What is Behavioral Health Nursing Specialty?

Behavioral health, which includes mental health, is one of the most important nursing specialties today. First, 20% of all adults in the United States struggle with mental health disorders, and this percentage is even higher for young adults (eighteen to twenty-five), 30% of whom have been diagnosed with a mental illness. Moreover, nineteen million people in the US struggle with substance abuse disorders, and that number has only been increasing since the COVID-19 pandemic.

Since behavioral health encompasses more than mental health and substance abuse disorders, the total number of patients seeking behavioral health services is even higher. According to the Maine Health Access Foundation (MEHAF), seven out of every ten people in a doctor’s office are seeking assistance with behavioral health conditions, ranging from depression, anxiety, diabetes management, and weight loss to smoking cessation, drinking, or drug use problems.

Due to this significant need for behavioral health professionals, new nurses or those debating a career change should consider pursuing a specialization in behavioral health. Read on to learn everything there is to know about this specialty and why you should choose behavioral health nursing.

What Does BH Stand For?

BH is an abbreviation that stands for behavioral health. This term refers to the way that people’s habits affect their physical and mental well-being. Behavioral health is a very broad area of healthcare that encompasses mental health. In fact, behavioral health and mental health are often used interchangeably.

What Does Behavioral Health Mean in Medical Terms?

By definition, behavioral health refers to the prevention and treatment of behavioral disorders as well as recovery support. BH professionals and healthcare facilities treat patients with disruptive or destructive behavior, which has become a pattern. These behavioral health disorders or conditions can include the following:

• Substance abuse
• Eating disorders
• Gambling addiction
• Sex addiction
• Attention deficit hyperactivity disorder (ADHD)
• Behaviors related to the autism spectrum

Mental health, which is included in behavioral health, refers to emotional, social, and psychological well-being. It is included in behavioral health because it encompasses how people act, interact, and react, in addition to how they think and feel. Here are some common mental health conditions:

• Anxiety
• Depression
• Schizophrenia
• Eating disorders
• Addictive behaviors

It is interesting to note that all mental health disorders are behavioral disorders, but the opposite is not always true. For example, a behavioral health professional might work with someone with obesity, a condition that primarily affects physical health, to identify and modify behaviors that lead to them being overweight. This treatment does not fall under the category of mental health services, but it is included in behavioral health.

Where Do Behavioral Health Specialists Work?

Behavioral health specialists, including BH nurses, work in many settings, including hospital psychiatric units or emergency departments, partial hospitalization programs, intermediate and long-term care, and outpatient clinics. They also work in residential care, such as halfway houses, substance abuse services, school-based services, and private practice.

What Is a Behavioral Unit in a Hospital?

A behavioral health unit (BHU), also sometimes referred to as a psychiatric unit, is an area designed for mental and behavioral health care. This unit is unique in many ways.

• It has many communal spaces, such as dining rooms for patients to eat meals together.
• These units are always locked.
• Patients can have limited personal belongings, such as clothes and paperback books; personal toiletries are not allowed.
• Visitors and visiting times are also limited to reduce interruptions and distractions.
• Staff members check on patients frequently day and night.

What Does a Behavioral Nurse Do?

BH nurses work as part of a multidisciplinary team, including physicians, psychiatric techs, social workers, and therapists. This team works together to create care plans based on each patient’s unique needs.

What Is the Role of a Behavioral Health Nurse?

Many of the duties of a behavioral health nurse are the same as those of any other nurse. These typical responsibilities include the following:

• Planning and providing nursing care, including pain management
• Taking and recording vital signs
• Recording treatments and lab results
• Documenting patient information and following physicians’ orders
• Performing administrative tasks, such as filing, typing, completing progress notes, and answering phones

Other responsibilities that are particular to a behavioral health nurse include the following:

• Conducting intake evaluations through interviews with patients and family members
• Diagnosing the medical and emotional status of patients and recommending treatment options
• Consulting with other members of the behavioral health team to create treatment plans for patients
• Administering and managing psychotropic drugs and other medications
• Maintaining secure environments for patients and staff
• Helping patients understand their conditions and accept treatments

How to Become a Behavioral Health Nurse?

Behavioral health nurses are registered nurses (RNs) or advanced practice registered nurses (APRNs) with experience in mental or behavioral health. RNs could have associate’s or bachelor’s degrees in nursing, although many employers prefer hiring RNs with bachelors of science in nursing (BSN).

Behavioral Health Certification for Nurses?

Besides nursing school and possible graduate studies, behavioral health nurses can pursue different certifications to complement their qualifications.

The American Nurses Credentialing Center (ANCC) offers certifications for both RNs and APRNs:

• The Psychiatric-Mental Health Nursing Certification (PMH-BC™) is a competency-based exam that assesses the clinical knowledge and skills of RNs in the mental health specialty after initial RN licensure. Eligibility requirements for this certification include the following:
• Holding a current, active RN license
• Having worked full-time as a registered nurse for at least two years
• Accruing a minimum of 2,000 clinical hours in mental health nursing within the previous three years.
• Having completed thirty hours of continuing education in mental health nursing within the last three years.

• The Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC™) (Formerly known as Family Psychiatric–Mental Health Nurse Practitioner) is a competency-based evaluation that assesses the clinical knowledge and skills of a psychiatric–mental health nurse practitioner (PMHNP). These are the eligibility requirements for this certification:
• Holding a current, active RN license
• Completing a master’s, post-graduate certificate, or doctor of nursing practice (DNP) from a nursing commission accredited program
• Completing three separate graduate-level courses in advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology
• Completing courses with content in health promotion and maintenance as well as differential diagnosis and disease management
• Completing clinical training in at least two psychotherapeutic treatment modalities

The Pediatric Nursing Certification Board offers a credential for nurses to specialize in pediatric mental health:

• The Pediatric Primary Care Mental Health Specialist (PMHS) exam assesses APRNs’ knowledge, skills, and expertise in early identification, intervention, and collaboration of care for children and adolescents with mental and behavioral health concerns. Eligibility requirements for APRNs include the following:
• A valid APRN license
• Holding a certification in one of the following areas:
• Primary Care Pediatric Nurse Practitioner (PNP)
• Family Nurse Practitioner (FNP)
• Child/Adolescent Psychiatric & Mental Health CNS (PMHCNS-BC)
• Psychiatric-Mental Health NP [formerly Family Psychiatric Mental Health Nurse Practitioner (PMHNP-BC)]
• Completing a minimum of 2,000 clinical practice hours within the previous five years.
• One graduate level course (of at least two credits) or thirty hours of continued education completed within the previous five years

How to Obtain the Necessary Clinical Practice Hours?

One challenge nurses face in the process of obtaining certifications is accruing the necessary number of clinical practice hours in behavioral health. Obtain clinical practice hours in behavioral health may seem impossible to nurses presently working in other areas. This is why PRN nursing jobs are such a valuable option.

Through PRN work, nurses can pick up shifts in any specialty area they need practice in. They can work PRN on their days off, or they can decide to work PRN full time. Full-time PRN work might be particularly appealing to nurses in graduate school or for those who need a flexible schedule for other reasons. Furthermore, this type of work offers the opportunity to work in different settings and explore different specialties, helping nurses determine which type of work is best for them.  

How Long Does It Take to Become a Behavioral Health Nurse?

RNs may be hired to work in behavioral health units straight out of nursing school. Depending on the program, nursing school could take approximately two years for an associate’s degree or about four years for a bachelor’s degree in nursing.

However, to become a behavioral health nurse practitioner, nurses must complete a master of science in nursing (MSN) program after completing a BSN, although there are some ADN-to-MSN programs as well. An MSN in itself takes two to three years. Furthermore, many MSN programs require nurses to have one or two years of work experience before beginning the program.

Therefore, becoming a BH nurse practitioner can easily take six to eight years or more. In fact, the average extent of nursing experience for nurse practitioners is eleven and a half years.

How Much Do Behavioral Health Nurses Make?

The average annual salary for RNs, including behavioral health nurses, is $82,750. However, the average RN salary can vary greatly across industries. The following represent average salaries for RNs in different work settings:  

• Outpatient care centers: $93,070
• General medical and surgical hospitals: $85,020
• Specialty hospitals except for psychiatric and substance abuse hospitals: $84,800
• Psychiatric and substance abuse hospitals: $80,260
• Home health care services: $78,190
• Offices of physicians: $73,860
• Nursing care facilities (skilled nursing facilities): $72,260

Nurses with graduate-level education earn a significantly higher average salary at $118,040 per year. This average can also vary depending on the type of facility where nurse practitioners work. Here are average salaries for behavioral health nurse practitioners in different settings:

• Home health care services: $133,170
• Psychiatric and substance abuse hospitals: $131,830
• Outpatient care centers: $129,190
• General medical and surgical hospitals: $122,960
• Offices of physicians: $114,870
• Offices of other health practitioners: $108,890

What Is Behavioral Health Nursing Like?

A significant portion of behavioral health nursing work is carried out in an office environment. However, nurses must be prepared to deal with emergency, critical, unusual, or potentially dangerous situations.

The most common reasons for admissions into a behavioral health unit include the following:

• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Bipolar disorder
• Depression
• Schizophrenia
• Borderline personality disorder

These admissions may be voluntary or involuntary. Voluntary admissions are usually due to the following causes:

• Acute psychosis
• Mental instability
• Extreme stress
• Symptoms related to patients’ illnesses
• Inability to function normally
• Daily activities that are negatively affected by patients’ illnesses

In the case of involuntary admissions, patients are usually required to remain in the BH unit for seventy-two hours to ensure that they are not a risk to themselves or others.

When patients require care for an extended period due to severe mental illness, disability, or advancement of their conditions, in the case of diseases such as Alzheimer’s, they are usually transferred to a long-term facility or unit.  

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Is Behavioral Health Nursing Hard?

As with every other nursing specialty, behavioral health has its challenges. Because patients are struggling with a wide range of symptoms and conditions, such as withdrawal or psychosis, they may be verbally and physically abusive with nurses and other staff. Furthermore, nurses may also be exposed to contagious diseases.

What Makes a Good Behavioral Health Nurse?

An excellent behavioral nurse has both extensive knowledge and skills in their chosen specialty. Here are some of the areas in which nurses should be knowledgeable:

• Nursing principles, procedures, and techniques used in behavioral health
• Social, psychological, and physical aspects of mental and emotional disorders
• Medical and psychological terms
• Psychotropic drugs and other medications, including medication management and effects
• Regulations relevant to psychiatric nursing
• Theories, principles, and techniques of psychotherapy in group and individual settings
• Symptoms and behavior patterns of patients with behavioral or mental health disorders
• Medical and psychiatric emergency procedures
• Basic computer programs

Behavioral nurses should also develop the following abilities:

• Applying principals and procedures of nursing care in the evaluation and treatment of behavioral and mental health patients
• Developing relationships with patients
• Documenting patient activities and progress
• Following rules, regulations, and protocols
• Applying appropriate interventions with patients in moments of crisis
• Communicating effectively and with great sensitivity, tact, and diplomacy
• Exercising judgement in releasing information, making decisions, and giving recommendations

Tips for New Behavioral Health Nurses?

Aside from the essential clinical knowledge and abilities that BH nurses must have, there are many qualities or soft skills that new nurses should strive to develop.

• Patience: Remember that many patients find themselves in BHUs involuntarily. Thus, it is only natural that many resist treatment and may even be in denial in regard to their conditions.
• Empathy: There is significant stigma surrounding behavioral and mental health disorders. Therefore, nurses working in this area must be sensitive to the social injustices that their patients suffer. Furthermore, nurses should analyze their own prejudices as well in order to offer their patients the best possible care.
• Critical thinking skills: Behavioral health nurses care for a diverse group of patients who may have mood disorders, psychotic disorders, substance abuse disorders, anxiety or panic disorders, personality disorders, cognitive disabilities, or a combination of the above. Furthermore, patients may have other medical conditions in addition to behavioral or mental health disorders. Therefore, nurses must have the critical thinking skills necessary to treat and care for patients with complex conditions.
• Open-mindedness: Treatment always involves collaboration with other members of the healthcare team as well as consultation with patients and family members. However, in behavioral health, patients play an even more crucial role in their recovery since they must commit to making the lifestyle changes that will help them stay healthy and functional after discharge. This is why nurses must be open to treatment plans based on patients’ unique  needs, personalities, and preferences.
• Assertive but not aggressive: Nurses must learn to tread a fine line between being sensitive and empathetic and getting necessary healthcare tasks done, such as administering medications. They must have authority and command patients’ respect without causing trauma to patients who might already be struggling to overcome trauma.

Final Thoughts on Behavioral Health Nursing

Behavioral health nursing is an essential specialty and one in great demand. However, nurses must reflect on whether this specialty is right for them based on a number of factors, including work setting preferences and personality types.

If you would like to consider more possibilities, read up on other nursing specialties to find the ones that resonate the most with you. Then, consider picking up per diem shifts in the areas you are interested in to help you determine whether certain healthcare facilities or nursing specialties are right for you.