Learn about the different kinds of experts and how they can help you.
Where should you turn when you suspect that you have a mental health condition: a psychiatrist, a psychologist, or some other type of mental health professional? It's tough to figure out what kind of clinician can best help you sort out your problems and provide the care you need.
Often a primary care visit is a good start. Your physician can assess your symptoms and refer you to a mental health professional for evaluation and appropriate treatment.
In the United States, at least one in five adults has a mental health disorder. "Mood and anxiety disorders are surprisingly common, as are stress disorders and personality disorders. A smaller but significant number of people have a major, disabling mental illness like schizophrenia," says Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School.
These conditions are just as real as physical disorders and should not be chalked up to older age. "Getting older presents challenges, but any increase in mental distress should not be considered normal," Dr. Miller says.
Who can help
Mental health professionals have a range of training and expertise. You may be referred to any of the following.
A psychiatrist. Psychiatrists can provide medical and psychiatric evaluations, treat psychiatric disorders, provide psychotherapy, and prescribe and monitor medications. Training: An M.D. or D.O. (Doctor of Osteopathy) degree, plus at least four years of special training in psychiatry.
A psychologist. Psychologists do psychological evaluations and testing. They provide psychotherapy to treat mental disorders. They cannot prescribe medication. Training: A doctorate (Ph.D., Psy.D., or Ed.D) in clinical, educational, counseling, or research psychology.
A psychiatric/mental health nurse practitioner (PMHNP). PMHNPs can evaluate and diagnose mental health disorders, provide psychotherapy, and prescribe medicine (in some states under a psychiatrist's supervision). Training: A master of science in nursing (M.S.N.) or doctor of nursing (D.N.P.) degree, with added mental health education.
Psychiatric/mental health nurse. Depending on the education level and the state, psychiatric or mental health nurses may be able to assess mental illnesses, provide psychotherapy, or prescribe medication. Training: An associate's degree (R.N.), bachelor's degree (B.S.N.), master's degree (M.S.N. or A.P.R.N.), or doctoral degree (D.N.Sc., Ph.D.).
Clinical social worker. Depending on their level of education, social workers can assess and treat mental illness and provide psychotherapy. They cannot prescribe medication. Training: A master's degree (M.A., M.S., M.S.W., or M.S.S.W.) or doctoral degree (D.S.W. or Ph.D.).
Licensed professional counselor. Licensed professional counselors, who come from a variety of backgrounds, are licensed by individual states. They can assess mental health conditions and provide individual, family, or group therapy. They cannot prescribe medication. Training: A master's degree (M.A. or M.S.) in psychology, counseling, or another mental health-related field and typically two years of supervised postgraduate experience.
Other specialists. Members of the clergy (ministers, priests, rabbis, or imams) or peer counselors (people who've experienced mental health issues) can provide support and advice. They cannot prescribe medication. Training: Certification varies by state for peer counselors. Some states require clergy members to be licensed in order to provide counseling.
Help for changes in memory and thinking skills
You might assume that a mental health professional is the first expert to consult if you are having trouble with your memory or mental skills. But if such problems are interfering with your day-to-day functioning, a physician should evaluate you to check for neurological illnesses such as mild cognitive impairment, Parkinson's disease, Alzheimer's disease, or vascular dementia.
Your primary care physician can perform the initial assessment. He or she may then refer you for an examination by a neurologist or for a scan of your brain. Or you might need to see a neuropsychologist, who can conduct extensive testing to identify specific areas of difficulty.
Once the problems have been defined, you may be given treatment to either reverse or prevent further progression of the underlying illness. You may also be referred to a clinician who specializes in helping people manage problems. For example, if decision making has become difficult, the clinician may look for practical, achievable ways to make decisions simpler, such as reducing the amount of clothing in your closet or paring down pots and pans in your kitchen.
You may also benefit by seeing a team of experts who can suggest activities and lifestyle changes to improve brain fitness. Treatment usually integrates physical exercise, nutrition, sleep, meditation, and cognitive training. Cognitive training routines make use of games, sometimes on a computer, to help you improve mental skills, response times, and attention.
Who's right for you?
The mental health professional you need depends on your condition, your preferences, and the availability of clinicians in your area. If your doctor suspects that you'll benefit from medication, you may be referred to a psychiatrist or a PMHNP. If your problems are milder or you're coping with life stress or situational issues, any kind of professional who provides therapy may be able to help. Sometimes a number of mental health professionals will work together to get you feeling better, such as a psychiatrist for medication and another professional for psychotherapy.
What you can expect
Any evaluation will involve you describing the problems and stresses in your life, the important people in your support system, and your feelings about your situation. Mental health professionals who can prescribe medicine will ask about your medical history and any other medications you're currently taking.
Psychotherapy involves talking about yourself, including some of your intimate thoughts and feelings. Your therapist will ask questions to guide you and will likely offer tips or tools to help you cope. He or she will keep all the information strictly confidential.
For more information, check out the Harvard Special Health Report Understanding Depression (www.health.harvard.edu/UD).
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