Every week, more patients are reaching out for help, and too often, they still wait weeks or even months for an initial consultation. The U.S. is in the middle of a growing mental health crisis, but access to care hasn’t kept up.
Of the nearly 58 million adults living with a mental illness, only about 47% report receiving any treatment. While more providers are entering the field, including physician associates/assistants (PAs) and nurse practitioners (NPs), the psychiatric workforce can’t grow fast enough to meet demand.
As a PA who’s worked in psychiatry for over a decade, I’ve watched the demand for care consistently outpace our ability to provide it. But as more PAs and NPs specialize in mental and behavioral health, patients stand to benefit from a more collaborative and team-based model of care that these providers enable.
Addressing the Shortage
The number of practicing psychiatrists has steadily declined in recent years due to retirement, burnout, and a growing shift toward non-clinical roles. While COVID-19 amplified mental health challenges, it also brought those struggles to the surface. As more adults experienced anxiety, depression, and emotional distress, they began speaking more openly about mental health, which encouraged more people to seek help. Culturally, this was a step forward. But clinically, we weren’t prepared.
Even now, stigma is still a barrier for many patients, especially when access is limited. If a patient has to call multiple clinics or wait months just to get in the door, that delay alone can be enough to discourage follow-through. Reducing stigma must go hand-in-hand with expanding timely and reliable access to care.
Psychiatry is a slow-growing specialty. It takes over a decade to complete the education and training required to become a psychiatrist. Given the urgency in improving care accessibility, waiting years to rebuild the psychiatric workforce isn’t viable.
NPs and PAs are part of that solution. These clinicians can be trained and deployed more quickly, and when supported appropriately, they provide high-quality care. In fact, a recent study found that the quality of care delivered by NPs and PAs was generally comparable to that of physicians, especially in areas like medication management and treatment decision-making.
An Evolving Scope of Practice
In 2013, just over 630 PAs were practicing in psychiatry. By 2021, that number had more than tripled. Psychiatric NPs have followed a similar trajectory. Today, PAs and NPs routinely conduct initial evaluations, manage medications, provide follow-up care, and often serve as primary mental health providers, especially in rural or underserved areas where psychiatrists are scarce.
Still, these providers don’t enter the field with the same depth of training as psychiatrists, and that’s intentional. These roles are designed to expand over time. Our training prepares us to grow into them through hands-on experience, mentorship, and ongoing education.
While this model increases access, it also allows for care stratification. When PAs and NPs manage a broad range of psychiatric needs, psychiatrists can focus where their expertise is most critical: patients with high acuity, complex presentations, or those requiring specialized treatments like electroconvulsive therapy or intensive psychotherapy.
In doing so, we stop relying on a workforce model that asks too few providers to do too much. NPs and PAs extend reach and capacity. Psychiatrists bring deep specialization. When roles are aligned that way, we see better patient outcomes and a more sustainable system for providers.
Complementary Strengths and Shared Goals
NPs and PAs share many responsibilities in practice, but our training models are different. NPs are educated in the nursing model, which emphasizes holistic care, patient relationships, and social determinants of health. PAs are trained in the medical model, which focuses on diagnostics, disease pathology, and psychopharmacology.
In psychiatry, both perspectives are essential. Together, they support more well-rounded care, especially for patients with complex or overlapping needs. This breadth also allows us to integrate treatment approaches, combining medication management with brief psychotherapy, behavioral interventions, or lifestyle counseling when appropriate.
Just as important is the ability to provide that care when patients need it. Timely access can be the difference between stability and crisis. That kind of access is possible when psychiatrists, PAs, and NPs work together, each contributing their strengths to meet growing demand. A recent analysis of Veterans Affairs facilities illustrates this well, which found that when psychiatric teams include PAs, patient satisfaction improved and physician workload reduced.
Supporting Mental Health Providers
Still, PAs and NPs need the right support to make a lasting impact in the field and provide the highest quality care. Historically, most new graduates developed under the guidance of a physician mentor. But as the psychiatric workforce shrinks, those opportunities are harder to find.
As a result, we need new structures to support early-career clinicians, including stronger onboarding, formal fellowships, or peer-to-peer mentorship. The support must help new providers practice safely, build their skills, and stay in the field long-term.
Organizations like POCN, the American Association of Physician Associates, and others play an important role in this effort by offering continuing education, clinical resources, and peer connections specific to NPs and PAs. Some also offer apps where providers can access educational content, connect with peers, and stay updated on clinical best practices.
At a time when mental health care demand is outpacing supply, we can’t afford to overlook the PA and NP workforce. The goal is not to replace psychiatrists but to create collaborative teams that draw on the strengths of every clinician.
Psychiatrists need PAs and NPs to help manage workload and expand access. PAs and NPs need psychiatrists for mentorship, consultation, and oversight in complex cases. Together, we can deliver high-quality mental health care to more patients and build a system where no one falls through the cracks simply because help wasn’t available.
Michael Asbach, DMSc, PA-C, is Associate Director of Interventional Psychiatry at DENT Neurologic Institute.
