Mental Health Crisis Meets Unnecessary Red Tape – It’s Time For Change

Millions of Americans struggle with depression, anxiety, and addiction, among other mental health issues. According to the National Institute of Mental Health, an estimated one in five adults lives with a mental illness, yet only half of them receive treatment. Children are also increasingly afflicted: The Centers for Disease Control reports that one in five children has unmet mental healthcare needs.

Yet, the country faces a staggering shortage of providers to address this crisis. Nearly half of Americans live in areas with a provider shortage, and two-thirds of those areas are rural.

One obvious way to improve access to care is to remove unnecessary barriers that keep patients from providers. That starts with recognizing that licensed nurse practitioners specializing in mental health are well-equipped to treat patients within their scope of practice. To expand access to these highly skilled nurse practitioners, state laws must allow them to practice independently, using their hard-earned education and experience.

According to a new report, 34 states and the District of Columbia authorize nurse practitioners to practice independently. In those states, they can evaluate patients; diagnose, order, and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances.

Unfortunately, laws in the other 16 states prohibit nurse practitioners from operating independently, even though they are highly qualified and trained. Instead, those states require nurse practitioners to contract with a physician, commonly known as a collaborative agreement. These agreements do little for the patients; after all, the “collaborating” physician is not required to supervise the treatment of patients or even be physically present to meet the patients.

Collaborative agreements impede access to much-needed patient care and stifle economic opportunity for nurse practitioners. And these are the providers who are most likely to work in rural and low-income settings. Nurse practitioners’ ability to treat patients hinges on finding a physician willing to enter into an agreement. But what happens when the physician is competing for the same patients?

Sometimes money talks: Nurse practitioners working in rural areas, where traditionally underserved patient populations face a severely reduced supply of providers, can pay between $6,000 and $50,000 annually in physician collaborative fees.

Even when nurse practitioners manage to secure a collaborative agreement, their practice and patients remain under threat of treatment interruption if a physician exits the agreement. More than one-third of nurse practitioners have experienced an interruption to their collaborative agreement. One nurse practitioner told of the sudden death of her dear friend and supervising physician, thus tragically and abruptly interrupting her ability to treat patients.

All of this adds up to a reduction in patient care. Because nurse practitioners are more likely to provide care to traditionally underserved communities, the most vulnerable patient populations are hit the hardest. During a time when this country faces not just a healthcare crisis, but a mental healthcare crisis, lawmakers should be expanding access to qualified providers, not restricting it.

To facilitate this expansion of patient access to care, we at Pacific Legal Foundation are challenging burdensome and unnecessary requirements that keep nurse practitioners from providing care to patients. For example, in California, we represent two psychiatric mental health nurse practitioners who wish to transition out of their collaborative practice agreement and operate independently. To do so, however, nursing board regulations require them to shut down their private practices and work for a hospital or clinic for three years, destroying their provider-patient relationships, interrupting their patients’ treatment, and undermining their patients’ access to care.

It is time for lawmakers and licensing boards to put patients first by trusting trained, capable professionals to do the jobs they are qualified to do. The mental health crisis is real, and some solutions are not hard.