In the United States, a psychiatric-mental health nurse practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. They are licensed to provide emergency psychiatric services, psychosocial and physical assessment of their patients, treatment plans, and manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, and on medication treatment for psychiatric disorders. A PMHNP is trained to practice autonomously. In 24 states, nurse practitioners (NPs) already diagnose and treat without supervision of a psychiatrist. This is in contrast to 2008, when nurse practitioners could autonomously diagnose and treat in 23 states, and could only prescribe in 12 states. In other states, PMHNPs have reduced or restricted practice, requiring a collaborative agreement with a physician expert, a standard scope of practice signed by a physician, or other limits on practice or prescribing. In these states, they still practice independently to diagnose disorders, provide therapy and prescribe medications. Titles vary by state, but usually NP, CRNP, APRN, or ARNP are commonly used. Education The first step to becoming a psychiatric-mental health nurse practitioner is becoming an RN. First it is required to earn a Bachelor of Science in Nursing degree from an accredited 4-year university, or an associate degree in a nursing program. After completing the program of choice, the National Council Licensure Examination for a Registered Nurse (NCLEX-RN) is available to take. One must pass the NCLEX-RN before applying for the state licensure for an RN. After the individual passes the NCLEX-RN, the individual can then start applying to a master’s or doctoral program that is accredited by the Commission on Collegiate Nursing Education (CCNE), or the Accreditation Commission for Education in Nursing (ACEN). A Psychiatric Mental Health Nurse Practitioner degree requires two to five additional years of training. At minimum, the candidate must complete an approved Master of Science in Nursing (MSN), Post-Master's Certificate, or Doctor of Nursing Practice (DNP) advanced nursing education program. Individuals who already possess a bachelor's degree in another field can attend one of many accelerated BSN programs before entering an approved MSN