We often get questions about Psychiatry and what services AWARE provides. This column by AWARE’s Medical Director, Dr. Kathryn Brogan is the first of a series designed to answer those questions.
What IS Psychiatry?
Psychiatry is a tricky word to pronounce, and it sounds similar to several other words we throw around in the mental health space. If you don’t exactly know what Psychiatry is (let alone how to spell it), you are not alone! Most politicians and even healthcare professionals I speak to regularly get confused about this topic. Simply put, Psychiatry is a branch of medicine concerned with the study, diagnosis, and treatment of mental illness. Since Psychiatry is a medical specialty, persons-served are referred to as “patients” (rather than clients) in this field.
What is NOT Psychiatry?
Although they sound very similar, Psychology and Psychiatry are different but overlapping fields. As noted above, Psychiatry is a medical specialty. Psychology is the scientific (not medical) study of the mind and behavior. A Psychiatrist has a medical degree (MD or DO) while a Psychologist has a doctoral degree (PhD or PsyD in Psychology). Psychologists may work in research, clinical, or corporate settings. When a psychologist performs psychotherapy with clients, they may refer to themselves as a “therapist” in that capacity. People with several other degree/training backgrounds (like social work or counseling) may also call themselves “therapists,” so it is important to inquire about this if this matters to a client. All the aforementioned professions can and do work closely together to treat the mental health of clients/patients.
Who Can Practice Psychiatry?
Psychiatry is a medical discipline. Psychiatrists are the leading experts in the field of psychiatry. Psychiatric-Mental Health Nurse Practitioners may also practice Psychiatry independently (in some states) or as part of a Physician-Led Interdisciplinary Team. As with all professionals, the quality of care provided is determined not only by training level, but also by each provider’s ongoing experience and continuing education and professional development.
Psychiatrists are doctors who attended medical school, just like other physicians. The minimum education/training required to become a Psychiatrist is as follows: four years of college meeting pre-medical prerequisites, four years of medical school, and four years of psychiatry residency. Residency is where a physician specializes in a type of medicine; for instance, a nephrologist specializes in treating conditions of the kidneys and urinary system while Psychiatrists specialize in treating conditions of the brain and mind. After residency, some psychiatrists may seek further specialty training through additional one-to-two-year fellowships (like child/adolescent or forensic psychiatry). All told, before they go into independent practice, psychiatrists have spent at least twelve years in full-time school/training.
In Montana, Psychiatric-Mental Health Nurse Practitioners (PMHNP’s) can also practice psychiatry. PMHNP’s are Advanced Practice Nurse Practitioners (APRN’s, sometimes called Nurse Practitioners or “NPs”) specialized in mental healthcare. The path to becoming a PMHNP is more variable than for a Psychiatrist; the minimum education/training required is as follows: four years of college earning a Bachelor of Science in Nursing (BSN), licensing as a Registered Nurse (RN), two years completing a Master of Science in Nursing (MSN) or three years completing a Doctor of Nurse Practice (DNP) licensing as an APRN, and then passing an exam to become a PMHNP. All together, a PMHNP has spent at least six years of full-time school/training.
Is a PMHNP the Same as a Psychiatrist?
No, but both kinds of professionals are valuable members of the psychiatric team. See other sections for differences in training and types of services offered. Of note, a DNP is a doctor in the same sense as other doctorate degree recipients, like a Doctor of Education or Philosophy (EdD or PhD). Whether to call a DNP “doctor” is a matter of personal preference in Montana (some states do not allow this). Often, DNPs go by a different title to reduce confusion in settings where physicians (MD/DO’s) also practice. It would be technically incorrect to call an NP with an MSN degree “doctor.”
While physicians (MD or DO) have full autonomy of medical practice in all 50 states and many other countries, the ability for nurse practitioners (with either a DNP or MSN degree) to practice differs state-by-state. Some states allow APRN’s to work only under full physician (MD/DO) supervision, others allow APRN’s partial independence, and about half of the states permit APRN’s full autonomy in practice. There are pros and cons to each of these approaches. Montana is one of the states which allows fully independent practice for APRN’s.
What Do Psychiatrists and PMHNP’s DO?
Psychiatrists are highly trained to deliver psychotherapy and psychopharmaceutical treatments to a variety of patients with mental illness. All psychiatrists, over their twelve-plus years of training, become experts in treating patients of all ages and with all presenting mental illnesses as well as co-occurring substance use disorders and medical problems. In states with full autonomy for APRN’s, PMHNP’s may perform many of the same roles and duties as Psychiatrists. The main difference between a Psychiatrist and a PMHNP is in the intensity and orientation of training. Some patients need and/or prefer the medical expertise that comes from working with a Psychiatrist while others appreciate the nursing background of a PMHNP in approaching their mental health challenges. Whether a patient chooses to work with a Psychiatrist or a PMHNP, they should expect and demand high-quality, evidence-based care, including medication management and/or behavioral interventions.
Assessment by a Psychiatrist or PMHNP starts with a comprehensive psychiatric assessment which results in a working diagnosis (a flexible explanation of the causes of one’s mental health challenges) and a treatment plan. Further appointments are often briefer and may occur as frequently as directed by the Psychiatrist or PMHNP. Psychiatric assessment and treatment planning generally seeks to address biological, psychological, and social aspects impacting the patient. Treatment options include medications, procedures, lifestyle modifications, supplements, social engagement, behavioral interventions, individual, group, or family therapies, and more. The Psychiatrist or PMHNP may provider all of these services herself or refer to other professionals. A combination of treatments unique to the patient’s situation are often necessary to effect meaningful improvement. After a patient is benefiting from psychiatric treatment, the Psychiatrist or PMHNP may continue to see them long-term or (more often, due to the scarcity of psychiatric providers) refer them back to their primary care provider for maintenance care (allowing the psychiatric provider time to work with other patients in need).
Who Should Get Psychiatric Care?
Anyone with a mental illness may benefit from psychiatric care. Whether to seek care from a Psychiatrist, PMHNP, psychologist, or therapist depends on personal preference and the goals of treatment. In most states, only Psychiatrists and sometimes PMHNP’s (or other physicians or APRN’s) may prescribe medications. For psychotherapy, there are more options, so a patient should choose the professional they feel most comfortable with. Psychologists and Psychiatrists may offer specialty services like Psychological Testing, Neuropsychological Testing, or procedures. Patients may also seek basic mental health care from their primary care provider, but more severe or complex issues would be better treated by a specialist.
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