APNA Position: Psychiatric-Mental Health Advanced Practice Nurses

The burgeoning mental health needs of the population demand access to highly qualified providers who are educated, certified, and licensed to provide the full range of psychiatric services (assessment, diagnosis, prescription of medication for mental health disorders, psychotherapy, etc.). Psychiatric-Mental Health Advanced Practice Nurses (PMH-APRNs) include both the Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP). Both are prepared at the graduate level in research, systems, and direct patient care to provide psychiatric evaluations, order and interpret diagnostic tests, develop treatment plans and work collaboratively with individuals to manage that plan.  They provide a range of interventions, including individual, family, and group therapy, psychopharmacological treatment, as well as primary, secondary, and tertiary levels of prevention across the lifespan. PMH-APRNs are a vital part of the workforce required to meet the increasing population’s mental health needs.

In 2008, owing to a new national model that organized how APRNs were certified and licensed, PMH-CNS programs transitioned to PMH-NP lifespan training (Drew, 2014). PMH-CNSs continue to practice and recertify with the American Nurses Credentialing Center based on practice hours.

The position of the American Psychiatric Nurses Association is, “whether practicing under the title of PMH-CNS or PMH-NP, Psychiatric-Mental Health Advanced Practice Registered Nurses share the same core competencies of clinical and professional practice” (ANA, APNA, ISPN, 2022, p.19).

Both PMH-CNSs and PMH-NPs are educationally prepared to “fulfill three key roles in a variety of clinical settings: provision of psychotherapy, provision of psychopharmacological interventions, and provision of clinical supervision” (p.19). They are “accountable for their own practice and are prepared to provide services independent of other disciplines in the full range of delivery settings” (p.21).

As of 2023, CNSs can practice independently in more than 30 states (NCSBN, 2023) and can bill for services in states where they are licensed to practice as APRNs (CMS, March 2022). PMH-NPs have full practice authority in 33 states and the District of Columbia (NCSBN, 2023), allowing nurse practitioners (NPs) to practice independently — meaning they can diagnose, treat, and prescribe medications without physician supervision. The remaining states allow PMH-NPs to practice contingent on a written collaborative agreement, the specifics of which vary by state. Medicare continues to reimburse ANCC-certified PMH-CNSs and PMH-NPs for CPT codes related to psychotherapeutic evaluation and treatment. Medicaid reimbursement for PMH APRNs varies by state.

PMH-CNSs and PMH-NPs are both advanced practice registered nurses (APRNs) who possess the same core competencies in practice (Rice, Moller, et al, 2007). They are both prepared to provide psychotherapy, psychopharmacological interventions, and clinical supervision across diverse healthcare settings. Recognizing these shared competencies and scope supports better workforce utilization, which ultimately improves access to the care needed to meet a growing demand for the full range of mental health services.

Adopted by APNA Board of Directors October 2010; Reviewed February 2020; Revised June 2022; Revised June 2025

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References

American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2022). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (3rd Ed.). Silver Spring, MD. ANA.

Center for Medicaid and Medicare Services (2024). MLN booklet, Medicare & Mental Health Coverage.https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf

Centers for Medicaid and Medicare Services (2022). MLN Booklet: Advanced Practice Registered Nurses, Anesthesiologist Assistants, & Physicians Assistants. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf

Drew, B. L. (2014). The evolution of the role of the psychiatric mental health advanced practice registered nurse in the United States. Archives of Psychiatric Nursing, 28(5), 298-300.

National Council of State Boards of Nursing (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. https://www.ncsbn.org/nursing-regulation/practice/aprn.page

National Council of State Boards of Nursing (2023). CNP independent practice map. https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cnp-independent-practice-map.page

National Council of State Board of Nursing (2023). CNS independent practice map. https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus-implementation-status/cns-independent-practice-map.page

Rice, M. J., Moller, M. D., DePascale, C., & Skinner, L. (2007). APNA and ANCC collaboration: achieving consensus on future credentialing for advanced practice psychiatric and mental health nursing. Journal of the American Psychiatric Nurses Association, 13(3), 153-159.