APNA Primary Care Statement
This statement addresses the reasons why psychiatric nursing is part of the primary care workforce. Psychiatric nurses provide essential expertise for meeting the health needs of persons with mental health needs across health settings. They provide integrated health services to persons with serious mental illness as well as to those who are not served in behavioral health settings.
The complex physical and mental health needs of persons with serious mental illness are well recognized. Two essential characteristics of services for this population should guide their care. First, because they meet the majority of their health care needs via specialty services, they often consider mental health programs as their primary point of access to all health care. The second essential characteristic guiding their care is their poor general health, and their critical needs for access to integrated care. What has not received adequate attention is the infrastructure that will be needed to build effective systems of integrated care. An important issue related to building this needed infrastructure is how primary care is defined which in turn impacts how the integrated care workforce is conceptualized. In 1994, the IOM published the findings of a study on the contemporary context of care and forwarded this definition of primary care: Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (Donaldson, Yordy, & Vanselow, 1994, p. 1). This definition recognized the need to integrate services and introduced the idea that primary care should address a large majority of personal health care needs. This broader definition of primary care is essential to the treatment of individuals with serious mental illness. The current conceptualization of primary care as point of first contact limits the primary care specialties to pediatrics, obstetrics-gynecology, general internal medicine, and family medicine. Using traditional definitions of primary care to organize funding streams and systems grants impedes the development of a work force that can effectively manage coexisting physical and mental disorders and the development of integrated care.
In addition to caring for persons with serious mental illness, psychiatric nurses can play an important role in providing integrated care in settings traditionally defined as providing primary care. Mental health and substance use disorders are among the most common disabling health problems worldwide and contribute to the presenting complaint in a high proportion of primary care visits. The majority of treated patients now receive some form of care for their mental disorder in a primary care setting, and primary care is currently the only form of health care used by over one-third of persons with a mental disorder who access the health care system. Given that the quality of primary care for mental disorders is rarely consistent with best practices, there is an urgent need for mental health providers to be routinely included as part of the primary care team.
Approved by the APNA Board of Directors February 23, 2013.
IOM. Defining Primary Care: An Interim Report. M. Donaldson, K. Yordy, and N. Vanselow, eds. Washington, D.C.: National Academy Press, 1994b.