Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study

In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal-distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low-income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development.

Keywords: primary care nurse practitioner, nurse practitioner curriculum, family nurse practitioner, primary care mental health

3. The Need for a Primary Care Based Mental Health Service

The recent (2013) Health Assessment Resource Centre report on more than 350,000 residents from the Coachella Valley affirmed that one quarter (25.3%) of the residents reported a disorder of mental health []; additionally, an unfavorable, upward trend was noted given that 18% reported a mental health disorder in 2010. The most common mental health disorders in descending order were depressive disorder, generalized anxiety disorder and phobias, with phobias reported significantly more frequently (4.7%) than the 2010 sample (1.8%). Suicidal ideation remained consistent with previous years with a prevalence of 2.5%. Despite 78% of the Coachella Valley population reporting that they knew where to seek appropriate mental health treatment, only 25.3% of those in need reported actually seeking treatment [].

When the Coachella Valley population was stratified by ethnicity, Hispanics/Latino adults were significantly less likely to have been treated with medication (83% not treated) for a mental health disorder in the past year than their white counterparts (53% not treated). The research does not comment on whether medication was in fact appropriate or desirable but it does suggest a possibility of inequitable access to specialist mental health services along racial/socio-economic lines. This data is in accordance with research conducted by Cook et al. (2014) in the USA, where nearly 7000 mental disorder episodes were analyzed, which showed that Latinos and Black participants were less likely to initiate and receive adequate mental health care []. Interestingly, Latinos had a significantly greater number of primary healthcare visits compared to other ethnic groups which means that access to quality mental health care in the primary care context is essential for this population [].

It was noted that there was a disparity between mental health insurance coverage for Hispanic adults (28%) as opposed to white (58%) participants []. This finding was likewise reflected in literature []. Similarly, lower income brackets were significantly less likely to have mental health insurance coverage than those in the higher income brackets, with over 70% of those earning less than $25,000 USD/annum reporting no mental health insurance. This represents over 103,700 people with no coverage [].