The National Board for Certified Counsellors, Inc. and Affiliates (NBCC) is an international certifying organisation for professional counsellors in the United States. It is an independent, not-for-profit credentialing organisation based in Greensboro, North Carolina. The purpose of the organisation is to establish and monitor a national certification system for professional counsellors, to identify certified counsellors, and to maintain a register of them.
NBCC has more than 66,000 certified counsellors across the US and in more than 40 countries. Its examinations for professional counsellors are used by all 50 states, the District of Columbia and Puerto Rico to license counsellors.
In December 1979, the American Personnel and Guidance Association (APGA) Board of Directors approved a plan to create a generic counsellor certification registry. In February 1982, the APGA President chose the members of the first NBCC Board, and the board’s first meeting was in April 1982. In July 1982, NBCC was incorporated as a not-for-profit entity separate from APGA. The separation ensured an unbiased certification process and an assumption of liability on the part of NBCC.
The NBCC established and now monitors a national certification system, to identify for professionals and the public those counsellors who have voluntarily sought and obtained certification. Unlike other professional mental health entities such as the American Counselling Association (ACA), the American Psychological Association (APA), and the Association for Counsellor Education and Supervision (ACES), NBCC does not have members. Instead, NBCC sets its own policies and procedures for national certification in professional counselling, administers the National Counsellor Examination to applicants, and keeps a register of counsellors who achieve certification.
Since 2001, NBCC has worked to pass legislation adding licensed professional counsellors (LPC) and marriage and family therapists (MFT) to Medicare. Medicare is the largest health care programme in the United States and currently recognises psychiatrists, psychologists, clinical social workers and psychiatric nurses for outpatient mental health services, but does not reimburse LPCs or MFTs for behavioural health services. As a result, a client who sees an LPC or MFT has to immediately cease therapy at the age of 65, when the government mandates that they must leave their health insurance to enrol in Medicare. NBCC believes that this Medicare exclusion of LPCs and MFTs should be removed, because they can play an important role in a functioning mental health system by maximising the capacity of the behavioural health workforce.
The certification programme recognises counsellors who have met predetermined standards in their training, experience, and performance on the National Counsellor Examination for Licensure and Certification (NCE).
National Certified Counsellor (NCC)
NBCC’s flagship certification is the National Certified Counsellor (NCC). The NCC is a generic certification for professional counsellors and does not designate a particular specialty area. Holding an NCC indicates that a counsellor is nationally board certified. There are currently over 63,000 NCCs in the US and many other countries.
The current requirements to become an NCC include:
A graduate degree in counselling (or one with a major in counselling) from a regionally accredited college or university.
At least 48 semester hours of graduate-level coursework, including at least one course in each of nine specified areas, as well as at least six semester hours of supervised field experience.
At least 3,000 hours of post-master’s counselling experience in an applied setting over a minimum of 24 months, 100 of which must be supervised by a qualified supervisor.
A passing score on the associated National Counsellor Exam (NCE).
After 01 January 2022, NCC applicants will be required to have a degree from a counsellor education programme accredited by the Council for Accreditation of Counselling and Related Educational Programmes (CACREP), which includes a minimum of 60 semester hours of coursework.
The NCC is the board certification for counsellors. It is not required for supervised or independent practice; it identifies counsellors who have voluntarily sought and met established professional standards, and who continue to fulfil requirements governing continuing education credits and certification renewal. Certification is not a substitute for state-mandated licensure. However, many states use the NCE examination as part of their licensing requirements.
In addition to the NCC, NBCC administers three specialty certifications that each have the NCC credential as a prerequisite, along with other requirements.
Certified Clinical Mental Health Counsellor (CCMHC).
Master Addictions Counsellor (MAC).
National Certified School Counsellor (NCSC).
Affiliates and Divisions
Since its establishment in 1982, NBCC has expanded to include:
The Centre for Credentialing & Education (CCE):
Created in 1995, CCE provides practitioners and organisations with assessments, business support services, and credentialing in a variety of fields, including counselling supervision, coaching, distance counselling, and human services.
CCE manages the Mental Health Facilitator (MHF) programme, which educates community members and leaders in providing basic mental health care and resources to their neighbours, especially in locations where mental health care is difficult to access.
NBCC International (NBCC-I):
Created in 2003, NBCC-I’s purpose is to promote the counselling profession worldwide.
With a focus on cultural sensitivity and understanding, as well as public awareness of the meaning of quality in professional counselling, NBCC-I offers programmes and institutes all over the world. NBCC-I also manages the international portion of the MHF programme.
The NBCC Foundation (NBCCF):
Created in 2005, NBCCF uses scholarships, fellowships, and capacity-building grants to encourage counsellors and counsellors-in-training to pursue careers as professional counsellors serving high-priority populations.
Increasing access to mental health care in rural, military, and minority communities is a major focus for NBCCF.
The European Board for Certified Counsellors (EBCC):
Created in 2010, EBCC is the hub for NBCC-I’s work in Europe.
EBCC provides support for European countries that are developing their own professional counselling efforts.
The Professional Counsellor (TPC):
Published by NBCC since 2011, TPC is a peer-reviewed, open-access, academic journal.
It is published online in a continuous format, and covers a wide range of topics including: mental and behavioural health counselling; school counselling; career counselling; couple, marriage, and family counselling; counselling supervision; theory development; professional counselling ethics; international counselling and multicultural issues; programme applications; and integrative reviews from counselling and related fields.
Author(s): Darcy L. Harris and Howard R. Winokuer.
Edition: Third (3rd).
Publisher: Springer Publishing Company.
Type(s): Paperback and Kindle.
This core introductory text, with a focus on clinical application, combines the knowledge and skills of counselling psychology with current theory and research in grief and bereavement. The third edition is updated to address issues related to the developmental aspects of grief, including grief in children and young people, grief as a lifespan concept, and grief in an increasingly aging demographic. It describes new therapeutic approaches and examines the neurological basis of grief as well as trauma from disruption and loss.
Also emphasized is the role of diversity, along with cultural considerations in grief counselling. Instructor’s resources include a Test Bank, Instructor’s Manual, and PowerPoint slides. User-friendly, while grounded in the latest research and theoretical constructs, the text offers such pedagogical aids as learning objectives, practice examples, glossary terms, and questions for reflection in each chapter. Above all, the book addresses grief counselling and support in a way that is informed and practical. The content explores concepts relevant to complicated grief, while differentiating the normal human experience of grief from mental disorders. Purchase includes digital access for use on mobile devices and computers.
Assessment Procedures for Counsellors and Helping Professionals.
Author(s): Carl Sheperis, Robert Drummond, and Karyn Jones.
Edition: Ninth (9th).
A classic textbook for aspiring counsellors, now updated and expanded to improve its usefulness and relevance for practicing counsellors.
Since its first publication in 1988, Assessment Procedures for Counsellors and Helping Professionals has become a classic among assessment textbooks designed specifically for aspiring counsellors. Now in its 9th Edition, the text includes extensive changes to content and updating throughout, while maintaining its popular, easy-to-read format and continuing emphasis on assessment information that is most useful and relevant for school counsellors, marriage and family therapists, mental health counsellors, and other helping professionals. Throughout the text, readers get invaluable information and examples about widely used assessment instruments in order to become familiar with these well-known tests.
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Encyclopaedia of Counselling: Master Review and Tutorial for the National Counsellor Examination, State Counselling Exams, and the Counsellor Preparation Comprehensive Examination.
Author(s): Howard Rosenthal.
Edition: Fourth (4th).
Type(s): Hardcover, Paperback, and Kindle.
With more questions and answers than any other edition, the Encyclopaedia of Counselling, Fourth Edition, is still the only book you need to pass the NCE, CPCE, and other counselling exams. Every chapter has new and updated material and is still written in Dr. Rosenthal’s lively, user-friendly style counsellors know and love. The book’s new and improved coverage incorporates a range of vital topics, including social media, group work in career counselling, private practice and non-profit work, addictions, neurocounselling, research trends, the DSM-5, the new ACA and NBCC codes of ethics, and much, much more.
Encyclopaedia of Counselling: Master Review and Tutorial for the National Counsellor Examination, State Counselling Exams, and the Counsellor Preparation Comprehensive Examination.
Author(s): Howard Rosenthal.
Edition: Third (3rd).
In the third edition of Howard Rosenthal’s best-selling test preparation guide for the National Counsellor Examination (NCE), students get more help than ever with an expanded section on marriage and family counselling, new material on web counselling, and updated material throughout. This resource now includes over 1,050 tutorial questions/answers and a new “Final Review and Last Minute Super Review Boot Camp” section. This guide is an ideal review tool for state licensing, the NCC credential, and preparation for written and oral boards. And because the new Counsellor Preparation Comprehensive Examination (CPCE), draws from the same subject areas, the Encyclopaedia is a perfect study guide for the CPCE as well. Written in a unique question/answer format, with a quick reference index, this is also an essential student reference volume for use in any counselling, social work, or human services course.
Counselling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counselling process and outcome; supervision and training; career development and counselling; and prevention and health. Some unifying themes among counselling psychologists include a focus on assets and strengths, person-environment interactions, educational and career development, brief interactions, and a focus on intact personalities.
The term “counselling” is of American origin, coined by Carl Rogers, who, lacking a medical qualification was prevented from calling his work psychotherapy. In the US, counselling psychology, like many modern psychology specialties, started as a result of World War II. During the war, the US military had a strong need for vocational placement and training. In the 1940s and 1950s, the Veterans Administration created a specialty called “counselling psychology”, and Division 17 (now known as the Society for Counselling Psychology) of the APA was formed. The Society of Counselling Psychology unites psychologists, students and professionals who are dedicated to promote education and training, practice, scientific investigation, diversity and public interest in the field of professional psychology. This fostered interest in counsellor training, and the creation of the first few counselling psychology PhD programmes. The first counselling psychology PhD programmes were at the University of Minnesota; Ohio State University; University of Maryland, College Park; University of Missouri; Teachers College, Columbia University; and University of Texas at Austin.
In recent decades, counselling psychology as a profession has expanded and is now represented in numerous countries around the world. Books describing the present international state of the field include the Handbook of Counselling and Psychotherapy in an International Context; the International Handbook of Cross-Cultural Counselling; and Counselling Around the World: An International Handbook. Taken together these volumes trace the global history of the field, explore divergent philosophical assumptions, counselling theories, processes, and trends in different countries, and review a variety of global counsellor education programmes. Moreover, traditional and indigenous treatment and healing methods that may predate modern counselling methods by hundreds of years remain of significance in many non-Western and Western countries.
Employment and Salary
Counselling psychologists are employed in a variety of settings depending on the services they provide and the client populations they serve. Some are employed in colleges and universities as teachers, supervisors, researchers, and service providers. Others are employed in independent practice providing counselling, psychotherapy, assessment, and consultation services to individuals, couples/families, groups, and organisations. Additional settings in which counselling psychologists practice include community mental health centres, Veterans Administration medical centres and other facilities, family services, health maintenance organisations, rehabilitation agencies, business and industrial organisations and consulting within firms.
The amount of training required for psychologists differs based on the country in which they are practicing. Typically, a psychologist completes an Undergraduate Degree followed by 5-6 years of further study and/or training, leading to the Ph.D. While both psychologists and psychiatrists offer counselling, psychiatrists must possess a medical degree and thus are able to prescribe medication where psychologists are not.
Process and Outcome
Counselling psychologists are interested in answering a variety of research questions about counselling process and outcome. Counselling process refers to how or why counselling happens and progresses. Counselling outcome addresses whether or not counselling is effective, under what conditions it is effective, and what outcomes are considered effective – such as symptom reduction, behaviour change, or quality of life improvement. Topics commonly explored in the study of counselling process and outcome include therapist variables, client variables, the counselling or therapeutic relationship, cultural variables, process and outcome measurement, mechanisms of change, and process and outcome research methods. Classic approaches appeared early in the US in the field of humanistic psychology by Carl Rogers who identified the mission of counselling interview as “to permit deeper expression that the client would ordinarily allow himself”
Therapist variables include characteristics of a counsellor or psychotherapist, as well as therapist technique, behaviour, theoretical orientation and training. In terms of therapist behaviour, technique and theoretical orientation, research on adherence to therapy models has found that adherence to a particular model of therapy can be helpful, detrimental, or neutral in terms of impact on outcome.
A recent meta-analysis of research on training and experience suggests that experience level is only slightly related to accuracy in clinical judgement, Higher therapist experience has been found to be related to less anxiety, but also less focus. This suggests that there is still work to be done in terms of training clinicians and measuring successful training.
Client characteristics such as help-seeking attitudes and attachment style have been found to be related to client use of counselling, as well as expectations and outcome. Stigma against mental illness can keep people from acknowledging problems and seeking help. Public stigma has been found to be related to self-stigma, attitudes towards counselling, and willingness to seek help.
In terms of attachment style, clients with avoidance styles have been found to perceive greater risks and fewer benefits to counselling, and are less likely to seek professional help, than securely attached clients. Those with anxious attachment styles perceive greater benefits as well as risks to counselling. Educating clients about expectations of counselling can improve client satisfaction, treatment duration and outcomes, and is an efficient and cost-effective intervention.
The relationship between a counsellor and client is the feelings and attitudes that a client and therapist have towards one another, and the manner in which those feelings and attitudes are expressed. Some theorists have suggested that the relationship may be thought of in three parts: transference and countertransference, working alliance, and the real – or personal – relationship. Other theorists argue that the concepts of transference and countertransference are outdated and inadequate.
Transference can be described as the client’s distorted perceptions of the therapist. This can have a great effect on the therapeutic relationship. For instance, the therapist may have a facial feature that reminds the client of their parent. Because of this association, if the client has significant negative or positive feelings toward their parent, they may project these feelings onto the therapist. This can affect the therapeutic relationship in a few ways. For example, if the client has a very strong bond with their parent, they may see the therapist as a father or mother figure and have a strong connection with the therapist. This can be problematic because as a therapist, it is not ethical to have a more than “professional” relationship with a client. It can also be a good thing, because the client may open up greatly to the therapist. In another way, if the client has a very negative relationship with their parent, the client may feel negative feelings toward the therapist. This can then affect the therapeutic relationship as well. For example, the client may have trouble opening up to the therapist because they lack trust in their parent (projecting these feelings of distrust onto the therapist).
Another theory about the function of the counselling relationship is known as the secure-base hypothesis, which is related to attachment theory. This hypothesis proposes that the counsellor acts as a secure base from which clients can explore and then check in with. Secure attachment to one’s counsellor and secure attachment in general have been found to be related to client exploration. Insecure attachment styles have been found to be related to less session depth than securely attached clients.
Counselling psychologists are interested in how culture relates to help-seeking and counselling process and outcome. Standard surveys exploring the nature of counselling across cultures and various ethnic groups include Counselling Across Cultures by Paul B. Pedersen, Juris G. Draguns, Walter J. Lonner and Joseph E. Trimble, Handbook of Multicultural Counseling by Joseph G. Ponterotto, J. Manueal Casas, Lisa A. Suzuki and Charlene M. Alexander and Handbook of Culture, Therapy, and Healing by Uwe P. Gielen, Jefferson M. Fish and Juris G. Draguns. Janet E. Helms’ racial identity model can be useful for understanding how the relationship and counselling process might be affected by the client’s and counsellor’s racial identity. Recent research suggests that clients who are Black are at risk for experiencing racial micro-aggression from counsellors who are White.
Efficacy for working with clients who are lesbians, gay men, or bisexual might be related to therapist demographics, gender, sexual identity development, sexual orientation, and professional experience. Clients who have multiple oppressed identities might be especially at-risk for experiencing unhelpful situations with counsellors, so counsellors might need help with gaining expertise for working with clients who are transgender, lesbian, gay, bisexual, or transgender people of colour, and other oppressed populations.
Gender role socialisation can also present issues for clients and counsellors. Implications for practice include being aware of stereotypes and biases about male and female identity, roles and behaviour such as emotional expression. The APA guidelines for multicultural competence outline expectations for taking culture into account in practice and research.
Counselling Ethics and Regulation
Perceptions on ethical behaviours vary depending upon geographical location, but ethical mandates are similar throughout the global community. Ethical standards are created to help practitioners, clients and the community avoid any possible harm or potential for harm. The standard ethical behaviours are centred on “doing no harm” and preventing harm.
Counsellors cannot share any confidential information that is obtained through the counselling process without specific written consent by the client or legal guardian except to prevent clear, imminent danger to the client or others, or when required to do so by a court order. Insurance companies or government programmes will also be notified of certain information about your diagnosis and treatment to determine if your care is covered. Those companies and government programmes are bound by HIPAA to keep that information strictly confidential.
Counsellors are held to a higher standard than most professionals because of the intimacy of their therapeutic delivery. Counsellors are not only to avoid fraternising with their clients. They should avoid dual relationships, and never engage in sexual relationships.
Counsellors are to avoid receiving gifts, favours, or trade for therapy. In some communities, it may be avoidable given the economic standing of that community. In cases of children, children and the mentally handicapped, they may feel personally rejected if an offering is something such as a “cookie”. As counsellors, a judgement call must be made, but in a majority of cases, avoiding gifts, favours, and trade can be maintained.
The National Board for Certified Counsellors states that counsellors “shall discuss important considerations to avoid exploitation before entering into a non-counselling relationship with a former client. Important considerations to be discussed include amount of time since counselling service termination, duration of counselling, nature and circumstances of client’s counselling, the likelihood that the client will want to resume counselling at some time in the future; circumstances of service termination and possible negative effects or outcomes.”
Counselling outcome measures might look at a general overview of symptoms, symptoms of specific disorders, or positive outcomes, such as subjective well-being or quality of life. The Outcome Questionnaire-45 is a 45-item self-report measure of psychological distress. An example of disorder-specific measure is the Beck Depression Inventory. The Quality of Life Inventory is a 17-item self-report life satisfaction measure.
Process and Outcome Research Methods
Research about the counselling process and outcome uses a variety of research methodologies to answer questions about if, how, and why counselling works. Quantitative methods include randomly controlled clinical trials, correlation studies over the course of counselling, or laboratory studies about specific counselling process and outcome variables. Qualitative research methods can involve conducting, transcribing and coding interviews; transcribing and/or coding therapy sessions; or fine-grain analysis of single counselling sessions or counselling cases.
Training and Supervision
Professional Training Process
Counselling psychologists are trained in graduate programmes. Almost all programmes grant a PhD, but a few grant a Psy.D. or Ed.D. Most doctoral programmes take 5-6 years to complete. Graduate work in counselling psychology includes coursework in general psychology and statistics, counselling practice, and research. Students must complete an original dissertation at the end of their graduate training. Students must also complete a one-year full-time internship at an accredited site before earning their doctorate. In order to be licensed to practice, counselling psychologists must gain clinical experience under supervision, and pass a standardised exam.
In Australia, counselling psychology programmes are accredited by the Australian Psychology Accreditation Council (APAC). To become registered as a counselling psychologist, one must meet the criteria for the area of practice endorsement. This includes an undergraduate degree in the science of psychology, an Honours degree or Postgraduate Diploma in Psychology, and a Master’s or Doctorate degree in counselling psychology. Graduates must then complete a registrar programme to obtain an area of practice endorsement and use the title counselling psychologist. A substantial component of this master’s degree is dedicated to individual psychotherapy, family and couples therapy, group therapy, developmental theory and psychopathology.
Training Models and Research
Counselling psychology includes the study and practice of counsellor training and counsellor supervision. As researchers, counselling psychologists may investigate what makes training and supervision effective. As practitioners, counselling psychologists may supervise and train a variety of clinicians. Counsellor training tends to occur in formal classes and training programmes. Part of counsellor training may involve counselling clients under the supervision of a licensed clinician. Supervision can also occur between licensed clinicians, as a way to improve clinicians’ quality of work and competence with various types of counselling clients.
As the field of counselling psychology formed in the mid-20th century, initial training models included Robert Carkuff’s human relations training model, Norman Kagan’s Interpersonal Process Recall, and Allen Ivey’s micro-counselling skills. Modern training models include Gerard Egan’s skilled helper model, and Clara E. Hill’s three-stage model (exploration, insight, and action). A recent analysis of studies on counsellor training found that modelling, instruction, and feedback are common to most training models, and seem to have medium to large effects on trainees.
Supervision Models and Research
Like the models of how clients and therapists interact, there are also models of the interactions between therapists and their supervisors. Edward S. Bordin proposed a model of supervision working alliance similar to his model of therapeutic working alliance. The Integrated Development Model considers the level of a client’s motivation/anxiety, autonomy, and self and other awareness. The Systems Approach to Supervision views the relationship between supervisor and supervised as most important, in addition to characteristics of the supervisor’s personal characteristics, counselling clients, training setting, as well as the tasks and functions of supervision. The Critical Events in Supervision model focuses on important moments that occur between the supervisor and supervised.
Problems can arise in supervision and training. First, supervisors are liable for malpractice. Also, questions have arisen as far as a supervisor’s need for formal training to be a competent supervisor. Recent research suggests that conflicting, multiple relationships can occur between supervisors and clients, such as that of the client, instructor, and clinical supervisor. The occurrence of racial micro-aggression against Black clients suggests potential problems with racial bias in supervision. In general, conflicts between a counsellor and his or her own supervisor can arise when supervisors demonstrate disrespect, lack of support, and blaming.
Vocational Development and Career Counselling
There are several types of theories of vocational choice and development. These types include trait and factor theories, social cognitive theories, and developmental theories. Two examples of trait and factor theories, also known as person-environment fit, are Holland’s theory and the Theory of Work Adjustment.
John Holland hypothesized six vocational personality/interest types and six work environment types:
When a person’s vocational interests match his or her work environment types, this is considered congruence. Congruence has been found to predict occupation and college major.
The Theory of Work Adjustment (TWA), as developed by René Dawis and Lloyd Lofquist, hypothesizes that the correspondence between a worker’s needs and the reinforced systems predicts job satisfaction, and that the correspondence between a worker’s skills and a job’s skill requirements predicts job satisfaction. Job satisfaction and personal satisfaction together should determine how long one remains at a job. When there is a discrepancy between a worker’s needs or skills and the job’s needs or skills, then change needs to occur either in the worker or the job environment.
Social Cognitive Career Theory (SCCT) has been proposed by Robert D. Lent, Steven D. Brown and Gail Hackett. The theory takes Albert Bandura’s work on self-efficacy and expands it to interest development, choice making, and performance. Person variables in SCCT include self-efficacy beliefs, outcome expectations and personal goals. The model also includes demographics, ability, values, and environment. Efficacy and outcome expectations are theorised to interrelate and influence interest development, which in turn influences choice of goals, and then actions. Environmental supports and barriers also affect goals and actions. Actions lead to performance and choice stability over time.
Career development theories propose vocational models that include changes throughout the lifespan. Donald Super’s model proposes a lifelong five-stage career development process. The stages are growth, exploration, establishment, maintenance, and disengagement. Throughout life, people have many roles that may differ in terms of importance and meaning. Super also theorised that career development is an implementation of self-concept. Gottfredson also proposed a cognitive career decision-making process that develops through the lifespan. The initial stage of career development is hypothesized to be the development of self-image in childhood, as the range of possible roles narrows using criteria such as sex-type, social class, and prestige. During and after adolescence, people take abstract concepts into consideration, such as interests.
Career counselling may include provision of occupational information, modelling skills, written exercises, and exploration of career goals and plans. Career counselling can also involve the use of personality or career interest assessments, such as the Myers-Briggs Type Indicator, which is based on Carl Jung’s theory of psychological type, or the Strong Interest Inventory, which makes use of Holland’s theory. Assessments of skills, abilities, and values are also commonly assessed in career counselling.
In the United States, the premier scholarly journals of the profession are the Journal of Counselling Psychology and The Counselling Psychologist.
In Australia, counselling psychology articles are published in the counselling psychology section of the Australian Psychologist.
In Europe, the scholarly journals of the profession include the European Journal of Counselling Psychology (under the auspices of the European Association of Counselling Psychology) and the Counselling Psychology Review (under the auspices of the British Psychological Society). Counselling Psychology Quarterly is an international interdisciplinary publication of Routledge (part of the Taylor & Francis Group).
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual’s mental health or to treat mental disorders.
This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e. state office personnel, private sector personnel, and non-profit, and now voluntary sector personnel) were the forefront brigade to develop the community programmes, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counselling.
Psychiatrists also are working in clinical fields with psychologists including in sociobehavioural, neurological, person-centred and clinical approaches (often office-based), and studies of the “brain disease” (which came from the community fields and community management and are taught at the MA to PhD level in education). For example, Nat Raskin (at Northwestern University Medical School) who worked with the illustrious Carl Rogers, published on person-centred approaches and therapy in 2004. The term counsellors often refers to office-based professionals who offer therapy sessions to their clients, operated by organisations such as pastoral counselling (which may or may not work with long term services clients) and family counsellors. Mental health counsellors may refer to counsellors working in residential services in the field of mental health in community programmes.
As Community Professionals
As Dr. William Anthony, father of psychiatric rehabilitation, described, psychiatric nurses (RNMH, RMN, CPN), clinical psychologists (PsyD or PhD), clinical social workers (MSW or MSSW), mental health counselors (MA or MS), professional counselors, pharmacists, as well as many other professionals are often educated in “psychiatric fields” or conversely, educated in a generic community approach (e.g. human services programmes or health and human services in 2013). However, his primary concern is education that leads to a willingness to work with “long-term services and supports” community support in the community to lead to better life quality for the individual, the families and the community.
The community support framework in the US of the 1970s is taken-for-granted as the base for new treatment developments (e.g. eating disorders, drug addiction programmes) which tend to be free-standing clinics for specific “disorders”. Typically, the term “mental health professional” does not refer to other categorical disability areas, such as intellectual and developmental disability (which trains its own professionals and maintains its own journals, and US state systems and institutions). Psychiatric rehabilitation has also been reintroduced into the transfer to behavioural health care systems.
As Certified and Licensed (Across Institutions and Communities)
These professionals often deal with the same illnesses, disorders, conditions, and issues (though may separate on-site locations, such as hospital or community for the same clientele); however, their scope of practice differs and more particularly, their positions and roles in the fields of mental health services and systems. The most significant difference between mental health professionals are the laws regarding required education and training across the various professions. However, the most significant change has been the Supreme Court Olmstead Decision on the most integrated setting which should further reduce state hospital utilisation; yet with new professionals seeking right for community treatment orders and rights to administer medications (original community programmes, residents taught to self-administer medications, 1970s).
In 2013, new mental health practitioners are licensed or certified in the community (e.g., PhD, education in private clinical practice) by states, degrees and certifications are offered in fields such as psychiatric rehabilitation (MS, PhD), BA psychology (liberal arts, experimental/clinical/existential/community) to MA licensing is now more popular, BA (to PhD) mid-level programme management, qualified civil service professionals, and social workers remain the mainstay of community admissions procedures (licensed by state, often generic training) in the US. Surprisingly, state direction has moved from psychiatry or clinical psychology to community leadership and professionalisation of community services management.
Entry level recruitment and training remain a primary concern (since the 1970s, then often competing with fast food positions), and the US Direct Support Workforce includes an emphasis on also training of psychiatric aides, behavioural aides, and addictions aides to work in homes and communities. The Centres for Medicaid and Medicare have new provisions for “self-direction” in services and new options are in place for individual plans for better life outcomes. Community programs are increasingly using health care financing, such as Medicaid, and Mental Health Parity is now law in the US.
Currently, psychologists may prescribe in US five states: Iowa, Idaho, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the Indian Health Service, the US military, and Guam.
Includes licensed dual inclusion educators, behaviour analyst, substance abuse and behavioural disorders, “inclusion educator”.
Treatment Diversity and Community Mental Health
Mental health professionals exist to improve the mental health of individuals, couples, families and the community-at-large (In this generic use, mental health is available to the entire population, similar to the use by mental health associations). Because mental health covers a wide range of elements, the scope of practice greatly varies between professionals. Some professionals may enhance relationships while others treat specific mental disorders and illness; still, others work on population-based health promotion or prevention activities. Often, as with the case of psychiatrists and psychologists, the scope of practice may overlap often due to common hiring and promotion practices by employers.
As indicated earlier, community mental health professionals have been involved in the beginning and operating community programmes which include ongoing efforts to improve life outcomes, originally through long term services and supports (LTSS). Termed functional or competency-based programmes, this service also stressed decision making and self-determination or empowerment as critical aspects. Community mental health professionals may also serve children who have different needs, as do families, including family therapy, financial assistance and support services. Community mental health professionals serve people of all ages from young children with autism, to children with emotional (or behavioural) needs, to grandma who has Alzheimer’s or dementia and is living at home after dad passes away.
Most qualified mental health professionals will refer a patient or client to another professional if the specific type of treatment needed is outside of their scope of practice. The main community concern is “zero rejection” from community services for individuals who have been termed “hard to serve” in the population (think schizophrenia or dual diagnosis) or who have additional needs such as mobility and sensory impairments. Additionally, many mental health professionals may sometimes work together using a variety of treatment options such as concurrent psychiatric medication and psychotherapy and supported housing. Additionally, specific mental health professionals may be utilised based upon their cultural and religious background or experience, as part of a theory of both alternative medicines and of the nature of helping and ethnicity.
Primary care providers, such as internists, paediatricians, and family physicians, may provide initial components of mental health diagnosis and treatment for children and adults; however, family physicians in some states refuse to even prescribe a psychotropic medication deferring to separately funded “medication management” services. Community programmes in the categorical field of mental health were designed (1970s) to have a personal family physician for every client in their programmes, except for institutional settings and nursing facilities which have only one or two for a large facility.
In particular, family physicians are trained during residency in interviewing and diagnostic skills, and may be quite skilled in managing conditions such as attention deficit hyperactivity disorder (ADHD) in children and depression in adults. Likewise, many (but not all) paediatricians may be taught the basic components of ADHD diagnosis and treatment during residency. In many other circumstances, primary care physicians may receive additional training and experience in mental health diagnosis and treatment during their practice years.
Both primary care physicians/general practitioners (GP’s) and psychiatrist are just as effective (in terms of remission rates) for the treatment of depression. However, treatment resistant depression, suicidal, homicidal ideation, psychosis and catatonia should be handled by mental health specialists. Treatment-resistant depression (or treatment refractory depression) refers to depression which remains at large after at least two antidepressant medications have been trailed on their own.
Some think that mental health professionals are less credible when they have personal experience of mental health. In fact, the mental health sector goes out of its way to hire people with mental illness experience. Those in the mental health workforce with personal experience of mental health are referred to as ‘peer (support) workers’. The balance of evidence appears to favour their employment: Randomised controlled trials consistently demonstrate peer staff produce outcomes on par with non-peer staff in ancillary roles, but they actually perform better in reducing hospitalisation rates, engaging clients who are difficult to reach, and cutting substance use. There is research that indicates peer workers cultivate a perception among service users that the service is more responsive to non-treatment things, increases their hope, family satisfaction, self-esteem and community belonging.
Psychiatrists are physicians and one of the few professionals in the mental health industry who specialize and are certified in treating mental illness using the biomedical approach to mental disorders including the use of medications. However, biological, genetic and social processes as part of pre-medicine have been the basis of education in fields such as BA psychology since the 1970s, and in 2013, such academic degrees also may include extensive work on the status of brain, DNA research and its applications. Clinical psychologists were hired by states and served in institutions in the US, and were involved in the transition to community systems.
Psychiatrists may also go through significant training to conduct psychotherapy and cognitive behavioural therapy;. The amount of training a psychiatrist holds in providing these types of therapies varies from program to program and also differs greatly based upon region (Cognitive therapy also stems from cognitive rehabilitation techniques, and may involve long-term community clients with brain injuries seeking jobs, education and community housing). In the 1970s, psychiatrists were considered to be hospital-based, assessment, and clinical education personnel which was not involved in establishing community programmes.
Specialties of Psychiatrists
As part of their evaluation of the patient, psychiatrists are one of only a few mental health professionals who may conduct physical examinations, order and interpret laboratory tests and EEGs, and may order brain imaging studies such as CT or CAT, MRI, and PET scanning. A medical professional must evaluate the patient for any medical problems or diseases that may be the cause of the mental illness.
Historically psychiatrists have been the only mental health professional with the power to prescribe medication to treat specific types of mental illness. Currently, physician assistants response to the psychiatrist (in lieu of and supervised) and advanced practice psychiatric nurses may prescribe medications, including psychiatric medications. Clinical psychologists have gained the ability to prescribe psychiatric medications on a limited basis in a few US states after completing additional training and passing an examination.
Educational Requirements for Psychiatrists
Typically the requirements to become a psychiatrist are substantial but differ from country to country. In general there is an initial period of several years of academic and clinical training and supervised work in different areas of medicine, in order to become a licensed medical doctor, followed by several years of supervised work and study in psychiatry, in order to become a licensed psychiatrist.
In the United States and Canada one must first complete a Bachelor’s degree. Students may typically decide any major subject of their choice, however they must enrol in specific courses, usually outlined in a pre-medical programme. One must then apply to and attend 4 years of medical school in order to earn their MD or DO and to complete their medical education. Psychiatrists must then pass three successive rigorous national board exams (United States Medical Licensing Exams “USMLE”, Steps 1, 2, and 3), which draws questions from all fields of medicine and surgery, before gaining an unrestricted license to practice medicine. Following this, the individual must complete a four-year residency in Psychiatry as a psychiatric resident and sit for annual national in-service exams. Psychiatry residents are required to complete at least four post-graduate months of internal medicine (paediatrics may be substituted for some or all of the internal medicine months for those planning to specialise in child and adolescent psychiatry) and two months of neurology, usually during the first year, but some programmes require more. Occasionally, some prospective psychiatry residents will choose to do a transitional year internship in medicine or general surgery, in which case they may complete the two months of neurology later in their residency. After completing their training, psychiatrists take written and then oral specialty board examinations. The total amount of time required to qualify in the field of psychiatry in the United States is typically 4 to 5 years after obtaining the MD or DO (or in total 8 to 9 years minimum). Many psychiatrists pursue an additional 1-2 years in subspecialty fellowships on top of this such as child psychiatry, geriatric psychiatry, and psychosomatic medicine.
In the United Kingdom, the Republic of Ireland, and most Commonwealth countries, the initial degree is the combined Bachelor of Medicine and Bachelor of Surgery, usually a single period of academic and clinical study lasting around five years. This degree is most often abbreviated ‘MBChB’, ‘MB BS’ or other variations, and is the equivalent of the American ‘MD’. Following this the individual must complete a two-year foundation programme that mainly consists of supervised paid work as a Foundation House Officer within different specialties of medicine. Upon completion the individual can apply for “core specialist training” in psychiatry, which mainly involves supervised paid work as a Specialty Registrar in different subspecialties of psychiatry. After three years there is an examination for Membership of the Royal College of Psychiatrists (abbreviated MRCPsych), with which an individual may then work as a “Staff grade” or “Associate Specialist” psychiatrist, or pursue an academic psychiatry route via a PhD. If, after the MRCPsych, an additional 3 years of specialisation known as “advanced specialist training” are taken (again mainly paid work), and a Certificate of Completion of Training is awarded, the individual can apply for a post taking independent clinical responsibility as a “consultant” psychiatrist.
A clinical psychologist studies and applies psychology for the purpose of understanding, preventing and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. In many countries it is a regulated profession that addresses moderate to more severe or chronic psychological problems, including diagnosable mental disorders. Clinical psychology includes a wide range of practices, such as research, psychological assessment, teaching, consultation, forensic testimony, and program development and administration. Central to clinical psychology is the practice of psychotherapy, which uses a wide range of techniques to change thoughts, feelings, or behaviours in service to enhancing subjective well-being, mental health, and life functioning. Unlike other mental health professionals, psychologists are trained to conduct psychological assessment. Clinical psychologists can work with individuals, couples, children, older adults, families, small groups, and communities.
Specialties of Clinical Psychologists
Clinical psychologists who focus on treating mental health specialises in evaluating patients and providing psychotherapy. They do not prescribe medication as this is a role of a psychiatrist (physician who specialises in psychiatry). There are a wide variety of therapeutic techniques and perspectives that guide practitioners, although most fall into the major categories of Psychodynamic, Cognitive Behavioural, Existential-Humanistic, and Systems Therapy (e.g. family or couples therapy).
In addition to therapy, clinical psychologists are also trained to administer and interpret psychological personality tests such as the MMPI and the Rorschach inkblot test, and various standardised tests of intelligence, memory, and neuropsychological functioning. Common areas of specialization include: specific disorders (e.g. trauma), neuropsychological disorders, child and adolescent, family and relationship counselling. Internationally, psychologists are generally not granted prescription privileges. In the US, prescriptive rights have been granted to appropriately trained psychologists only in the states of New Mexico and Louisiana, with some limited prescriptive rights in Indiana and the US territory of Guam.
Educational Requirements for Clinical Psychologists
Clinical psychologists, having completed an undergraduate degree usually in psychology or other social science, generally undergo specialist postgraduate training lasting at least two years (e.g. Australia), three years (e.g. UK), or four to six years depending how much research activity is included in the course (e.g. US). In countries where the course is of shorter duration, there may be an informal requirement for applicants to have undertaken prior work experience supervised by a clinical psychologist, and a proportion of applicants may also undertake a separate PhD research degree.
Today, in the US, about half of licensed psychologists are trained in the Scientist-Practitioner Model of Clinical Psychology (PhD) – a model that emphasizes both research and clinical practice and is usually housed in universities. The other half are being trained within a Practitioner-Scholar Model of Clinical Psychology (PsyD), which focuses on practice (similar to professional degrees for medicine and law). A third training model called the Clinical Scientist Model emphasizes training in clinical psychology research. Outside of coursework, graduates of both programmes generally are required to have had 2 to 3 years of supervised clinical experience, a certain amount of personal psychotherapy, and the completion of a dissertation (PhD programmes usually require original quantitative empirical research, whereas the PsyD equivalent of dissertation research often consists of literature review and qualitative research, theoretical scholarship, programme evaluation or development, critical literature analysis, or clinical application and analysis).
Continuing Education Requirements for Clinical Psychologists
Most states in the US require clinical psychologists to obtain a certain number of continuing education credits in order to renew their license. This was established to ensure that psychologists stay current with information and practices in their fields. The license renewal cycle varies, but renewal is generally required every two years.
The number of continuing education credits required for clinical psychologists varies between states. In Nebraska, psychologists are required to obtain 24 hours of approved continuing education credits in the 24 months before their license renewal. In California, the requirement is for 36 hours of credits. New York State does not have any continuing education requirements for license renewal at this time (2014).
Activities that count towards continuing education credits generally include completing courses, publishing research papers, teaching classes, home study, and attending workshops. Some states require that a certain number of the education credits be in ethics. Most states allow psychologists to self-report their credits but randomly audit individual psychologists to ensure compliance.
Counselling Psychologist or Psychotherapist
Counselling generally involves helping people with what might be considered “normal” or “moderate” psychological problems, such as the feelings of anxiety or sadness resulting from major life changes or events. As such, counselling psychologists often help people adjust to or cope with their environment or major events, although many also work with more serious problems as well.
One may practice as a counselling psychologist with a PhD or EdD, and as a counselling psychotherapist with a master’s degree. Compared with clinical psychology, there are fewer counselling psychology graduate programs (which are commonly housed in departments of education), counsellors tend to conduct more vocational assessment and less projective or objective assessment, and they are more likely to work in public service or university clinics (rather than hospitals or private practice). Despite these differences, there is considerable overlap between the two fields and distinctions between them continue to fade.
Mental health counsellors and residential counsellors are also the name for another class of counsellors or mental health professionals who may work with long-term services and supports (LTSS) clients in the community. Such counsellors may be advanced or senior staff members in a community program, and may be involved in developing skill teaching, active listening (and similar psychological and educational methods), and community participation programmes. They also are often skilled in on-site intervention, redirection and emergency techniques. Supervisory personnel often advance from this class of workers in community programmes.
Behaviour Analysts and Community/Institutional Roles
Behaviour analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness. This profession draws on the evidence base of applied behaviour analysis, behaviour therapy, and the philosophy of radical behaviourism. Behaviour analysts have at least a master’s degree in behaviour analysis or in a mental health related discipline as well as at least five core courses in applied behaviour analysis (narrow focus in psychological education). Many behaviour analysts have a doctorate. Most programmes have a formalised internship programme and several programmes are offered online. Most practitioners have passed the examination offered by the behaviour analysis certification board or the examination in clinical behaviour therapy by the World Association for Behaviour Analysis. The model licensing act for behaviour analysts can be found at the Association for Behaviour Analysis International’s website.
Behaviour analysts (who grew from the definition of mental health as a behavioural problem) often use community situational activities, life events, functional teaching, community “reinforcers”, family and community staff as intervenors, and structured interventions as the base in which they may be called upon to provide skilled professional assistance. Approaches that are based upon person-centred approaches have been used to update the stricter, hospital based interventions used by behaviour analysts for applicability to community environments. Behavioural approaches have often been infused with efforts at client self-determination, have been aligned with community lifestyle planning, and have been criticised as “aversive technology” which was “outlawed” in the field of severe disabilities in the 1990s.
Certified Mental Health Professional
The Certified Mental Health Professional (CMHP) certification is designed to measure an individual’s competency in performing the following job tasks. The job tasks are a sampling of job tasks with a clinical emphasis, and represents a level of line staff in community programmes reporting to a community supervisor in a small site based programme. Personnel in community housing, nursing facilities, and institutional programmes may be covered by these kinds of certifications.
Maintain confidentiality of records relating to clients’ treatment (and daily affairs as desired by the person).
Encourage clients to express their feelings, discuss what is happening in their lives, and help them to develop insight into themselves and their relationships.
Guide clients in the development of skills and strategies for dealing with their problems (and desired life outcomes).
Prepare and maintain all required treatment (and/or community service) records and reports.
Counsel clients and patients, individually and in group sessions, to assist in overcoming dependencies (seeking new relationships), adjusting to life, and making changes.
Collect information about clients through interviews, observations, and tests (and most importantly, speaking with and planning with the person).
Act as the client’s advocate in order to coordinate required services or to resolve emergency problems in crisis situations (often first line of emergency response).
Develop and implement treatment (or “person-centred”) plans based on clinical (and community) experience and knowledge.
Collaborate with other staff members to perform clinical assessments (and health may be contracted for specific consultations) and develop treatment (service) plans.
Evaluate client’s physical or mental condition (plan, not condition) based on review of client information (Evaluate outcomes as planned with the client on a “quarterly basis”).
However, these position levels have undergone decades of academic field testing and recommendations with new competencies in development in 2011-2013 by the Centres for Medicaid and Medicare (at the categorical aide levels). New professionals were recommended with a community services coordinator (commonly known as “hands on” case management), together with services and personnel management, and community development and liaison roles for community participation.
School Psychologist and Inclusion Educators
School psychologists’ primary concern is with the academic, social, and emotional well-being of children within a scholastic environment. Unlike clinical psychologists, they receive much more training in education, child development and behaviour, and the psychology of learning, often graduating with a post-master’s educational specialist degree (EdS), EdD or Doctor of Philosophy (PhD) degree. Besides offering individual and group therapy with children and their families, school psychologists also evaluate school programmes, provide cognitive assessment, help design prevention programmes (e.g. reducing drops outs), and work with teachers and administrators to help maximise teaching efficacy, both in the classroom and systemically.
In today’s world, the school psychologist remains the responsible party in “mental health” regarding children with emotional and behavioural needs, and have not always met these needs in the regular school environment. Inclusion (special) educators support participation in local school programmes and after school programmes, including new initiatives such as Achieve my Plan by the Research and Training Centre on Family Support and Children’s Mental Health at Portland State University. Referrals to residential schools and certification of the personnel involved in the residential schools and campuses have been a multi-decade concern with counties often involved in national efforts to better support these children and youth in local schools, families, homes and communities.
Psychiatric rehabilitation, similar to cognitive rehabilitation, is a designated field in the rehabilitation often academically prepared in either Schools of Allied Health and Sciences (near the field of Physical Medicine and Rehabilitation) and as rehabilitation counselling in the School of Education. Both have been developed specifically as preparing community personnel (at the MA and PHD levels) and to aid in the transition to professionally competent and integrated community services. Psychiatric rehabilitation personnel have a community integration-related base, support recovery and skills-based model of mental health, and may be involved with community programmes based upon normalisation and social role valourisation throughout the US. Psychiatric rehabilitation personnel have been involved in upgrading the skills of staff in institutions in order to move clients into community settings. Most common in international fields are community rehabilitation personnel which traditionally come from the rehabilitation counselling or community fields. In the new “rehabilitation centres” (new campus buildings), designed similar to hospital “rehab” (physical and occupational therapy, sports medicine), often no designated personnel in the fields of mental health (now “senior behavioural services” or “residential treatment units”). Psychiatric rehabilitation textbooks are currently on the market describing the community services their personnel were involved within community development (commonly known as deinstitutionalisation).
Psychiatric rehabilitation professionals (and psychosocial services) are the mainstay of community programs in the US, and the national service providers association itself may certify mental health staff in these areas. Psychiatric interventions which vary from behavioural ones are described in a review on their use in “residential, vocational, social or educational role functioning” as a “preferred methods for helping individuals with serious psychiatric disabilities”. Other competencies in education may involve working with families, user-directed planning methods and financing, housing and support, personal assistance services, transitional or supported employment, Americans with Disabilities Act (ADA), supported housing, integrated approaches (e.g. substance use, or intellectual disabilities), and psychosocial interventions, among others. In addition, rehabilitation counsellors (PhD, MS) may also be educated “generically” (breadth and depth) or for all diagnostic groups, and can work in these fields; other personnel may have certifications in areas such as supported employment which has been verified for use in psychiatric, neurological, traumatic brain injury, and intellectual disabilities, among others.
Social workers in the area of mental health may assess, treat, develop treatment plans, provide case management and/or rights advocacy to individuals with mental health problems. They can work independently or within clinics/service agencies, usually in collaboration with other health care professionals.
In the US, they are often referred to as clinical social workers; each state specifies the responsibilities and limitations of this profession. State licensing boards and national certification boards require clinical social workers to have a master’s or doctoral degree (MSW or DSW/PhD) from a university. The doctorate in social work requires submission of a major original contribution to the field in order to be awarded the degree.
In the UK there is a now a standardised three-year undergraduate social work degree, or two-year postgraduate masters for those who already have an undergraduate social sciences degree or others and relevant work experience. These courses include mandatory supervised work experience in social work, which may include mental health services. Successful completion allows an individual to register and work as a qualified social worker. There are various additional optional courses for gaining qualifications specific to mental health, for example training in psychotherapy or, in England and Wales, for the role of Approved Mental Health Professional (two years’ training for a legal role in the assessment and detention of eligible mentally disordered people under the Mental Health Act (1983) as amended in 2007).
Social workers in England and Wales are now able to become Approved Clinicians under the Mental Health Act 2007 following a period of further training (likely at postgraduate degree/diploma or doctoral level). Historically, this role was reserved for psychiatrist medical doctors, but has now extended to registered mental health professionals, such as social workers, psychologists and mental health nurses.
In general, it is the psycho-social model rather than, or in addition to, the dominant medical model, that is the underlying rationale for mental health social work. This may include a focus on social causation, labelling, critical theory and social constructiveness. Many argue social workers need to work with medical and health colleagues to provide an effective service but they also need to be at the forefront of processes that include and empower service users.
Social workers also prepare social work administration and may hold positions in human services systems as administration or Executives to Administration in the US. Social workers, similar to psychiatric rehabilitation, updates its professional education programmes based upon current developments in the fields (e.g. support services) and serve a multicultural client base.
Educational Requirements for Social Workers
In the United States, the minimum requirement for social workers is generally a bachelor’s degree in social work, though a bachelor’s degree in a related field such as sociology or psychology may qualify an applicant for certain jobs. Higher-level jobs typically require a master’s degree in social work. Master’s programs in social work usually last two years and consist of at least 900 hours of supervised instruction in the field. Regulatory boards generally require that degrees be obtained from programmes that are accredited by the Council of Social Work Education (CSWE) or another nationally recognised accrediting agency for promotion and future collaboration.
Before social workers can practice, they are required to meet the licensing, certification, or registration requirements of the state. The requirements vary depending on the state but usually involve a minimum number of supervised hours in the field and passing of an exam. All states, except California, also require pre-licensure from the Association of Social Work Boards (ASWB).
The ASWB offers four categories of social work license. The lowest level is a Bachelors, for which a bachelor’s degree in social work is required. The next level up is a Masters and a master’s degree in social work is required. The Advanced Generalist category of social worker requires a master’s degree in social work and two years of supervised post-degree experience. The highest ASWB category is a Clinical Social Worker which requires a master’s degree in social work along with two years of post-master’s direct experience in social work.
Continuing Education Requirements for Social Workers
Most states require social workers to acquire a minimum number of continuing education credits per license, certification, or registration renewal period. The purpose of these requirements is to ensure that social workers stay up-to-date with information and practices in their professions. In most states, the renewal process occurs every two or three years. The number of continuing education credits that is required varies between states but is generally 20 to 45 hours during the two- or three-year period prior to renewal.
Courses and programs that are approved as continuing education for social workers generally must be relevant to the profession and contribute to the advancement of professional competence. They often include continuing education courses, seminars, training programs, community service, research, publishing articles, or serving on a panel. Many states enforce that a minimum amount of the credits be on topics such as ethics, HIV/AIDs, or domestic violence.
Psychiatric and Mental Health Nurse
Psychiatric Nurses or Mental Health Nurse Practitioners work with people with a large variety of mental health problems, often at the time of highest distress, and usually within hospital settings. These professionals work in primary care facilities, outpatient mental health clinics, as well as in hospitals and community health centres. MHNPs evaluate and provide care for patients who have anything from psychiatric disorders, medical mental conditions, to substance abuse problems. They are licensed to provide emergency psychiatric services, assess the psycho-social and physical state of their patients, create treatment plans, and continually manage their care. They may also serve as consultants or as educators for families and staff; however, the MHNP has a greater focus on psychiatric diagnosis (typically the province of the MD or PhD), including the differential diagnosis of medical disorders with psychiatric symptoms and on medication treatment for psychiatric disorders.
Educational Requirements for Psychiatric and Mental Health Nurses
Psychiatric and mental health nurses receive specialist education to work in this area. In some countries, it is required that a full course of general nurse training be completed prior to specialising as a psychiatric nurse. In other countries, such as the UK, an individual completes a specific nurse training course that determines their area of work. As with other areas of nursing, it is becoming usual for psychiatric nurses to be educated to degree level and beyond. Psychiatric aides, now being trained by educational psychology in 2014, are part of the entry-level workforce which is projected to be needed in communities in the US in the next decades.
In order to become a nurse practitioner in the US, at least six years of college education must be obtained. After earning the bachelor’s degree (usually in nursing, although there are master’s entry level nursing graduate programs intended for individuals with a bachelor’s degree outside of nursing) the test for a license as a registered nurse (the NCLEX-RN) must be passed. Next, the candidate must complete a state-approved master’s degree advanced nursing education program which includes at least 600 clinical hours. Several schools are now also offering further education and awarding a DNP (Doctor of Nursing Practice).
Individuals who choose a master’s entry level pathway will spend an extra year at the start of the programme taking classes necessary to pass the NCLEX-RN. Some schools will issue a BSN, others will issue a certificate. The student then continues with the normal MSN programme.
Mental Health Care Navigator
A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. Individuals who are care navigators are often also trained therapists and doctors. The need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave those in need with more questions than answers. Care navigators work closely with patients through discussion and collaboration to provide information on options and referrals to healthcare professionals, facilities, and organisations specialising in the patients’ needs. The difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering diagnosis, prescription of medications or treatment.
Many mental health organisations use “navigator” and “navigation” to describe the service of providing guidance through the health care industry. Care navigators are also sometimes referred to as “system navigators”. One type of care navigator is an “educational consultant.”
Behavioural health disorders are prevalent in the United States, but accessing treatment can be challenging. Nearly 1 in 5 adults experience a mental health condition for which approximately only 43% received treatment. When asked about access to mental health treatment, two-thirds of primary care physicians reported that they were unable to secure outpatient mental health treatment for their patients. This is due, in part, to the workforce shortage in behavioural health. In rural areas, 55% of US counties have no practicing psychiatrist, psychologist, or social worker. Overall, 77% of counties have a severe shortage of mental health workers and 96% of counties had some unmet need. Some of the reasons for the workforce shortage include high turnover rates, high levels of work-related stress, and inadequate compensation. Annual turnover rate is 33% for clinicians and 23% for clinical supervisors. This is compared to an annual PCP turnover rate of 7.1%. Compensation in behavioural health field is notably low. The average licensed clinical social worker, a position that requires a master’s degree and 2,000 hours of post-graduate experience, earns $45,000/year. As a point of reference, the average physical therapist earns $75,000/year. Substance abuse counsellor earnings are even lower, with an average salary of $34,000/year. Job stress is another factor that may lead to the high turnover rates and workforce shortage. It is estimated that 21-67% of mental health workers experience high levels of burnout including symptoms of emotional exhaustion, high levels of depersonalisation and a reduced sense of personal accomplishment. Researchers have offered various recommendations to reduce the critical workforce gaps in behavioural health. Some of these recommendations include the following: expanding loan repayment programmes to incentivise mental health providers to work in underserved (often rural) areas, integrating mental health into primary care, and increasing reimbursement to health care professionals.
Social workers also tend to experience competing for work and family demands, which negatively affects their job well-being and subsequently their job satisfaction, resulting in high turnover in the profession.
Mental Health Emergencies: A Guide to Recognising and Handling Mental Health Crises.
Author(s): Nick Benas and Michele Hart (LCSW).
Edition: First (1st).
Publisher: Hatherleigh Press.
Type(s): Paperback and Kindle.
One in three people will deal with some kind of mental health concern during their lifetime and odds of knowing a loved one dealing with problems in mental health is even greater.
Mental Health First Aid is a comprehensive guide that provides an overview of the most common mental health problems as well as provide expert guidance on more serious problems such as self-injury, eating disorders, substance abuse, psychosis and attempted suicides.
Way from Chaos to a Better Life: Developing Mental health and Recovering from a Mental Illness: By a Survivor’s Inside-Out Persepctive.
Author(s): Henri Kulm.
Edition: First (1st).
Publisher: Independently Published.
Type(s): Paperback and Kindle.
My name is Henri. I was born in 1990 in the capital of Estonia, Tallinn and I have lived there my entire life. I have been diagnosed with schizoaffective disorder, mixed type. This means that I must cope with psychotic episodes and mood disturbances (symptoms of schizophrenia and bipolar disorder). I have been struck by the illness more seriously twice: the first blow was, when I was 22 years old, and the second one was, when I was 25 years old. I have gotten my education by finishing a bachelors and master's degree in energetics and now, I work full-timely in that area. I have gotten my training from Tallinn Mental Health Centre and Loov Ruum Koolitused OÜ to be a licensed experience counsellor and I have been involved in the following activities during my work at Tallinn Mental Health Centre: Individual and group counselling, sharing experience story, conducting trainings, representing organization in media. In the training process, I decided to write deeply about my experience recovering from a major mental illness and I want share that with you. Experience counsellor is a person, who has been diagnosed with a mental illness, but has recovered well. He/she can tell his/her experience with the illness from inside and share things, what a psychiatrist or a psychologist might not know. Because the speciality of the sufferers illness is different in every case, the experience counsellor does not give concrete advice, but encourages and supports basing on his/her experience. Despite the risk of possible negative attitudes from society, I wish to publish this book, because after my first psychotic episode and first treatment in the psychiatric hospital, I fell into the zero point of life. It took a lot of time and work to get out of that zero point and now, I can say that I am satisfied with my life. I have been able to live a full life, start and finish a master’s degree, work full timely in my area and be a licensed experience counsellor. I wish to help people with mental illnesses to recover from a mental illness, to re-establish life quality and develop mental health. I wish to show that recovery from a major mental illness is possible. This book might also be useful to people, who are mentally well, but wish to gain more insight of what a mental illness is all about. This book might also be useful to professionals of mental health.
LGBTQ Clients in Therapy: Clinical Issues and Treatment Strategies.
Author(s): Joe Kort.
Edition: First (1st).
Publisher: W.W. Norton & Company.
Type(s): Paperback and Kindle.
All the answers clinicians need to work effectively with LGBTQ clients.
A therapist who treats LGBTQ clients often must be more than “gay friendly.” Clinical experience, scientific research, and cultural understanding are advancing rapidly, and the task of being LGBTQ informed is ever-changing in today’s world.
This book covers topics such as how to avoid making the common mistake of believing that “a couple is a couple,” thus treating LGBTQ couples the same as their heterosexual counterparts; how to treat clients struggling in “mixed” orientation marriages and relationships (straight and LGBTQ spouses in the same couple); and how to work with all clients who have non-heteronormative sexual behaviours and practices. Perhaps most importantly, the book discusses covert cultural sexual abuse (the trauma suffered from having to suppress one’s own sexual and gender identity) as well as the difficult process of coming out to family and friends.
A therapist’s job is to help clients and their identities through their own lens and not anyone else’s – especially the therapist’s. The gay affirmative principles put forward in this book will help you build a stronger relationship with your LGBTQ clients and become the go-to therapist in your area.