Whos Who In The Mental Health Service Gps Psychiatrists Psychologists Cpns And Allied Therapists



Who’s Who in​ the​ Mental Health Service GPS,​ Psychiatrists,​ Psychologists,​ CPNS and Allied Therapists
When a​ person is​ experiencing psychological or​ emotional difficulties hereafter called mental health problems,​ they may well attend their GP. the​ GP will interview them and based on​ the​ nature and severity of​ the​ persons symptoms may either recommend treatment himself or​ refer the​ person on​ to​ a​ specialist. There can seem a​ bewildering array of​ such specialists,​ all with rather similar titles,​ and one can wonder as​ to​ why they’ve been referred to​ one specialist rather than another. in​ this article I ​ give an outline of​ the​ qualifications,​ roles and typical working styles of​ these specialists. This may be of​ interest to​ anyone who is​ about to,​ or​ already seeing,​ these specialists.
The General Practitioner
Although not a​ mental health specialist,​ the​ GP is​ a​ common first contact for those with mental health problems. a​ GP is​ a​ doctor who possesses a​ medical degree usually a​ fiveyear course and has completed a​ oneyear preregistration period in​ a​ general hospital sixmonths on​ a​ surgical ward and sixmonths on​ a​ medical ward as​ a​ junior house officer. Following this a​ GP has completed a​ number of​ sixmonth placements in​ various hospitalbased specialities typical choices include obstetrics and gynaecology,​ paediatrics,​ psychiatry and/or general medicine. Finally,​ a​ year is​ spent in​ general practice as​ a​ GP registrar under the​ supervision of​ a​ senior GP. During this period,​ most doctors will take examinations to​ obtain the​ professional qualification of​ the​ Royal College of​ General Practitioners Member of​ the​ Royal College of​ General Practitioners,​ or​ MRCGP. Others qualifications,​ such as​ diplomas in​ child health,​ may also be obtained.
The GP is​ thus a​ doctor with a​ wide range of​ skills and experience,​ able to​ recognise and treat a​ multitude of​ conditions. of​ course the​ necessity of​ this wide range of​ experience places limits on​ the​ depth of​ knowledge and skills that they can acquire. Therefore,​ if​ a​ patient’s condition is​ rare or,​ complicated,​ or​ particularly severe and requiring hospitalbased treatment,​ then they will refer that patient on​ to​ a​ specialist.
Focusing on​ mental health problems it​ will be noted that whilst the​ majority of​ GP’s have completed a​ sixmonth placement in​ psychiatry,​ such a​ placement is​ not compulsory for GP’s. However,​ mental health problems are a​ common reason for attending the​ GP and,​ subsequently,​ GP’s tend to​ acquire a​ lot of​ experience on​ the​ job.
Most GP’s feel able to​ diagnose and treat the​ common mental health problems such as​ depression and anxiety. the​ treatments will typically consist of​ prescribing medication such as​ antidepressants or​ anxiolytics in​ the​ first instance. if​ these are ineffective,​ alternative medication may be tried,​ or​ they may refer the​ patient to​ a​ specialist. GP’s are more likely to​ refer a​ patient to​ a​ specialist immediately if​ their condition is​ severe,​ or​ they are suicidal,​ or​ they are experiencing psychotic symptoms such as​ hallucinations and delusions.
The Psychiatrist
This is​ a​ fully qualified doctor possessing a​ medical degree plus one year preregistration year in​ general hospital who has specialised in​ the​ diagnosis and treatment of​ mental health problems. Most psychiatrists commence their psychiatric training immediately following their preregistration year and so have limited experience in​ other areas of​ physical illness although some have trained as​ GP’s and then switched to​ psychiatry at​ a​ later date. Psychiatric training typically consists of​ a​ threeyear basic training followed by a​ three year specialist training. During basic training,​ the​ doctor as​ a​ Senior House Officer or​ SHO undertakes sixmonth placements in​ a​ variety of​ psychiatric specialities taken from a​ list such as; General Adult Psychiatry,​ Old Age Psychiatry Psychogeriatrics,​ Child and Family Psychiatry,​ Forensic Psychiatry the​ diagnosis and treatment of​ mentally ill offenders,​ Learning Disabilities and the​ Psychiatry of​ Addictions. During basic training,​ the​ doctor takes examinations to​ obtain the​ professional qualification of​ the​ Royal College of​ Psychiatrists Member of​ the​ Royal College of​ Psychiatrists or​ MRCPsych.
After obtaining this qualification,​ the​ doctor undertakes a​ further threeyear specialisttraining placement as​ a​ Specialist Registrar or​ SpR. at​ this point the​ doctor chooses which area of​ psychiatry to​ specialise in​ General Adult Psychiatry,​ Old Age Psychiatry etc and his placements are selected appropriately. There are no further examinations,​ and following successful completion of​ this threeyear period,​ the​ doctor receives a​ Certificate of​ Completion of​ Specialist Training or​ CCST. He can now be appointed as​ a​ Consultant Psychiatrist.
The above is​ a​ typical career path for a​ psychiatrist. However,​ there are an increasing number of​ job titles out with the​ SHOSpRConsultant rubric. These include such titles as​ Staff Grade Psychiatrist and Associate Specialist in​ Psychiatry. the​ doctors with these titles have varying qualifications and degrees of​ experience. Some may possess the​ MRCPsych but not the​ CCST typically,​ these are the​ Associate Specialists; others may possess neither or​ only part of​ the​ MRCPsych many Staff Grades.
Psychiatrists of​ any level or​ job title will have significant experience in​ the​ diagnosis and treatment of​ people with mental health difficulties,​ and all unless themselves a​ consultant will be supervised by a​ consultant.
Psychiatrists have particular skill in​ the​ diagnosis of​ mental health problems,​ and will generally be able to​ provide a​ more detailed diagnosis i. e. what the​ condition is​ and prognosis i. e. how the​ condition changes over time and responds to​ treatment than a​ GP. the​ psychiatrist is​ also in​ a​ better position to​ access other mental health specialists such as​ Psychologists and Community Psychiatric Nurses or​ CPNs when needed. They also have access to​ inpatient and day patient services for those with severe mental health problems.
The mainstay of​ treatment by a​ psychiatrist is,​ like with GP’s,​ medication. However,​ they will be more experienced and confident in​ prescribing from the​ entire range of​ psychiatric medications some medications such as​ the​ antipsychotic Clozapine are only available under psychiatric supervision and others such as​ the​ moodstabiliser Lithium are rarely prescribed by GP’s
without consulting a​ psychiatrist first.
A psychiatrist,​ as​ a​ rule,​ does not offer talking treatments such as​ psychotherapy,​ cognitive therapy or​ counselling. the​ latter may be available inhouse at​ the​ GP surgery some surgeries employ a​ counsellor to​ whom they can refer directly.
Psychologists and allied mental health staff typically provide the​ more intensive talking therapies. Some senior mental health nurses and CPNs will have been trained in​ specific talking therapies. it​ is​ to​ a​ Psychologist or​ a​ trained nurse that a​ psychiatrist will refer a​ patient for talking therapy. These therapies are suitable for certain conditions and not for others generally,​ conditions such as​ Schizophrenia and psychosis are less appropriate for these therapies than the​ less severe and more common conditions such as​ depression,​ anxiety,​ posttraumatic stress disorder,​ phobias and addictions. in​ many cases,​ a​ patient will be prescribed both medication and a​ talking therapy thus they may be seen by both a​ therapist and a​ psychiatrist over the​ course of​ their treatment.
The Psychologist
A qualified clinical psychologist is​ educated and trained to​ an impressive degree. in​ addition to​ a​ basic degree in​ Psychology a​ three year course they will also have completed a​ PhD Doctor of​ Philosophy or​ Doctorate a​ further threeyear course involving innovative and independent research in​ some aspect of​ psychology. They will also be formally trained in​ the​ assessment and treatment of​ psychological conditions,​ although with a​ more psychological slant than that of​ psychiatrists. Psychologists do not prescribe medication. They are able to​ offer a​ wide range of​ talking therapies to​ patients,​ although they typically specialise and become expert in​ one particular style of​ therapy. the​ therapies a​ particular psychologist will offer may vary from a​ colleague,​ but will usually be classifiable under the​ title of​ Psychotherapy e. g. Analytic Psychotherapy,​ Transactional Analysis,​ Emotive therapy,​ Narrative therapy etc or​ Cognitive Therapy e. g. Cognitive Behavioural Therapy CBT or​ NeuroLinguistic Programming NLP etc.
The Community Psychiatric Nurse CPN
These are mental health trained nurses that work in​ the​ community. They will have completed a​ two or​ three year training programme in​ mental health nursing this leads to​ either a​ diploma or​ a​ degree,​ depending on​ the​ specific course. They are not usually general trained,​ meaning their experience of​ physical illness will be limited. Following completion of​ the​ course they will have spent a​ variable amount of​ time in​ placements on​ an inpatient psychiatric unit this time can range from twelve months to​ several years. They can then apply to​ be a​ CPN they are required to​ show a​ good knowledge and significant experience of​ mental health problems before being appointed.
CPNs are attached to​ Community Mental Health Teams and work closely with psychiatrists,​ psychologists and other staff. They offer support,​ advice and monitoring of​ patients in​ the​ community,​ usually visiting them at​ home. They can liaise with other mental health staff on​ behalf of​ the​ patient and investigate other support networks available such as​ the​ mental health charities.
Some CPNs will be formally trained in​ one or​ more talking therapies,​ usually a​ cognitive therapy such as​ CBT see Allied Therapists below.
Allied Therapists
Many talking therapies are offered by nonpsychologists for example,​ mental health nurses and mental health occupational therapists,​ can undertake a​ training course in​ a​ cognitive therapy like CBT. After successful completion of​ the​ course,​ the​ nurse will be qualified and able to​ offer CBT to​ patients. the​ length and intensity of​ these courses can vary dramatically,​ depending on​ the​ type of​ therapy and the​ establishment providing the​ course. Some are intensive,​ fulltime one or​ two week courses; others are parttime and can extend over months and years. Perhaps a​ typical course will be one or​ two days a​ week for two to​ three months. Formal educational qualifications are not necessary to​ undertake these courses,​ and they are open to​ lay people with little or​ no experience of​ the​ NHS mental health services. of​ course this is​ not necessarily a​ problem it​ may even be considered a​ positive point!
Some of​ those therapists thus qualified will offer their skills as​ part of​ their work in​ the​ NHS for instance,​ a​ nurse,​ CPN or​ occupational therapist may offer cognitive therapy to​ a​ patient that has been referred by a​ psychiatrist. Unfortunately this is​ relatively rare at​ the​ moment,​ presumably due to​ the​ reluctance of​ the​ NHS to​ pay for such training for their staff. as​ a​ result these therapies are more accessible on​ a​ private basis.
Summary
An individual with psychological difficulties will normally attend their GP in​ the​ first instance. the​ GP will usually have encountered similar problems with other patients and can offer a​ diagnosis and appropriate treatment. if​ the​ condition is​ unusual or​ particularly severe,​ the​ GP can refer the​ patient to​ a​ psychiatrist. the​ psychiatrist is​ able to​ access a​ wider range of​ treatments medications and hospital care and can,​ if​ necessary,​ recruit other mental health professionals to​ help the​ patient. This system perhaps works best with the​ severely mentally ill such as​ those with psychotic symptoms or​ who are suicidal.
The Mental Health Services in​ the​ NHS are generally less well suited to​ those with psychological problems of​ a​ less severe nature the​ moderately depressed,​ the​ anxious,​ the​ phobic etc. the​ availability of​ talking therapies is​ limited in​ the​ NHS,​ with long waiting lists or​ even no provision at​ all in​ some areas. This appears to​ be due both to​ the​ cost of​ training staff appropriately and the​ timeintensive nature of​ these therapies.
For those with such conditions,​ the​ main option is​ to​ seek help outside the​ NHS. There are some voluntary organisations that offer free counselling for specific problems such as​ bereavement or​ marital/relationship difficulties,​ but more intensive therapies such as​ CBT or​ NLP are typically fee based. Your GP or​ local Community Mental Health Team may be able to​ recommend a​ local private therapist.





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