The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) will greatly increase the demand for mental health (MH) services, as 62.5 million Americans from relatively high-need populations will be newly eligible for MH benefits. Consequently, the supply of MH care provider services is expected to proportionately decrease by 18% to 21% in 2014. ACA funding does not demonstrate the ability to increase turnout of psychiatrists sufficiently to meet the need. Available data indicate that the numbers of advanced practice psychiatric nurses (APPNs) continue to increase at a much greater rate, but information from either a clinical perspective or a market perspective is complicated by the weak distinctions that are made between nurse practitioners (NPs) and other nonphysician care professionals. The following recommendations are made: (a) some of the ACA funding for research into efficient and effective care delivery systems should be allocated to acquiring data on APPNs in leadership roles or clinical settings in which they are ultimately responsible for management of MH care, as differentiated from settings in which they provide support for psychiatrists; and (b) since the available data indicate nurse practitioners achieve good outcomes and are more economically viable than psychiatrists, placement of psychiatric-mental health nurse practitioners in community settings should be recognized as a realistic solution to the shortfall of MH services.

[1]  M. Lambert,et al.  Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency , 2013, Current opinion in psychiatry.

[2]  Genevieve M. Kenney,et al.  Health status, risk factors, and medical conditions among persons enrolled in Medicaid vs uninsured low-income adults potentially eligible for Medicaid under the Affordable Care Act. , 2013, JAMA.

[3]  B. Druss,et al.  Addressing public stigma and disparities among persons with mental illness: the role of federal policy. , 2013, American journal of public health.

[4]  S. Glied,et al.  Affordable Care Act Will Expand Mental Health and Substance Use Disorder Benefits and Parity Protections for 62 Million Americans , 2013 .

[5]  P. Ubel,et al.  What's it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses. , 2012, Psychiatric services.

[6]  Jessica R. Jones,et al.  Mental Health Conditions Among School-Aged Children: Geographic and Sociodemographic Patterns in Prevalence and Treatment , 2012, Journal of developmental and behavioral pediatrics : JDBP.

[7]  K. Kelleher,et al.  National surveys of child mental health: a measure of children's services or service vagaries? , 2012, Journal of developmental and behavioral pediatrics : JDBP.

[8]  Denise V. D’Angelo,et al.  Mental illness surveillance among adults in the United States. , 2011, MMWR supplements.

[9]  D. Cherry,et al.  Nurse practitioners, certified nurse midwives, and physician assistants in physician offices. , 2011, NCHS data brief.

[10]  T. McGuinness,et al.  Advanced Practice Psychiatric Nurses Legislative Update: State of the States, 2010 , 2011, Journal of the American Psychiatric Nurses Association.

[11]  K. Delaney,et al.  Health Care Reform and the Federal Transformation Initiatives: Capitalizing on the Potential of Advanced Practice Psychiatric Nurses , 2010, Policy, politics & nursing practice.

[12]  Erika C. Ziller,et al.  Access to rural mental health services: service use and out-of-pocket costs. , 2010, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[13]  T. Selden,et al.  Mental Health and Family Out-of-Pocket Expenditure Burdens , 2010, Medical care research and review : MCRR.

[14]  C. Reynolds,et al.  DEPRESSION STIGMA, RACE, AND TREATMENT SEEKING BEHAVIOR AND ATTITUDES. , 2010, Journal of community psychology.

[15]  C. Reynolds,et al.  Mental health treatment seeking among older adults with depression: the impact of stigma and race. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[16]  Alan R. Ellis,et al.  County-level estimates of mental health professional shortage in the United States. , 2009, Psychiatric services.

[17]  A. Peden,et al.  Clinical Outcomes of Depressed Clients: A Review of Current Literature , 2009, Issues in mental health nursing.

[18]  P. Jensen,et al.  Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management , 2007, Pediatrics.

[19]  Alex J Sutton,et al.  Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. , 2006, Archives of internal medicine.

[20]  M. Goolsby.  2004 AANP National Nurse Practitioner Sample Survey, Part II: Nurse Practitioner Prescribing , 2005, Journal of the American Academy of Nurse Practitioners.

[21]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[22]  P. Newacheck,et al.  The National Survey of Children's Health: A New Data Resource , 2004, Maternal and Child Health Journal.

[23]  L. Leslie,et al.  Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. , 2004, Pediatrics.

[24]  B. Bordeaux,et al.  Outcomes and Satisfaction of Patients of Psychiatric Clinical Nurse Specialists , 2001 .

[25]  G. Byck,et al.  A Comparison of the Socioeconomic and Health Status Characteristics of Uninsured, State Children's Health Insurance Program-Eligible Children in the United States With Those of Other Groups of Insured Children: Implications for Policy , 2000, Pediatrics.

[26]  J. Baradell.  Clinical outcomes and satisfaction of patients of clinical nurse specialists in psychiatric-mental health nursing. , 1995, Archives of psychiatric nursing.