Promoting integrated mental health care through an accelerated online post-graduate PMHNP program

Mental disorders make up 14% of the global burden of disease, yet over 25% of adults and children with mental health needs have difficulty accessing mental health services. The state of Maryland has 49 designated mental health care professional shortage areas (HPSAs), located primarily in the more rural regions of the state. It is very difficult to entice mental health professionals from the larger metropolitan areas to move to these rural outposts. Local primary care providers, often nurse practitioners, provide much of the mental health care. Although primary care nurse practitioners have generally not had diagnosis and management courses specific to mental health care, it is difficult to leave homes and family to travel long distances to obtain additional training. In support of an effort to improve access to mental health care education, the state Higher Education Commission funded the development of a new accelerated online post-graduate PMHNP program for primary care nurse practitioners. The program was designed to encourage nurse practitioners to continue to live and work in their own communities while learning the knowledge and skills to practice in integrated care environments with dual primary care and psychiatric mental health competencies (NONPF, 2013) and credentials. The curriculum includes one fully online didactic semester and two precepted clinical semesters. The core psychiatric courses: differential diagnosis, neurobiology, psychopharmacology, and brief psychotherapy are taught simultaneously in a streamlined and synchronous fashion, with modules focused on one diagnostic category per weekly module. Interaction and discussion are fostered through group problem-based case reviews and  Voicethread discussions of current practice issues. A competency based approach to clinical learning and evaluation allows student-centered clinical assignments during one child/family-focused and one adult/gero-focused clincal semester. With a small student body of 10-15 students per year, faculty are able to provide one-on-one bi-weekly telephone consultation, alternating with student online case presentations and discussions. Generous donations of lecture content by psychiatric clinicians with subspecialty expertise are a benefit of being co-located in a large academic and research institution and hospital center. Mid-term evaluations by students from the first semester were overwhelmingly positive, however we will await post-completion certification pass rates and practice locations to evaluate the overall feasibility and outcomes of accelerated distance PMHNP education.