How collaborative practice agreements impede the provision of vital behavioral health services.

Background: The critical shortage of behavioral health professionals impairs the ability of the U.S. health care system to respond to the growing demand for services to address mental illness and substance use disorders. Purpose: To identify how restrictive state regulations act as barriers to full utilization of psychiatric mental health advanced practice registered nurses (PMHAPRN), whose scope of practice enables them to provide a full range of behavioral health services. Methods: A sequential mixed methods study combining interview data (n = 94) from a qualitative study of PMH-APRN practice with a subset of quantitative data (n = 699) from a national APRN survey examining the impact of state-mandated APRN/MD collaborative practice agreements. Discussion: Data sources converged to portray challenges to optimal use of APRNs providing psychiatric/mental health services, including high out-of-pocket fees, irregular communication with supervisors, mandated chart reviews, and supervisor turnover. Conclusion: Inconsistent and burdensome supervision requirements contribute to cost inflation and may limit patient access.