Goal 1

cash rates, charity applications, payment plans, and freeclinic participation to broaden access.”

Cansler Health’s model works well, but more clinics and providers are needed in rural underserved communities nationwide.

“The mental health care needs and challenges of individuals in rural Kentucky are similar to those in other areas of our country,” Dr. Cansler said. “Lack of availability of and accessibility to high-quality mental healthcare, including medication management and psychotherapy services, is a complex and longstanding problem. Unbridled mental health disparities complicate every aspect of the delivery of healthcare. There is a critical shortage of trauma-informed and culturally competent care across the board. Most notable is a lack of racially and culturally diverse providers, dualdiagnosis providers, and LGBTQIA+ affirming providers.”

Frontier students working with sites like Cansler Health are not only learning how to utilize their clinical skills but also gaining valuable insight into the realities of healthcare shortages. It is an often eye-opening validation of the importance of their presence in their communities.

“Having students participate in clinical benefits the clients in many ways,” Dr. Cansler said. “They get to share their experiences with a big-picture perspective since the students do not know their history. It is encouraging for them to be able to see the progress they have made over time. I also explain to my clients that it is my responsibility to make sure there are well-trained providers to take care of my people after I’m gone, and I add that I appreciate their help in preparing the students. Very few clients refuse student participation when they learn that they play such an important role.”

Dr. Phillips, who also has her own practice and sometimes precepts students, pointed out that the student-preceptor relationship is mutually beneficial. “These students come out with the freshest, up-to-date information for you,” she said. “So it really helps to stimulate your practice. It makes you take a step back and do some critical thinking.”

“My practice has benefited greatly from having students, partly because four of my graduated students have joined my team,” Dr. Cansler added. “However, my favorite part about having students is knowing that the level of care I provide improves every single day because I have to actively consider every decision to ensure that I can rationalize it to my students. This unanticipated accountability demands that my care is evidence-based and client-centered. That benefits my clients, my students, my practice, my community, and me.”

After A Successful First Five Years, the PMHNP Program Continues to Grow

Five years ago, Frontier Nursing University began offering a psychiatric-mental health nurse practitioner (PMHNP) degree/ certificate option. As has been the case throughout FNU’s history, this decision was made in response to the healthcare needs of the country. The need for more mental health providers is significant and ever-increasing.

According to the Health Resources and Services Administration (HRSA), 160 million Americans live in one of the nation’s 6,063 mental health professional shortage areas. HRSA estimates that the U.S. needs an additional 8,024 mental health providers to fill these shortage gaps.* Approximately two-thirds of the shortage areas are in rural or partially rural parts of the country.

Severe mental illness, defined by the National Institute of Mental Health (NIMH), is a mental illness that interferes with a person’s life and ability to function. According to NIMH^, in 2021, 14.1 million American adults (5.5%) had SMI. Of those adults with SMI, 9.1 million (65.4%) received mental health treatment in 2021.

The COVID-19 pandemic brought to light and exacerbated mental health issues for many. A 2022 study by the World Health Organization (WHO) found that there was a significant increase in mental health** problems in the general population in the first year of the pandemic and that the risk of severe illness and death from COVID-19 was higher among people living with mental disorders.

“According to multiple national surveys and national data on the availability of mental health services, we remain a country experiencing a mental health crisis,” said Dr. Jess Calohan, DNP, PMHNP-BC, FAAN, FNU Department Chair for the Department of Psychiatric-Mental Health Nursing. “There are multiple barriers to care that prevent access to mental health services. These barriers include provider shortages, national and state regulations/policies that place limitations on the delivery of mental health care, insurance companies that place limitations on reimbursement for mental health care, lack of synchronous leadership amongst professional organizations in advocating for improving the availability and delivery of mental health care and finally, the continued limitations on Psychiatric-Mental Health Nurse Practitioner scope of practice in 23 states.”

In many states, PMHNPs are not allowed to practice independently and must be supervised by a physician. This creates an additional hurdle to access to mental health care.

“The issue is accessibility to mental health services,” Dr. Calohan said. “Very few healthcare organizations are structured in a way to ensure access to behavioral health care. Integration of behavioral health services into the primary care setting is limited, which has been shown to improve access to care and improve health outcomes. Care coordination is another major issue. When patients are referred by primary care providers for behavioral health services, they often have little support in finding care, which means many referrals go unanswered.”

The increased use of telehealth has provided greater access to care for some, but many still struggle to find accessible and culturally concordant care. These are the types of gaps that FNU’s curriculum, combined with its commitments to rural and underserved populations and diversity, equity, and inclusion, are designed to address.

“The biggest gaps in mental health care remain in rural and underserved populations,” Dr. Calohan said. “LGBTQIA+ people and people of color have significant issues accessing competent mental healthcare. There is also a lack of social support service infrastructure to assist underserved populations, which creates burdens on the existing healthcare systems and, unfortunately, justice systems in these communities.”

FNU’s PMHNP graduates represent a growing part of the solution to this national problem. As of January 2023, just five years after the launch of the PMHNP program, FNU has graduated 733 PMHNPs from 49 states. Additional data demonstrate the geographic and ethnic diversity of these graduates:

PMHNP Alumni Data (733 Graduates from 49 States)

• Graduates of Color: 190 (26%)

• Graduates Living in Rural Areas: 161 (22%)

• Graduates from Western States: 220 (30%)

• Graduates from Kentucky: 73 (10%)

“We have seen tremendous growth in the PMHNP program in the last five years, nearly quadrupling our enrollment from 2018 to 2022,” Dr. Calohan said. “In early 2019, we began revising the curriculum in response to current trends in mental health care and evaluation of our board certification pass rates. With the curriculum revision, we increased our overall board pass rates from 81% to 93%, which is currently 7% above the national average, and our students score on average about 10% points above the national average on each of the three domains on the exam. Our MSN graduates achieved a first-time pass rate of 96% in 2022, which ranks FNU in the top 3% of schools nationwide.”

The overwhelming response to the program and the success of its students, coupled with the growing national need for mental health providers, has led FNU to begin developing a program of study that will allow a post-graduate certificate student to earn a DNP while also in the PMHNP curriculum. “We are in the early stages of beginning to explore a postmaster’s DNP with a psychiatric focus for current NPs who want to earn a DNP and get additional training and clinical expertise,” Dr. Calohan said. Dr. Calohan hopes to submit the accreditation application by the end of 2023 in order to start the new offering in 2024.

Frontier’s PMHNP program is preparing its students to address urgent mental health care needs in their communities. The impact of the PMHNP program promises to grow exponentially over the next five years and beyond.

* https://data.hrsa.gov/topics/health-workforce/shortage-areas

^ https://www.nimh.nih.gov/health/statistics/mental-illness

** https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_BriefMental_health-2022.1