Contributor, Frances Okpaluba

Should nurses view mental health access as a moral responsibility or an ethical requirement? Although these terms are frequently used synonymously, they possess a slight variation. Ethics represents the structured analysis of morality, while morals demonstrate the principles that influence our individual and professional decisions. For nurses, ethics and morals matter deeply. In fact, ethical knowing in one the fundamental patterns of knowing in nursing.  A responsibility lies at the heart of nursing: to care, advocate, and act. The nursing profession builds on moral sensitivity and professional values that influence our daily ethical decision-making processes. The current most urgent decision facing us involves access to healthcare. Is our voice strong enough to stand for people who battle against barriers to mental health care?

The United States remains one of the world’s most advanced nations but still encounters significant obstacles in delivering timely and fair health services to all its citizens. The mental health care sector remains severely overlooked, resulting in fatal outcomes. The United States had an age-adjusted suicide rate of 14.0 per 100,000 people in 2021. The suicide rate reaches 22.8 per 100,000 individuals among men. According to the CDC and the National Institute of Mental Health data, Texas reported a suicide rate of 14.2 per 100,000 individuals. These are not just numbers. These statistics represent the lives of sons, daughters, friends, and neighbors. Despite these devastating statistics, mental health access expansion efforts continue to face legislative delays in Texas. As nurses, we cannot stay silent. Advocacy is an essential part of our professional responsibilities and a moral and ethical obligation. We must apply our voices and influence alongside compassion to advocate for mental health policies that provide necessary care for everyone before time runs out.

Six Months Too Late: The Mental Health Crisis That Almost Destroyed My Family.

The fall season of 2021 brought about a life-changing event for me. My son delivered the heartbreaking news that my husband was in the garage holding a rope around his neck because he planned to end his own life. During the height of the COVID-19 pandemic, I functioned as a Nurse Practitioner in the ICU, which left me overwhelmed on every level, including physical, emotional, and mental. The daily deaths of patients and the relentless chaos had exhausted me, but the personal crisis that day caught me entirely off guard. During the summer of 2021, my husband received a dystonia diagnosis, followed by brain surgery. Following the brain procedure, his deep depression began as an unfortunate consequence. The mental health stigma in our African community made the situation worse. He denied his difficulties and dismissed any suggestion of getting help.

When my son called, I panicked. I do not even remember the drive home. I felt compelled to rescue him. I rushed my husband to the emergency room but received nothing more than a referral list for psychiatrists. After I made the call, every provider told me about a six-month waiting period. I was furious and heartbroken. What kind of expectation is it to force someone with suicidal thoughts to endure such an extended waiting period? Driven by desperation, I turned to my professional network for support. My colleagues’ doctors helped me secure a virtual meeting with a psychiatrist who accepted my husband as a patient. That appointment was a turning point. What happens to people who lack access to a personal contact network? Countless individuals remain in the dark without assistance to guide them through the healthcare system, which should support them.

Answering the Call

The Texas Department of State Health Services (2024) indicates that more than 243,000 registered nurses were in Texas during 2024, which made them the largest healthcare workforce in the United States and the backbone of Texas healthcare. Although we have large numbers and frontline experience, nurses receive inadequate representation in healthcare policy dialogues that determine mental health access in the future.

Desperate Need for Change.

The incidence of mental health problems keeps increasing nationwide while care access stays unequal, particularly in marginalized areas. Our nursing profession requires us to fulfill moral and ethical responsibilities to support and protect our patients outside traditional patient care settings. Nurses’ duty requires participation as vocal advocates in policy decisions that determine patient access to mental health support.

Why Nurses? Why Now?

The World Health Organization (WHO) describes health policy as the collective decisions and strategies implemented to reach societal healthcare objectives. According to WHO, effective health policy requires collaboration among various professions while staying responsive to community health needs (Hajizadeh et al., 2021). Nurses are the best professionals to deliver practical perspectives on mental healthcare access. As nurses, we encounter every delayed appointment alongside patients who struggle with insurance navigation or transportation problems at every turn while missing chances where mental health support would have helped. Our distinct role enables us to serve as both observers and advocates for equal access to mental health. To bring real change, we need to enter the policy realm with determination.

How to Get Involved: From the Bedside to the Boardroom

You do not need a political science degree or a position in Washington, D.C., to help advance access to mental health care. The first step involves recognizing the power nurses possess and deliberately choosing to apply that power for influence. Envision how our world would transform if 243,000 nurses engaged actively in shaping health care policies and political systems.

Educate Yourself

Familiarize yourself with the issues surrounding mental health access in your local area. The American Nurses Association (ANA), the National Alliance on Mental Illness (NAMI), and the American Psychiatric Nurses Association (APNA) offer updates, advocacy tools, and continuing education opportunities.

Reframe Politics as Advocacy

Many nurses steer clear of policy involvement because they dislike political activities. However, advocacy is not about partisanship. It is about justice. Nursology.net has published blogs that speak to the importance of political activism in nursing, which is informed by nursing’s commitment to health justice.  The focus is to ensure that patients without access to necessary care receive support. Take part in town hall meetings and local coalitions and support your community’s political campaigns and public health boards. Become an active member of your workplace policy committee or establish it if it does not exist. Every conversation counts. Use public speaking to advocate on social media platforms and through op-ed pieces or by communicating with legislative representatives. Use personal accounts to reveal healthcare deficiencies while proving how nurse-led solutions can address these challenges.

The Ethical Mandate

Promoting access to mental health care is a professional challenge and an ethical imperative. The American Nurses Association (ANA) Code of Ethics calls on us to:

• Promote, advocate for, and protect patients’ rights, health, and safety (Provision 3).
• Advance the profession through contributions to practice, education, and policy (Provision 7)
• Collaborate to protect human rights and reduce health disparities (Provision 8) (American Nurses Association (ANA), 2015).

Advanced Practice Registered Nurses (APRNs) in Texas and multiple other states face limitations that prevent full utilization of their education and training in professional practice. Full practice authority in some states has led to better patient care access, especially in rural and underserved areas, and has resulted in increased provider retention rates and patient satisfaction improvements (National Academies of Sciences, Engineering, and Medicine, 2021). Your voice holds significance regardless of whether you work in critical care, primary care, school health, or psychiatric nursing. The mental health landscape would undergo a remarkable transformation if all nurses in Texas demanded equitable mental health access through their collective voices. So, let us get involved. Let us get loud. We must unite our efforts both beside patients and in policy-making discussions because our patients need us there. And because we owe it to them.

References:

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses’ participation in the health policy-making process: a systematic review. BMC nursing, 20(1), 128. https://doi.org/10.1186/s12912-021-00648-6

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982

Texas Department of State Health Services. (2024). Registered nurses, 2024. https://www.dshs.texas.gov/center-health-statistics/health-professions-resource-center-hprc/supply-distribution-tables-state-licensed-health-professions-texas/registered-nurses/registered-nurses-2024

About Frances Okpaluba

My name is Frances Okpaluba, and I began my career as a registered nurse in my early twenties. From a young age, I was drawn to the caring professions, with a deep-rooted desire to care for others. As a child, I took it upon myself to check on sick family members, especially at night, to ensure their well-being. This innate sense of responsibility and compassion ultimately guided me toward a career in nursing.Over the past eight years, I have transitioned from providing direct patient care to serving as an advanced practice provider (APP) in critical care. In my current role, I have witnessed firsthand the complex challenges our patients face, including high hospital readmission rates and the rapid decline in health outcomes. It is particularly concerning that, despite being one of the most developed nations, the United States lags behind peer countries in healthcare outcomes. Improving access to care has been identified as a key strategy to address these disparities.

I am pursuing a Doctor of Philosophy in nursing science at Texas Woman’s University. My research focuses on exploring the concept of professional autonomy among intensive care unit (ICU) nurses. The literature suggests that nurses often have limited involvement in healthcare policy development and that other professional groups frequently shape their practice. My research aims to better understand how ICU nurses perceive their autonomy and how this perception influences their engagement in policy-making processes.

Beyond my professional pursuits, I am a proud mother of three teenage boys, two of whom are in college, and the youngest a high school junior. Outside of my role as a nurse practitioner, I sincerely enjoy motherhood, particularly watching my sons grow and thrive. I enjoy cooking, exercising, outdoor activities, and traveling with my children.
I am an active member of several professional organizations, including the American Nurses Association (ANA), the Texas Nurses Association (TNA), the American Association of Critical-Care Nurses (AACN), and the Society of Critical Care Medicine (SCCM), a multidisciplinary organization dedicated to the care of critically ill patients. Additionally, I participate in local politics, church, and charitable organizations, where I frequently hear firsthand accounts of patients’ struggles. I am passionate about encouraging nurses to become more involved in political advocacy and healthcare policy to elevate the voice of the nursing profession and drive systemic change.