In seeking a clinical opinion, you may face a treatment landscape which is heavily populated by different types of professional offering a range of interventions. An initial belief that a particular type of clinician is best suited for a problem may not be realistic. In addition, the expertise and professional limitations of different types of mental health professionals may seem unclear when you are relatively unfamiliar with the professional landscape.
We list the main types of professionals, their relative expertise and limitations.
In the private sector, most mental health professionals work independently. It is important to consider whether a provider is constituted as a team – and if not, their prior experience of multi-disciplinary team work and the current means to engaging another professional if needed.
A GP provides treatment for a wide range of medical conditions (including mental health conditions) where this is appropriate in the primary care setting, with a referral to specialists in the NHS or private sector where needed. A GP may provide a fit note during a period of sick leave but is unlikely to be able to provide a specialist-level fitness to work assessment; that is, in the mental health field equivalent to a fitness to work assessment provided by a consultant psychiatrist with expertise in occupational mental health.
An occupational health physician is a doctor who has completed specialist training in the management of a range of medical conditions as related to the work situation. An occupational physician can provide a fitness for work report and provide recommendations on a return to work programme and reasonable adjustments. Occupational health physicians do not usually have specialist training in psychiatric conditions.
Some health professionals (such as nurses or physiotherapists) may also have received additional basic training in occupational health matters and may be employed by an occupational health provider to conduct telephone screening assessments. In general, they do not have expertise to carry out specialist fitness to work assessments for mental health conditions or to provide mental health treatments.
A psychiatrist is a medical doctor who has completed specialist training in the diagnosis and treatment of mental ill-health conditions. Psychiatrists have a deep understanding of physical and mental health – and how they affect each other. Some psychiatrists have additional training in treating a particular group of people (such as children or the elderly), or particular types of treatment (such as psychotherapy). Psychiatrists can provide a fitness to work report and may provide or oversee specialist treatment if required. However, not all psychiatrists have experience in occupational aspects of mental ill-health or the related medico-legal considerations. Neither are they necessarily trained in the understanding of organisational dynamics and related consultancy skills.
A psychologist has studied human behaviour and mental functioning. Some psychologists (with the title ‘Clinical Psychologist’ or ‘Counselling Psychologist’) have had clinical training enabling them to help people learn to cope more effectively with life issues and mental health problems. A psychologist may offer treatment such as psychotherapy or counselling. Some clinical psychologists provide fitness to work reports. Psychologists have not had medical training, and do not have specialist expertise in diagnosis and overall medical treatment. As with psychiatrists, not all psychologists have experience in occupational aspects of mental ill-health or the related medico-legal implications.
Cognitive-behavioural therapy (CBT) and psychotherapy are specific talking treatments that help people address psychological difficulties, and in some cases mental ill-health conditions. Some doctors or psychologists complete additional training in these talking therapies. However, in the UK most therapists train in these therapies without having first trained as a doctor or psychologist. In most cases, CBT therapists and psychotherapists do not have the expertise to provide fitness to work assessments or reports.
An occupational therapist (OT) helps people develop skills to live a full life by defining and working towards goals. They have particular skills in rehabilitation. Some, but not all, occupational therapists have specific expertise in the application of OT to helping mental health conditions.
A counsellor usually provides general support and help for an individual to clarify their situation. Some mental health counsellors have training and skills to deliver psychological intervention for common mental health difficulties of a low severity, such as mild depression. They are not qualified to provide treatment for more serious conditions. They are not trained to provide specialist fitness for work assessments.