Nurse's Guide to Caring for Patients With Mental Health Challenges

Mental health care is a large and often unmet need in the United States. Fewer than half of adults with mental health challenges get the care they need, and for children the gap is wider: only about one in five with a mental health condition receives sufficient care. Access is one of the biggest disparities in health, hitting rural and lower-income patients hardest, and disproportionately affecting communities of color.

Mental health nursing can be rewarding, but it is also demanding. This guide covers how to provide better care for patients with mental health challenges.

Health Disparities for Patients With Mental Health Challenges

• Nationally, 29.7% of patients with a cognitive disability could not see a mental health provider because of cost, and the rate varies widely by state: 18.5% in Rhode Island versus 40.7% in Texas.
• African Americans were the least likely of any racial group to receive mental health care, with only 45% reporting access to treatment.
• African Americans are less likely than white patients to receive culturally competent care. Physicians are 33% more likely to use patient-centered communication with white patients than with African Americans.
• Biracial adults report mental health conditions at the highest rate of any group: 24.9%, compared with 22.7% of American Indian and Alaska Native adults, 19% of white adults, and 16.8% of African American adults.
• Among transgender adults, 48% reported considering suicide, compared with 4% of all adults.

Barriers to Care

Several barriers stand between patients and mental health care:

• Too few providers and poor access, especially in rural and low-income communities
• Trouble finding in-network providers
• High cost, especially for the uninsured or those with high deductibles or copays
• Stigma, the perception that mental health problems reflect personal or moral weakness
• Cultural beliefs that depression or anxiety isn't real, or that those who experience it are weak
• Distrust of the medical establishment, especially among African Americans
• A lack of public education about mental health conditions and treatment
• Difficulty finding culturally competent care or care in one's own language

Many of these barriers feed each other. People without access are more likely to face financial hardship, which further limits access, and those who hold stigmatizing beliefs are less likely to seek out education that might change them.

Best Practices for Caring for These Patients

You can address many of these barriers by educating yourself, your patients, and your community, and by advocating for better access.

1. Build your cultural competence. Improve through formal education, mentoring, and independent study. Use resources from your hospital or public library, online and in-person courses, and conferences.

2. Keep learning. Most states require continuing education to maintain a license, which keeps you current on best practices and new developments in care.

3. Educate your patients. Many people carry misconceptions, like the idea that depression is just feeling down or that cognitive decline is a normal part of aging. Correct those and help patients find appropriate care.

4. Consider becoming a mental health nurse. The field is in demand, with strong programs for registered nurses and psychiatric nurse practitioners. If you carry student loans, working in underserved areas may make you eligible for loan forgiveness.

5. Advocate for funding and access. Nurses and nursing associations carry weight in policy. Write to legislators and newspaper editors, and push your organization's leadership on funding and access.

6. Protect your own mental health. This work is demanding. Take care of yourself so you can keep taking care of others.

Mental Health Resources for Nurses

• Mental Health America promotes awareness and access through advocacy, research, and education, with condition information, self-screening tools, current advocacy efforts, an annual conference, and online education.
• CDC Support for Public Health Workers and Health Professionals shares guidance on mental wellness and stress management for providers, including material on compassion fatigue, burnout, and workplace mental health.
• National Alliance on Mental Illness provides support, education, a national hotline, and referrals to pro bono care for frontline providers, plus personal stories, support groups, infographics, and public-service videos.
• American Psychiatric Nurses Association (APNA) offers an online community, continuing education, an annual conference, and publications for psychiatric nurses, and advocates for both mental health care and the profession. Membership covers national and local chapters and is open to nurses at all levels.
• National Association of Psychiatric Mental Health Nurse Practitioners is open to NPs and students, with continuing education, school discounts, conference discounts, and scholarship and grant opportunities. It advocates for access to care and for psychiatric NPs.
• Healthy Nurse, Healthy Nation, part of the American Nurses Foundation, supports nurses' health, including mental well-being, with relaxation and mindfulness resources.