Mental health in America requires a collaborative solution


Getting mental health right for all Americans is a huge undertaking. For the last 150 years, our “solutions” to mental illness can, at best, be characterized as a series of good intentions that were poorly, if not disastrously, implemented. But while there may be a conversation that needs to happen about how we got here, what’s important right now is how we go about shoring up a system that is on the verge of collapse.

This year, one in five adults in the United States will suffer from a diagnosable mental disorder. Some will be mild, some severe and some chronic, and more than 68 percent of these patients will also suffer from some form of simultaneous physical ailment. Antiquated legislation, impractical insurance coverage practices, and an increasing patient population have created one of the most severe provider shortages of any medical specialty. It is becoming harder than ever for some of our nation’s most vulnerable populations to access critical, often life-saving, comprehensive mental health care.

There is a consensus across the medical community that this crisis requires fast, effective and sustainable solutions. Health care providers from around the nation have begun to rally together to help identify specific problems and how to fix them. The American Psychiatric Association recently invited us to their annual IPS medical conference to speak on a panel discussing an important, viable and ongoing plan to increase access to quality mental health care. The panel was entitled, Psychiatrists and PAs Collaborating to Expand Access, and highlighted the huge impact PAs in psychiatry could have on our nationwide access-to-care problem.

Like other illnesses, mental illnesses range from common and easily treatable conditions to much more rare and complex disorders. In the instances where the mental health diagnosis is straightforward, a primary care physician or PA can provide quality mental health care. In those instances where the mental health condition is more complex, the psychiatrist or psychiatric PA may be the best option. In either case, America needs more primary care and mental health clinicians. As providers trained in the medical model, PAs possess the skills, education, and necessary training to diagnose and treat the vast majority of people in need of health care. They work in collaboration with other clinicians to ensure the best possible outcomes for their patients. This constant link to the rest of the medical community provides PAs a unique ability to move patients effectively and efficiently through different levels of care across specialties and through the complex health care system.

As PAs, we are nationally certified and state licensed medical providers fully qualified to deliver the complete spectrum of mental health care, including psychiatric evaluations and assessments, ordering and interpreting diagnostic tests, establishing and managing treatment plans and prescribing medications. We are trained alongside physicians in the medical model and receive a broad medical education that includes coursework in subjects including pharmacology, physical diagnosis, behavioral sciences and medical ethics. Every PA student must also participate in more than 2,000 hours of formal clinical training in all of the basic disciplines of medicine, including internal medicine, family medicine, emergency medicine, surgery, pediatrics, women’s health, and psychiatry.

One of the key strengths of PAs is their versatility and ability to navigate diverse situations. The intensive education PAs receive in medicine allows them to expertly provide a continuum of care by designing, coordinating and overseeing a care plan based on the patient’s individual needs. Some PAs specialize in psychiatry and are able to handle significantly more complex mental health cases on their own. What makes PAs unique among providers is that each PA collaborates directly with a physician, and like a primary care physician referring a cancer patient to an oncologist, PAs are trained to recognize when a patient needs a more intensive form of care and to guide them to the right specialty provider.

Most importantly, PAs are a realistic and readily available solution to safely and successfully increase access to quality health care. Today there are approximately 104,000 certified PAs working in every medical specialty and practice setting and the profession is projected to grow by 38 percent between 2012 and 2022. And to meet the still growing demand for PAs, there are currently 200 accredited PA programs, with an additional 66 programs expected to launch by 2019.

Right now, millions of Americans are suffering from treatable mental illnesses and lack access to even the most basic mental health care. A staggering 77 percent of counties in the U.S. report a “severe shortage” of available mental health services. These treatable illnesses destroy families, hurt loved ones and cause both physical and emotional pain.

While there are no easy fixes, when PAs are allowed to practice to the full extent of our medical training and with full recognition by the insurance system, we can dramatically increase access to the kind of quality care that is so desperately needed today. With our ability to work autonomously in most areas, PAs stand ready to provide a unique and incredibly powerful combination of quality, affordable and accessible mental health care for millions of Americans, many of whom are the most vulnerable. Like our health care system at large, the mental health crisis gripping our nation requires a multipronged approach if we want to fix it, and as PAs, we are poised to be a significant part of that solution.

Jeffrey A. Katz is president and chair of the board, American Academy of Physician Assistants.  James Cannon is a hospitalist physician assistant.


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