Different Types of Psychiatric Providers

new doc 2017-11-17 12.15.36_4There are many different players in the world of psychiatric treatment.  The descriptions below just brush the surface, there is some overlap, and the actual role of each player can vary from location to location, but it’s a good start.

What’s a treatment team?

While this article is about the different types of psychiatric care providers, it’s important to address the expression, “treatment team.”  Treatment team is a term used in hospitals to describe the group of people who are involved in the care of a patient.  Inherent to psychiatry is the “team approach,” which involves different players taking over different aspects of care for a single patient.  A treatment team usually involves:

  • a psychiatrist
  • possibly a psychiatric physician extenders
  • sometimes a psychologist
  • one or two social workers
  • psychiatric nurses and nursing assistants
  • occasionally other players, like occupational therapists and vocational rehabilitation therapists.

The psychiatrist is the team leader, but everyone plays a key role in making decisions and caring for the patient.  The treatment team advocate for the patient.  They handle both inpatient care and discharge planning.

What’s a psychiatrist?

A psychiatrist is a physician who has specialized in psychiatry, the field of medicine that deals with mental illness. They’ve gone through medical school and typically have 12 or more years of education before they practice completely on their own.  Psychiatrists can prescribe medicines, do medical work-ups for symptoms, and diagnose medical and mental disorders.  Appointments last 15 to 30 minutes, and the focus is illness and medication.  Some psychiatrists also do psychotherapy, or talk-therapy, with their patients.  Physicians who’ve specialized in psychiatry work in private practice, clinics, hospitals, nursing homes, ACT teams, and many other settings.  Not all psychiatrists treat patients.  Some work in animal laboratories doing research.  Others only do evaluations for the court or disability.  Still, others teach at medical schools or universities.

What are psychiatric physician extenders?

Physician extenders include nurse practitioners (NP) and physician assistants(PA).  NPs are nurses who have gone back to school to receive their masters or doctorate in nursing.  That usually means six to eight years of total schooling to be a NP. PA’s generally have six to eight years of education before they can practice independently.  Both types of physician extenders work under the supervision of a psychiatrist and carry their own patients.  Both can prescribe medications, do medical work-ups for symptoms, and diagnose medical and mental disorders.  Like psychiatrists, their appointments usually last 15 to 30 minutes.  They tend to focus on illness and medication but sometimes also do psychotherapy.  Psychiatric physician extenders have a tendency to work in the same types of settings as psychiatrists.  NP’s also teach at nursing schools.

What’s a psychologist?

Psychologists usually have six or more years of education and often have a master’s degree or doctorate in psychology. Many people can’t distinguish between a psychologist and psychiatrist.  What’s the difference?

  • First, many perform neuropsychiatric evaluations to test for an array of disorders, like dementia, intellectual deficits, attention deficits, personality disorders, and autism. Psychiatrists typically don’t do testing.
  • Second, for those who practice patient care, they typically don’t prescribe meds* but tend to have extensive training in psychotherapy.

There are similarities.  Like psychiatrists, psychologists can be found in research and teaching at universities.  Psychologists often have their own practice and/or consult at a hospital offering testing and treatment recommendations. (*Note that in some states, psychologists are fighting for the right to prescribe basic psychiatric medications.)

What’s a social worker? 

Social workers are found in many places in the psychiatric community, and they do many types of work.  Typically a social worker has between four and eight years of education.  A social worker must have a master’s degree and certain amount of patient care hours to be able to do certain kinds of work.  Job description varies according to the kind of job they have, and in some positions social workers tend to take on multiple roles. Those roles can include:

  • new doc 2017-11-17 11.55.39_3Psychotherapists diagnose mental health disorders and do individual, couple, family, and group therapy to help people with these issues. Some therapists have their own practice, but many work in clinics.  Appointments usually last an hour, and they see patients once a week or biweekly.  Type of therapy varies according to the therapist’s training, interests, and client profile.  Therapy might include individual, couple, group, and family therapy.  Types include cognitive behavioral, dialectical behavioral, substance abuse therapy, plus others.
  • Case managers help patients access community services. These mental health workers are the go-to person when it comes to knowing what’s out there. They typically work with the severely mentally ill in the community, or with the medically or psychiatrically ill in the hospital working on a discharge plan. Case managers come up with plans to connect a patient with what services are best for them.
  • Crisis and emergency workers are usually found in the emergency room, where they evaluate the person in crisis and help establish a crisis plan. This might include being admitted to the hospital or connecting the patient to their families, providers, and services in the community.  Many social workers man crisis phone lines.
What’s a licensed professional counselors (LPC) and substance abuse counselor (SAC)?

LPC’s, also called licensed mental health counselors, make up a large percentage of the workforce in community mental health treatment.  They are master’s and doctorate level therapists who do individual, couple, family, and group therapy.  Types of therapy include cognitive behavioral, dialectical behavioral, substance abuse therapy, and others.  SACs are individuals with specialized training in substance use disorder counseling; they often have Master’s degrees, but not always.  Some are sober or clean addicts who have invested their lives into helping others with substance use problems.

What’s a psychiatric nurse?

There are many types of nurses, and they vary according to specialty and education. In psychiatric nursing, education level varies from 4-6 weeks for psychiatric technicians (certified nursing assistants in psychiatric settings) to four years for registered nurses.  Psychiatric technicians work in mental health hospitals and are the front-line when it comes to caring for individuals with mental illness.  Psychiatric nurses work in clinics and hospitals.  They monitor both medical and psychiatric issues, provide emotional/cognitive support to the patient, hand out medications, run the unit, and maintain documentation

What’s an occupational therapist?

Most psychiatric occupational therapists, also called OT, work in mental health hospitals.  Their role is to run some of the classes patients attend during the day.  This includes activities like art classes, skills-training groups, meditation groups, and music therapy.  OT also does Occupational Therapy Evaluations. This might include assessing an individual’s ability to handle basic emergencies, cook, clean, catch transportation, and deal with the unexpected.  OT then makes recommendations to the patient’s treatment team, who use this information to better plan discharge.

What’s a vocational specialist?

A vocational specialist, often called voc rehab, is someone who helps patients find work. They often cater to the mentally ill population. Voc rehab can assist with writing resumes and going over job listings, and often have a list of employers who are looking for help.  They can also help with applications for state and federal financial help, arranging job-related classes, and finding volunteer positions for those not ready to work.  Connecting with voc rehab is often a big part of the discharge plan for patients leaving the hospital.

If you are a psychiatric provider and find I’m incorrect in any of my descriptions, please let me know and I’ll update the information ASAP.  Thanks.

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