How PAs Are Meeting Mental Health Care Needs

The United States is in the midst of a mental health provider crisis. According to the US Health Resources and Services Administration (HRSA), the country faces substantial shortages of psychologists, licensed social workers, and psychiatrists — and more than half the population lives in a part of the country designated by the agency as a mental health professional shortage area.

With the number of mental diagnoses growing, especially in adolescents and young adults, the medical community must find creative and effective ways to increase access to care. Physician associates (PAs), said Jennifer M. Orozco-Kolb, DMSc, PA-C, interim executive director of the Physician Associate Foundation and chief medical officer, senior vice president of Clinical Affairs at the American Academy of Physician Associates, are in a strong position to do just that.

“There are almost 155 million people without access to mental health care in this country,” she said. “PAs are trained in mental health care…and we have the tools and resources to help improve access as well as enhance quality care so we can improve outcomes for patients.”

PAs are helping to close the mental health gap in various ways. Some PAs are working directly as mental health care providers, especially in rural areas, to help address conditions ranging from substance abuse to generalized anxiety disorders. Others help train those who are “boots on the ground,” most likely to interact with at-risk populations, including educators and community program leaders, helping expand mental health support opportunities.

Providing Direct Care

More and more PAs are specializing in psychiatric care, said Mirela Bruza-Augatis, PhD, MS, PA-C, a research scientist at the National Commission on Certification of Physician Assistants. A recent workforce analysis discovered a significant jump in the number of PAs working as mental health providers over the past decade.

“In 2012, we had about 630 PAs working in psychiatry. By 2023, that number was almost 3000 — which is a huge boost,” Bruza-Augatis told Medscape Medical News. “About half work in mental health shortage areas. And unlike MDs in this field, who tend to be White males, PAs in psychiatry are much more diverse. More than 70% are women, and we also see a broader distribution across races and ethnicities.”

Elisa Hock, PA-C, is a behavioral health provider for the Mental Health Authority in El Paso, Texas. She said the metropolitan area is home to almost 1 million people — yet, in 2021, there were only an estimated 67 mental health providers. That lack of access, she said, is “scary.”

“PAs can help with this. We are trained to do medication management and psychiatric evaluations. We can also be trained to do therapy,” she said. “We really are a lifeline for so many people who need mental health care in areas where there aren’t enough other types of providers.”

Jennifer Coombs, PhD, PA-C, a professor at The University of Utah in Salt Lake City, Utah, added that PAs can play a pivotal role in helping those living in rural areas get the care they need. She and her colleagues recently received a grant from the HRSA to provide primary care PAs with the specialized skills required to care for patients with mental health needs outside the city limits.

“It is so difficult to access even general healthcare when you live in a rural area,” she said. “PAs can fill the gap in these underserved areas to make sure patients are properly diagnosed and treated. This is so important because some of these patients may be in crisis, and there’s just no care for them. PAs can step in and make a real difference.”

Hock added that thanks to the generalist training PAs receive, they can also help ensure that patients’ other chronic medical conditions are appropriately managed. Because physical and mental health conditions often accompany one another, PAs can provide comprehensive care to support the whole person.

“[Mental health] is a great place for our versatility to be utilized,” Hock said. “As part of a psychiatric team, we can render integrative services, ranging from addiction medicine to headache medicine. We can help with a patient’s mental health condition, but we can also address diabetes or heart disease. All of that together is going to help the patient feel better.”

Training Additional Mental Health Support

Mental Health America estimates that the United States has only one mental health provider for every 350 people, so it’s essential that the medical community find innovative ways to support those living with mental health conditions, said Orozco-Kolb. To that end, the Physician Associate Foundation recently announced that they received a grant from The Cigna Group Foundation to support a new program, PArtnership to Improve Youth Mental Health.

The program relies on the expertise of PAs to equip youth-serving professionals with the tools and skills needed to better support youth mental health in their greater communities. By engaging teachers, school staff, and other community leaders, Orozco-Kolb said, local areas can better address the youth mental health crisis by working to prevent issues, detect potential mental health conditions early, and refer children and adolescents for care so they can be treated early.

“We may not be able to create more providers, but we can support unique approaches like this one to help young people who may be experiencing problems with their mental health,” she said.

The Physician Associate Foundation plans to further evolve and expand the program to intervene in the youth mental health crisis more effectively and continues to look at other ways PAs can help remove the various barriers that far too many people face when seeking care.

For her part, Hock said she hopes that more PAs will start working in mental health care, particularly in underserved areas.

“We need more PAs to join the fight,” she said. “We have the ability to make a real difference for patients by not only giving them the mental health services they need but optimizing their overall care. You can directly help people who would not otherwise have a voice and would likely not receive treatment. That’s a beautiful thing.”

Kayt Sukel is a healthcare and science writer based outside Houston.