Mental health professionals
Mental health services use a multidisciplinary approach, where a number of professionals offer their particular skills in a co-ordinated and complementary way.
Family doctor (GP)
Your GP is often the first person you will seek help from. He/she will assess the problem and may either provide medication and monitor your condition or may refer you to a specialist, for example, psychiatrist, psychologist or counsellor, if necessary. Your GP may be able to recommend a support group for the particular problem. Where others are involved in the patient's care (for example, psychiatrist, social worker, family members, etc.) your GP may liaise with them in order to provide you with the best overall care.
A psychiatrist is a medical doctor that specialises in mental health. Psychiatrists are responsible for the medical care of psychiatric patients (medication, physical symptoms, etc.) and are also involved in counselling. A psychiatrist usually works in a psychiatric hospital or unit or as part of a community care team but he or she can also be part of a private practice. In most cases, your GP will refer you to a psychiatrist if he or she considers it necessary or if you request a referral. A psychiatrist will assess the person, usually at a hospital out-patient clinic, form a diagnosis and treat the person accordingly. This may involve treatment with medication or referral to a member of the mental health team. If a psychiatrist thinks it necessary, he or she may suggest that a patient be admitted to hospital. This suggestion is generally only made if a person's difficulties are severe.
A psychologist is trained in the study of human behaviour and tries to explain feelings, thoughts and behaviour. Psychologists can provide assessment and treatment of a psychological nature that includes personality assessment through a structured interview, assessment of a wide range of psychological problems – anxiety, depression, self esteem issues, psycho-sexual and marital problems. They can also help patients examine the effects their illness is having on their lives and methods of coping with those effects. Bringing a patient closer to an understanding of his or her illness is a key aim of a psychologist. When involved in the area of mental health, the psychologist usually works as a clinical, community or counselling psychologist, and unless also medically qualified, does not prescribe medication.
The clinical psychologist has a specialist qualification in mental health and works as part of the mental health team in a unit or hospital and is involved in assessment and counselling therapy. Family therapy may be provided where appropriate and a particular approach may be used for specific problems, such as a cognitive-behavioural approach for phobias. Referral is often through a GP or psychiatrist, but self-referral is possible.
The community psychologist has a clinical qualification and works as part of a community-based team with individuals such as social workers, speech therapists and community welfare officers. The community psychologist is involved in assessing and working with those with a wide range of problems, including children with behavioural, educational and other difficulties.
Counselling psychology, as a specialist area, encompasses a broad range of practices that help people improve their well being, alleviate distress and maladjustment, resolve crises, and increase their ability to live more highly functioning lives. Counselling psychologists can be found working in diverse areas such as schools and colleges, industrial workplaces and health services.
Behavioural therapy works on the premise that you can change what people do by teaching them to respond to things in a different way. Behavioural therapy aims to help the patient control undesirable habits or irrational fears and can be used in the treatment of behavioural conditions like eating disorders and phobias. In many cases, behaviours can be learned or unlearned through basic conditioning techniques. Behavioural therapy uses such techniques as aversive conditioning, where unwanted habits are paired with unpleasant stimuli, and systematic desensitisation, where a stimulus that causes anxiety is paired with a pleasant one. Some behavioural therapists may also be psychiatrists or psychologists but this is not necessarily the case. They may be people like psychiatric nurses or social workers who have received the relevant training to work in this area. While this kind of therapy is frequently used in the treatment of behaviour disorders, it may not be available in all regions.
Cognitive behavioural therapist
Cognitive behavioural therapy (CBT) aims to reduce dysfunctional emotions and behaviour by changing behaviour and thinking patterns. Professionals who specialise in this kind of therapy believe that a change in symptoms and behaviour follows a change in thinking. This change can be brought about in a number of ways, including the practice of new behaviours and analysis of faulty thinking patterns. The purpose of CBT is to reduce distress or unwanted behaviour by undoing this learning or by providing new, more adaptive learning. Again, cognitive behavioural therapists may not all be psychologists or psychiatrists and you should check with your Health Service Executive (HSE) Area to see if the service is available in your area.
There are many forms of counselling available for a wide range of problems and many counsellors specialise in particular areas such as addiction or bereavement. All approaches emphasise non-judgemental, attentive listening and respect for the client. Counselling aims to enable people to take control of their own lives, and the counsellor may not adhere to one particular theory. Self-referral is the usual route to counselling, although a GP, psychiatrist or trusted friend may be able to recommend someone suitable. Some counsellors are qualified psychologists, but many are not. Those who are not may have a basic degree or training in other areas and/or relevant work experience (for example, teaching, nursing, etc.) plus a counselling qualification. These qualifications can vary from Masters degrees to short-term courses. It is important to make sure you are happy with the training and qualifications of any counsellor that you choose. Counselling is often one session per week and tends to be short-term rather than longer-term, although this can vary.
Addiction counsellors provide assessment, counselling, information and treatment services for people suffering from alcohol, drugs and gambling addictions. Before receiving counselling for addiction, a patient must go through a detoxification programme, if necessary. The patient is then referred to the community-based addiction treatment service. An individual and group counselling approach is commonly used with an emphasis on the consequences of the addict's behaviour. The main aspect of treatment examines the triggering factors that lead to the development of the addiction. Target goals are set to try and establish new patterns of healthy behaviour. An important part of the treatment is the involvement of a family member, which can help to achieve these targets. The programme lasts for an average of six to eight weeks and is followed by an after care service.
Psychotherapy tends to be more in-depth than counselling. It is based on the idea that the less aware we are of our motives, feelings and actions, the more they control us and the more we stay stuck in old patterns that may be harmful to us. A psychotherapist can help patients to examine their subconscious mind. By bringing any unconscious motives, fears and feelings to light and dealing with them, patients can often get relief from their symptoms. Psychotherapists usually undertake a long postgraduate training that requires trainees to undergo therapy, often twice per week, for several years. The techniques and interventions used by the psychotherapist vary according to the theoretical framework within which he or she is working.
The psychiatric nurse plays a central role in the care of the psychiatric patient, both in a hospital setting and in the community. He or she works within a psychiatric service as part of a health care team. Nurses provide both physical and psychological care to their patients and can also provide essential support and encouragement to the patients' families. The nurse's activities are varied but can include:
- Day patient care
- Detoxification programmes
- Education of student nurses and community groups
- Family education and support
- Group therapies, individual counselling
- Acting as a liaison with in-patient services, GPs, strategy and voluntary organisations
- Organisation of admissions to hospital and reception
- Initial assessment of referrals from GPs
The community psychiatric nurse usually follows up patients on discharge from hospital, calling to their homes and attending out-patients' clinics and day care centres. Community psychiatric nurses are now becoming involved in patients' rehousing needs.
Mental health social worker
Mental health social workers carry out a range of functions as members of a multi-disciplinary team. Individual counselling is one of their key tasks in assisting those with a variety of emotional difficulties. Another key function is 'psycho-education'. Psycho-education refers to work with individuals and their families to explain aspects of the mental illness. Psycho-education also involves offering coping strategies appropriate to the specific mental illness. Given that mental health service provision is sometimes fragmented, mental health social workers are committed to 'case management' or 'care management'. This refers to working with individuals with a view to ensuring continuity of care and the co-ordination of services. This helps to maximise their wellbeing and quality of life. Case management involves the integration of health services with a range of other services. Examples include, housing, social welfare, job training and employment, liaison with statutory and voluntary agenices, etc. All of these links may contribute to positive mental health.
Occupational therapists provide services to people whose ability to cope with everyday activities is threatened or impaired in some way by physical, psychological or developmental problems. Occupational therapists can assess and treat anyone (adult or child) who has practical difficulties due to mental illness, accidental injury, arthritis, cerebral palsy, learning difficulties, stroke, and other congenital, developmental, degenerative or neurological conditions. Occupational therapy aims to enable the person to have as independent, productive and satisfying a lifestyle as possible. Treatment can include self care, personal development, mobility and access, skills and training, home management, disability awareness, work preparation, directed play, stress management and compensatory techniques.
Vocational supports trainer
Vocational training is a service provided for people whose lives have been disrupted by mental health problems and who wish to make a fresh start. It aims to provide participants with the skills, knowledge and attitudes necessary for progression into employment, further training, education, and self-employment. It also aims to provide participants with other work opportunities, the opportunity to rebuild self-confidence and restore self-worth and the opportunity to make new friends and develop hobbies and pastimes. A Vocational Training Centre provides activities such as woodwork, metalwork, office procedures, arts and crafts and life skills (for example, interpersonal skills and personal development). An individual programme is agreed with each trainee. Referral is usually through a professional such as a psychiatrist, but self-referral is also possible. While some trainers are mental health professionals, such as psychiatric nurses, others may not have specific medical training.
You do not have to pay to use the services of mental health professionals who work in the public health system. If you decide to use private mental health professional services, the cost will vary greatly. You should check with the individuals involved for more details.
How to apply
Contact your GP to access to mental health professionals, both public and private. Some private counsellors, psychologists, etc., can be approached directly.