Mental health professional
The examples and perspective in this article deal primarily with North America and do not represent a worldwide view of the subject. (December 2010) |
A mental health professional is a
Psychiatrists - physicians who use the biomedical model to treat mental health problems - may prescribe medication. The term counselors often refers to office-based professionals who offer therapy sessions to their clients, operated by organizations such as pastoral counseling (which may or may not work with long-term services clients) and family counselors. Mental health counselors may refer to counselors working in residential services in the field of mental health in community programs.
As community professionals
As Dr. William Anthony, father of psychiatric rehabilitation, described,
The community support framework in the US of the 1970s[4][5][6] is taken-for-granted as the base for new treatment developments (e.g., eating disorders, drug addiction programs) which tend to be free-standing clinics for specific "disorders". Typically, the term "mental health professional" does not refer to other categorical disability areas, such as intellectual and developmental disability (which trains its own professionals and maintains its own journals, and US state systems and institutions). Psychiatric rehabilitation has also been reintroduced into the transfer to behavioral health care systems.
As certified and licensed (across institutions and communities)
These professionals often deal with the same illnesses, disorders, conditions, and issues (though may separate on-site locations, such as hospital or community for the same clientele); however, their
In 2013, new mental health practitioners are licensed or certified in the community (e.g., PhD, education in private clinical practice) by states, degrees and certifications are offered in fields such as psychiatric rehabilitation (MS, PhD), BA psychology (liberal arts, experimental/clinical/existential/community) to MA licensing is now more popular, BA (to PhD) mid-level program management, qualified civil service professionals, and social workers remain the mainstay of community admissions procedures (licensed by state, often generic training) in the US. Surprisingly, state direction has moved from psychiatry or clinical psychology to community leadership and professionalization of community services management.
Entry level recruitment and training remain a primary concern (since the 1970s, then often competing with fast food positions), and the US Direct Support Workforce includes an emphasis on also training of psychiatric aides, behavioral aides, and addictions aides to work in homes and communities.[8] The Centers for Medicaid and Medicare have new provisions for "self-direction" in services and new options are in place for individual plans for better life outcomes. Community programs are increasingly using health care financing, such as Medicaid, and Mental Health Parity is now law in the US.
Professional distinctions
Comparison of American mental health professionals
The examples and perspective in this article deal primarily with North America and do not represent a worldwide view of the subject. (December 2010) |
Occupation | Degree | Common licenses | Prescription privilege | Average income (US$) |
---|---|---|---|---|
Psychiatrist | MD/DO[9] | Physician | Yes | $275,000[10] |
Psychiatric Rehabilitation Counselor | Master of Rehabilitation Sciences[11] PhD Doctor of Philosophy | Similar to Related Personnel (Cognitive Sciences), Rehabilitation Counselors | No | $50,000 |
Clinical Psychologist
|
PhD/PsyD | Psychologist | Varies by State[a] | $85,000[13] |
School Psychologist | Doctoral level PhD/EdD/PsyD
Post-master's terminal degree (not doctoral level) EdS Doctoral degrees, PhD Inclusion educators Master's level MA/MS |
Certified School Psychology, National Certified School Psychologist | No | $78,000 |
Counselor/Psychotherapist (Doctorate) | DMFT
|
Psychologist | No | $45,000-$75,000 |
Counselor/Psychotherapist/Rehabilitation/Mental Health (Master's) | MA/MS/MC plus two to three years of post-master's supervised clinical experience[14] | LMHC
|
No | $49,000 |
Clinical or Psychiatric Social Worker | MSW/DSW/PhD plus two to three years of post-master's supervised clinical experience | LCSW /LMSW/LSW
|
No | $50,700 |
Social Worker (agency based master's/doctoral levels) | MSW/DSW/PhD[15] | LMSW/GSW/LSW | No | $46,170-$70,000 |
Social Worker (bachelor or diploma level)
|
BSW or SSW[15] | RSW, RSSW, SWA, social work assistant | No | $35,000 |
Occupational therapist (Doctorate/master level) | MOT, MSOT, OTD, ScD, PhD | Related supervised community personnel in physical, speech and communication, OTR, COTA | No | $45,000-69,630 |
Licensed behavior analysts Licensed dual inclusion educators (Doctorate/master level)
Behavior analyst, substance abuse and behavioral disorders, "inclusion educator" |
PhD/EdD/MS/MEd/MA | LBA/LBS/BCBA/BCBA-D[16] Dual Licensed inclusion educator | No | $60,000, $80,000 up for inclusion educator |
Psychiatric-mental health nurse practitioner | MSN/DNP/PhD | PMHNP-BC[17][18] | Yes | $128,000[19] |
Physician assistant | MPAS/MHS/MMS/DScPA | PA/PA-C/APA-C/RPA/RPA-C | Yes | $124,000[20] |
Expressive Therapist/Creative Arts Therapist
|
MA/ATR/ATR-BC[21] | RDT/CPT
|
No | $30,000-70,000 |
- ^ Currently, psychologists may prescribe in six states: Colorado, Iowa, Idaho, Illinois, Louisiana, and New Mexico, as well as in the Public Health Service, the Indian Health Service, the U.S. military, and Guam.[12]
Additional Sources/Clarifications:[23] now operating programs with health care financing in the community. Higher paid medical and health services manager which only operates facilities,[24] considered to be easier than dispersed services management in the community for long-term services and supports (LTSS) often by disability NGOs or state governments (civil service).
The Mental Health Professional Class has often not been included in these occupational schemas in which Occupational Handbooks often separate Human Service Management Classes and Professional Classes from the term Health Care. Common salary ranges are in the $30,000-40,000 for the higher professional at the small community agency. The professionals are considered to be part of the federal Health and Human Services Professions. Their responsibilities at the high gates are greater than a psychiatrist assistant who is responsible, to date, only to the psychiatrist. The occupational therapist is considered as an aide to that professional level, as is a behavioral specialist as hired by the agency and the nurse practitioner. Mental health workers in the community (e.g., workers with the homeless, in homes, families and jails, community programs such as group homes) may still be termed Community Support Workers with diverse degrees and qualifications [US Direct Support Professional Workforce].
Children's professionals in the field of mental health include inclusion educators (over $80,000 at the PhD levels) who have been cross-educated in the fields, and "residential treatment" personnel which need dual reviews of credentials (child care, family support, child welfare, independent living, special education and home life, residential skills training programs).
Treatment diversity and community mental health
Mental health professionals exist to improve the mental health of individuals, couples, families and the community-at-large. [In this generic use, mental health is available to the entire population, similar to the use by mental health associations.] 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; still, others work on population-based health promotion or prevention activities. Often, as with the case of psychiatrists and psychologists, the scope of practice may overlap often due to common hiring and promotion practices by employers.
As indicated earlier, community mental health professionals have been involved in the beginning and operating community programs which include ongoing efforts to improve life outcomes, originally through long term services and supports (LTSS). Termed functional or competency-based programs, this service also stressed decision making and self-determination or empowerment as critical aspects. Community mental health professionals may also serve children who have different needs, as do families, including family therapy, financial assistance and support services. Community mental health professionals serve people of all ages from young children with autism, to children with emotional (or behavioral) needs, to grandma who has Alzheimer's or dementia and is living at home after dad dies.
Most qualified mental health professionals will refer a
Primary care providers, such as internists, pediatricians, and family physicians, may provide initial components of mental health diagnosis and treatment for children and adults; however, family physicians in some states refuse to even prescribe a psychotropic medication deferring to separately funded "medication management" services. Community programs in the categorical field of mental health were designed (1970s) to have a personal family physician for every client in their programs, except for institutional settings and nursing facilities which have only one or two for a large facility (1980, 2013).
In particular, family physicians are trained during residency in interviewing and diagnostic skills, and may be quite skilled in managing conditions such as
Relative effectiveness
Both primary care physicians (PCP) (also known as General Practitioners (GP)) and psychiatrist are just as effective (in terms of remission rates) for the treatment of depression.[25] However, treatment resistant depression, suicidal, homicidal ideation, psychosis and catatonia should be handled by mental health specialists. Treatment-resistant depression (or treatment refractory depression) refers to depression which remains at large after at least two antidepressant medications have been trailed on their own.
Peer workers
Some think that mental health professionals are less credible when they have personal experience of mental health. In fact, the mental health sector goes out of its way to hire people with mental illness experience. Those in the mental health workforce with personal experience of mental health are referred to as 'peer support workers' or 'peer support specialists'. The balance of evidence appears to favor their employment:[26] Randomized controlled trials consistently demonstrate peer staff produce outcomes on par with non-peer staff in ancillary roles, but they actually perform better in reducing hospitalization rates, engaging clients who are difficult to reach, and cutting substance use. There is research that indicates peer workers cultivate a perception among service users that the service is more responsive to non-treatment things, increases their hope, family satisfaction, self-esteem and community belonging.[27]
Psychiatrists
Psychiatrists are
Psychiatrists may also go through significant training to conduct psychotherapy and cognitive behavioral therapy. 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. [Cognitive therapy also stems from cognitive rehabilitation techniques, and may involve long-term community clients with brain injuries seeking jobs, education and community housing.] In the 1970s, psychiatrists were considered to be hospital-based, assessment, and clinical education personnel which was not involved in establishing community programs.
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
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,
Educational requirements for psychiatrists
Typically the requirements to become a psychiatrist are substantial but differ from country to country.[28][29] 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 licensed psychiatrist.
In the United States and Canada one must first complete a Bachelor's degree.[29] Students may typically decide any major subject of their choice, however they must enroll in specific courses, usually outlined in a pre-medical program.[29] One must then apply to and attend 4 years of medical school in order to earn his MD or DO and to complete his medical education.[29] 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,[29] 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.[29] 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
Clinical psychologists
A clinical psychologist studies and applies
Specialties of clinical psychologists
Clinical psychologists who focus on treating mental health specializes in evaluating patients and providing psychotherapy. They do not prescribe medication as this is a role of a psychiatrist (physician who specializes in psychiatry). There are a wide variety of therapeutic techniques and perspectives that guide practitioners, although most fall into the major categories of
In addition to therapy, clinical psychologists are also trained to administer and interpret psychological personality tests such as the
Educational requirements for clinical psychologists
Clinical psychologists, having completed an
Today, in the U.S., about half of licensed psychologists are trained in the
Continuing education requirements for clinical psychologists
Most states in the US require clinical psychologists to obtain a certain number of continuing education credits in order to renew their license. This was established to ensure that psychologists stay current with information and practices in their fields. The license renewal cycle varies, but renewal is generally required every two years.[35]
The number of continuing education credits required for clinical psychologists varies between states. In Nebraska, psychologists are required to obtain 24 hours of approved continuing education credits in the 24 months before their license renewal.[36] In California, the requirement is for 36 hours of credits. New York State does not have any continuing education requirements for license renewal at this time (2014).[37]
Activities that count towards continuing education credits generally include completing courses, publishing research papers, teaching classes, home study, and attending workshops. Some states require that a certain number of the education credits be in ethics. Most states allow psychologists to self-report their credits but randomly audit individual psychologists to ensure compliance.
Counseling psychologist or psychotherapist
One may practice as a counseling psychologist with a PhD or EdD, and as a counseling psychotherapist with a master's 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).[40] Despite these differences, there is considerable overlap between the two fields and distinctions between them continue to fade.
Mental health counselors and residential counselors are also the name for another class of counselors or mental health professionals who may work with long-term services and supports (LTSS) clients in the community. Such counselors may be advanced or senior staff members in a community program, and may be involved in developing skill teaching, active listening (and similar psychological and educational methods), and community participation programs. They also are often skilled in on-site intervention, redirection and emergency techniques. Supervisory personnel often advance from this class of workers in community programs.
Behavior analysts and community/institutional roles
Behavior analysts are licensed in five states to provide services for clients with
Behavior analysts (who grew from the definition of mental health as a behavioral problem) often use community situational activities, life events, functional teaching, community "reinforcers", family and community staff as intervenors, and structured interventions as the base in which they may be called upon to provide skilled professional assistance. Approaches that are based upon person-centered approaches have been used to update the stricter, hospital based interventions used by behavior analysts for applicability to community environments[44] Behavioral approaches have often been infused with efforts at client self-determination, have been aligned with community lifestyle planning, and have been criticized as "aversive technology" which was "outlawed" in the field of severe disabilities in the 1990s.
School psychologist and inclusion educators
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-master's educational specialist degree (EdS), EdD or Doctor of Philosophy (PhD) 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.[45]
In today's world, the school psychologist remains the responsible party in "mental health" regarding children with emotional and behavioral needs, and have not always met these needs in the regular school environment. Inclusion (special) educators support participation in local school programs and after school programs, including new initiatives such as Achieve my Plan by the Research and Training Center on Family Support and Children's Mental Health at Portland State University.[46] Referrals to residential schools and certification of the personnel involved in the residential schools and campuses have been a multi-decade concern with counties often involved in national efforts to better support these children and youth in local schools, families, homes and communities.[47]
Psychiatric rehabilitation
Psychiatric rehabilitation professionals (and psychosocial services) are the mainstay of community programs in the US, and the national service providers association itself may certify mental health staff in these areas. Psychiatric interventions which vary from behavioral ones are described in a review on their use in "residential, vocational, social or educational role functioning" as a "preferred methods for helping individuals with serious psychiatric disabilities".[50] Other competencies in education may involve working with families, user-directed planning methods and financing, housing and support, personal assistance services, transitional or supported employment, Americans with Disabilities Act (ADA), supported housing, integrated approaches (e.g., substance use, or intellectual disabilities), and psychosocial interventions, among others.[51] In addition, rehabilitation counselors (PhD, MS) may also be educated "generically" (breadth and depth) or for all diagnostic groups, and can work in these fields; other personnel may have certifications in areas such as supported employment which has been verified for use in psychiatric, neurological, traumatic brain injury, and intellectual disabilities, among others.[52]
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 master's 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 or others 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
Social workers in England and Wales are now able to become Approved Clinicians (AC) under the
In general, it is the psycho-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 constructiveness. 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 service users.[53]
Social workers also prepare social work administration and may hold positions in human services systems as administration or Executives to Administration in the US. Social workers, similar to psychiatric rehabilitation, updates its professional education programs based upon current developments in the fields (e.g., support services) and serve a multicultural client base.[54][55]
Educational requirements for social workers
In the United States, the minimum requirement for social workers is generally a bachelor's degree in social work, though a bachelor's degree in a related field such as sociology or psychology may qualify an applicant for certain jobs. Higher-level jobs typically require a master's degree in social work. Master's programs in social work usually last two years and consist of at least 900 hours of supervised instruction in the field.[56] Regulatory boards generally require that degrees be obtained from programs that are accredited by the Council of Social Work Education (CSWE) or another nationally recognized accrediting agency for promotion and future collaboration.[57]
Before social workers can practice, they are required to meet the licensing, certification, or registration requirements of the state. The requirements vary depending on the state but usually involve a minimum number of supervised hours in the field and passing of an exam.[56] All states except California also require pre-licensure from the Association of Social Work Boards (ASWB).
The ASWB offers four categories of social work license. The lowest level is a Bachelors, for which a bachelor's degree in social work is required. The next level up is a Masters and a master's degree in social work is required. The Advanced Generalist category of social worker requires a master's degree in social work and two years of supervised post-degree experience. The highest ASWB category is a Clinical Social Worker which requires a master's degree in social work along with two years of post-master's direct experience in social work.
Continuing education requirements for social workers
Most states require social workers to acquire a minimum number of continuing education credits per license, certification, or registration renewal period. The purpose of these requirements is to ensure that social workers stay up-to-date with information and practices in their professions. In most states, the renewal process occurs every two or three years. The number of continuing education credits that is required varies between states but is generally 20 to 45 hours[58] during the two- or three-year period prior to renewal.
Courses and programs that are approved as continuing education for social workers generally must be relevant to the profession and contribute to the advancement of professional competence. They often include continuing education courses, seminars, training programs, community service, research, publishing articles, or serving on a panel.[59] Many states enforce that a minimum amount of the credits be on topics such as ethics, HIV/AIDs, or domestic violence.
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 psycho-social 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 (typically the province of the MD or PhD), 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 course of general
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 master's entry level nursing graduate programs intended for individuals with a bachelor's degree outside of nursing) the test for a license as a registered nurse (the NCLEX-RN) must be passed. Next, the candidate must complete a state-approved master's degree advanced nursing education program which includes at least 600 clinical hours. Several schools are now also offering further education and awarding a DNP (Doctor of Nursing Practice).
Individuals who choose a master's 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.[60][61][62]
A mental health care navigator is an individual who assists patients and families to find appropriate mental health
Many mental health organizations use "navigator" and "navigation" to describe the service of providing guidance through the health care industry.[63][64][65][66] Care navigators are also sometimes referred to as "system navigators".[67] One type of care navigator is an "educational consultant".[68]
Workforce shortage
Behavioral health disorders are prevalent in the United States, but accessing treatment can be challenging. Nearly 1 in 5 adults experience a mental health condition for which approximately only 43% received treatment.[69] When asked about access to mental health treatment, two-thirds of primary care physicians reported that they were unable to secure outpatient mental health treatment for their patients.[70] This is due, in part, to the workforce shortage in behavioral health. In rural areas, 55% of US counties have no practicing psychiatrist, psychologist, or social worker. Overall, 77% of counties have a severe shortage of mental health workers and 96% of counties had some unmet need.[71] Some of the reasons for the workforce shortage include high turnover rates, high levels of work-related stress, and inadequate compensation. Annual turnover rate is 33% for clinicians and 23% for clinical supervisors. This is compared to an annual PCP turnover rate of 7.1%. Compensation in behavioral health field is notably low. The average licensed clinical social worker, a position that requires a master's degree and 2000 hours of post-graduate experience, earns $45,000/year. As a point of reference, the average physical therapist earns $75,000/year. Substance abuse counselor earnings are even lower, with an average salary of $34,000/year.[71] Job stress is another factor that may lead to the high turnover rates and workforce shortage. It is estimated that 21-67% of mental health workers experience high levels of burnout including symptoms of emotional exhaustion, high levels of depersonalization and a reduced sense of personal accomplishment.[72] Researchers have offered various recommendations to reduce the critical workforce gaps in behavioral health. Some of these recommendations include the following: expanding loan repayment programs to incentivize mental health providers to work in underserved (often rural) areas, integrating mental health into primary care, and increasing reimbursement to health care professionals.[73]
Social workers also tend to experience competing for work and family demands, which negatively affects their job well-being and subsequently their job satisfaction, resulting in high turnover in the profession.[74]
See also
- Community integration
- Community Psychology
- Clinical Psychology
- List of credentials in psychology
- Psychologist
- Psychotherapy
- Clinical Associate (Psychology)
- Global mental health
- Health care providers
- Inclusion (education)
- Mental health
- Mental illness
- Psychiatric rehabilitation
- Psychiatry
- List of counseling topics
- Supported housing
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Further reading
- Atkinson, Jacqueline M. (2006). Private and Public Protection: Civil Mental Health Legislation. Edinburgh: Dunedin Academic Press. OCLC 929258401.[ISBN missing]
- Tighe, James (April 2007). "Mental health professionals". BBC Health. Archived from the original on 12 February 2011.
- OCLC 872320044.