nursing homes or government facilities. Psychiatrists may also work typical hours but are sometimes on-call for emergencies.
Good psychiatrists are more than the sum of their years of education and expertise. Psychiatrists who are consistently empathic, responsive and genuine can better support individual patients and their families. In many ways, what a psychiatrist does is support and advocate for patients on the front lines of mental health care.
Psychiatrists and Psychotropic Medication Prescription
All psychiatrists can prescribe psychotropic medications, including:
- Antidepressants (for depression, PTSD, anxiety or eating disorders)
- Antipsychotics (for schizophrenia or psychosis)
- Sedatives and anxiolytics (for anxiety or insomnia)
- Mood stabilizers (for bipolar disorder)
- Stimulants (for ADHD)
Psychiatrists and Psychiatric Subspecialties
Many psychiatrists target a particular patient population by focusing their education and training on psychiatric subspecialties, such as:
- Addiction disorders
- Adolescent or child psychiatry
- Sleep disorders
- Cognition and dementia
- Military psychiatry
- Sports psychiatry
Psychiatrists and Psychotherapy
Psychiatrists today typically combine medication with psychotherapy sessions to help patients cope with a range of issues, including daily life stressors; dealing with grief or serious illness; or experiencing a specific mental health condition, such as anxiety or depression.
Common psychotherapy approaches psychiatrists may apply, depending on the patient’s unique situation and preferences, include:
- Cognitive-behavioral therapy: Helping patients change harmful or ineffective thinking and behaviors
- Interpersonal therapy: Delivering short-term therapy for relationship issues, such as changes in a work role or conflicts with a spouse
- Dialectical behavior therapy: Helping patients regulate emotions, such as chronic suicidal thoughts or PTSD
- Psychodynamic therapy: Discovering and taking responsibility for changing inappropriate thoughts or emotions based on childhood experiences
- Psychoanalysis: Treating emotional disorders by frequent sessions in which patients discuss personal experiences, early childhood and dreams (similar to psychodynamic therapy)
- Supportive therapy: Using guidance and encouragement to help people build self-esteem, reduce anxiety, strengthen coping mechanisms and become responsible for their own growth
PMHNP vs. Psychiatrist: Key Differences
While looking at psychiatric nurse practitioners vs. psychiatrists highlights differences, they are natural partners. Their roles overlap, sharing responsibilities such as diagnosing mental health conditions, prescribing medications and administering therapy to patients.
In fact, given the shortage of mental health providers in the U.S., PMHNPs serve not only as an alternative to psychiatrists but as valuable collaborators, working together to implement mental health care strategies.
The roles have core differences important for individuals planning a career path in mental health care to consider. Differences in educational requirements, prescribing authority and administrative authority distinguish the thin line between PMHNPs and psychiatrists.
Differences in Educational Requirements
The educational and certification requirements differ for PMHNPs vs. psychiatrists. A practicing clinical psychiatrist is a medical doctor who evaluates and treats people with mental health issues. Therefore, psychiatrists must earn medical degrees, obtain state certification, and complete an internship or residency in the field.
PMHNPs, on the other hand, typically earn a Bachelor of Science in Nursing (BSN), followed by an advanced degree, whether a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP).
Although the steps on the path to becoming a PMHNP can vary, they typically involve the following:
- Earn a Bachelor of Science in Nursing
- Take the NCLEX-RN and become a licensed RN
- Complete a PMHNP or NP graduate program
- Complete the required clinical hours
- Pass a board-certified exam for PMHNPs
- Apply for a state license (renewable every five years)
The academic preparation psychiatrists need to complete is quite different from a PMHNP’s educational path. The typical steps are:
- Earn a bachelor’s degree, usually with coursework in biology, chemistry, physics, calculus and statistics
- Pass the Medical College Admission Test (MCAT)
- Graduate from medical school
- Pass an examination and gain a state license to practice medicine
- Complete a psychiatric residency (typically takes four years)
- Obtain certification (optional but desirable) through the American Board of Psychiatry and Neurology (renewable every 10 years)
- Complete any continuing education required by the state to keep medical license current
Two of the key differences in the educational requirements for psychiatric nurse practitioners vs. psychiatrists are the education length and residency requirements. As the lists outlined, a psychiatrist’s education and training last longer than a PMHNP’s, and psychiatrists must complete an internship or residency that gives them firsthand experience in a real-world mental health care setting, such as a hospital.
PMHNPs, on the other hand, need not complete an internship or residency before beginning their careers. Instead, PMHNPs have earned, at minimum, a Master of Science in Nursing (MSN). After graduating with their degree, they must obtain certification and licensing to practice mental health care, for example, by qualifying for Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification. They must then apply for and obtain licensure in the state in which they plan to practice.
As mentioned, PMHNPs and psychiatrists often collaborate. However, the different educational requirements correspond with the distinct authority and responsibilities of each role.
Differences in Prescribing Authority
In the past, only a psychiatrist wielded the authority to prescribe medications to treat mental health conditions. Now, PMHNPs prescribe medications, but their authority to do so independently varies by state.
This geographical difference in prescribing authority makes a difference to people considering becoming a PMHNP because their ability to practice autonomously depends on where they practice. In other words, prospective PMHNPs in certain states can expect to prescribe medications only under a psychiatrist’s supervision.
Differences in Administrative Authority
Both PMHNPs and psychiatrists diagnose and treat mental health disorders. In many states, both types of providers can establish and run their own independent practices. They can also both conduct research and publish the results of that research.
However, the administrative authority each position can take on differs. For example, a psychiatrist can work in a supervisory role in a psychiatric hospital. Additionally, psychiatrists often review and sign off on decisions made by PMHNPs under their supervision. By nature of their authority to supervise PMHNPs, psychiatrists can exercise greater authority and take on greater responsibility than their PMHNP counterparts.
PMHNPs and Psychiatrists Collaborate to Meet Mental Health Needs
Although the balance of authority between psychiatric nurse practitioners and psychiatrists favors psychiatrists, they work together in partnership to strategize mental health care delivery, to the benefit of patients and communities.
Collaboration between these two roles can consist of precepting when a physician instructs and mentors a new PMHNP on the job. It may also involve PMHNPs supporting one another as they work side by side with psychiatrists.
According to Sara Robinson, MSN, RN, PMHNP-BC, in Psychiatric Times, “In my experience, PMHNPs greatly value working as a team with our colleagues within the field — psychiatrists, clinical psychologists, therapists, etc. We greatly value our collaboration with physicians and appreciate the many psychiatrists who have offered their expertise and time to PMHNP students by precepting.”
With the physician shortage and circumstances brought on by the COVID-19 pandemic, PMHNPs are increasingly joining forces with psychiatrists. Their continued collaboration is key to the future of mental health care.
Psychiatrist Salary and Job Growth
By virtue of their lengthier education and greater administrative authority compared with PMHNPs, psychiatrists typically hold high salaries. According to the U.S. Bureau of Labor Statistics, the median annual psychiatrist salary is $217,100 (2020). The BLS also projects the employment of psychiatrists will grow by 13% between 2020 and 2030.
Note that all salary figures can vary based on educational level, years of experience, work environment and job location.
PMHNP Salary and Job Growth
A PMHNP’s salary may be lower than a psychiatrist’s due to the educational requirements and work environment. According to PayScale, the median annual PMHNP salary is $111,635 (2021). The BLS projects the employment of all nurse practitioners will grow by 52% between 2020 and 2030.
Note that all salary figures can vary based on educational level, years of experience, work environment and job location.
Help Confront the Mental Health Crisis
PMHNPs and psychiatrists are at the front lines of mental health care, collaborating to provide essential mental health services to patients. If you want to improve patient outcomes and bolster the health care system as a mental health professional, an advanced degree could be a good stepping stone along the way.
The University of North Dakota’s online Master of Science in Nursing program, which offers a Psychiatric-Mental Health Nurse Practitioner specialization, can teach students organizational systems and leadership, advanced nursing skills, and how to integrate knowledge from different subjects into nursing practice. Explore the curriculum and start pursuing your professional goals today.