A person who is depressed can seek professional help from many sources. They may see their GP for initial help or go to an independent counsellor or psychotherapist.
The professionals who can be involved in the care of somebody with depression are described below.
- GPs are often the first point of contact for people with depression and treat most patients themselves.
- A GP will almost certainly provide advice and support for the depressed person. They may also have some training and experience of a more specific psychological treatment. They may well advise a depressed patient to take an antidepressant.
- Where they feel the patient needs further specialist help, GPs can refer the person to a number of different services such as a counsellor, community psychiatric nurse (CPN), psychologist or a consultant psychiatrist.
- Basic medical training: five years at medical school (obtaining a medical degree such as MB BS or MB ChB) and one year being a house officer (the most junior grade of doctor in hospitals) in medicine and surgery. A minimum of two years in various hospital specialities (senior house officer). This involves six-month placements in various specialties such as medicine, surgery, accident and emergency, paediatrics and psychiatry. A placement in psychiatry is not mandatory, but is usually considered important because mental health problems are common. Training also involves a year's placement in a general practice.
- A consultant psychiatrist usually works in a community mental health team which is involved in looking after people living in a certain area. Team members include trainee psychiatrists, social workers, community psychiatric nurses, psychologists and others.
- The consultant or the team will have patients referred to them by GPs and other professionals such as health visitors and social workers. Referrals are then allocated to various members in the team, depending on the nature of the individual's problems. The consultant has overall responsibility for the management of patients under the care of the team.
- The consultant will also have responsibility for a certain number of patients in a hospital ward.
- A consultant is approved under Section 12 of the Mental Health Act, enabling them to recommend the involuntary detention of a patient who is severely ill in hospital in the interests of their health, their safety or the safety of others. Involuntary detention in hospital only occurs if two doctors and an approved social worker all agree that this is an appropriate thing to happen.
- The consultant often has a senior house officer or a specialist registrar under their supervision. The consultant closely supervises and monitors their work and progress.
- A psychiatrist may use psychological treatments or medication to help a patient with depression.
- Basic medical training: the same as for GPs.
- Many psychiatrists then gain training and experience for a few years in a branch of medicine before entering psychiatry, such as general practice or hospital based medicine.
- Training in psychiatry takes a minimum of six years. During the first three years, the trainee (senior house officer in psychiatry) gains experience in a broad range of mental health services (eg general psychiatry, old age and child psychiatry, drug and alcohol services and psychotherapy). The trainee then has to pass an exam for the qualification Membership of the Royal College of Psychiatrists (MRCPsych).
- Trainee psychiatrists (specialist registrars in psychiatry) then spend three years specialising in a branch of psychiatry (such as general adult psychiatry, old age psychiatry or psychotherapy). Training will involve learning about the appropriate use of both psychological and drug treatments for psychiatric illnesses. Upon satisfactory completion of this training they obtain a Certificate of Completion of Specialist Training (CCST). They are then eligible to apply for a consultant psychiatrist post in their specialty.
People often get confused about the difference between a psychiatrist and a psychologist: a psychiatrist is a qualified medical doctor, but a psychologist is not. As a result, a psychiatrist is able to prescribe medicines, but a psychologist cannot.
- Clinical psychologists work both in hospitals and within community mental health teams.
- Clinical psychologists see patients who are referred by GPs or the mental health team. Their work involves assisting in the assessment of the mental health needs of patients and undertaking psychological therapies with individuals and groups. Some also specialise in family or marital (or partner) therapy.
- Undergraduate degree in psychology (BSc).
- Clinical experience for a few years as an assistant psychologist is then usually undertaken.
- Three years postgraduate training, leading to a doctorate in clinical psychology (DClinPsychol), before becoming registered as a chartered clinical psychologist.
- Psychologists often have areas of special experience and expertise, such as with drugs and alcohol problems, child and adolescent psychiatry or general adult psychiatry.
Nurses in psychiatric hospitals
There are a number of grades of nurses who work in psychiatric hospitals, such as auxiliary nurses, staff nurses and charge nurses.
- Nurses assess all patients who attend inpatient wards to understand their nursing needs.
- Usually one staff nurse is appointed as the 'named nurse' for each patient. This nurse keeps regular contact with the patient and assesses changes in their mental health and their day-to-day needs. The nurse also liaises with the patient's family and friends, and the psychiatrist who has responsibility for the patient. This nurse will also help co-ordinate any further care that may be needed once the patient is discharged.
- In hospital, patients will have the opportunity to talk with the nursing staff (not just their named nurse). Nurses carry out counselling and psychotherapy with patients. This may be done in a formal way or be very informal such as over a cup of tea. They may also help patients learn relaxation techniques to cope with anxiety.
- A charge nurse has responsibility for the nursing staff and for the nursing care of the patients. They supervise the work conducted by auxiliary and staff nurses.
- A nurse can request an urgent opinion from a psychiatrist if they are concerned about the condition of the patient. If the nurse believes the patient may be a risk to themselves or others if they left the ward, they have the power to detain the patient for up to six hours, to enable assessment by a psychiatrist.
- An auxiliary nurse may have training, such as an NVQ (National Vocational Qualification).
- Staff nurses undertake a three or four year degree or a diploma in psychiatric nursing.
- Charge nurses (or sisters) are nurses who have had several years experience as staff nurses before being promoted.
Community psychiatric nurses (CPNs)
- A CPN sees people who are living in the community. This is most often in the person's own home but it can also be in clinics based, for example, in a GP's surgery.
- CPNs provide support to people through difficult periods of their illness. They may also see patients who are currently well to check everything is going okay and be the first point of contact if the patient starts becoming unwell again.
- A CPN will help patients with their medication and make sure that the patient understands what they should be taking and when.
- Because CPNs see patients in their own homes, they also play a valuable role in helping the patient's family and carers understand and cope with the illness.
- Patients may be referred to CPNs from a number of sources including GPs, psychiatrists and inpatient wards so that the CPN can help the patient's transition from hospital back into the community.
- CPNs are often a patient's keyworker.
- A community psychiatric nurse (CPN) is a fully trained staff or charge nurse who has had several years of experience working on psychiatric wards in hospitals.
- Every patient referred to the mental health services is allocated a keyworker.
- The keyworker may be any member of the community mental health team (such as a psychiatrist, CPN, occupational therapist, psychologist or social worker).
- The role of the keyworker is to act as the co-ordinator of the mental health services needed by their patients. The keyworker has a responsibility to regularly review the progress of their patients and assess if all of their needs are being addressed. This involves gaining feedback from the patients about what they think about the help and support they are getting from the mental health team.
Occupational therapists (OTs)
- An occupational therapist can have many different roles. They help people to adapt to their environment and to cope with their daily life.
- OTs may work in hospitals or in the community. They supervise and assess a person's ability to look after themselves, eg self-care, cooking and housework. This may be done in purpose-built occupational therapy departments in hospitals or in the patient's own home.
- OTs work with both individuals and groups. They can set goals for individuals with depression to encourage them to achieve more than they have been able to do while ill. They may get patients involved in specific job-related training schemes to improve their decision making and planning about the future. Group work is often aimed at increasing people's social interactions.
- OTs may use many different types of therapy on an individual or group basis, including cognitive behavioural therapy and art and music therapy. They may also be involved in providing relaxation training to patients referred to them by the mental health team or GPs.
- If patients have been in hospital for a long time, OTs become involved in rehabilitation work to help them reintegrate back into life outside hospital.
- An occupational therapist has usually taken a degree in occupational therapy (BSc).
- Social workers are employed by social services rather than the health service. However, most mental health social workers are based in multidisciplinary community mental health teams.
- Social workers may see patients referred to the team by GPs. They are likely to be involved if patients have social problems, such as housing, money and work. They may provide counselling and advice or more specific therapies.
- Social workers may control access to some services such as day centres, respite care, residential care and other community support services, eg home helps.
- The primary role of an approved social worker (ASW) is to act as the guardian of the patient's rights. If a psychiatrist believes that a patient should be detained in hospital against their will, they will request an ASW to see the patient, along with another doctor. If both doctors and the ASW agree that the patient is mentally ill and that it is in the interests of their health, safety or the safety of others, that they remain in hospital, then an order under the Mental Health Act will be applied to detain the patient. The ASW has responsibilities to contact the patient's next of kin and to help any appeals against the order that the patient wants to make.
- A social worker has to complete a Higher National Certificate (HNC), followed by a two-year diploma in social work. They can then study another year towards a degree.
- During a social worker's training they undergo two placements. The first placement lasts three months and can be in any specialty of social work. The other placement lasts six months and is in the field in which the person ultimately wants to work, eg child protection or adult mental health.
- After gaining several years of experience in mental health, social workers can train to become approved social workers under the Mental Health Act.
- Some social workers in mental health choose to train and specialise in therapies such as family or marital therapy.
- Support workers work in the community as part of the mental health team. They supplement the work by CPNs, eg by helping a patient to socialise more by taking them out or helping them with their shopping.
- One or more of the community mental health team members, such as a CPN, regularly supervise their work.
- The training of support workers varies considerably. They may or may not have professional qualifications, or they may have undertaken a National Vocational Qualification (NVQ) in health or care-related subjects.
- Some support workers have spent years working with patients with mental health problems and their experience is highly valued.
Community support workers
- Community support workers have a role very similar to support workers, but they are supervised by social services rather than the mental health team. They include residential social workers (who help to look after people in residential care), and domiciliary care workers (who act as home helps, visiting people who are unwell and helping with daily chores).
- Psychotherapists offer therapy to those who are referred to them. They are mostly patients who have been referred by psychiatrists, GPs, social workers and psychologists.
- The exact nature of the help they provide depends on the type of psychotherapy they specialise in.
- Psychotherapists should liaise with the person who has referred the patient and keep them updated about the progress of the individual.
- You do not need any formal training to call yourself a psychotherapist, but most psychotherapists have previously trained as doctors, psychiatrist, psychologists, CPNs or occupational therapists.
- Psychotherapists usually have training in one or more forms of psychotherapy, eg psychodynamic psychotherapy (psychoanalysis), cognitive behavioural therapy or interpersonal therapy. Training in these different forms of therapy can vary tremendously - from a couple of weeks followed by some supervised work to several years of intensive training.
- Most psychotherapists working within the NHS have had substantial training in psychotherapy. This is not always the case with psychotherapists who work privately. If you are at all unclear as to the background or training of a psychotherapist, ask them. This is particularly important if you are seeing a psychotherapist without going through your GP.
- Counsellors offer counselling to those in need. Counselling aims to identify the problems a person is facing in any sphere of life and to help them discover effective ways of dealing with these. Simply talking through a problem with somebody neutral can often help a person to see a way forward.
- Counsellors work in various settings such as the independent or voluntary sector, GPs' surgeries and hospitals.
- Counselling can be carried out informally by GPs, psychiatrists, nurses or in a more formal manner by counsellors. CPNs often carry out counselling in general surgeries.
- Counsellors have people referred to them by GPs, social workers, CPNs and, in many cases, the people themselves.
- Counsellors come from a wide variety of backgrounds (eg nursing, psychology, social work, medicine) and can be from fields unrelated to mental health.
- Training is variable and can range from diploma/degree courses to short courses or even correspondence courses.
- Counsellors often have areas of special interest and expertise, such as bereavement, drugs and alcohol, marital guidance or mental health.
- As with psychotherapists, most counsellors working within the NHS have been well trained. However, this is not always the case with those that work privately.
- A befriender can be anyone who is interested in helping other people. They do not need any qualifications for this job other than a willingness to help others. Official befrienders are carefully vetted and may well liaise with a member of a community mental health team.
- They can be contacted through local befriending agencies that have lists of suitable people or accessed through mental health services or social workers.
- The role of a befriender is to spend time with a person who may be unwell or is in need of social support. They will visit the person at home and encourage them to get out and about. They may offer to take people out to various social events and occasions.