Getting specialist treatment

Who gets specialist treatment?

About 10% of people who experience mental or emotional distress get treatment from the mental health services (traditionally known as ‘psychiatric services’). To get treatment at this level, you need a referral from your GP or another health professional.

Most people who are referred on to mental health services will be treated by members of a Community Mental Health Team (CMHT).

What are Community Mental Health Teams (CMHTs)?

Community Mental Health Teams (CMHTs) are multidisciplinary teams of mental health workers. This simply means that they are made up of mental health workers with different types of expertise. Each member has different skills and knowledge. For example, some have expertise in medicine, others in social work. Each member of the team works together to help you manage and cope with your mental health difficulty.

Who is on the Mental Health Team?

Most teams include a consultant psychiatrist, a mental health nurse, a clinical psychologist, an occupational therapist, a social worker and others. Some mental health teams may have a peer support worker or even a creative therapist. In the Child and Adolescent Mental Health Service (CAMHS) most teams include a social worker and a speech and language therapist.
Below, we explain what some of these people do.

Clinical Psychologist

A clinical psychologist uses expert knowledge to assess, understand and treat mental health difficulties. While a psychiatrist holds a medical degree, a psychologist holds a doctorate-level degree in psychology, the science of the mind.

Psychologists primarily think about distress under a psychological model that considers how a person’s thoughts (cognitions), emotions, experiences and behaviour work together in a mental health difficulty. They draw from up-to-date research from science in their attempt to understand and treat mental health difficulties.

One difference between a psychiatrist and a psychologist is that a psychologist does not treat mental health difficulties using medication, though they may work closely with a psychiatrist and advise on medical treatment. The psychologist is usually more heavily involved with assessment, understanding and providing psychological interventions. Principles of psychotherapy are central to the work of a clinical psychologist.

Consultant Psychiatrist

Psychiatrists assess, diagnose and manage mental disorders. Psychiatry now draws from many fields, including biology, psychology and the social sciences. A psychiatrist is expected to be a specialist in both the brain and mind and to use psychiatry that is based on evidence from science and suited to the person’s individual needs.
The psychiatrist usually leads the mental health team. Each service user has a named consultant who has overall responsibility for their treatment. The consultant can fulfil this role through direct management as well as through shared management and delegation.

Psychiatrists are trained as medical doctors. However, they are expected to be competent in:

• Leadership
• Professional standards
• Ethics
• Communication skills
• Legal and psychological areas

Training

In order to become a psychiatrist the doctor must take on specialist training for three years after their intern year. During this training they learn about the assessment, diagnosis and management of mental health difficulties. To become a consultant, they must take on four more years of higher training. During this time they become experts in research, teaching and clinical leadership.

Diagnosing

One role of the psychiatrist is making diagnoses. A diagnosis can be thought of as a label that describes a collection of mental experiences and/or behaviour. A diagnosis can be helpful in deciding appropriate treatment, though some people reject the idea that mental/emotional distress can be categorised in this way.

Prescribing

One role of the psychiatrist is prescribing medication. In psychiatry, medication is sometimes used to reduce symptoms of distress. Your psychiatrist might try different medications to find the right one for you.

For more information on psychiatry, visit the The College of Psychiatrists of Ireland at www.irishpsychiatry.ie

Mental Health Nurse

The mental health nurse is an integral part of the Community Mental Health Team. The nurse can be involved in both the physical and psychological health of patients.

Roles may include:

• Communicating between different members of the mental health team
• Making care plans with the individual in distress
• Keeping an eye on physical health
• Helping with assessments and interventions
• Helping educate individuals and families about mental health

Two core aims of a mental health nurse are promotion of mental health and prevention of mental health difficulties.
The mental health nurse should play a crucial role in building a strong relationship with you based on equality and compassion. Nurses aim to treat service “holistically”. This means treating the whole person rather than just their mental health difficulty.

As well as providing support while you get treatment, the mental health nurse sometimes follows up with people after they have been discharged from hospital. They can thus play a role in recovery both in the hospital and in a community setting.

Mental Health Social Worker

The Mental Health Social Worker shares many of the skills of other professionals on the Mental Health Team; however, the Social Worker will focus more closely on supporting the recovery of the individual within their social context. This means that the Social Worker will focus more closely on the social circumstances that may be fostering recovery, as well as those that impede it by having adverse effects on mental health. Thus, the social worker will identify any social conditions that may be causing isolation, distress or deprivation of some kind. This could include anything from family conflict to accommodation issues to job insecurity. The Social Worker will then work with you and support you in developing a more optimal social environment for your mental well-being and recovery.

The aim of the social worker is to help you to engage in productive work, contribute to society and develop a meaningful attachment to your community, all of which foster a sense of belonging, usefulness and fulfilment that can improve your mental health. The Social Worker may achieve this in a number of ways; for example, they may use counselling skills to help you explore your options and make life choices that will foster social inclusion and fulfilment. They may also work with the family of the individual to ensure that they understand the nature of the mental health difficulties and can offer guidance on how best to support recovery, so that the individual is recovering within a supportive and sensitive social environment.

Your Social Worker will also be familiar with local voluntary and statutory services and can guide you towards services in your community that can help you to engage in leisure, training or employment activities. Finally, your Social Worker can advocate on your behalf to help to ensure that your mental health difficulties, or stigma towards mental health difficulties, do not get in the way of you accessing accommodation, employment or services you are entitled to. Primarily, your mental health Social Worker will be involved in case management. This means that they will help to integrate health services with a range of other services, such as housing, social welfare, job training and other services that help to support mental well-being.

For more information on social work, visit the Irish Association of Social Workers at www.iasw.ie

Occupational Therapist

Occupational Therapists are health professionals who work with you to increase your independence in and satisfaction with the everyday activities and roles that give meaning to your life.
An occupational therapist will help you to develop personal goals and to understand what is preventing you from reaching these goals. Your occupational therapist will then support you, using your strengths, to achieve these goals. You might see the occupational therapist individually, as part of a group or both.

Your plan may include some of the following:

– Gaining a better understanding of your mental health so you can take an active part in your wellness and recovery
– Developing the skills you need to live more independently such as shopping, cooking, budgeting, using public transport and home management.
– Finding a routine that allows you to do everything you want or need to do in your life.
– Learning how to cope with stress or anxiety.
– Taking part in enjoyable activities.
– Making friends and finding social support
– Returning to or staying in work or education
– Taking part in the life roles that are important to you and define who you are
– Getting in touch with community groups or organisations

Because you are a unique person your occupational therapy plan will be designed with you taking into account what is important for your mental health and the quality of your life.

For more information on occupational therapy, visit the Association of Occupational Therapists of Ireland at www.aoti.ie

Creative Arts Therapist

Creative arts therapies use the arts as a form of self-expression. Art therapy, dance-movement therapy, drama therapy or music therapy is practiced by a qualified therapist who supports you through your mental health recovery. You do not have to have any previous experience or skill in art, drama, dance or music to participate in or benefit from creative arts therapy. The aim of using a creative medium is to enhance self-expression beyond the use of words and to discover new ways of experiencing yourself.

Your therapist will encourage you to think about what you create and how it is reflective of your own feelings and experiences. Creative arts therapies are evidence-based meaning that therapists use the best available evidence to inform their practice. Sessions can be offered on a on a one-to-one or group basis and are held in a range of settings such as day centres, acute units and residential facilities.

For more information on art, dance-movement, drama or music therapy visit the Irish Association of Creative Arts Therapists at www.iacat.ie