A mental health professional is a health care practitioner or community services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders.
This broad category was developed as a name for community personnel
who worked in the new community mental health agencies begun in the
1970s to assist individuals moving from state hospitals, to prevent
admissions, and to provide support in homes, jobs, education and
community. These individuals (i.e., state office personnel, private
sector personnel, and non-profit, now voluntary sector personnel) were
the forefront brigade to develop the community programs, which today may
be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.
The category seldom includes psychiatrists (DO or MD) who remained institutional based and guarded the admissions procedures at institutionalization (both private and state specialty hospitals). However, in 2013, psychiatrists also are working in clinical fields with psychologists including in sociobehavioral, neurological, person-centered and clinical approaches (often office-based), and studies of the "brain disease" (which came from the community fields and community management and are taught at the MA to PhD level in education). For example, Nat Raskin (at Northwestern University Medical School) who worked with the illustrious Carl Rogers, published on person-centered approaches and therapy in 2004. 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.
The category seldom includes psychiatrists (DO or MD) who remained institutional based and guarded the admissions procedures at institutionalization (both private and state specialty hospitals). However, in 2013, psychiatrists also are working in clinical fields with psychologists including in sociobehavioral, neurological, person-centered and clinical approaches (often office-based), and studies of the "brain disease" (which came from the community fields and community management and are taught at the MA to PhD level in education). For example, Nat Raskin (at Northwestern University Medical School) who worked with the illustrious Carl Rogers, published on person-centered approaches and therapy in 2004. 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, psychiatric nurses (RNMH, RMN, CPN), clinical psychologists (PsyD or PhD), clinical social workers (MSW or MSSW), mental health counselors (MA or MS), professional counselors, pharmacists,
as well as many other professionals are often educated in "psychiatric
fields" or conversely, educated in a generic community approach (e.v
fdcgaxbgcg., human services programs, or health and human services in
2013). However, histxt primary concern is education that leads to a
willingness to work with "long-term services and supports" community
support in the community to lead to better life quality for the individual, the families and the community.
The community support framework in the US of the 1970s
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 scope of practice
differs and more particularly, their positions and roles in the fields
of mental health services and systems. The most significant difference
between mental health professionals are the laws regarding required education and training across the various professions.
However, the most significant change has been the Supreme Court
Olmstead Decision on the most integrated setting which should further
reduce state hospital utilization; yet with new professionals seeking
right for community treatment orders and rights to administer
medications (original community programs, residents taught to
self-administer medications, 1970s).
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.
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
| Degree | Common licenses | Prescription privilege | Average income (US$) | |
|---|---|---|---|---|
| Psychiatrist | MD/DO | Psychiatrist | Yes | $200,000 |
| Psychiatric Rehabilitation Counselor | Master of Rehabilitation Sciences PhD Doctor of Philosophy | Similar to Related Personnel (Cognitive Sciences), Rehabilitation Counselors | No | $50,000 |
| Clinical Psychologist | PhD/PsyD | Psychologist | No | $85,000 |
| 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) | PhD/EdD/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 | Mental health counselors/LMFT/LCPC/LPC/LPA/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 | LMSW/GSW/LSW | No | $46,170-$70,000 |
| Social Worker (bachelor or diploma level) | BSW or SSW | 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 Dual Licensed inclusion educator | No | $60,000, $80,000 up for inclusion educator |
| Psychiatric and mental health nurse practitioner | MSN/DNP/PhD | PMHNP-BC | Yes | $135,000 |
| Physician assistant | MPAS/MHS/MMS/DScPA | PA/PA-C/APA-C/RPA/RPA-C | Yes | $80,356 |
| Expressive Therapist/Creative Arts Therapist | MA | ATR-BC/MT-BC/BC-DMT/RDT/CPT | No | $30,000-70,000 |
Exceptions include New Mexico, Louisiana, and limited rights in Indiana and Guam.
Additional Sources/Clarifications:
now operating programs with health care financing in the community.
Higher paid medical and health services manager which only operates
facilities,
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 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, these service also stressed decision making
and self-determination or empowerment as critical aspects. Community
mental health professionals may also serve children which 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 passes away.
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. The main community
concern is "zero rejection" from community services for individuals who
have been termed "hard to serve" in the population ["schizophrenia"]
["dual diagnosis"] or who have additional needs such as mobility and
sensory impairments. Additionally, many mental health professionals may
sometimes work together using a variety of treatment options such as
concurrent psychiatric medication and psychotherapy and supported housing.
Additionally, specific mental health professionals may be utilized
based upon their cultural and religious background or experience, as
part of a theory of both alternative medicines and of the nature of
helping and ethnicity.
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 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.
Relative effectiveness
Both
primary care physicians (GP's) and psychiatrists are just as effective
(in terms of remission rates) for the treatment of depression.
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 a personal experience of
mental health are referred to as ‘peer (support) workers’. The balance
of evidence appears to favour their employment:
Randomised controlled trials consistently demonstrate peer staff
produce outcomes on par with non-peer staff in ancillary roles, but they
actually perform better in reducing hospitalisation 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
Psychiatrists and clinical psychology
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.
However, biological, genetic and social processes as part of
premedicine have been the basis of education in fields such as BA
psychology since the 1970s, and in 2013, such academic degrees also may
include extensive work on the status of brain, DNA research and its
applications.[See, Cornell University, Liberal Arts, College of Arts and
Sciences, endowed institution in the US] Clinical psychologists were
hired by states and served in institutions in the US, and were involved
in the transition to community systems.
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. [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 were not involved in establishing
community programs. They were often criticized for serving the "young,
white, urban, professional" as their main clientele groups, though
piloting services such as hospital social day care which are now in
senior 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 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 responsible to the psychiatrist (in lieu of and supervised)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.
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.
Students may typically decide any major subject of their choice,
however they must enroll in specific courses, usually outlined in a pre-medical program. 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.
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,
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.
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,
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 programmer that mainly consists of supervised paid work as a Foundation House Officer within different specialties of medicine.
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. 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.
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.
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. 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 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), 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.
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).
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).
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.
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.
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).
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
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.
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 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). 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 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 (narrow focus in psychological
education). 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.
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
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.
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 a sampling of job tasks with a clinical
emphasis, and represents a level of line staff in community programs
reporting to a community supervisor in a small site based program. Personnel in community housing, nursing facilities, and institutional programs may be covered by these kinds of certifications.
- Maintain confidentiality of records relating to clients’ treatment (and daily affairs as desired by the person).
- Encourage clients to express their feelings, discuss what is happening in their lives, and help them to develop insight into themselves and their relationships.
- Guide clients in the development of skills and strategies for dealing with their problems (and desired life outcomes).
- Prepare and maintain all required treatment (and/or community service)records and reports.
- Counsel clients and patients, individually and in group sessions, to assist in overcoming dependencies (seeking new relationships), adjusting to life, and making changes.
- Collect information about clients through interviews, observations, and tests (and most importantly, speaking with and planning with the person).
- Act as the client’s advocate in order to coordinate required services or to resolve emergency problems in crisis situations. [often first line of emergency response]
- Develop and implement treatment (or "person-centered") plans based on clinical (and community) experience and knowledge.
- Collaborate with other staff members to perform clinical assessments (and health may be contracted for specific consultations) and develop treatment (service) plans.
- Evaluate client’s physical or mental condition (plan, not condition)based on review of client information. [Evaluate outcomes as planned with the client on a "quarterly basis".]
However, these position levels have undergone decades of academic
field testing and recommendations with new competencies in development
in 2011-2013 by the Centers for Medicaid and Medicare (at the
categorical aide levels). New professionals were recommended with a
community services coordinator (commonly known as "hands on" case
management), together with services and personnel management, and
community development and liaison roles for community participation.
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.
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.
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.
Psychiatric rehabilitation
Psychiatric rehabilitation,
similar to cognitive rehabilitation, is a designated field in the
rehabilitation often academically prepared in either Schools of Allied
Health and Sciences (near the field of Physical Medicine and
Rehabilitation) and as rehabilitation counseling in the School of
Education. Both have been developed specifically as preparing community
personnel (at the MA and PHD levels) and to aid in the transition to
professionally competent and integrated community services. Psychiatric
rehabilitation personnel have a community integration-related
base, support a recovery and skills-based model of mental health, and
may be involved with community programs based upon normalization and
social role valorization throughout the US. Psychiatric rehabilitation
personnel have been involved in upgrading the skills of staff in
institutions in order to move clients into the community settings. Most
common in international fields are community rehabilitation personnel
which traditionally come from the rehabilitation counseling or community
fields. In the new "rehabilitation centers" (new campus buildings),
designed similar to hospital "rehab" (physical and occupational therapy,
sports medicine), often no designated personnel in the fields of mental
health (now "senior behavioral services" or "residential treatment
units"). Psychiatric rehabilitation textbooks are currently on the
market describing the community services their personnel were involved with in community development (commonly known as deinstitutionalization).
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".
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.
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.
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 master's 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 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).
Social workers in England and Wales are now able to become Approved Clinicians under the Mental Health Act 2007
following a period of further training (likely at postgraduate
degree/diploma or doctoral level). Historically, this role was reserved
for psychiatrist medical doctors, but has now extended to registered mental health professionals, such as social workers, psychologists and mental health nurses.
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.
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.
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.
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.
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. 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 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. 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 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. Psychiatric aides, now being trained by educational psychology
in 2014, are part of the entry level workforce which is projected to be
needed in communities in the US in the next decades.
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 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.
A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers,
facilities and services. Individuals who are care navigators are often
also trained therapists and doctors. The need for mental health care
navigators arises from the fragmentation of the mental health industry,
which can often leave those in need with more questions than answers.
Care navigators work closely with patients through discussion and
collaboration to provide information on options and referrals to
healthcare professionals, facilities, and organizations specializing in
the patients’ needs. The difference between other mental health
professionals and a care navigator is that a care navigator provides
information and directs a patient to the best help rather than offering
diagnosis, prescription of medications or treatment.
Many mental health organizations use “navigator” and “navigation”
to describe the service of providing guidance through the health care
industry. Care navigators are also sometimes referred to as “system navigators”. One type of care navigator is an "educational consultant."
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.
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.
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.
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 on
average. As a point of reference, the average physical therapist earns
$75,000/year on average. Substance abuse counselor earnings are even
lower, with an average salary of $34,000/year.
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.
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.
Social workers also tend to experience competing work and family
demands, which negatively affects their job well-being and subsequently
their job satisfaction, resulting in high turnover in the profession.
