The Integration of Mental Health Competencies Into a Primary Care Nurse Practitioner Curriculum
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Primary care clinicians must be prepared to assess, treat, and refer patients for appropriate services for mental health care. Studies have shown that the majority of prescriptions for antidepressant and anxiety medication are written in primary care offices. More than 50% of adult patients with depression are diagnosed and managed by primary care providers (Scandis and Watt, 2013). Less than 60 percent of adults with significant mental illness receive treatment in the United States (NSDUH, 2013).
Mental health services need to be better integrated into primary care given the shortage of mental health providers in many areas.
There is a great need to address these problems and try and get patients connected to therapeutic services in primary care. One study found that the average wait time for a first time visit with a psychiatrist in the United States is 25 days, although many communities report much longer rates (Mozes, 2014). Providing mental health care in primary care settings improves access to care, improves clinical outcomes and saves money (Insel, 2008). With these facts in mind we undertook a curriculum revision to add content on the treatment and management of common mental health and behavioral issues to our primary care Nurse Practitioner (NP) tracks in our online DNP program.
Many primary care NP programs have not traditionally included a strong focus on behavioral health issues. However, recognizing the need we undertook a comprehensive revision of our content and clinical courses. After soliciting input from community practitioners on important content we revised the curriculum to address the importance of mental health awareness and treatment throughout the primary care tracks: Family NPs (FNPs) and Adult Gerontology Primary Care NPs (AGPCNPs). A required three-credit course entitled Assessment and Diagnosis of Psychiatric and Mental Health Disorders course was created and added to the curriculum to address this need. This course reviews mental health disorders using DSM5, reviews diagnostic and screening tools, familial patterns, community, and socio-cultural contributions to the diagnostic process. In addition mental health topics were integrated into core DNP courses in Family Systems, Pharmacology, Pathophysiology, Health Policy and Ethics as well as case studies in all the clinical courses. We have also incorporated content regarding evidence based complimentary and integrative treatment into the curriculum via webinars and workshops.
Our Primary Care NP students rated this course highly and were surveyed to see how much of this mental content they felt they learned in their program of study. Multiple student reflections in clinical logs and surveys support the integration of behavioral health into the student clinical education and experiences. Faculty and preceptors concur on the need to better educate students on the assessment and treatment of mental health issues in primary care settings.
Given the realities that much of mental health care is being provided in primary care settings, it is clear that primary care NPs must be competent to address these types of issues. We have seamlessly integrated mental health content and competencies throughout our curriculum. The required course has emphasized the importance of this content for primary care clinicians who will be encountering patients with mental health problems such as substance abuse, depression, anxiety, and dementia in primary care. Integrating mental health concepts throughout the curriculum has also emphasized the skills needed to treat patients and families in crisis, mental health assessment and diagnosis.