Hello and welcome to The Nice-ish Ramblings podcast with me, the Nice-ish Psychologist, where today I am going to be discussing the first half of a two-part series focusing on the different types of mental health professionals that exist in the United Kingdom.
So, initially I wanted to focus on the differences between psychiatrists, psychologists, psychotherapists, and counsellors. For two reasons. Firstly, I am forever bemused by the number of times someone asks me – as a psychologist – if I can prescribe medication (and right at the start I want to clarify that I cannot); and I think this is because sometimes people confuse what I do with what a psychiatrist does. So, I thought it might be helpful to clarify that. And secondly, there have been times when even I am like, well, what is the difference between what I do versus what a psychotherapist does versus what a counsellor does. And I figured that if I sometimes find myself asking these questions, then it’s possible that members of the general public must be asking these questions, too.
So, that was going to be the initial podcast. However, when I shared a blurb of this episode on social media (you know, to generate that ever important hype) several followers got in touch to request that their professions be also be acknowledged within the realm of mental health professionals. Which I think is fair.
And so, along with wanting to discuss the differences between psychiatrists, psychologists, psychotherapists, and counsellors, I was also going touch on mental health nursing, occupational therapy, and social work within the realms of the mental health field; additionally, under the section on psychologists I was also going to include the other sub-roles within psychology (like trainee and assistant psychologists). Then, while researching and writing this episode, all of that started to get too big, too long, and too in-depth. And seeing as I had already missed a podcast deadline last week, I decided rather than half-arsing the whole thing, it would make sense to split the episode into two parts. With this first part focusing on the professions that I would consider focus on psychiatric care. This distinction is pretty arbitrary and stems mostly from my experiences of working in psychiatric inpatient settings. For this reason, I am going to spend some time talking you through the roles of psychiatrists, mental health nurses and support workers, occupational therapists, and social workers within the field of mental health. And in the next episode I will focus more on what could be considered the “talking therapies”; namely, psychology, psychotherapy and counselling.
It might be worth noting that while I’ve put these episodes together because I thought it might be helpful for the general public to have an overview of some of the professions involved in the field of mental health in the UK, this is exactly that: an overview. The information I have put into this episode was gathered from as many sources as I could find relating to the numerous professions discussed; but I am conscious that I might not capture all the specifics of the professions quite right. Therefore, if there are any mistakes – or for any listeners who may be part of some of the professions listed, if I do not get the nuances of your job quite right – I am sorry.
Anyway, on with the show…
First off, we’ll start with psychiatrists, mostly because this is the profession which is most unlike that of a psychologist, psychotherapist, or counsellor (as far as I can tell anyway and is one of the main reasons why I started writing this podcast episode). So, according to the NHS website, “psychiatry is a medical field concerned with the diagnosis, treatment and prevention of mental health conditions” and “a doctor who works in psychiatry is called a psychiatrist.” Psychiatrists are medical doctors who specialise in the diagnosis, treatment, and prevention of mental illness and emotional disorders.
According to the website of the Royal College of Psychiatrists (RCP, the medical body responsible for regulating and supporting psychiatrists throughout their career) a psychiatrist will have spent five to six years training to be a doctor. They will then have worked as a doctor in general medicine and surgery for at least a year, before then undertaking at least six years of further training in helping people with psychological problems. So, all in all, it takes about 12 to 13 years for a psychiatrist to get to the very end of their training.
Now, I am aware that there are different levels of doctoring. For example, before you become a consultant, there are six different levels of being a junior doctor, such as FY1 and FY2 (which are known as foundation year doctors), moving up to speciality trainee (or ST) doctors, which I think is where doctors start to specialise in different areas of medicine such as psychiatry. The specifics of progressing through the junior doctor level up to consultant are beyond the scope of my understanding, but the end result is that if someone is a consultant psychiatrist, they have pretty been doing the gig for at least a decade.
Because of this, psychiatrists have a range of specialist skills when it comes to mental health. For example, and according to the RCP website, psychiatrists can assess a person’s mental state, diagnose mental illness, and prescribe a range of medications to manage symptoms of mental illness. At this point, I am aware that some listeners might have strong views of psychiatrists and the prescribing of psychiatric medications. Or the idea of diagnosis in general. Indeed, if anyone has read up about the Power Threat Meaning Framework, it’s possible you may disagree with diagnosis and medication altogether. This is something that I would like to address and talk about in another episode in the future – but if you have any views of queries about this particular area let me know. Also, if you haven’t heard of the Power Threat Meaning Framework, have a read of it.
Right, back to psychiatrists. So, on top of these “core skills” as it were, psychiatrists will develop skills in working with specific difficulties that affect specific populations. For example, the skills and knowledge needed to work within general adult mental health will differ to those needed to work with children, and again will differ when working with a forensic population. Additionally, and whilst this is not necessarily typical (as far as I am aware, and I am always open to being wrong) some psychiatrists will train to become a psychotherapist, too; and as part of their psychiatric practice will offer therapy. This is something we I will focus on a bit more in the next episode when we look at psychotherapy.
Psychiatrists will often work in mental health settings such as community mental health centres or psychiatric hospitals, and they will often work with a breadth of other mental health disciplines such as mental health nurses and support workers (otherwise known as healthcare assistants), occupational therapists, and social workers. All of which we will now look at (and this is why I have included these professions within the distinction of those who work in psychiatric care).
Registered mental health nurses (RMNs) and support workers (also known as health care assistants or HCAs) are nursing staff who provide the day-to-day care to those experiencing mental illness either in hospital or in the community. They may work across various settings within hospitals such as psychiatric wards, outpatient clinics, psychiatric intensive care units, or specialist units such as eating disorders units or forensic psychiatric hospitals. In the community you may find nursing staff in GPs, prisons, community mental health centres, residential care, or even visiting clients in their home.
RMNs jobs and responsibilities are different from those of HCAs. RMNs will ensure that the psychiatric treatment plan outlined by the psychiatrists is carried out. They will write care plans, administer medications, monitor health conditions, take charge of shifts (especially in psychiatric wards), oversee the maintenance of notes, and make sure the legal documentation required to detain someone in hospital is above board (by this I mean paperwork required to section individuals under the Mental Health Act). HCAs duties are related to assisting the RMNs in carrying out their duties and there is some overlap. The main difference being that that nurses usually have overall responsibility and accountability for making sure that the things needed to be done in relation to patient care get done. In the UK, RMNs are regulated by the NMC, the Nursing and Midwifery Council.
So, HCAs may assist with doing the hourly observations of their service users, assist with escorting them on their leave, assisting with meals, and along with the nursing staff ensuring that the day-to-day care for those within hospital or psychiatric settings are carried out. Some further examples listed on a job application website note that HCAs are responsible for supervising service users to make sure they are safe. Now, safety could relate to safety to the service users themselves or safety from others, and health care assistants may, in collaboration with registered nursing staff, make day-to-day or moment-to-moment risk assessments to help make sure that service users do things safely or that they aren’t endangering themselves or others, which can happen.
HCAs also give practical support to service users and their families, such as with household tasks, personal care or managing their money and financial paperwork. And it is not uncommon for HCAs to provide emotional support and reassurance to service users and their families, and sometimes – again, in conjunction with registered nursing staff – educate service users and their relatives about the sorts of mental health difficulties the service users might have. So that’s nursing staff.
Another important job that is found within the realm of mental health professionals is that of the occupational therapist (OTs). The Royal College of Occupational Therapists (RCOT) notes that occupational therapy helps individuals live their best life at home at work – and everywhere else. OTs who work in mental health are concerned with helping people who are struggling with their mental health to engage in meaningful activities, which can help to improve their well-being and quality of life. Once more, according to the Royal College of Occupational Therapists, “occupational therapy in mental health is about enabling people to do the activities that matter to them, regardless of their mental health condition”. Some examples of activities that occupational therapists might help people to engage in include self-care tasks (such as washing and dressing), household tasks (such as cooking and cleaning), work-related activities, leisure activities, and social activities. The aim is to help people to develop the skills and confidence they need to manage their mental health condition and live as independently as possible. OTs use a range of different interventions to help people, which can be done on an individual or group basis.
Some examples of specific interventions that OTs might use include the use of graded exposure, which is an approach that involves gradually exposing people to situations or activities that they find anxiety-provoking, in order to help them to overcome their fears. OTs might provide practical life skills training and support to help people develop skills in areas such as time management, budgeting, and cooking. OTs can assist people who have sensory processing difficulties, which can be a symptom of certain mental health conditions or neurodevelopmental conditions (such as autism, for example). This kind of work would involve assessing what sensory difficulties service users have, and then using sensory experiences (such as touch, movement, and sound, for example) to help people to regulate their emotions and feel calmer and more relaxed. In the UK, OTs who work in mental health are regulated by the Health and Care Professions Council (HCPC).
The final role within the sort of psychiatric care side of mental health is that of mental health social workers. Now, unlike the rest of the roles discussed above, it a was a little more challenging to pin down the specifics of the social worker role in within mental health services. And so, this section is made up from some bits that I sourced from seemingly relevant webpages about social work within mental health, while some bits are from what I remember during my training.
So, according to the global definition of social work provided by the International Federation of Social Workers, social work is a practise-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility, and respect for diversity are central to social work.
In relation to mental health specifically, and according to a document written by the College of Social Work in 2014, social workers have a “crucial part to play in improving mental health services and mental health outcomes for citizens”. Social workers are trained to work in partnership with people using services, their families and carers, to optimise involvement and collaborative solutions (so, making sure that the voice and needs of psychiatric service users are heard and respected and advocated for). It the document also notes that “social workers...manage some of the most challenging and complex risks for individuals and society and take decisions with and on behalf of people within complicated legal frameworks, balancing and protecting the rights of different parties. The NHS website also goes on to say that as part of their job roles, social workers protect vulnerable people from harm or abuse. And I guess this in one of my main anecdotal understandings of the roles of social workers within the mental health field, is that they were really good at holding in mind the rights and privileges of those who were receiving psychiatric care. They were also a vital link, particularly in impatient settings, between service users and their families. I am pretty sure there are lots of things that mental health social workers do that I have not captured here. But, if you would like to hear more about this role (or any of the roles discussed in fact), then let me know and I can try see if anyone would like to come on and talk about their job in a bit more detail.
Now, before I end, I’m not quite able to do justice – with words – to the job that these professions do within psychiatric care. I am aware that there are criticisms that people have of psychiatric services, and it is not my place to change your views about that. But what I will say, from both my time as an HCA on psychiatric wards and through numerous inpatient placements while completing my doctoral training, the work these professionals do is tough. They are really tough and demanding job that I think often go unrecognised and underappreciated when thinking about mental health professionals. So, with that in mind, I hope this has been a helpful episode. Additionally, whenever I’ve referred to websites or documents I've read, you can always go and check them out within the transcript I’ve written to this episode (and most of my other episodes, in fact). I always put hyperlinks in the relevant sections where I talk about references. So, if I said something that piques interest please do go back and have a look through the transcripts and you will find what I'm talking about linked there.
And finally, if you have got to the end of this episode and you think, “fucking hell, that was some interesting shit” why not give it a rating, share it, or recommend it to your friends. It’s always appreciated. And as always, please do come say hi on my Instagram page. Let me know your thoughts, good or bad. I am always happy to talk further about these things. So, until next time. Hope you have a great day. Or not. No pressure!
Music
Opening: “Chilled Ambient Minimal”
Closing: “Seven” - Tobu
28: UK Mental Health Professionals - Psychiatric Care