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Behavioral health, which includes mental health, has shifted from a “niche” specialty to the very core of modern healthcare.
Want to guess why?
First, 25% of all adults in the United States struggle with mental health disorders, and this percentage is even higher for young adults (18-25), 30% of whom have been diagnosed with a mental illness. Moreover, 19 million people in the US struggle with substance abuse disorders, and that number has only been increasing. BH nurses are no longer seen as just “sitters”—they are high-tech clinical leaders in high demand.
Behavioral health encompasses more than mental health and substance abuse disorders.
1 out of every 4 people in a doctor’s office is seeking assistance with behavioral health conditions, ranging from depression, anxiety, diabetes management, weight loss, smoking cessation, drinking, or drug use problems.
Given this significant need for behavioral health professionals, new nurses or those considering 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 stands for behavioral health. This term refers to how 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 encompasses 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
Common mental health conditions
Recent data shows that 38% of Americans made a mental health-related New Year's resolution, with the highest engagement among those aged 18–34.
Mental health refers to emotional, social, and psychological well-being. It is included in the behavioral health umbrella because it encompasses how people act, interact, and respond, as well as 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 being overweight. This treatment does not fall under 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 known as a psychiatric unit, is a designated area for mental and behavioral health care. This unit is unique in many ways:
- It has many communal spaces, including dining rooms where patients can eat 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.
A major new tech trend involves using Digital Twins—virtual replicas of a patient's physiological and lifestyle data—to predict how they will respond to specific psychotropic medications before the first dose is even administered. Digital Twins is a predictive modeling tool using patient data (genetics and history) to simulate drug metabolism.
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
- Assessing 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
Emergency departments are transitioning from “holding areas” to Behavioral Health Decision Centers.
Nurses now use AI-based triage to predict patient escalation and match patients with the right level of care (inpatient vs. intensive outpatient) within minutes.
Integrated care pillars
Behavioral health is now a core pillar of value-based care. You’ll find BH nurses embedded not just in psych units, but in other settings as well, such as:
- Primary care
- Cardiology
- Oncology
Despite tech advances, rural wait times for psychiatric evaluations can still reach 3-6 months, making PRN and travel nurses in this field more essential than ever.
How much do behavioral health nurses make?
The average annual salary for RNs, including behavioral health nurses, ranges from $93,600 to $98,430. However, RN salaries can vary widely across industries. The demand-to-supply ratio is 4-to-1, which has driven salaries higher than in the pre-pandemic era.
Registered nurse (RN) - behavioral health salary
- National average: $93,600
- Top 10% (specialists/senior): $108,437+
- Highest paying regions: District of Columbia ($98,480), California ($98,110), and Massachusetts ($96,800).
Psychiatric-mental health nurse practitioner (PMHNP)
- National average: $145,278
- Top earners (metropolitan/specialized): $220,000+
- Trend: Telehealth PMHNP roles now offer the highest “per-hour” flexibility, with many startups offering base salaries of $150,000 for remote work.
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 can have associate’s or bachelor’s degrees, although many employers prefer hiring RNs who have a Bachelor 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.
Psychiatric-Mental Health Nursing Certification (PMH-BC™)
The PMH-BC™ is a competency-based certification 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 3 years.
- Having completed 30 hours of continuing education in behavioral health/mental health nursing specifically within the last 3 years.
Many hospitals now offer “certification bonuses” up to $5,000 to meet new 1095 Strong readiness standards. (1095 Strong is the AAAHC’s quality accreditation initiative that focuses on clinical excellence every day of the 3-year/1095-day cycle.)
Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC™)
The PMHNP-BC™ (Across the Lifespan) certification (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 3 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 2 psychotherapeutic treatment modalities
Many states have expanded the NP practice authority, allowing PMHNPs to lead their own private practices or community crisis teams without physician oversight.
Credentials from the Pediatric Nursing Certification Board
The Pediatric Nursing Certification Board offers a credential for nurses to specialize in pediatric mental health:
The Pediatric Primary Care Mental Health Specialist (PMHS) certification assesses APRNs’ knowledge, skills, and expertise in the early identification, intervention, and collaborative care of children and adolescents with mental and behavioral health concerns.
Eligibility requirements for APRNs include a valid APRN license and a minimum of 2,000 clinical practice hours within the previous 5 years, or 30 hours of continuing education within the previous 5 years, and 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)]
How to obtain the necessary clinical practice hours?
One challenge nurses face in obtaining specialty certifications is meeting the required number of clinical practice hours in behavioral health. Obtaining clinical practice hours in behavioral health may seem challenging to nurses presently working in other areas.
This is why PRN nursing jobs are such a valuable option.
Through PRN work, nurses can choose what units and settings to pick up shifts in. They can work PRN on their days off or choose 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.
Time to become a behavioral health nurse
RNs may find work in behavioral health units straight out of nursing school. Depending on the program, nursing school could take approximately 2-4 years.
To become a behavioral health nurse practitioner, nurses must complete a Master of Science in Nursing (MSN) program. An MSN in itself takes 2-3 years.
Furthermore, many MSN programs require nurses to have 1-2 years of work experience before beginning the program.
Therefore, becoming a BH nurse practitioner can easily take 6-8 years. In fact, the average nursing experience of nurse practitioners is 11.5 years.
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
Voluntary admissions
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 72 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.
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 to nurses and other staff. Furthermore, nurses may also be exposed to contagious diseases.
What makes a good behavioral health nurse?
A successful 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
Additional abilities for behavioral health nurses
Behavioral nurses should also develop the following abilities:
- Applying principles 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 judgment 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 be in denial regarding 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 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, as they must commit to making lifestyle changes to help them stay healthy and functional after discharge. This is why nurses must be open to treatment plans tailored to patients’ unique needs, personalities, and preferences.
Assertive but not aggressive
Nurses must learn to tread a fine line between being sensitive and empathetic and completing necessary healthcare tasks, 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.
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