Eastern Mediterranean Health Journal | All issues | Volume 31 2025 | Volume 31, issue 3 | The role of advanced practice nursing in the integration of mental health into primary care

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The role of advanced practice nursing in the integration of mental health into primary care

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Letter to the editor

Abbas Alameddine1, Marianne Chamoun2 and Jamal Almasri3

1Department of Psychiatry, Hotel-Dieu de France, Beirut, Lebanon (Correspondence to Abbas Alameddine: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ). 2Université Laval, faculté des sciences infirmières, Québec, Canada. 3International Orthodox Christian Charities, Mansourieh, Lebanon.

Keywords: nursing, mental health, primary health care

Citation: Alameddine A, Chamoun M, Almasri J. The role of advanced practice nursing in the integration of mental health into primary care. East Mediterr Health J. 2025;31(3):198–199. https://doi.org/10.26719/2025.31.3.198.

Received: 01/12/2024; Accepted: 26/01/2025

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo

Dear Editor,

Mental, neurologic and substance use disorders are prevalent and impairing conditions that contribute majorly to morbidity and premature mortality (1), and the resources needed to tackle these high burden diseases are often not available, especially in low- and middle-income countries, thus creating a wide treatment gap (2). In its Comprehensive Mental Health Action Plan 2013–2030, the WHO recommends the development of comprehensive community-based mental health programmes and the integration of mental health into primary care. This integration is considered a global target essential for the achievement of Universal Health Coverage (2).

When compared to other WHO regions, Eastern Mediterranean Region (EMR) countries were found to be the most active in developing and adopting guidelines for the integration of mental health into primary health care (3). Although frameworks for the delivery of services have been proposed (4), there is limited understanding of how best to integrate mental health into primary care. Preliminary evidence indicates that integration is feasible and effective, and highlights the role of nurses as effective treatment providers in primary care (5).

An advanced practice nurse is “one who has acquired, through additional education, the expert knowledge base, complex decision-making skills and clinical competencies for expanded nursing practice” (6). The clinical nurse specialist and nurse practitioner are 2 types of advanced practice nurses most frequently identified internationally. Although the advanced practice nurse role is still underdeveloped and lacking regulatory frameworks in most Arab EMR countries, its value and recognition is steadily increasing (7).

In addition to closely working with psychiatrists at the specialized level, we believe that mental health advanced practice nurses can be very effective for the integration of mental health into primary care. They can assist general practitioners in providing psychoeducation and evidence-based counselling as well as in coordinating referrals to specialized services for complex cases. We believe that mental health practice nurses can help general practitioners in their skill and knowledge development, filling an important clinical supervision gap.

Training general practitioners on the management of mental, neurologic and substance use disorders is considered a pillar for scaling up services in nonspecialized settings. It is now recognized that training alone is insufficient; continuous supervision is essential for training to be impactful (8), especially when it includes regular discussions and corrective feedback (9), and when integrated into routine daily practice. Unfortunately, for logistic reasons, psychiatrists tend to conduct clinical supervision less frequently, consisting usually of intermittent programmed formal visits or virtual contacts (10,11). In contrast, because of their expertise and availability, mental health practice nurses can provide effective supervision integrated into their daily practice. Such accessible supervision, in collaboration with psychiatrists, can ideally become a routine mode of operation, allowing them to play a delicate dual role of assisting and simultaneously supervising general practitioners caring for mental, neurologic and substance use patients. We believe that a positive epiphenomenon of this dual role is the valorisation of nurses and nurse-physician collaboration, which has been shown to improve health care services generally (12).

In many EMR countries, local and international nongovernment organizations have become main partners and stakeholders in mental health advocacy and service delivery (3) and can help develop the mental health advanced practice nursing role for the integration of mental health into primary health care. We suggest that these organizations incorporate it into their service provision models and actively work with the ministries of health, social affairs and education to develop the relevant legal, regulatory, logistic and educational frameworks for operationalisation.

Conflicting of interest: None declared.

Funding: None.

References

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  2. World Health Organization. Comprehensive Mental Health Action Plan 2013-2030, 1st ed. Geneva: World Health Organization, 2021. https://www.who.int/publications/i/item/9789240031029.
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