APNA Position: Integrated Care

Abstract

Integrated care has become an essential strategy for addressing the complex mental, behavioral, physical, and social needs of individuals, families, and communities. Fragmented health systems contribute to delayed treatment, poor care coordination, worsening health inequities, and higher healthcare costs. Evidence consistently demonstrates that integrated, team-based, and measurement-based care improves access, clinical outcomes, patient experience, and health system performance. Psychiatric-mental health registered nurses (PMH-RNs) and psychiatric-mental health advanced practice registered nurses (PMH-APRNs) are essential leaders in designing, implementing, evaluating, and sustaining integrated care across primary care, mental health, community, and digital health settings. This position outlines the American Psychiatric Nurses Association’s (APNA) recommendations for advancing integrated care through workforce development, evidence-based practice, implementation, innovation, education, technology, sustainable reimbursement and supportive regulatory policies, and continuous quality improvement. APNA affirms that integrated, whole-person care should become the national priority for addressing mental health issues, substance use, chronic physical illness, trauma, and social needs. APNA therefore calls for policies that strengthen psychiatric-mental health nursing leadership in transforming health systems to improve equitable, person-centered, and measurable whole-health outcomes across the lifespan.

Introduction

As the professional organization representing psychiatric-mental health nurses, APNA recognizes that mental health issues, substance use, chronic physical illness, and social needs are experienced together, yet the systems designed to serve individuals and families often remain fragmented. This fragmentation delays care, burdens families, strains health systems, and deepens inequities, particularly for communities facing barriers to transportation, housing, insurance coverage, and timely access to person-centered care (Alegría et al., 2021; Millender et al., 2020; Reist et al., 2022). Consequences include missed treatment opportunities, preventable crises, poorly managed chronic illness, caregiver burden, and loss of trust in difficult-to-navigate health systems.

For this position statement, APNA defines integrated care as a whole-person approach that brings mental health, substance use, physical health, and social needs together (Delaney et al., 2018, 2025; Millender et al., 2020). Care is coordinated across professionals, settings, and the lifespan, guided by the goals, preferences, cultures, strengths, and lived experiences of individuals and families (Minkman et al., 2025). Integrated care relies on evidence, partnerships, shared accountability, outcome measurement, and continuous improvement to advance equitable health and well-being for individuals and communities (American Psychiatric Nurses Association et al., 2022). APNA recognizes that integrated care is no longer a novel concept. It is best practice for improving the health and well-being of individuals, families, and communities. Evidence demonstrates that integrated care improves access, strengthens coordination across mental, physical, and social health services, and leads to better health outcomes than fragmented models of care (Reist et al., 2022; Schillok et al., 2025; University of Washington AIMS Center, n.d.).

Psychiatric-mental health nurses bring a distinctive whole-person perspective that integrates mental, physical, and social dimensions of health and coordinates care across settings. Evidence from nurse-led and psychiatric nurse-led integrated care models demonstrates that psychiatric-mental health nurses improve care coordination, expand access to services, strengthen team-based care, and advance better outcomes for underserved populations (Birch et al., 2021; Caldwell et al., 2021; Delaney et al., 2025; Millender et al., 2020). APNA recognizes psychiatric-mental health nurses as essential leaders in developing, implementing, and sustaining integrated care across healthcare settings.

Discussion

The Health Care System and Integrated Care Framework

The Six Levels of Collaboration and Integration, developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA), provide a foundation for understanding integrated care, but successful implementation requires more than defining collaboration levels (Heath et al., 2013). Effective integrated care depends on aligned payment policies, workforce capacity, quality measurement, accountability, and sustainable implementation strategies. Contemporary frameworks emphasize bidirectional integration of mental and physical health care, continuous quality improvement, response to social needs, and measurable outcomes that improve the health of individuals and communities (Agency for Healthcare Research and Quality, n.d.; National Council for Mental Wellbeing, 2025). Integrated care models improve access and patient outcomes, may reduce emergency department use, and may support primary care clinician well-being (Reist et al., 2022; Schillok et al., 2025; Serrano et al., 2018; Zubatsky et al., 2018).

Evidence-Based Practices

Evidence-based integrated care is central to improving outcomes for individuals and families with co-occurring mental health conditions, substance use, chronic physical health illness, and social needs. Evidence demonstrates that integrated, team-based, and measurement-based care models improve mental, physical, and social health outcomes, strengthen care coordination, expand timely access to care, promote health equity, and support long-term system sustainability. Landmark Collaborative Care research further demonstrates that accountable, team-based care improves outcomes for individuals with co-occurring depression and chronic physical conditions when guided by measurement-based care (Katon et al., 2010). Integrated care models should incorporate the best available evidence with patient and family preferences, cultural context, and community priorities. Routine measurement-based care and continuous quality improvement should guide clinical decision-making, monitor outcomes, and strengthen accountability for whole-person health outcomes (Birch et al., 2021; Delaney et al., 2025; Millender et al., 2020; Reist et al., 2022; Schillok et al., 2025).

PMH-RNs and PMH-APRNs are essential leaders in implementing and sustaining evidence-based integrated care. Their expertise in psychiatric assessment, therapeutic engagement, care coordination, measurement-based care, consultation, and interprofessional collaboration strengthens the quality, continuity, and effectiveness of integrated care across mental health, primary care, and community settings.

Barriers to Access and the Role of PMH Nurses in Integrated Care

Individuals with serious mental illness experience persistent barriers to comprehensive healthcare and disproportionate physical health morbidity (Kaufman et al., 2012; Lerbaek et al., 2019). Persistent shortages of mental health providers contribute to delayed diagnosis, fragmented care, untreated mental health and substance use conditions, and reduced access to timely treatment. Workforce shortages are even more pronounced in underserved communities and pediatric populations, where specialty psychiatric services are often limited. A recent nationally representative study found that approximately one in five U.S. households reported that a child needed mental health treatment, and nearly one quarter of those households reported an unmet need (Burnett et al., 2026). No single integrated care model fits every population or setting. The approach should reflect community needs, available resources, workforce capacity, and where people are most likely to engage in care (Minkman et al., 2025; National Council for Mental Wellbeing, 2025). Options include the Collaborative Care Model (CoCM), the Primary Care Behavioral Health Model, nurse-led community-based care, and bidirectional approaches that bring physical health services into mental health settings (Millender et al., 2020; National Council for Mental Wellbeing, 2025; Reist et al., 2022; Serrano et al., 2018; Thoren & Vista-Wayne, 2021).

PMH-RNs and PMH-APRNs represent an essential workforce solution to these access challenges. Within CoCM, PMH-RNs strengthen care coordination, patient and family engagement, health education, and measurement-based care, while PMH-APRNs provide advanced psychiatric assessment, diagnosis, psychopharmacologic management, consultation, and clinical leadership. PMH-APRNs serve as psychiatric consultants and integrated care leaders, extending specialty expertise into primary care settings with limited psychiatric resources (Thoren & Vista-Wayne, 2021). Similarly, Birch et al. (2021) found that PMHNPs serving as mental health integration specialists, consultants, and educators contributed to increased mental and behavioral health integration and improvements in depression and diabetes outcomes.

Workforce Development and Professional Education

Integrated care should be considered foundational for contemporary practice. Workforce development should include pre-licensure and graduate education as well as continuing professional development to prepare nurses for evolving models of integrated care. Foundational preparation should include population health, chronic disease management, social drivers of health, and community partnerships (Manderscheid & Ward, 2024). Graduate education and continuing professional development should strengthen competencies in digital mental health, telehealth, implementation science, and emerging technologies that support integrated care (Johnson, 2025).

Educational preparation for integrated care should prepare nurses in team-based care, population health, chronic disease management, trauma-informed and culturally responsive care, social drivers of health, measurement-based care, and digital health technologies (Corcoran et al., 2026; Delaney et al., 2018; Delaney et al., 2025). Faculty development and academic-practice partnerships can strengthen this preparation through evidence-based, interprofessional education (Jackson-Burns et al., 2025).

Ongoing professional development is essential to ensure the psychiatric-mental health nursing workforce remains prepared to lead changes in practice, technology, payment, and healthcare delivery. Achieving these goals will require sustained federal, state, and organizational investment in workforce development and academic-practice partnerships.

Innovative Approaches

The next phase of integrated care must focus on building systems that are easier to enter and navigate and more accountable for patient outcomes. Future integrated care models must move beyond short-term pilots and isolated service changes toward system redesign that emphasizes community partnerships, proactive and technology-enabled care, interorganizational collaboration, and continuous learning (Minkman et al., 2025). Psychiatric-mental health nurses are uniquely positioned to lead this transformation because they bring clinical expertise, therapeutic engagement, care coordination, population health thinking, and a deep understanding of how illness is shaped by lived experience and social context (Birch et al., 2021; Delaney et al., 2025; Millender et al., 2020).

Innovation should strengthen, not replace, the therapeutic relationships at the center of integrated care. The thoughtful implementation of digital technologies can identify needs earlier, monitor outcomes over time, and enable timely intervention before individuals reach crisis. These technologies include screening platforms, patient registries, remote monitoring, e-consultation, clinical decision support, and artificial intelligence. Psychiatric-mental health nurses play a critical leadership role in ensuring these technologies protect privacy, minimize bias, strengthen crisis pathways, and reduce rather than widen health inequities (Garcia, 2025; Milasan & Scott-Purdy, 2025; Robinson et al., 2024; Torous et al., 2025).

Innovation in integrated care must include not only how care is delivered, but also how success is defined and measured. Evaluation should move beyond traditional clinical and service-use indicators to reflect outcomes that matter to individuals, families, communities, and health systems. These broader measures should include access, quality, patient and family experience, equity, workforce sustainability, population health, and whole-person outcomes. By incorporating community-level outcomes and relevant measures of success, integrated care models can demonstrate meaningful improvements in health, system performance, and the lived experience of the populations they serve.

Position

APNA affirms that integrated, whole-person care should be the national goal for improving the mental, physical, and social health of individuals, families, and communities. To achieve this vision, APNA advances three priorities that strengthen integrated care nationwide.

First, APNA calls for policies that build sustainable, evidence-based integrated health systems by aligning payment, reimbursement, community partnerships, technology, infrastructure, and care delivery to support coordinated, team-based care across healthcare settings. This includes reimbursement for collaborative care, psychiatric consultation, care coordination, measurement-based care, and hybrid models that improve access, quality, and continuity of care.

Second, APNA supports policies that prepare, recognize, and fully utilize PMH-RNs and PMH-APRNs as essential leaders of integrated care. Workforce investment, education, leadership development, faculty support, academic-practice partnerships, and practice to the full extent of education, training, and licensure are critical to expanding access and improving outcomes.

Finally, APNA supports accountability systems that measure what matters most to individuals, families, communities, and health systems. Integrated care should be evaluated by improvements in access, quality, patient and family experience, equity, workforce sustainability, and whole-person health outcomes while fostering continuous learning, innovation, and improvement. APNA envisions healthcare systems that are easier to enter, easier to navigate, and more accountable for improving health and well-being.

Conclusion

APNA is committed to advancing psychiatric-mental health nursing practice, education, research, and policy that strengthen integrated, equitable, and accountable systems of care. As essential leaders in this transformation, psychiatric-mental health nurses will help shape healthcare systems that are easier to access, better coordinated, and more responsive to the people and communities they serve. APNA calls on policymakers, health systems, educators, payers, and community partners to work together to advance integrated care as a national priority for improving health and well-being.

Hence, APNA supports the position that integrated care models should be utilized to improve health equity by collaboratively and comprehensively addressing the complex physical, mental, and sociocultural needs of patients to decrease morbidity and mortality.

APNA Board Committee on Integrated Care and Professional Practice

Eugenia Flores Millender, PhD, RN, PMHNP-BC, FAAN, FAANP, Chair
Joyce Shea, DNSc, APRN, PMHCNS-BC, FAAN
Beth Smith, DNP, MBA, CRNP, PMHNP-BC
Brittany Evans, DNP, APRN, PMHNP-BC, NEA-BC

Approved by the APNA Board of Directors January 10, 2023. Reviewed February 2026. Updated November 2026.

References

1. Agency for Healthcare Research and Quality. (n.d.). Integrating behavioral health and primary care playbook. AHRQ Academy for Integrating Behavioral Health and Primary Care. Retrieved June 23, 2026, from https://integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care
2. Alegría, M., Frank, R. G., Hansen, H. B., Sharfstein, J. M., Shim, R. S., & Tierney, M. (2021). Transforming mental health and addiction services. Health Affairs, 40(2), 226–234. https://doi.org/10.1377/hlthaff.2020.01472
3. American Psychiatric Nurses Association, International Society of Psychiatric-Mental Health Nurses, & American Nurses Association. (2022). Psychiatric-mental health nursing: Scope and standards of practice (3rd ed.). American Nurses Association.
4. Birch, K., Ling, A., & Phoenix, B. (2021). Psychiatric nurse practitioners as leaders in behavioral health integration. The Journal for Nurse Practitioners, 17(1), 112–115. https://doi.org/10.1016/j.nurpra.2020.09.001
5. Burnett, A. L., Breslau, J., Cantor, J. H., McBain, R. K., Kofner, A., Ali, M. M., Zhang, F., Stein, B. D., & Yu, H. (2026). US child mental health care need, unmet needs, and difficulty accessing services. JAMA Pediatrics, 180(4), 451–453. https://doi.org/10.1001/jamapediatrics.2025.6162
6. Caldwell, B. A., Alessi, E. J., DiGiulio, M., Findley, P., Oursler, J., & Wagner, M. (2021). Integrating behavioral health into primary care: The role of psychiatric nursing in the development of the interprofessional team. Issues in Mental Health Nursing, 42(8), 758–767. https://doi.org/10.1080/01612840.2020.1867676
7. Corcoran, K. J., Phillips, K. E., & Shea, J. (2026). The future is now: Scaffolding telemental health skills across the curriculum to ensure PMHNP competency. Journal of the American Psychiatric Nurses Association. Advance online publication. https://doi.org/10.1177/10783903261442919
8. Delaney, K. R., Emerson, M. R., Soltis-Jarrett, V., Barton, A. J., & Weber, M. (2025). Engineering integrated care expansion and innovation: Drawing upon nursing leadership. International Journal of Environmental Research and Public Health, 22, Article 598. https://doi.org/10.3390/ijerph22040598
9. Delaney, K. R., Naegle, M. A., Valentine, N. M., Antai-Otong, D., Groh, C. J., & Brennaman, L. (2018). The effective use of psychiatric mental health nurses in integrated care: Policy implications for increasing quality and access to care. The Journal of Behavioral Health Services & Research, 45(2), 300–309. https://doi.org/10.1007/s11414-017-9555-x
10. Garcia, G. (2025). The role of AI in transforming psychiatric-mental health care: Enhancing the role of psychiatric-mental health nurse practitioners. Nursing Outlook, 73(4), Article 102461. https://doi.org/10.1016/j.outlook.2025.102461
11. Heath, B., Wise Romero, P., & Reynolds, K. A. (2013). A standard framework for levels of integrated healthcare. SAMHSA-HRSA Center for Integrated Health Solutions. https://archive.thepcc.org/sites/default/files/resources/SAMHSA-HRSA%202013%20Framework%20for%20Levels%20of%20Integrated%20Healthcare.pdf
12. Jackson-Burns, S., Fowler, L., & Rivera, S. (2025). Enhancing psychiatric mental health nurse practitioner education through academic-practice partnerships in integrated care settings. The Journal for Nurse Practitioners, 21(6), Article 105403. https://doi.org/10.1016/j.nurpra.2025.105403
13. Johnson, D. J. (2025). Integrated behavioral healthcare in the modern age: There’s an app for that. Journal of Technology in Behavioral Science. Advance online publication. https://doi.org/10.1007/s41347-025-00525-y
14. Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. The New England Journal of Medicine, 363(27), 2611–2620. https://doi.org/10.1056/NEJMoa1003955
15. Kaufman, E. A., McDonell, M. G., Cristofalo, M. A., & Ries, R. K. (2012). Exploring barriers to primary care for patients with severe mental illness: Frontline patient and provider accounts. Issues in Mental Health Nursing, 33(3), 172–180. https://doi.org/10.3109/01612840.2011.638415
16. Lerbaek, B., Jørgensen, R., Aagaard, J., Nordgaard, J., & Buus, N. (2019). Mental health care professionals’ accounts of actions and responsibilities related to managing physical health among people with severe mental illness. Archives of Psychiatric Nursing, 33(2), 174–181. https://doi.org/10.1016/j.apnu.2018.11.006
17. Manderscheid, R. W., & Ward, A. (2024). Looking toward the future of integrated care: History, developments, and opportunities. The Journal of Behavioral Health Services & Research, 51, 609–617. https://doi.org/10.1007/s11414-024-09894-3
18. Milasan, L. H., & Scott-Purdy, D. (2025). The future of artificial intelligence in mental health nursing practice: An integrative review. International Journal of Mental Health Nursing, 34(1), Article e70003. https://doi.org/10.1111/inm.70003
19. Millender, E., Valentine, K., Eggenberger, T., Lucier, C., Sandala, H., & Bruneau, D. (2020). Implementing interprofessional collaboration to improve patient outcomes: A caring and social approach to integrated nurse-led community-based care. International Journal for Human Caring, 24(1), 39–49. https://doi.org/10.20467/1091-5710.24.1.39
20. Minkman, M. M. N., Zonneveld, N., Hulsebos, K., van der Spoel, M., & Ettema, R. (2025). The renewed Development Model for Integrated Care: A systematic review and model update. BMC Health Services Research, 25, Article 434. https://doi.org/10.1186/s12913-025-12610-2
21. National Council for Mental Wellbeing. (2025). Comprehensive Health Integration (CHI) framework: Roadmap to design, implement, and sustain physical health–behavioral health integration (2nd ed.). Center of Excellence for Integrated Health Solutions. https://www.thenationalcouncil.org/wp-content/uploads/2025/02/25.02.10_CHI-White-Paper.pdfReist, C., Petiwala, I., Latimer, J., Raffaelli, S. B., Chiang, M., Eisenberg, D., & Campbell, S. (2022). Collaborative mental health care: A narrative review. Medicine, 101(52), e32554. https://doi.org/10.1097/MD.0000000000032554
22. Robinson, A., Flom, M., Forman-Hoffman, V. L., Histon, T., Levy, M., Darcy, A., Ajayi, T., Mohr, D. C., Wicks, P., Greene, C., & Montgomery, R. M. (2024). Equity in digital mental health interventions in the United States: Where to next? Journal of Medical Internet Research, 26, Article e59939. https://doi.org/10.2196/59939
23. 24. Schillok, H., Gensichen, J., Panagioti, M., Gunn, J., Junker, L., Lukaschek, K., Jung-Sievers, C., Sterner, P., Kaupe, L., Dreischulte, T., Ali, M. K., Aragonès, E., Bekelman, D. B., Herbeck Belnap, B., Carney, R. M., Chwastiak, L. A., Coventry, P. A., Davidson, K. W., Ekstrand, M. L., … Bühner, M., for the POKAL Group. (2025). Effective components of collaborative care for depression in primary care: An individual participant data meta-analysis. JAMA Psychiatry, 82(9), 868–876. https://doi.org/10.1001/jamapsychiatry.2025.0183
24. Serrano, N., Prince, R., Fondow, M., & Kushner, K. (2018). Does the primary care behavioral health model reduce emergency department visits? Health Services Research, 53(6), 4529–4542. https://doi.org/10.1111/1475-6773.12862
25. Thoren, K. L., & Vista-Wayne, J. (2021). The collaborative care model: Improving access to children’s mental health care. Journal of Child and Adolescent Psychiatric Nursing, 34(2), 83–87. https://doi.org/10.1111/jcap.12309
26. Torous, J., Linardon, J., Goldberg, S. B., Sun, S., Bell, I., Nicholas, J., Hassan, L., Hua, Y., Milton, A., & Firth, J. (2025). The evolving field of digital mental health: Current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality. World Psychiatry, 24(2), 156–174. https://doi.org/10.1002/wps.21299
27. University of Washington AIMS Center. (n.d.). Evidence base for Collaborative Care. https://aims.uw.edu/evidence-base-for-cocm/
28. Zubatsky, M., Pettinelli, D., Salas, J., & Davis, D. (2018). Associations between integrated care practice and burnout factors of primary care physicians. Family Medicine, 50(10), 770–774. https://doi.org/10.22454/FamMed.2018.655711