How Advanced Practice Nurses Can Revolutionize Mental Health in Primary Settings

The report advocates for integrating advanced practice nurses into primary care to bridge mental health service gaps, especially in low- and middle-income countries. It emphasizes their role in supervision, collaboration, and strengthening healthcare systems across the Eastern Mediterranean Region.

Researchers Abbas Alameddine from the Department of Psychiatry at Hotel-Dieu de France in Beirut, Marianne Chamoun of Université Laval’s Faculty of Nursing Sciences in Québec, and Jamal Almasri from the International Orthodox Christian Charities in Mansourieh, Lebanon, argue for a renewed push to integrate mental health services into primary health care systems. Citing alarming statistics, the report emphasizes the profound burden of mental, neurological, and substance use disorders, particularly in low- and middle-income countries where such conditions contribute disproportionately to disability and premature death. Despite growing international awareness, the resources and trained personnel to meet this burden remain acutely insufficient, leading to significant treatment gaps. The World Health Organization (WHO), through its Comprehensive Mental Health Action Plan 2013–2030, has called for the integration of mental health services into primary care as a central pillar in achieving Universal Health Coverage. While countries in the WHO Eastern Mediterranean Region (EMR) have demonstrated greater policy engagement than their global peers, real-world implementation remains patchy, and practical models for integration are still evolving.

Nurses at the Frontline: An Untapped Resource

Central to the authors’ proposal is the transformative potential of advanced practice nurses (APNs) in bridging the divide between psychiatric and primary care. These nurses, defined by their expert clinical knowledge, expanded decision-making capabilities, and additional education, represent a crucial yet underutilized tier of the healthcare workforce. The roles of clinical nurse specialists and nurse practitioners are well recognized in many parts of the world, but in the Arab countries of the EMR, they remain largely unregulated and underdeveloped. Despite these challenges, the authors argue that the tide is beginning to shift, with increasing recognition of the value APNs can bring to health systems struggling to manage rising mental health demands. These specially trained nurses can work directly with general practitioners (GPs), offering psychoeducation to patients, administering evidence-based counseling, and streamlining referrals to psychiatrists for complex or treatment-resistant cases. By embedding themselves in primary care settings, mental health APNs can also act as vital intermediaries, supporting GPs in ways that elevate clinical capacity and overall care quality.

Supervision That Sticks: A New Model for GP Support

A particularly novel aspect of the letter’s argument is its emphasis on clinical supervision. Training GPs to handle mental health issues is widely regarded as a crucial strategy, but the authors stress that without continuous supervision, such training tends to lose impact over time. The WHO and other global health bodies have echoed this sentiment, identifying regular, structured follow-up as essential to ensure quality care and practitioner confidence. However, psychiatrists, often burdened with their own caseloads, typically offer only periodic supervision, through scheduled visits or remote consultations, which can leave GPs feeling unsupported. The authors propose that mental health APNs could fill this gap by offering daily, integrated supervision as part of their existing duties. Unlike sporadic oversight from psychiatrists, this form of embedded support would allow for real-time feedback, collaborative problem-solving, and ongoing mentorship. It would help solidify mental health skills among GPs and ensure adherence to best practices. More than a practical solution, this model represents a paradigm shift in how mental health expertise is distributed and sustained within primary care.

Elevating Nursing and Redefining Teamwork

Beyond its clinical benefits, the integration of APNs in mental health settings may also catalyze broader improvements in healthcare systems. The authors highlight research suggesting that stronger nurse-physician collaboration correlates with better patient outcomes, more efficient services, and improved job satisfaction across professional lines. By positioning APNs as both supervisors and collaborators, the model challenges traditional hierarchies and acknowledges the expertise that nurses bring to multidisciplinary teams. This shift can help elevate the status of nursing as a profession while simultaneously reducing the burden on overstretched physicians. Moreover, such collaboration fosters a culture of mutual respect and shared responsibility, which has been shown to enhance service delivery and patient trust. The authors suggest that this dual benefit, clinical improvement and professional empowerment, makes the APN integration model a win-win for healthcare systems seeking innovation under resource constraints.

NGOs and Governments Must Lead the Way

Recognizing the operational challenges involved in rolling out such a transformative model, the authors call on both governments and non-governmental organizations (NGOs) to step up. In many EMR countries, NGOs already play a central role in mental health advocacy and service delivery. The letter urges these organizations to incorporate APNs into their existing service delivery models and to work alongside ministries of health, education, and social affairs to establish the necessary regulatory, educational, and logistical infrastructure. This includes the development of certification programs, practice guidelines, and legal protections that can help institutionalize the APN role within national mental health frameworks. The authors stress that this collaboration will be key to unlocking the full potential of mental health APNs, not just as a stopgap solution but as a foundational element of future-ready healthcare systems.

The authors present a clear, evidence-informed roadmap for integrating mental health into primary care, one that prioritizes sustainability, empowerment, and local adaptation. By elevating the role of advanced practice nurses, they offer a timely and pragmatic solution to one of the most persistent challenges in global health. Their call is not merely to plug a gap, but to reimagine care delivery through collaboration, innovation, and trust in underutilized professionals. In doing so, they provide a bold vision for mental health systems that are both more inclusive and more effective.