Arkansas is currently ranked 39th in the nation based on prevalence of mental illness and access to care for children and adults by Mental Health America. When you break it down by age groups, Arkansas ranks 48th in the nation for children and adolescents, said Crissy Allen-Doyle, DNP, APRN, a Psychiatric Mental Health Nurse Practitioner (PMHNP) with the Department of Psychiatry at the University of Arkansas for Medical Sciences, who treats psychiatric patients in Arkansas Children’s Hospital’s emergency room. 


According to Mental Health America, there are about 460,000 adults in Arkansas with a diagnosable mental, behavioral or emotional disorder with only about half of those reported as receiving treatment. Mental Health America also reports there are also about 33,000 children and adolescents who have experienced severe depressive symptoms alone. 


“Only about 7,000 of those children and adolescents reported receiving some form of consistent treatment, and this doesn’t even account for the myriad of other mental health disorders that also need treatment,” Allen-Doyle said. “Research published in Mental Health Clinician indicates only about half of the pediatric population is diagnosed with depression before adulthood, which increases the risk of this untreated disorder still being present as an adult.”


Patients in need of mental health services can often be faced with barriers such long appointment wait times or a lack of mental health providers nearby. The County Health Rankings and Roadmaps recently estimated there is only one mental health provider for every 400 residents of Arkansas. This also includes mental health providers who do not provide medication management for psychiatric disorders, and according to  Allen-Doyle, this data does not reflect the true need for mental health providers who can offer those specialized services. 


“PMHNPs are trained to provide psychiatric medication management, therefore playing a vital role in closing the gaps for this service throughout Arkansas,” Allen-Doyle said. “There are various types of graduate nursing programs in mental health that may include online, traditional in-person or hybrid plans of study. We are fortunate to have a rigorous but exceptional program at UAMS. UAMS PMHNP graduates are advanced practice registered nurses educated at the masters or doctoral level with expertise in the care of mental illness across the lifespan.”


In addition to the core curriculum at UAMS, PMHNPs are required to complete curriculum specific to the specialty and complete practicum hours in tandem with a specialist in the psychiatric field. Masters level students complete three practicum courses, totaling 540 hours and doctoral students complete four practicum courses, totaling 1,080 hours. After successful completion of the program, the nurse must pass the national PMHNP certification exam through the American Nurses Credentialing Center.


“We are trained to care for pediatric, adult and geriatric patients,” Allen-Doyle said. “Psychiatric Mental Health Nurse Practitioners can work in any setting such as outpatient clinics, hospitals, emergency departments, psychiatric private practice, school systems, prisons and so many others. We perform comprehensive psychiatric evaluations to diagnose and formulate plans of care for diagnoses in the DSM-5, such as depressive disorders, bipolar disorders, anxiety disorders, trauma and stress related disorders, obsessive compulsive disorder, schizophrenia and psychotic disorders, neurocognitive disorders, personality disorders, sleep disorders and substance abuse. This also includes disorders related to pediatric patients such as oppositional defiant disorder, disruptive mood dysregulation disorder, attention-deficit hyperactivity disorder, conduct disorders and eating disorders.”


PMHNPs provide assessment and evaluation of the patient to rule out any medical or substance induced causes of symptoms using interventions such as ordering labs, identifying risk factors and analyzing medical and mental health history. Allen-Doyle said they can prescribe necessary psychiatric medications, order pertinent lab work prior to beginning treatment and during treatment to monitor therapeutic benefit, explain the test results to patients and families and provide patient education regarding medications, risks, benefits and reasonable outcome expectations. 


“At each encounter, we evaluate a patient’s physical symptoms and health to determine the potential for underlying medical conditions and possible side effects of medications and collaborate with primary medical providers to address medical needs,” she said. “When needed, we perform crisis intervention, de-escalation, risk assessment for suicide and self-harm and formulate treatment plans to address the patient’s needs. The PMHNP is trained to perform psychotherapy, but often works in collaboration with psychologists, licensed social workers, licensed professional counselors and marriage and family therapists who provide these specialized services. Patient and family education is also a very important component of the PMHNP role.” 


Primary care providers are also vital. 


“Our goal as mental health providers is to collaborate with primary providers to improve the overall well-being and quality of life of the patient,” she said. “For example, patients with chronic medical conditions have an increased risk of developing a mental health disorder. Likewise, untreated mental health disorders can impede the patient’s ability to effectively manage a chronic medical condition. This correlation is not just isolated in adults; it is also seen in pediatric and adolescent patients. For example, adolescents with diabetes have a higher risk of developing a mental health condition, with the most common being depressive disorders. Research has shown adolescents with diabetes who experience depressive symptoms are less likely to adhere to recommended treatment, experience longer episodes of depression and have a higher rate of suicidal ideation.” 


PMNHPs can solely focus on the overall mental health of the patient during each encounter. “This allows us to monitor the patient closely and assess for improvement or worsening of symptoms of the disorder or disorders, efficacy of psychiatric medications, potential adverse effects of medications and provide education,” Allen-Doyle said. “We are also able to build relationships with patients and families and partner with them to create plans of care specific for their mental health.”