About 23 percent of American adults live with a mental health condition, but only around 50 percent of these individuals receive treatment. Many factors contribute to this treatment gap, including stigma around mental illness, costs and insurance challenges, and difficulty navigating the healthcare system. Even when patients can overcome these barriers, they may still struggle to find a provider, in large part because the United States is facing a shortage of advanced practice mental health prescribers. Moreover, proposed changes to student loan eligibility categories threaten to exacerbate these shortages and worsen access to qualified providers.
Patient care is shifting to advanced practice providers
The mental healthcare workforce includes many types of professionals, from counselors, therapists, and social workers to psychologists, psychiatrists, and advanced practice medical professionals. Although most types of mental health providers are in short supply, there is a particular need for mental health specialists who can prescribe medications. Managing mental health conditions with medication can be complex and requires a sophisticated understanding of conditions and the medications used to treat them. Although any prescriber can prescribe medications for mental health conditions, primary care providers often report low comfort levels doing so, making mental health specialist prescribers increasingly important.
Psychiatrists, advanced practice psychiatric nurses, and physician assistants who specialize in psychiatry can prescribe in all 50 states (although specifics vary for certain professions), and some states allow psychologists who complete extra training to prescribe. Although primary care providers still write about 42 percent of all mental health medication prescriptions, the share written by mental health specialists is growing. Ongoing and/or predicted shortages among all of these positions will only continue as demand grows.
In 2011, advanced practice psychiatric nurses conducted 12.5 percent of all mental health prescriber office visits for Medicare beneficiaries. By 2019, that number had more than doubled to 29.8 percent.
A dataset that encompasses Medicare, Medicaid, and commercially insured patients found that the volume of visits conducted by advanced practice psychiatric nurses increased by 79.8 percent between 2018 and 2021. In contrast, the volume of visits provided by psychiatrists decreased by 1.3 percent over that period. The same data showed that the share of prescriptions for behavioral health medications written by physician assistants and advanced practice nurses increased from 16.6 percent in 2017 to 22 percent in 2021.
Despite the importance of mental health specialist prescribers, their professions continue to face shortages. Projections show that by 2038, the United States will be will be short up to 86,430 adult psychiatrists; 19,770 child and adolescent psychiatrists; 20,790 psychiatric nurse practitioners; and 4,860 psychiatric physician assistants.
While the supply of advanced practice psychiatric care providers is closer to meeting demand, the supply of adult psychiatrists is decreasing. This suggests that the trend toward advanced practice providers delivering more patient care will likely continue. However, continued growth of the advanced practice provider pool is only possible if individuals are able to access the required education.
Student loan policy changes could affect future mental health prescribers
All mental health prescribers are educated to at least the master’s level, which means there are significant time and financial costs to obtaining the needed qualifications. Increasing the supply of psychiatrists is challenging because they are physicians—a career that requires at least 12 years of higher education. There are also limited slots for medical students seeking psychiatric residencies, where doctors specialize in mental health treatment. Although advanced practice mental health providers typically have similar roles and responsibilities to psychiatrists, their training is less time-intensive, making them a particularly important resource. However, proposed changes to student loan policy would treat students pursuing advanced practice medical training differently than physicians, which could deter people from entering these fields.
In November 2025, the U.S. Department of Education released a draft rule that would recategorize degrees, thereby changing the amount of student loans some students would be eligible to receive. The draft rule narrows the types of degrees categorized as “professional.” Students pursuing professional degrees are eligible to receive $50,000 in student loans each year (up to $200,000), whereas students pursuing graduate degrees outside of this category are eligible to receive $20,500 in loans each year (up to $100,000). Students pursuing graduate degrees to become advanced practice providers—including nurses and physician assistants—used to qualify as professional degree students. Now, the only degrees that qualify are doctoral-level degrees in pharmacy, dentistry, veterinary medicine, chiropractic, law, medicine, optometry, osteopathic medicine, podiatry, clinical psychology, and graduate theology.
These changes are significant given the high cost of obtaining any type of medical education. Because providers who can prescribe mental health medications must train through at least the master’s level, they often use student loans to cover living expenses, tuition, and other costs of attendance. For example, the median tuition to complete a physician assistant program is $96,900 for an in-state student and $101,229 for an out-of-state student. The average new physician assistant graduate has $112,500 to $116,773 in student loan debt, not including any undergraduate debt.
Nurse practitioner programs cost an average of $20,260 to $166,500 in tuition, depending on a number of factors. A recent survey of advanced practice nurses in Michigan found a median student loan debt of $66,420, while 28.9 percent of nurses surveyed carried balances of more than $100,000. These figures suggest that the $100,000 loan maximum may be too low for many people pursuing training to become an advanced practice provider.
Organizations representing healthcare providers and healthcare systems have voiced concerns about the draft rule. Additionally, nearly 81,000 public comments have been submitted to the Federal Register regarding the proposed change to professional degree classifications and other changes to student loan rules.
Conclusion
Advanced practice providers—particularly those who prescribe mental health medications—play an ever-growing role in the healthcare ecosystem. Limiting opportunities for graduate healthcare training by changing student loan maximums puts pressure on an already strained system that does not meet demand for mental health care. With that demand increasing, now is not the time to erect more barriers for aspiring mental health prescribers.