In recent years, the medical industry has seen seismic growth in the number of active nurse practitioners (NPs), surpassing 325,000 as of December 2020, according to the American Association of Nurse Practitioners. All of this comes as NPs take on a larger role within the healthcare system, especially during the pandemic and as new models of healthcare delivery are introduced.
Among the many capabilities of nurse practitioners, specifically psychiatric NPs, is ADHD diagnosis and treatment, also on the rise in recent years. The National Institute of Health estimates its prevalence at 11% in children and 8.1% in adults in the U.S.
Psychiatric nurse practitioners can evaluate, diagnose and treat children (if trained), as well as adults with ADHD and other mental conditions such as anxiety, depression and substance abuse. In many states, NPs work autonomously, without the supervision of a general practitioner and they can do the same things with their patients as a psychiatrist would. This includes conducting regular therapy appointments, ordering diagnostic testing, prescribing medication (where permitted) and monitoring treatment outcomes.
“There are more psychiatric nurse practitioners than there used to be,” said Dr. Breanna Jain, DNP, PMHNP-BC, CARN-AP and CEO of Eustasis Psychiatric & Addiction Health, a multi-state organization. “The nurse practitioner is the new mainstay in treating psychiatric conditions as more realize it’s well within our scope to meet the gap in mental health care.”
Dr. Jain also noted that the number of psychiatrists has decreased, as many fall within the Baby Boomer generation and are retiring, creating further demand. That vacated role now falls on nurse practitioners to meet patient demand.
“The number of nurse practitioners coming into the workforce, sooner than physicians, is allowing them to fill some of the gaps in healthcare, like with mental health, that need addressing a little more,” said Apryl Watson, FNP-BC of Greenville ADHD Specialists in Greenville, SC. “It’s great because multiple studies and analyses have been done to show their quality of care – the counseling and education that they provide is really important.”
This is especially true when supporting the patient demand for ADHD diagnosis and treatment, which reached a tipping point during the pandemic.
“We saw a huge uptick of patients who needed treatment for ADHD who maybe had been compensating with a highly structured workplace or school environment and now had to work or do school from home and just couldn’t do that,” said Dr. Jain. “Many people started reaching out during that time, as some had the chance to become more educated about what ADHD looks like and what the common struggles are when undiagnosed.”
“Part of that is, during the pandemic, awareness surrounding ADHD and what it is and what it means grew,” Watson added. “Even five years ago, people didn’t talk about ADHD as much as they do now.”
NPs and ADHD Diagnosis
Amidst this rising need for ADHD diagnoses, NPs are looking for innovative ways to cater to the modern healthcare industry and patient, including new forms of testing.
Technology such as QbTest from Qbtech utilize computer software to test both children and adults for signs of ADHD during the course of a 15 to 20-minute in-clinic test. For those who are looking for a remote solution with the rise of telehealth options, the company launched FDA-Cleared QbCheck to provide a reliable remote testing option, of which the need for was highlighted by the pandemic.
More and more, nurse practitioners are utilizing such technology as the first line of testing for patients – it’s a quick, validated solution that reduces the potential for over reliance on more subjective assessments, such as the Vanderbilt, which require observation of social interaction – something that’s not always an easy option during a pandemic.
One of the benefits, says Jain, is that patients are able to objectively see the results of their test and understand how they compare to someone their age/gender who does not have ADHD.
For NPs serving ADHD patients there are further challenges when it comes to efficient reimbursement, however.
“Dealing with all the insurance companies and their coverage can be a challenge,” admitted Dr. Jain. “Trying to explain to these companies the importance of treatment all the way down to getting the prescriptions approved and validating the reason why we need one over the other – it can be a disservice to the patient.”
Another benefit, according to Watson, is that for those patients who might be hesitant to test in-person (adults especially), telehealth testing options provide a more private solution.
“It has really opened a lot of doors for people who maybe wouldn’t have signed up to come in and test in-office,” said Watson. “There are all these thoughts going through that person’s mind like, ‘I’m going to this ADHD specialist and what if someone is there that I know?’ I’ve had numerous patients say that if we weren’t offering a virtual option, they would have never come in. But now, they’re thankful they sought diagnosis the way they did – that’s huge.”
The Future for NPs in Mental Health
Having NPs that can offer mental health services and testing is crucial to meet surging demand and ease the burden within the healthcare system. While some of the challenges they face, like insurance coverage, which is already improving, will take some time to overcome, we can already see that the NP’s role is critical in getting patients in the door, properly diagnosed and treated.