America’s mental health care system is in disarray. A lack of health care providers who can diagnose mental health disorders, prescribe medications, and provide therapy leaves millions of Americans who desperately need mental health care out in the cold. The latest evidence comes from a workforce assessment by the American Psychiatric Nurses Association that finds a chronic lack of mental health professionals who can care for 56 million Americans with mental health or substance abuse issues.

These problems are even more acute in Iowa, where the state is consistently near the bottom of rankings of mental health care services. The crisis is especially acute in rural areas, where it’s made even worse by the lack of health care of any type. Only 56 communities in Iowa have a physician, nurse practitioner, or physician’s assistant who can provide mental health services.

Changes need to be made, and I’m hopeful they’ve begun with new laws that expand mental health services. The Iowa legislature and Gov. Kim Reynolds made a good first step this past legislative session by approving additional access centers for people who need immediate mental health care, and treatment teams to encourage people with mental health conditions to stay on their medication. The bill also requires teachers and anyone else who works with children to undergo training to identify and provide assistance to students who show signs of suicidal mental distress.

These changes will fill some of the many gaps in the system and we look forward to future legislatures continuing this forward momentum. But that momentum is not guaranteed, and future funding continues to be uncertain. In the meantime, the University of Iowa College of Nursing is doing what it can to plug some of those gaps through its educational programs, including a post-graduate nurse practitioner program that can serve as an important resource to deliver health care services to rural areas underserved by psychiatrists and other health care providers.

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Nurse practitioners are advanced practice registered nurses who take additional training beyond the bachelor’s degree. They are able to examine patients and assess their health needs, order lab tests, diagnose illnesses, and prescribe medications. Iowa is one of 20 states in which nurse practitioners can work independent of the authority of a physician, so they are able to provide the kinds of services that are missing in rural areas.

Nurse practitioners can also provide specialized care, including psychiatric and mental health care, through additional training. Every year, about 15 current nurse practitioners in the state study for a post-graduate certificate from the College of Nursing. The need for mental health services among their patients is so great that more than half of nurse practitioners who seek additional certification study for a psychiatric/mental health certificate.

Once they’ve completed the certificate, they can offer a wide array of mental health services, including prescribing medications and providing psychotherapy services to individuals, groups, and families. Most of the students who take the course are from rural Iowa, and most intend to stay in rural Iowa. Iowa currently has 139 psychiatric/mental health nurse practitioners working 32 counties.

A nurse practitioner certified in both primary care and mental health provides additional benefits for patients, as well. They can see a single provider for all of their health care, physical as well as psychiatric, making it more convenient and less costly.

The University of Iowa College of Nursing is one of several nursing programs in the state preparing nurse practitioners to provide health care to Iowans. We believe that nurse practitioners dually certified to manage both the psychiatric/mental health and physical needs of their patients is an important part of the solution to the mental health crisis.

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Bio: Julie Zerwic is the University of Iowa College of Nursing Kelting Dean and Professor. She joined the College in the Fall of 2017 after a 24-year career at the University of Illinois – Chicago and she’s a national leader in developing strategies to diversify the nursing profession. Zerwic is a Fellow of the American Heart Association and the American Academy of Nursing.


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