The health care system currently faces many challenges, including a physician shortage around the country and right here in Ohio. Looking at practitioners available to provide patients with mental health services, the picture becomes even bleaker. As the second oldest group of physicians, the 49,000 psychiatrists practicing in the U.S. are aging and less than four percent of graduating medical students choose psychiatry. These staggering statistics, coupled with the fact that psychiatric illnesses are the number one health problem,[i] prove that something needs to be done to help patients.
However, current Ohio laws limit many practitioners, including Advanced Practice Registered Nurses (APRNs), from helping address some of these issues. As a psychiatric Nurse Practitioner (NP) in Findlay, OH, I have firsthand experience on how Ohio’s laws limit my ability to help patients.
Under current Ohio law, I cannot practice without a collaborating physician. This means that I need a legal, written agreement with a physician, and without one, I cannot practice. I am one of only two psychiatric NPs in all of Findlay. Additionally, I am the only NP certified to treat the mental health needs of children and adolescents. There are psychiatrists in the area who can treat children 14 years and older, but I am qualified to see children as young as four years old.
I lost one collaborator when one of the psychiatrists in my practice switched jobs. A few months ago, I found out my current collaborator was leaving. Thankfully, I was able to find another psychiatrist at a sister practice in Fremont. However, if that collaborating agreement were to end, it would be a struggle to find another collaborating psychiatrist, leaving more than 500 patients without mental health services. The closest psychiatric health care option would be in Toledo or Columbus, a significant drive for my patients, especially parents who would most likely need to miss work and pull their child out of school to seek care.
It scares me to think of what could happen for patients if we continue down the current path. One in four adults are affected by a mental health disorder, yet two-thirds don’t seek help from a health care practitioner.[ii] One in five children ages 13-18 have or will have a serious mental illness, and the average delay from when symptoms appear to seeking care is 8-10 years.[iii]
In Ohio, there is a solution – House Bill 216. The bill would allow APRNs to practice to the full extent of their education, training and certification without a legally mandated collaboration agreement with a physician. We would continue to professionally collaborate with our medical colleagues and could serve our patients with fewer barriers to care. We are liable for our own actions. It would not increase risk to patients, but would ensure NPs like myself could continue to practice without having to worry about what would happen if our collaborating agreement was in jeopardy. I encourage you to learn more by visiting www.oaapn.org/?page=LegisStatus or https://vimeo.com/128204064.
Tiffany Pottkotter, PMHNP-BC, PCC, MSN, is a board certified psychiatric nurse practitioner at Promedica Physicians Behavioral Health. Tiffany completed her post-Masters in Psychiatry degree at The Ohio State University. She also has a Master’s degree in nursing and mental health counseling, and has been certified as a Professional Clinical Counselor for 10 years, and as an RN for five years. Tiffany has 15 years of experience in the mental health field including teaching psychology courses at several universities, serving as a clinical instructor for psychiatric nursing students, and managing a group home for the severely mentally ill for seven years.
[i] Journal News. “Ohio has ‘critical’ shortage of psychiatric hospital beds. March 1, 2015. http://www.journal-news.com/news/news/ohio-has-critical-shortage-of-psychiatric-hospital/nkKLW
[ii] World Health Organization. Mental health disorders affect one in four people. http://www.who.int/whr/2001/media_centre/press_release/en/
[iii] National Alliance on Mental Illness. Mental Health Facts: Children & Teens. https://www.nami.org/getattachment/Learn-More/Mental-Health-by-the-Numbers/childrenmhfacts.pdf