Mental health professional

A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists (D.O. or M.D.), psychiatric nurses (RNMH, RMN, CPN), clinical psychologists (Psy.D or Ph.D.), clinical social workers (MSW or MSSW), mental health counselors(MA or MS), professional counselors, pharmacists, as well as many other professionals. These professionals often deal with the same illnesses, disorders, conditions, and issues; however, their scope of practice differs. The most significant difference between mental health professionals are the laws regarding required education and training across the various professions.^[1]

Professional distinctions

Comparison of American mental health professionals

Sources:^{[4][5][6][7][8][9]}

^Only in New Mexico and Louisiana, with limited rights in Indiana and Guam.^[10]

Treatment diversity

Mental health professionals exist to improve the mental health of individuals, couples, and families. Because mental health covers a wide range of elements, the scope of practice greatly varies between professionals. Some professionals may enhance relationships while others treat specific mental disorders and illness. Often, as with the case of psychiatrists and psychologists, the scope of practice may overlap.

Most qualified mental health professionals will refer a patient or client to another professional if the specific type of treatment needed is outside of their scope of practice. Additionally, many mental health professionals may sometimes work together using a variety of treatment options such as concurrent psychiatric medication and psychotherapy. Additionally, specific mental health professionals may be utilized based upon their cultural and religious background or experience.

Increasingly, primary care providers, such as internists, pediatricians, and family physicians, provide many initial components of mental health diagnosis and treatment for children and adults. In particular, family physicians are trained during residency in interviewing and diagnostic skills, and may be quite skilled in managing conditions such as ADHD in children and depression in adults. Likewise, many (but not all) pediatricians may be taught the basic components of ADHD diagnosis and treatment during residency. In many other circumstances, primary care physicians may receive additional training and experience in mental health diagnosis and treatment during their practice years.

Psychiatrist

Psychiatrists are physicians and one of the few professionals in the mental health industry who specialize and are certified in treating mental illness using the biomedical approach to mental disorders including the use of medications.

Psychiatrists may also go through significant training to conduct psychotherapy and cognitive behavioral therapy; however psychologists and clinical psychologists specialize in the research and clinical application of these techniques. The amount of training a psychiatrist holds in providing these types of therapies varies from program to program and also differs greatly based upon region.

Specialties of psychiatrists

As part of their evaluation of the patient, psychiatrists are one of only a few mental health professionals who may conduct physical examinations, order and interpret laboratory tests and EEGs, and may order brain imaging studies such as CT or CAT, MRI, and PET scanning. A medical professional must evaluate the patient for any medical problems or diseases that may be the cause of the mental illness.

Historically psychiatrists have been the only mental health professional with the power to prescribe medication to treat specific types of mental illness. Currently, Physician Assistants and advanced practice psychiatric nurses may prescribe medications, including psychiatric medications. Clinical psychologists have gained the ability to prescribe psychiatric medications on a limited basis in a few U.S. states after completing additional training and passing an examination.

Educational requirements for psychiatrists

Typically the requirements to become a psychiatrist are substantial but differ from country to country.^[11][12] In general there is an initial period of several years of academic and clinical training and supervised work in different areas of medicine, in order to become a licensed medical doctor, followed by several years of supervised work and study in psychiatry, in order to become a liceensed psychiatrist.

In the United States and Canada one must first complete a Bachelor's degree.^[12] Students may typically decide any major subject of their choice, however they must enroll in specific courses, usually outlined in a pre-medical program.^[12] One must then apply to and attend 4 years of medical school in order to earn their MD or DO and to complete their medical education.^[12] Psychiatrists must then pass three successive rigorous national board exams (United States Medical Licensing Exams "USMLE", Steps 1, 2, and 3), which draws questions from all fields of medicine and surgery, before gaining an unrestricted license to practice medicine. Following this, the individual must complete a four-year residency in Psychiatry as a psychiatric resident and sit for annual national in-service exams. Psychiatry residents are required to complete at least four post-graduate months of internal medicine (pediatrics may be substituted for some or all of the internal medicine months for those planning to specialize in child and adolescent psychiatry) and two months of neurology, usually during the first year,^[12] but some programs require more. Occasionally, some prospective psychiatry residents will choose to do a transitional year internship in medicine or general surgery, in which case they may complete the two months of neurology later in their residency. After completing their training, psychiatrists take written and then oral specialty board examinations.^[12] The total amount of time required to qualify in the field of psychiatry in the United States is typically 4 to 5 years after obtaining the MD or DO (or in total 8 to 9 years minimum). Many psychiatrists pursue an additional 1–2 years in subspecialty fellowships on top of this such as child psychiatry, geriatric psychiatry, and psychosomatic medicine.

In the United Kingdom, the Republic of Ireland, and most Commonwealth countries, the initial degree is the combined Bachelor of Medicine and Bachelor of Surgery,^[11] usually a single period of academic and clinical study lasting around five years. This degree is most often abbreviated 'MBChB', 'MB BS' or other variations, and is the equivalent of the American 'MD'. Following this the individual must complete a two-year foundation programme^[11] that mainly consists of supervised paid work as a Foundation House Officer within different specialties of medicine.^[13] Upon completion the individual can apply for "core specialist training" in psychiatry, which mainly involves supervised paid work as a Specialty Registrar in different subspecialities of psychiatry.^[14] After three years there is an examination for Membership of the Royal College of Psychiatrists (abbreviated MRCPsych), with which an individual may then work as a "Staff grade" or "Associate Specialist" psychiatrist, or pursue an academic psychiatry route via a PhD.^[15] If, after the MRCPsych, an additional 3 years of specialization known as "advanced specialist training" are taken (again mainly paid work), and a Certificate of Completion of Training is awarded, the individual can apply for a post taking independent clinical responsibility as a "consultant" psychiatrist.^[16]

Clinical psychologist

A clinical psychologist studies and applies psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. In many countries it is a regulated profession that addresses moderate to more severe or chronic psychological problems, including diagnosable mental disorders. Clinical psychology includes a wide range of practices, such as research, psychological assessment, teaching, consultation, forensic testimony, and program development and administration. Central to clinical psychology is the practice of psychotherapy, which uses a wide range of techniques to change thoughts, feelings, or behaviors in service to enhancing subjective well-being, mental health, and life functioning. Unlike other mental health professionals, psychologists are trained to conduct psychological assessment. Clinical psychologists can work with individuals, couples, children, older adults, families, small groups, and communities.

Specialties of clinical psychologists

Clinical psychologists who focus on treating mental health specialize in evaluating patients and providing psychotherapy and prescribing medication. There are a wide variety of therapeutic techniques and perspectives that guide practitioners, although most fall into the major categories of Psychodynamic, Cognitive Behavioral, Existential-Humanistic, and Systems Therapy (e.g. family or couples therapy).

In addition to therapy, clinical psychologists are also trained to administer and interpret psychological personality tests such as the MMPI and the Rorschach inkblot test, and various standardized tests of intelligence, memory, and neuropsychological functioning. Common areas of specialization include: specific disorders (e.g. trauma or depression), neuropsychological disorders, child and adolescent, family and relationship counseling. Internationally, psychologists are generally not granted prescription privileges. In the US, prescriptive rights have been granted to appropriately trained psychologists only in the states of New Mexico and Louisiana, with some limited prescriptive rights in Indiana and the US territory of Guam.^[10]

Educational requirements for clinical psychologists

Clinical psychologists, having completed an undergraduate degree usually in psychology or other social science, generally undergo specialist postgraduate training lasting at least two years (e.g. Australia), three years (e.g. UK), or four to six years depending how much research activity is included in the course (e.g. US). In countries where the course is of shorter duration, there may be an informal requirement for applicants to have undertaken prior work experience supervised by a clinical psychologist, and a proportion of applicants may also undertake a separate PhD research degree.

Today, in the U.S., about half of licensed psychologists are trained in the Scientist-Practitioner Model of Clinical Psychology (PhD)—a model that emphasizes both research and clinical practice and is usually housed in universities. The other half are being trained within a Practitioner-Scholar Model of Clinical Psychology (PsyD), which focuses on practice (similar to professional degrees for medicine and law).^[17] A third training model called the Clinical Scientist Model emphasizes training in clinical psychology research. Outside of coursework, graduates of both programs generally are required to have had 2 to 3 years of supervised clinical experience, a certain amount of personal psychotherapy, and the completion of a dissertation (PhD programs usually require original quantitative empirical research, whereas the PsyD equivalent of dissertation research often consists of literature review and qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis, or clinical application and analysis).

Counseling psychologist or psychotherapist

Counseling generally involves helping people with what might be considered "normal" or "moderate" psychological problems, such as the feelings of anxiety or sadness resulting from major life changes or events.^[18][19] As such, counseling psychologists often help people adjust to or cope with their environment or major events, although many also work with more serious problems as well.

One may practice as a counseling psychologist with a PhD or EdD, and as a counseling psychotherapist with a Masters degree. Compared with clinical psychology, there are fewer counseling psychology graduate programs (which are commonly housed in departments of education), counselors tend to conduct more vocational assessment and less projective or objective assessment, and they are more likely to work in public service or university clinics (rather than hospitals or private practice).^[20] Despite these differences, there is considerable overlap between the two fields and distinctions between them continue to fade.

Behavior Analyst

Behavior analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness. This profession draws on the evidence base of applied behavior analysis, behavior therapy, and the philosophy of behaviorism. Behavior analysts have at least a master's degree in behavior analysis or in a mental health related discipline as well as at least five core courses in applied behavior analysis. Many behavior analysts have a doctorate. Most programs have a formalized internship program and several programs are offered online. Most practitioners have passed the examination offered by the behavior analysis certification board or the examination in clinical behavior therapy by the World Association for Behavior Analysis . The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

Certified Mental Health Professional

The Certified Mental Health Professional (CMHP) certification is designed to measure an individual’s competency in performing the following job tasks. The job tasks are not presented in any particular order of importance.

1. Maintain confidentiality of records relating to clients’ treatment.
2. Encourage clients to express their feelings, discuss what is happening in their lives, and help them to develop insight into themselves and their relationships.
3. Guide clients in the development of skills and strategies for dealing with their problems.
4. Prepare and maintain all required treatment records and reports.
5. Counsel clients and patients, individually and in group sessions, to assist in overcoming dependencies, adjusting to life, and making changes.
6. Collect information about clients through interviews, observations, and tests.
7. Act as the client’s advocate in order to coordinate required services or to resolve emergency problems in crisis situations.
8. Develop and implement treatment plans based on clinical experience and knowledge.
9. Collaborate with other staff members to perform clinical assessments and develop treatment plans.
10. Evaluate client’s physical or mental condition based on review of client information.

School psychologist

School psychologists' primary concern is with the academic, social, and emotional well-being of children within a scholastic environment. Unlike clinical psychologists, they receive much more training in education, child development and behavior, and the psychology of learning, often graduating with a post-Masters Educational Specialist Degree (EdS), EdD or Doctor of Philosophy (Ph D) degree. Besides offering individual and group therapy with children and their families, school psychologists also evaluate school programs, provide cognitive assessment, help design prevention programs (e.g. reducing drops outs), and work with teachers and administrators to help maximize teaching efficacy, both in the classroom and systemically.^[21]

Social worker

Social workers in the area of mental health may assess, treat, develop treatment plans, provide case management and/or rights advocacy to individuals with mental health problems. They can work independently or within clinics/service agencies, usually in collaboration with other health care professionals.

In the US, they are often referred to as clinical social workers; each state specifies the responsibilities and limitations of this profession. State licensing boards and national certification boards require clinical social workers to have a masters or doctoral degree (MSW or DSW/PhD) from a university. The doctorate in social work requires submission of a major original contribution to the field in order to be awarded the degree.

In the UK there is a now a standardized three-year undergraduate social work degree, or two-year postgraduate Masters for those who already have an undergraduate social sciences degree and relevant work experience. These courses include mandatory supervised work experience in social work, which may include mental health services. Successful completion allows an individual to register and work as a qualified social worker. There are various additional optional courses for gaining qualifications specific to mental health, for example training in psychotherapy or, in England and Wales, for the role of Approved Mental Health Professional (two years' training for a legal role in the assessment and detention of eligible mentally disordered people under the Mental Health Act (1983) as amended in 2007).

In general, it is the social model rather than, or in addition to, the dominant medical model, that is the underlying rationale for mental health social work. This may include a focus on social causation, labeling, critical theory and social constructivism. Many argue social workers need to work with medical and health colleagues to provide an effective service but they also need to be at the forefront of processes that include and empower services users.^[22]

Psychiatric and mental health nurse

Psychiatric Nurses or Mental Health Nurse Practitioners work with people with a large variety of mental health problems, often at the time of highest distress, and usually within hospital settings. These professionals work in primary care facilities, outpatient mental health clinics, as well as in hospitals and community health centers. MHNPs evaluate and provide care for patients who have anything from psychiatric disorders, medical mental conditions, to substance abuse problems. They are licensed to provide emergency psychiatric services, assess the psychosocial and physical state of their patients, create treatment plans, and continually manage their care. They may also serve as consultants or as educators for families and staff; however, the MHNP has a greater focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms and on medication treatment for psychiatric disorders.

Educational requirements for psychiatric and mental health nurses

Psychiatric and mental health nurses receive specialist education to work in this area. In some countries it is required that a full general nurse training be completed prior to specializing as a psychiatric nurse. In other countries, such as the U.K., an individual completes a specific nurse training course that determines their area of work. As with other areas of nursing, it is becoming usual for psychiatric nurses to be educated to degree level and beyond.

In order to become a nurse practitioner in the U.S., at least six years of college education must be obtained. After earning the Bachelor's degree (usually in nursing, although there are Masters Entry Level Nursing graduate programs intended for individuals with a Bachelors degree outside of nursing) the test for licensure as a registered nurse (the NCLEX-RN) must be passed. Next, the candidate must complete a state-approved Masters Degree advanced nursing education program which includes at least 600 clinical hours. Several schools are now also offering further education and awarding a DNP( Doctorate of Nurse Practice).

Individuals who choose a Masters Entry Level pathway will spend an extra year at the start of the program taking classes necessary to pass the NCLEX-RN. Some schools will issue a BSN, others will issue a certificate. The student then continues with the normal MSN program.^{[23][24][25][26]}

See also

• Health care providers
• Mental health
• Mental illness
• Global mental health
• Psychiatry
  • Anti-psychiatry
• Psychology
  • Clinical Psychology
  • List of credentials in psychology
  • Psychologist
  • Psychotherapy
  • Clinical Associate (Psychology)
• List of counseling topics

References

Further reading

• Atkinson, J. (2006) Private and Public Protection: Civil Mental Health Legislation, Edinburgh, Dunedin Academic Press.
• BBC Headroom: What job do Mental Health Professionals perform?
• World Health Organization. (2011) Human resources for mental health: workforce shortages in low- and middle-income countries. Geneva, WHO Press.