of this article series provided an overview of what makes the mental health industry unique among medical specialties and defined 10 terms that are important to understand for anyone in the mental health field.  In this article, I will cover the different types of mental health professionals. 

To outsiders, a mental health clinic may seem like any other specialty healthcare clinic.  After all, patients who go there are often presenting with similar complaints.  However, mental health clinics are more like medical homes than they are like specialty clinics.  In fact, they are most similar to patient-centered specialty practices or Integrated Practice Units in that they include different types of uniquely specialized providers working together to address clinical issues and communicate findings and recommendations back to family members and referral sources.

Below are the different types of professionals you are most likely to find in clinical mental health settings:

1. Psychiatrist: Psychiatrists are physicians who have graduated from either an allopathic (MD) or osteopathic (DO) medical school and have completed a four-year psychiatric residency program.  Their first year of training after medical school is referred to interchangeably as either “internship,” or “Post-Graduate Year one (PGY-1)” of their residency.  Psychiatrists must have a state license to practice.  Board certification by the American Board of Psychiatry and Neurology (ABPN) is typically required for all academic faculty positions and is highly preferred for other positions.  Psychiatrists are trained to treat the full spectrum of psychiatric conditions and episodes, evaluate underlying medical causes and co-occurring conditions, perform physical and mental status exams, conduct psychotherapy, and provide medications.  Some psychiatrists are also trained to administer more complicated somatic treatments, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), certain infusions (i.e. ketamine, brexanolone), and treatments involving psychedelic drugs.

2. Psychologist: Psychologists are doctoral (Ph.D. or Psy.D.) level providers who have graduated from a clinical or counseling psychology graduate school program. They are required to complete clinical hours throughout the program prior to graduation.  Additionally, they must complete a one-year pre-doctoral internship program after completing their coursework. This internship is full-time and is focused on direct clinical care. In order to obtain a state license to practice as a Clinical Psychologist, they must also successfully pass the National Examination for Professional Practice in Psychology as well as a State Psychology Exam.  Training programs accredited by the American Psychological Association (APA) are preferred to non-accredited programs.  Board certification by the American Board of Professional Psychology (ABPP) is optional, but indicates a high degree of competency and commitment to the profession.  The field of psychology is broad; skillsets include, but are not limited to, comprehensive assessments, psychological testing, psychotherapy, consulting, behavioral management, psychoeducation, and research.  PhD psychologists receive more training in statistics and data analysis than PsyD psychologists, and they are also more likely to be employed as research psychologists.  PsyD training emphasizes psychological theory and psychotherapy techniques, and is designed to optimize clinical skills.

3. Licensed Clinical Social Worker: A Masters in Social Work (MSW) degree paves the way to becoming a licensed social worker. Licensing requirements vary by state, but generally include 2000-3000 hours (2-3 years) of post-graduate supervised clinical practice, as well as a passing score on the Association of Social Work Boards licensing exam. Non-clinical social workers often act as case managers or care coordinators, connecting clients with community resources. Clinical social workers can additionally provide counseling and psychotherapy services. Licensed Independent Social workers (LCSW, LiCSW) can practice without supervision and must have an MSW degree from a university accredited by the Council on Social Work Education (CSWE).  Board certification by the American Board of Clinical Social Work (ABCSW) is increasingly viewed as a discriminating factor by potential employers.  Social Work graduate programs typically include courses such as social policy, human behavior, research, and clinical practice. The second year of graduate studies and field placements typically explore concentrations (which vary among institutions) or specialization areas, including children, youth, and families; health; mental health; and older adults and aging societies.     

4. Psychiatric-Mental Health Nurse Practitioner (PMHNP): PMHNPs are masters-level registered nurses with specialty training in psychiatric nursing.  To practice, they must pass the PMHNP board certification exam offered by the American Nurses Credentialing Center and have an active license.  In some states, licensed PMHNPs can practice independently, while in others they must practice collaboratively with or be supervised by a psychiatrist.  PMHNPs can have widely variable backgrounds and mental health experience.  Some worked for years on inpatient psychiatric units before becoming PMHNPs.  Others spent years in a different nursing field before becoming PMHNPs.  Still others have completed on-line certification programs and have very limited psychiatric experience overall.  Most PMHNP programs emphasize medication management and offer limited training in psychotherapy, but some PMHNPs have pursued additional training and can be very competent psychotherapists.  It is important to understand the particular experience level and aptitudes of a given nurse practitioner to ensure their responsibilities are commensurate with their skill set.  All PMHNPs should be able to provide comprehensive psychiatric assessments, mental status exams, crisis management, supportive therapy, family counseling, psychoeducation, and medication management.  Those receiving their PMHNP in 2010 or later have been trained to treat patients of all ages.

5. Licensed Masters-Level Counselors: This is perhaps the most confusing type of provider within the field of mental health because their professional title and exam required for licensure vary by state.  To check the requirements for each state, click here.  The most common titles include Licensed Professional Counselor (LPC), Licensed Mental Health Counselor (LMHC), Licensed Clinical Professional Counselor (LCPC), and Licensed Professional Clinical Counselor (LPCC).  These providers must possess a master’s or higher-level degree in mental health counseling from a program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).  They must also complete two years of post-graduate supervised counseling, including 3,000 hours of supervised practice and 100 hours of face-to-face supervision meeting standards set by the American Mental Health Counselors Association (AMHCA).  Master’s Level Counselors can have widely variable backgrounds and mental health experience, but should all be able to perform basic mental health assessments, safety evaluations, crisis management, and supportive counseling. 

6. Licensed Marriage and Family Therapist (LMFT): LMFTs must complete a master’s or higher-level accredited program in Marriage and Family Therapy followed by two years of post-graduate supervised counseling.  Licensing requirements vary by state, but all states require a passing score on a state licensing exam or the national exam offered by Association of Marital and Family Therapy Regulatory Boards (AMFTRB).  LMFTs have a clinical skill set similar to that of other Master’s-Level Counselors, but they perform assessments and provide care within the context of marriage, couples and family systems, primarily focusing on and addressing family and partner dynamics.

7. Substance Abuse Counselors: Also known as Addiction Counselors, these professionals comprise a community of mental health professionals who have additional expertise in the field of Addiction.  The most common pathway for professional certification is through NAADAC – the Association for Addiction Professionals, which was originally known as the National Association for Alcoholism and Drug Abuse Counselors (NAADAC).  A table of the various certifications offered by NAADAC in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA) is available here.  Substance Abuse Counselors provide education, assessment, and treatment of individuals at risk for or struggling with addiction and recovery.  Their specific responsibilities are dependent upon their professional background, licensure, level of certification, and clinical setting.

8. Psychiatric Physician Assistant (PA): Psychiatric PAs are being seen with increasing frequency in mental health environments.  They must have graduated from a two-year PA school and have worked for some period of time in a psychiatric setting.   A Certificate of Added Qualifications (CAQ) in Psychiatry, which requires 150 hours of psychiatric Continuing Medical Education and 2000 hours of clinical practice, is preferred, but is not required.  All PAs must practice under the license of a physician.  One of their major responsibilities is to ensure that patients’ psychological problems are not due to underlying medical conditions.  They can also provide medication management for relatively minor or stable psychiatric conditions.  PA school does not include training in psychotherapy, but most PAs have been trained in the management of challenging patients, so may be able to provide supportive psychotherapy.  They can be employed in inpatient or outpatient environments, conducting history and physical exams, mental status exams, psychiatric assessments, and medication management.

9. Psychiatric Technician: The term Psychiatric Technician is used to describe various assistants who support nurses and other mental health professionals operating in inpatient, residential, emergency, and outpatient settings. Their job titles may vary, but often start with the words psychiatric, mental health, or behavioral health, and are followed by technician, aide, worker, counselor, assistant or associate.  Many, but not all, have experience in nursing fields.  Some positions require an Associate’s or Bachelor’s degree, but others require only a high school education.  The American Association of Psychiatric Technicians offers four levels of certification to those desiring it, although certification is not generally required.  Psychiatric Technicians can typically perform mental health triage, basic psychological screenings, general assessments, administration of some psychological tests, supportive counseling, supervision of group activities, patient de-escalation, one-on-one observation, physical restraint, and various inpatient duties.

10. Other Staff: A variety of other professional disciplines may be working in mental health environments, including healthcare administrators, occupational therapists, case managers, dieticians, nutritionists, art therapists, music therapists, horticulturalists, and many more.

Dr. Wendi Waits (she/her) is an adult and child psychiatrist, certified lifestyle medicine physician, and consultant at MH Insight, LLC.  She has written numerous articles, book chapters, and scientific publications on medical leadership and various mental health topics, and she is an experienced public speaker.  To see more of Wendi’s work, please visit MHInsight.com.

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