By Jennifer Fernandez
As the mental health crisis for adults and kids worsened during the COVID-19 pandemic, Ivy Bagley decided to go back to school for one more certification.
A nurse practitioner for 17 years, Bagley saw more and more children needing help in eastern North Carolina. Many ended up waiting months for appointments or being sent to doctors an hour or more away, she said.
“I decided during the pandemic, when we could not get kids seen for mental health, I wanted to be part of the solution,” Bagley said.
The search for that solution led her to East Carolina University’s psychiatric mental health nurse practitioner program. She graduated in December.
The number of such programs has nearly doubled in the past eight years, according to a 2022 report by the American Psychiatric Nurses Association. And while that same report shows there are more than 130,000 psychiatric mental health nurses in the U.S., more are needed to address the growing need for care, the organization said.
Rural areas, especially, struggle with having enough health care workers, said Bagley, who lives in Greenville.
“The ECU program is great in that it helps build providers throughout North Carolina,” she said.
Meeting a need
ECU’s program launched in fall 2017 with 21 students.
At the time, officials cited the low rate of nurse practitioners certified in psychiatric and mental health care — only 1.8 percent — as one reason for offering the program.
Sylvia T. Brown, who was dean of the School of Nursing, also noted a 2012 North Carolina Medical Journal report that showed that 95 percent of all North Carolina counties had an unmet need for medical providers who can prescribe psychiatric medications — a deficit that psychiatric/mental health nurse practitioners are able to fill.
“This program will help close that gap,” Brown wrote.
In the U.S., 77 percent of counties are struggling with a shortage of mental health care providers, according to the American Psychiatric Nurses Association. Only 41 percent of youth who are having a major depressive episode get treatment, the group said.
Few psychiatric mental health nurses work in rural areas, the nurses’ association found in a 2020 survey.
‘We’ve lost a lot’
Rural health care access in general across North Carolina has suffered in recent years.
A dozen rural hospitals have either shut down or stopped providing inpatient care since 2005, according to data from the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.
“We’ve lost a lot of health care access points,” Bagley said, noting the 2023 closing of Martin General Hospital in neighboring Martin County.
At least 10 other hospitals in rural towns across the state are at risk of going under.
A lot of areas don’t even have a primary care provider, Bagley said.
Statewide provider shortage
To help address the nation’s shortage of mental health providers, the federal Substance Abuse and Mental Health Services Administration has cited a need for more than half a million additional psychiatric mental health nurses to reach “merely adequate access” to mental health and substance use disorder care.
That lack can be seen in North Carolina, which is struggling statewide to provide mental health services, said Maggie Sauer, director of the North Carolina Office of Rural Health.
For rural residents, getting help is more difficult because of a lack of transportation and internet access that could connect people with telepsychiatry services, she said.
ECU’s behavioral health programs, which extend beyond the psychiatric mental health nurse practitioner training, have “been an important part of the health care infrastructure in eastern North Carolina and other places,” Sauer said.
The university also has been teaching people to work in an integrated care setting. For example, instead of referring a patient to another provider — perhaps across town on a different day, the patient would be able to see the primary care physician along with a behavioral health provider in the same care setting, sometimes at the same appointment.
The integrated care model works well in rural settings to streamline services, Sauer said.
There are also other opportunities for medical professionals to get training in behavioral health through organizations such as North Carolina’s Area Health Education Centers, Sauer said. And it’s important that schools have enough nurses and others trained to work with students facing mental health issues. Programs such as Mental Health First Aid teach adults how to assess for signs and symptoms that children and teens may be experiencing mental health issues or be in crisis.
Children are struggling
Five years after the start of the pandemic, North Carolina’s children continue to struggle with mental health issues.
The state’s biennial Youth Risk Behavior Survey in 2023 showed that about a third of middle and high school students report feeling sad or hopeless. About two in 10 have seriously considered suicide.
The most recent survey in 2023 showed some improvement in mental health issues among the state’s youth from the previous survey in 2021. However, a higher percentage of youth are reporting mental health issues than in 2017.
Rural areas are also dealing with mental health issues among youth, which is compounded by the lack of providers, Bagley said.
More Coverage of Children’s Health
Staying close to home
One factor driving the staffing shortage is that pay in rural areas is not competitive with other areas of the state, Bagley said.
ECU’s psychiatric mental health nurse practitioner program draws students from across North Carolina, but they don’t all stay in the eastern part of the state or serve in rural counties. But research shows that people who come from an area are more likely to stay there.
“I think it takes special people to stay in eastern North Carolina,” said Bagley, whose class at ECU had about 20 students from all over the state. “I love this region. I grew up here. I’m passionate about the people who are here.”
The program teaches more than just the medical side, she said.
“You learn the therapy piece of it, and you can combine both in your care,” she said. “That’s so important for overall wellness.”
The program’s focus is on the whole health lifespan. Bagley was interested in working with children, so she used any extra hours she had to work in pediatric settings.
Serving children
Bagley’s already working on her next project. She’s started a support group for young people with attention deficit hyperactivity disorder.
“It’s important, and a lot of parents beg for that,” Bagley said. “I … feel that those families really need to better understand ADHD and how they can help their children thrive with ADHD.”
She also opened her own practice in November. While she plans to see all ages as part of her practice, she has a particular interest in helping children. Especially, she said, because of the continuing lack of providers focused on youth.
“I feel like I make a difference,” she said.
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