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Bridging the Gap, How PAs Serve Mental Health Patients


Certified PAs are stepping in to provide much needed mental health services in communities hard hit by psychiatrist shortages.

States across the country are dealing with the shortage of psychiatrists and the impact it has on caring for patients with mental illness. In my home state where "everything is bigger in Texas," it's certainly a problem. With 200 of the state's 254 counties lacking enough psychiatrists, Texas stands out as one of the most severely affected states.

To help solve the problem, certified physician assistants (PA-Cs) are being tapped to fulfill an important role in caring for mentally ill patients.

As a certified PA working with psychiatrists, I enable additional patients to be seen, diagnosed, and managed. I see patients as young as 5 years old and as old as 100 years old for a range of mental disorders including ADHD, depression, anxiety, bipolar disorder, and schizophrenia. Most referrals come from primary care, neurology, or infectious disease specialists, and many of my patients also have chronic conditions such as obesity, diabetes, or AIDS.

Currently, 1.3 percent of the nation's 108,500 certified PAs practice in the field of psychiatry, and we are well prepared to step up and specialize in this growing field. PAs are educated at the master's degree level to practice in medical and surgical specialties. Plus, all PAs are certified by passing a national exam, and we maintain certification through substantive continuing medical education and passing rigorous exams at regular intervals throughout our career.

Certified PAs provide mental healthcare by:

1. Performing initial psychiatric evaluations.

I see new patients, usually referrals, formulate a diagnosis, and develop a treatment plan. It can be challenging, as some patients are forthcoming and eager for treatment, while others omit information they are uncomfortable sharing.

2. Educating patients about mental illness.

I usually begin with a family history, trying to understand how that may influence current dynamics and the patient's and family's perception of the illness. We discuss the journey ahead, and I connect them with community resources. Unfortunately, we have a high suicide rate in this area, so I often refer them to counselors on suicide prevention. Educating the families on what they can expect and how to support the patient is also part of my mandate.

3. Managing patient medications.

Of course, many of these patients are on long-term medications. I want to treat each patient with the same high standards and compassion I would treat a family member, so I try not to prescribe medication unless it is absolutely warranted. For example, I try not to automatically prescribe ADHD medication without considering early interventions first, such as cognitive behavioral therapy or behavior modification therapy. However, when I do prescribe medication for any mental illness, I explain the importance of compliance and also monitor the patient's prognosis. I review labs to make sure they are not elevated, monitor thyroid and liver function, and manage patient treatment plans.

4. Teaching a healthy lifestyle.

I talk to my patients at length about lifestyle and modifications they can make to feel better both mentally and physically. This may include a discussion about moderation and substance abuse, including abstaining from smoking and alcohol. This is particularly important if they are abusing a controlled substance, for which we regularly do drug screens and refer to support groups. I discuss stress management as well as the importance of exercise, and encourage them to start a simple routine like walking or joining an exercise group. Patients tell me this does make them feel better.

5. Collaborating with other providers.

Many PAs choose this profession because we like working on a team. Daily, I collaborate with physicians in many specialties. For example, I consult with a rheumatologist if the patient is asking for early refills of pain medication for arthritis or fibromyalgia. I have a great deal of crossover communication with primary-care physicians. Together we stabilize and improve patient health.

Certified PAs can make a big difference to any practice, particularly in the area of mental health - where there is a significant and growing need.

Kristi Kincheloe, PA-C,has been a PA for four years and took a job in psychiatry immediately after graduating from Texas Tech Health Center with a master's degree in Physician Assistant Studies. Before becoming a PA, she was a school psychologist for 10 years. She is employed by the Shannon Clinic in San Angelo, Texas.

This blog was written in partnership with the National Commission on Certification of Physician Assistants.

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