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

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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