Psychiatric Mental Health Nursing: Roles, Training and Pay

Psychiatric mental health nursing is the nursing specialty that assesses, diagnoses, cares for and treats people with mental health and substance use disorders, and works on prevention and education^[1]. The American Psychiatric Nurses Association (APNA) describes PMH nurses as the second-largest group of behavioral health professionals in the U.S.^[1]

The specialty covers the full range of psychiatric disorders, including co-occurring psychiatric and substance use disorders^[1]. How many people live with those conditions is tracked on the any mental illness page; this article covers the nurses who treat them.

PMH nursing is practiced at two levels^[1]:

• Psychiatric-mental health registered nurses (PMH-RNs) assess mental health, contribute to the diagnosis and plan of care, and deliver evidence-based interventions as members of interdisciplinary teams^[1].
• Psychiatric-mental health advanced practice registered nurses (PMH-APRNs) hold a master's or doctoral degree, national certification and additional state licensure, and practice as clinical nurse specialists (CNS) or nurse practitioners (NP), with titles that vary by state^[1].

Within either level, nurses focus on areas such as acute care, child and adolescent mental health, gerontological psychiatric care, forensics, substance use disorders, disaster care and military mental health^[1]. Under the APRN Consensus Model, every PMH-APRN is educated to treat patients across the full lifespan^[1].

PMH-RNs care for people with mental health problems, psychiatric disorders and co-occurring substance use disorders, working with individuals, families, groups and communities^[1]. Their work centers on helping patients gain or regain coping abilities and living skills, manage symptoms and prevent further disability^[1].

Most PMH-RNs work in hospitals. In the most recent national PMH nursing workforce survey, run from October 2020 to February 2021, 62.4% of PMH-RNs named a hospital as their primary employment setting^[2]. Hospital-based care is covered in our guides to the psychiatric ward and inpatient mental health treatment.

PMH-APRNs work mainly in outpatient care. In the same survey, 70.4% practiced in outpatient settings, and 44% said most of their patients had federal insurance^[2]. The survey drew 4,088 PMH-RN and 5,158 PMH-APRN responses at a combined response rate of 12.1%, so its figures describe respondents rather than a random sample^[2].

PMH-APRNs provide the full range of specialized psychiatric services^[1]. Their work overlaps with that of psychiatrists, psychologists and social workers: all four usually provide psychotherapy, but among them only PMH-APRNs and psychiatrists prescribe, and psychologists are the group trained in psychological testing^[1]. The wider lineup of professions is laid out in kinds of therapists.

Some PMH-APRNs specialize in consultation-liaison work for patients with complex physical and mental health needs, and others in collaborative roles alongside primary care providers^[1].

The path starts with a registered nurse license. BLS lists three education routes into RN practice: a bachelor's degree in nursing (BSN), an associate's degree in nursing (ADN) or a diploma from an approved program, followed by state licensure^[7].

RNs can then sit for ANCC's Psychiatric-Mental Health Nursing certification (PMH-BC). Eligibility requires the equivalent of 2 years of full-time RN practice, at least 2,000 hours of psychiatric-mental health clinical practice within the last 3 years, and 30 hours of PMH continuing education within the last 3 years^[8]. The exam has 150 questions (125 scored) in 3 hours, and the credential is renewed every 5 years^[8].

The nurse practitioner route adds graduate education. APRNs need at least a master's degree in their specialty role, an RN license, a passing score on a national certification exam and a state APRN license^[5].

For ANCC's PMHNP-BC, the degree can be a master's, post-graduate certificate or Doctor of Nursing Practice (DNP) from an accredited PMHNP (across the lifespan) program^[6]. The program must include at least 500 faculty-supervised clinical hours, separate graduate courses in advanced pathophysiology, advanced health assessment and advanced pharmacology, and clinical training in at least two psychotherapy modalities^[6]. The exam has 175 questions (150 scored) in 3.5 hours^[6].

PMHNPs tend to enter practice with more background than other nurse practitioners. An analysis of the 2022 National Sample Survey of Registered Nurses found PMHNPs more likely than family and pediatric NPs to be older, doctorally prepared and to have completed post-graduate education^[9].

The clearest national measure of the shift comes from Medicare. From 2011 to 2019, the number of PMHNPs treating Medicare beneficiaries grew 162%, while the number of psychiatrists doing so fell 6%^[3]. Over the same years, psychiatrist visits per 100 beneficiaries fell from 24.0 to 17.0, and PMHNP visits rose from 3.4 to 7.2^[3].

PMHNPs' share of all mental health prescriber visits rose from 12.5% to 29.8%^[3]. In rural counties with full scope-of-practice rules, PMHNP supply rose from 17.7 to 28.7 per 100,000 beneficiaries while psychiatrist supply fell from 36.1 to 22.4, and PMHNPs provided 50.8% of mental health office visits in rural full-scope areas in 2019^[3].

Federal projections point the same way. HRSA's 2025 workforce brief projects that in 2038, psychiatric nurse practitioner supply will meet 108% of demand if current use patterns hold, against 50% for adult psychiatrists and 61% for child and adolescent psychiatrists^[4].

That margin disappears under HRSA's other scenarios. If demand rises to cover unmet need, PMHNP adequacy falls to 98%, and if access also improves, it falls to 64%, a shortfall of 20,790 full-time equivalents^[4]. Shortages across other professions are covered in our analysis of the mental health workforce shortage.

Federal wage data for nurses are reported by occupation, not by specialty. The median annual wage for registered nurses was $97,550 in May 2025, and RN employment is projected to grow 6% from 2025 to 2035, with about 180,800 openings a year^[7].

For advanced practice, BLS reports a combined median of $134,920 in May 2025 for nurse anesthetists, nurse midwives and nurse practitioners, so the figure is not specific to nurse practitioners or to psychiatry^[5]. Nurse practitioner jobs numbered 336,300 in 2025 and are projected to reach 474,100 by 2035, a 41% increase^[5]. The three APRN occupations together are projected to have about 32,200 openings a year^[5].

The evidence on outcomes is thinner than the evidence on workforce growth. A 2023 systematic review of U.S. studies published since 2014 on nurse practitioner care for anxiety, depression and substance use disorders in primary care included 17 studies^[10]. Four high-quality studies found NP evidence-based care and prescribing comparable to physicians', and seven low-quality studies associated NP-led collaborative care with reduced symptoms^[10].

The reviewers concluded that more high-quality evidence is needed^[10]. The Medicare analysis compared practice patterns rather than patient outcomes, finding that psychiatrists and PMHNPs treated roughly comparable patient populations with similar services and prescriptions^[3].

PMH-APRNs, like psychiatrists, can practice independently, but state law governs their scope of practice^[1]. How these prescribers divide care in one common condition is covered in ADHD psychiatrist.

The PMH nursing workforce is aging. The authors of the 2020–2021 national survey concluded that nursing must plan for significant retirements in the PMH workforce within the next 5 years^[2].

Access is uneven by geography. In 2021, 69% of rural U.S. counties had no psychiatric mental health nurse practitioner, compared with 31% of urban counties^[4].

Psychiatric care settings also carry injury risk. In 2021–2022, psychiatric aides had 543.6 workplace-violence injury cases requiring days away from work, job restriction or transfer per 10,000 full-time workers^[11]. Healthcare practitioner and technical occupations, the group that includes registered nurses, recorded 14,040 such cases, with a median of 12 days away, restricted or transferred^[11].

Mental health data on clinicians themselves are on the healthcare workers page.