Psychiatric-Mental Health Nursing: Data-Driven Policy Platform for a Psychiatric Mental Health Care Workforce

Disparate Treatment

Current estimates indicate 89.3 million Americans live in mental health professional shortage areas (Health Resources and Services Administration [HRSA], 2015). More than 77% of all U.S. counties report a shortage of any type of mental health worker and 96% of all counties have an unmet need for mental health prescribers (Thomas, Ellis, Konrad, Holzer, & Morrissey, 2009). This national need is exacerbated by the disproportionate impact on racial, cultural, and ethnic minorities who have higher levels of unmet mental health needs (Leong & Kalibatseva, 2011). Even with targeted efforts to address care disparities, between 2004 and 2012 there were no reductions for African Americans and Hispanics experienced an increase in unmet needs (Cook, Trinh, Li, Hou, & Progovac, 2017).

Inadequate Care Models

Inadequate mental health treatment is often compounded by undetected comorbid medical conditions. Sixty-eight percent of those suffering with mental health disorders have at least one medical condition, with mental health conditions being the second most frequently co-occurring illness in Medicare populations (Centers for Medicare & Medicaid Services [CMS], 2014). Evidence suggests a link between inflammatory cytokines, psychiatric illnesses, and undetected medical conditions that increases the risk of poor outcomes (Santos & Pyter, 2018). While one would anticipate mental health conditions are routinely identified during visits for physical illnesses, reports show the current system of care models do not address mental health care issues. Ironically, the reverse is also true for the percentage of undetected medical conditions among those suffering from mental illnesses (Cranwell, Polacsek, & McCann, 2016).

The American Psychiatric Nurses Association argues screening for mental health and substance abuse disorders should be included in an integrated care model (American Psychiatric Nurses Association—Board of Directors, 2017). Evidence from integrated behavioral health care models do demonstrate effective outcomes and cost containment at several levels. Integrated mental health care in primary care settings are projected to save between $26 and $48 billion annually (Melek, Norris, & Pailus, 2014). This matches the Substance Abuse and Mental Health Services Administration’s (SAMHSA) fiscal projections through 2020, which move costs away from specialty providers to nonspecialty mental health providers. SAMHSA models also decrease mental health care spending from 2009 to 2020 by 2%, through continued reduction of psychiatric hospital beds (SAMHSA, 2014).

Workforce

While health care costs can be decreased using integrated behavioral health care models, the need for psychiatric-mental health providers across the nation, such as psychiatrists, is expected to grow 6% by 2025 (HRSA, 2016). At the same time, there is an expected 69% increase in the need for mental health services due to a rapidly growing and aging population (HRSA, 2016). This need generates a psychiatric workforce shortage during a period of increasing need for services (Rice, 2018).

The 2010 Institute of Medicine (IOM) Future of Nursing report served as a starting point for many nursing workforce initiatives (IOM, 2010). However, the follow-up reanalysis (IOM, 2016), continues to encourage more effective use of nurses to meet evolving health care needs. There are also strong recommendations that the nursing workforce place a greater emphasis on generating a more diverse nursing workforce, particularly in the areas of gender and race/ethnicity, in order to match population parameters (IOM, 2010). The underlying assumption is that a more representative mental health workforce will attract talent, promote participation, and lead to attention in high need areas (Sherbin & Rashid, 2017).

While both IOM reports note a need for more effective use of nurses, it is unclear exactly how much impact changes in the nursing workforce would have on psychiatric-mental health care. The IOM reports suggest that nurses will be able to address some of the workforce issues supported by federal regulatory changes. The Affordable Care Act currently prohibits insurers from discriminating against various types of health care providers acting within their state regulated scope of practice (CMS, 2014). The CMS regulations also support requiring nurse practitioners to use their full scope of practice for both inpatient and outpatient services (CMS, 2014). However, much of the data on the distribution and outcomes of the nursing workforce, even the advanced practice workforce, is fragmented, has not been collected, or is simply not available (Rice, 2018).

The absence of this workforce data complicates the ability to identify changes in regulations needed to have a substantive impact on psychiatric-mental health care. One of the most visible limitations to psychiatric mental health nursing are variations in legal and regulatory barriers between states (Phoenix, 2018). While a total of 49 states permit advanced practice registered nurses some level of prescribing authority, only 22 states allow full independent practice, 15 states limit practice, and 13 states severely restrict scope of practice (American Academy of Nurse Practitioners, 2016). Within states with a restricted scope of practice, “Supervision” is mandated by written agreements that are variably enforced, if enforced at all (IOM, 2010).

Variation in state regulations are also partially based on variations across advanced practice psychiatric nursing training programs. While educational programs generally follow a set of accreditation guidelines, enough variation exists between programs to hamper interstate licensing. The differences in educational outcomes are exacerbated by the rapid expansion of new programs offering psychiatric nurse practitioner education (Delaney, Drew, & Rushton, 2018). Delaney et al. (2018) report 33 programs expanded to offer psychiatric nurse practitioner programs, perplexingly, in the face of declining numbers of qualified faculty (Kaplan, Klein, Skillman, & Andrilla, 2016).

Data-Driven Policy Platform

The critical issues on psychiatric mental health nursing’s role in addressing national mental health care needs cannot be answered with a general consensus of opinion and beliefs. The paucity of data is widespread across the workforce, educational outcomes, patient care outcomes, and policy positions. The current status of the profession substantiates a need for the development of a comprehensive database on the impact of the psychiatric mental health nursing workforce on health care. The foundation of this database must address the treatment effect size of relationships between patients and providers on health outcomes. Recent studies indicate that a failure to engage in relationships, individually and on a community basis, is the major factor limiting health and wellness (Iyer, Pancake, Dandino, & Wells, 2015).

One of the major limitations to generating the database is the use of multiple terms and variables for the same phenomena. This makes findings from any set of studies useless when addressing care needs. For example, the Agency for Health Research Quality recently completed a systematic review of strategies and programs to reduce patient aggression. The report examined data from 29 primary studies; 11 were controlled trials with 4 of these trials occurring in the United States (Gaynes et al., 2017). The results were limited by a lack of comparability and common variables, even across well-designed studies (Gaynes et al., 2017). The development of a common database of variables and terms shared by all psychiatric-mental health nurses would provide a platform for defining comparable outcomes. If the databases are also developed using shared industry business terms, outcomes can also be compared across studies and used in large-scale cost analytic studies. At a minimum, research studies and practice settings should use common terms to report cost, cost-effectiveness, and treatment outcomes.

Restructuring Workforce

Bottlenecks in developing a psychiatric-mental health workforce begin with addressing the stigma against psychiatric-mental health care in undergraduate nursing programs (Delaney et al., 2018). These bottlenecks begin with the stigma against psychiatric-mental health care in undergraduate nursing programs and the associated absence of mental health care content and clinical competencies (Delaney et al., 2018). Analysis in commonalities and differences in baccalaureate course work suggests that career models benefit from the use of foundational courses (Giddens & Meyer, 2016). This approach suggests developing foundational content applied across educational levels and systems (Table 1). The foundation course should contain tiered competencies that progress as the level of education progresses. The content should also be mandatory similar to the standards for cardio pulmonary resuscitation (Kane et al., 2012). The minimum skills should include the following:

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Table 1.

Educational Data-Driven Policy Solutions.

Educational pipeline problems	Policy-directed solution
• Stigma in all undergraduate educational programs (Delaney, 2018) • Lack of focus on whole health in the face of need (McLoughlan, 2018) • Absence of integrated behavioral skills and competencies • Provide continuing education—Remediation education	• Educate all on impact of mental health on holistic health • Address whole health as a psychiatric mental health (PMH) based data relationship criteria for program accreditation • Require transferable content to a BSN degree as the standard for professional practice (Krugman & Goode, 2018) • Mandate data driven psychiatric nursing competencies across programs (CNA, LVN/LPN, AD, etc.) • Reexamine Undergraduate essentials by Kane et al. (2012) and Alaska Core Competencies, including: • Family dynamics and communication strategies integrated across the lifespan (postpartum to dementia) • Integrated self\community safety assessment • Suicide, homicide, firearms, substance abuse • Aggression prevention\interventions including partner violence • Emergency\trauma centered communications • Relationship data collection and data driven care: Expanding role through quality improvement and research. • Role of technology in delivering relationship based care. • Community engagement on mental health across all educational levels. • Basic political processes, economics\liability and positioning for the role.
• Business models focus on institutions including political essentials	• Level and mandate core content on the business of health care from patient to population variables and terms
• Absence of faculty trained in PMH care • Curriculum exposure is limited due to shortage of qualified faculty • Undergraduate content and competencies in curriculum is not grounded in demonstrated performance • Graduate faculty shortage—Acute in Western U.S. (AACN 2013) • Opportunities for faculty roles is vertical no horizontal moves	• Eliminate separate PMH silos of multiple educational levels, disciplines and professions • Cross list courses to faculty from undergrad to grad with content leveling • Break silo accreditation of professional specialties and cross list courses with family therapy, social work, psychology • Establish horizontal faculty development roles with cross cutting DNP/PhD program involvement • Incorporate practice relationship data development • Cross teach integrated care and cross cover clinical • Alter the apprenticeship model allowing cross professional mentorship within defined limits • Design leveled career advancement and job security—i.e., “Practice Professors” • Rolling block 5 year reviews all levels: Education, practice, and research • Salary structure becomes competitive with marketplace • Adjust colleges and universities reimbursement based on practice marketplace salaries
• Graduate educational structure	• Radically modify the apprentice model for clinical training • Work on academic clinical partnership models and federal/state appropriations that could be used for Nurse Training Act • Integrate faculty into PhD/DNP programs and supervision work load • Policies should not allow DNP content to be removed from specialty role functions • Work with AACN/NONPF to define mandatory PMH integration • Streamline educational process (IOM, 2010) and refine data driven relationship care • National analysis of program quality and products based on data! • Use NONPF/NTF to remove barriers, redefine roles, and percent of faculty required for accredited programs • Identify cost-benefit ratios and track economic benefits of models • Expand allowable clinical supervisors—Interprofessional with group supervision models • Accreditation criteria that all programs must focus on whole health data driven relationships across the lifespan • Must demonstrate distinct content demonstrating interprofessional relationships and technology • Psychiatric nursing outcomes must be demonstrated and documents to obtain accreditation • Content measured empirically established relationship performance (clinical and simulation—Minimum hours)
• Lack of research connected to translational and implementation outcomes	• Integrate pathways with Implementation science and discovery relationship pathways with psychiatric mental health focused PhD projects • Focus psychiatric mental health DNP programs to specialty needs and define the expected outcomes • Expand PhD/DNP program focus to include common language and common relationship data algorithms. • Outcomes must be demonstrated (data based) relationship performance in measurement of content • Clinical performance relationship (clinical & simulation—Minimum hours—NLN modules) • Student exemplars and community engagement

Note. AACN = American Association of Colleges of Nursing; NONPF = National Organization of Nurse Practitioner Faculties; NTF = National Task Force on Quality Nurse Practitioner Education; PMH = psychiatric mental health.

Facilitating tiered content for psychiatric mental health nursing must be accompanied by structural changes in the current educational system (Table 1). The first stage is opening the pipeline for those interested in psychiatric mental health nursing using a career ladder educational framework (Rice, 2018). The career ladder model provides a pathway for promotion and recruitment of nursing assistants, licensed vocational nurses, associate degree nurses, and bachelor-degree nurses currently working in psychiatric mental health care settings. The inability to engage these individuals in the field is an oversight which narrows the workforce pipeline and hampers psychiatric mental health nursing education, practice and research. Use of the career ladder should be accompanied by educational structural changes including the following:

Special note must be made that the lack of adequately prepared psychiatric mental health nursing faculty hampers all levels of undergraduate and graduate programs (American Association of Colleges of Nursing, 2015). In terms of advanced practice nurses and PhDs, currently only 3.8% of the total nursing population are psychiatric oriented (American Academy of Nurse Practitioners, 2016). The total number of PhD prepared psychiatric mental health nurses is debatable but limit the specialty’s contribution to the science of psychiatric mental health care (Rice & Cunningham, 2014). The use of a career ladder for interested professionals opens the pipeline and will increase the available students for all levels of educational preparation.

Inherent in this discussion is the educational program accreditation standards and the performance competencies required of the students. For example, there is increasing discussion about whether to retain psychotherapy as a performance competency in nurse practitioner curriculums (McCoy, 2018; Wheeler, 2014). The current evidence shows that nurse practitioners are more likely than other professionals to use psychotherapy interventions with the most vulnerable populations (Cohen-Mansfield, Jensen, Resnick, & Norris, 2012) and even masters prepared practitioners can use the intervention effectively (Fields, Schutte-Rodin, Perlis, & Myers, 2013). Yet, variation in graduates’ preparation for psychotherapy fuels scope of practice debates across state boards of nursing (McCoy, 2018).

Practice

At the practice level, psychiatric mental health nurse practitioners must participate in addressing the lack of clinical training sites, contributing to building an outcomes database and help construct post graduate residency programs. The first step is changing the focus of clinical training sites. Continuing to focus on inpatient settings as the preferred training site places all professional training in competition with medical residency programs, medical students, and other professions. Psychiatric mental health nursing must seriously consider the alternative model of academic–clinical partnerships, which depend heavily on the advanced practice nurses (Table 2). These academic–clinical partnerships can be encouraged by calculating the agency’s cost savings through elimination of costs for recruitment, the reduced costs of orientation, reduced costs of human resources for onboarding, and the increased billing from new hires requiring minimal orientation. This move would be also consistent with the financial move away from psychiatric hospitals toward integrated care settings.

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Table 2.

Practice Data-Driven Policy Solutions.

Practice problems	Policy directed solution
• Role elements	• Become full partner with responsibility for identifying psychiatric mental health nursing problems (IOM, 2010, 2016) • Eliminate infighting among subtypes of related educational credentialing and focus on  • Generating common relationship data elements contributing to a national database  • Utilization, costs, and outcomes based on relationships  • Participate in defining a model of academic partnerships, contracts and malpractice arrangements  • Define nonhospital-based mechanisms for “launching” new practitioners  • Design a databased model for tracking lives served, care delivered and cost effectiveness • Become local expert on a specialty sub focus to share with community • Advocate for national psychiatric mental health nursing APRN movement through NCSBN compacts • Establish Models for psychiatric mental health nursing focused DNP’s on data collection on  • Relationship based outcome reports  • Relationship based clinical practice standards  • Development of a common language to guide studies and reports  • Models for PhD and DNP collaborative studies
• Operations and structure	• Develop viable models with PhD studies on relationships, discovery, and treatment implementation projects • Provide no care without efforts directed toward using common data elements such as: relationships, cost, cost effectiveness and length of stay, using common data terms, that is, per member per month • Develop a model for mandatory cost ratio of underserved populations in every practice • Expand into integrated interprofessional care practices (nonprescribing therapists\primary care as targets) • Cover some aspect of child\elder care relationship • Provide no care without community involvement of practitioners on advisory boards • Provide ongoing community education • Participate in efforts to integrate DNP and PhD projects into the practice • Commit to engaging in eliminating barriers to practice and the impact on access to care
• Inadequate workforce numbers	• Expand the supportive staff workforce—Use interprofessional models that are outside the box • Formal alliances with peer services, community-based service workers, such as shelters, respites, homeless outreach, and first responders • Devise new models! That is, nurse tech and clinical scholars that cover some aspect of indirect care in the front office • Reengaging public health, school nursing, health educators, emergency room nurses in psychiatric mental health care, and referral services • Develop models of community engaged spotters • Community case management by registered nurse specialists as frontline psychiatric mental health staff

Note. APRN = advanced practice registered; NCSBN = National Council of State Boards of Nursing.

Psychiatric mental health nurse practitioners must participate in the development and growth of the workforce and outcomes databases. No single group of psychiatric mental health nurses has a better grasp of the success of treatments, treatment limitations, and cost effectiveness. Core data elements on the treatment models must be built through collaboration with DNP- and PHD-oriented projects. Only through practitioner input will the common data elements be accurately defined. This requires use of the databases in tracking that data during patient visits. The outcome provides a stable common database that can be tapped for DNP and PhD projects and larger databased studies.

Advanced practice nurses must also join in the discussion about the form and value of accredited post graduate nursing residency programs, particularly when merged with DNP programs. Advanced practice residency programs offered by schools of medicine and public health organizations do not advance psychiatric nursing, but the disciplines offering those programs. This type of post graduate residency programs also run the risk of adding more levels, more credentialing and more confusion about psychiatric mental health practice roles. Nurse residency programs for baccalaureate, masters and DNP graduates must also be legitimized by building nursing accreditation standards in order to advance psychiatric mental health nursing and not another discipline.

Graduate Database Projects

One of the largest unanswered questions posed by the IOM (2010, 2016) reports is, “Will the nurse researchers respond?” The question must now be expanded to include the question, “Will the DNP nurses respond?” Both are the most highly educated nurses within the specialty and have the preparation and skills to define and generate the proposed workforce databases. It is worth noting that this is not consistent with the mission of either form of doctoral education. PhD prepared nurses focus on the science of discovery while DNP prepared nurses focus on advancing practice. The element missing from both levels of preparation is the development of the specialty. This suggests that the content and focus of both forms of doctoral preparation must be changed to include a commitment to the specialty’s professional development.

At the most fundamental level, DNP and PhD programs must include educational outcomes on discovering care metrics and assuring practice quality for patient health (Table 3). Collaborating with all psychiatric mental health nurses on defining and building the database are not distractions, but open doors for new discovery and methods of examining care. This also opens practice sites to collaborations between PhD and DNP projects that would only further the opportunities for discovery and improving care delivery. Only through collaboration with all psychiatric mental health settings, will it be possible to identify common data elements that have the greatest impact on health.

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Table 3.

Research Data-Driven Policy Solutions.

Research structure	Solution
• Current structure not producing the results needed	• Design and comparatively test new models other than pure apprenticeship • Expand use of nontraditional funding from any source • Redesign for “Common Data Driven” outcome focus • Define common core relationship data algorithms for  • Development of a common shared “big data” elements for relationships, discovery, relationship care outcomes and treatment models  • Connect workforce to care outcomes  • Establish models for examining relationship to cost effectiveness  • Examine AANP, AACN, ANCC, NCSBN-NPDB, and DHHS for developing a data based on malpractice related to background conditions and outcomes • Legitimize research on  • Workforce  • Educational innovations • Focus on development of expanded funding from  • All divisions of the National Institutes of Health  • All divisions of the Department of Health and Human Services including Medicare and Medicaid Private Foundations- Focused care initiatives.
• Functions and focus	• Screening, new relationship affect models and interventions (IOM, 2010, 2016) • Aggression—Define common terms and expected outcomes (see Gaynes et al., 2017) • Design new models for relationship on prevention and recovery in genomic, biobehavioral, environmental and mental health data sets • Add workforce elements to all studies • Define relationships between workforce, markets, and relationship care efficacy • Focus on developing “big data” on relationship databases and integration with government, medically underserved databased and national provider identifier systems

Note. AACN = American Association of Colleges of Nursing; AANP = American Academy of Nurse Practitioners; ANCC = American Nurses Credentialing Center; NCSBN = National Council of State Boards of Nursing; NPDB = National Practitioner Data Bank; DHHS = Department of Health and Human Services.

A final cautionary note must be made about the utility of the common data elements to psychiatric mental health nursing and the national health care debate. The common data elements currently used by psychiatric mental health nursing do not contain business elements used to publicly validate the value of the profession. The common databases must reflect elements of the financial industry supporting the “business and social value” of relationships to mental health care. This includes using terms few nurses are familiar with, such as per month per member, nonqualified treatment limitations (identified as NQTLs), lives served, units of care, and intervention cost effectiveness. The effort to address these elements must include contexts and relationships outside the paradigm of the hospital-clinic box, in order to collect data on care delivered in services with peers, community service workers in shelters, law enforcement, police, emergency medical technicians, and firemen. These are the lost data points of psychiatric mental health nurses’ roles limiting the role’s social value.

Political Action

On a policy front, the psychiatric mental health nursing must look at using the common language relationship database in all communications to ensure accurate representation of the psychiatric mental health care workforce (Table 4). Policy needs may initially require psychiatric mental health nursing to develop its own workforce database to share with government agencies and organizations. The collection and use of the data must be consistently used as a reference point to direct workforce development efforts on education, practice, research, and policy.

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Table 4.

Data-Driven Policy Solutions.

Policy issues	Solutions
• Policy does not address workforce	• Redefine Title VIII appropriations that could be used for to shape the workforce similar to the nursing training act of 1964 • Redirecting Medicare for educational costs of training, which is 6% of total Medicare direct graduate medical education payments (Akin, Cheung, & Olds, 2009) • Use the rational that nurses in graduate programs provide significant clinical care to Medicare beneficiaries in hospitals and other settings (Akin et al., 2009). • Advocate for models expanding relationships with academic clinical partners • Shift recruitment and orientation costs to educational institutions instead of training agencies as a rational for engagement • Address policy affecting pipeline bottlenecks:  • Address workforce remediation and training pipeline  • Establish educational competencies • Work on policy for defining postgraduate program competencies • Advocate for funding to establish relationship knowledge generation • Address regulatory actions that would enhance access through new models, such as interprofessional expansion—peers, public health, and population-based community initiatives
• Nursing leadership is not unified	• Work on incorporating nursing leadership to lead curriculum change • Lead establishing the common language database for all psychiatric mental health care • Lead establishing the funding and support for an integrated national database defining the impact of relationships on care outcomes • Lead establishing the standards for faculty teaching undergraduate and graduate programs at all levels • Lead in improving work processes on the front lines to craft practice policy • Support creating relationship based integrated practice models • Redefine relationships on organizational policy allowing more flexibility in roles and faculty definition • Develop relationships with state legislators on a range of topics, not just PMH but access • Translate and apply relationship-based research findings at all levels
• Front line assistance in policy	• Define key concept—relationships with the social system, that is, opiate use • Expand definition of relationships to political activity and range of political supports offered • Define remedial education programs for the 3.1 million RNs mandating CPR type requirements • Implement and support education on varying role relationships to policy, structure and operations • Expand nurse assignment to on boarding to state/national committees • Organizational empowerment and acknowledgement of RN’s (IOM, 2010, 2016). • Enhance and support nominations to HRSA, SAMHSA, NIH, NIMH, CMS, and state-level committees. • Establish a national accessible PMH workforce database that tracks outcomes as a quality indicator
• Not speaking political business language	• Talk of lives touched, per month per member costs savings over 1 to 5 years • Talk workforce and impact of numbers, that is, voters • Relationships quality and cost implications • Speak of health equity and relationship outcomes • Emphasize public business trust\safety through relationship performance measures • Highlight economic value through data-based functions mentioned in Table 3 • Note how workload affects relationship to care • Translate all care data into psychiatric mental health nursing policy.
• Begin on local level	• Join groups at state government (health care policy and finance) deciding local functions including  • ACOs  • Exchanges  • Reimbursement panels  • State behavioral health committees  • Identify political groups that respond to tragedy, that is, suicide initiatives • Define models for response to politicians levels of support

Note. HRSA = Health Resources & Services Administration; SAMHSA = Substance Abuse and Mental Health Services Administration; NIH = National Institutes of Health; NIMH = National Institute of Mental Health; CMS = Centers for Medicare & Medicaid Services; RNs = registered nurses; PMH = psychiatric mental health.

Policy leaders must also become more proactive to ensure psychiatric mental health nursing is identifiable and visible. This includes proactively advocating for nurses of all levels of preparation to participate on local, state, and national committees. The IOM (2010, 2016) recommends proactively identifying participant’s roles as mediators, collaborators, and followers. These levels of involvement must include crafting practice policy, creating integrated practice models, working on organizational policy, working with state legislators, leading curriculum change, and translating and applying research findings (IOM, 2010). Psychiatric mental health nurses must engage in state committees and discussions with state agencies to demonstrate psychiatric mental health care is interested and involved. Policy strategies must strategically target organizations and agencies with pivotal roles in the decision-making process. To obtain key positions, psychiatric mental health nurses must support all levels of nominations to governmental positions in HRSA, SAMHSA, National Institutes of Health, National Institute of Mental Health, and CMS. While some of the roles may only be as a participating member, their presence at the table provides evidence that psychiatric mental health nurses are involved!

Policy leaders must also push for the advancement of the psychiatric mental health nursing workforce with professional and accrediting organizations (Table 4). These efforts must include work with the American Association of Colleges of Nursing, National Organization of Nurse Practitioner Faculties, and relevant specialty professional organizations to define performance competencies and integration into general health care. This sets the cornerstone for accreditation criteria focusing on the whole health of individuals across the lifespan beginning with identification and detection of mental illness during childhood.

Summary

Psychiatric mental health nursing faces many challenges in developing a workforce to address current and future mental health challenges. From education through practice, and research to policy, the specialty must build a data-driven, relationship-to-care platform emphasizing how psychiatric mental health relationships affect health outcomes. The use of this data-based platform should engage the public and define the impact on health. The evolving public opinion would anchor psychiatric mental health care as an integral part of all health care. The support of public opinion would eventually lead to eliminating barriers through modification of scope of practice regulations. Psychiatric mental health nursing must also interact with the various nursing organizations to modify the attitude toward mental health care using the common language database. This strategy must be developed because even the best evidence-based strategies fail to solve mental health care problems when no provider is available to provide that care.