Mental Health Team

Members of the Mental Health Care Team are:

Psychiatrists

Psychiatrists are medical doctors trained in psychiatry. They are typically the individuals who are primarily responsible for a patient’s health and safety and thus are often the leaders of the mental health care team. Psychiatrists may sub-specialize in specific mental disorders including schizophrenia, addiction, and depression and are usually the key prescribers of psychotropic medication and/or psychotherapy. While these physicians may administer psychotherapy, it also may be provided by other members of the team.

Primary Care Physician (PCP)

Primary care physicians (PCPs) are sometimes the first health care professionals to see a patient with mental illness. PCPs may diagnose and treat the patient’s mental disorder or refer the patient to a mental health specialist. PCPs may also inform patients about community services and act as a resource for patients even after referring them to a mental health specialist. PCPs may work with other team members to prescribe or monitor patient treatment, and they may act as a liaison between the patient’s family, psychiatrist, and other team members. PCPs who see their patients on a regular basis can also help ensure that the patient is adhering to a treatment regimen and help detect adverse medication effects that could interfere with adherence. In addition, the PCP may help detect warning signs of an impending relapse or exacerbation of symptoms. However, PCPs in general are not the primary contact for patients with serious mental disorders such as schizophrenia; rather, they are more involved in refilling prescriptions.

Residents/Fellows

Residents and fellows are licensed physicians who are receiving specialized training and who are often limited to practice within a specific institution. Although senior fellows in psychiatry may be relatively independent, the responsibility for their decisions lies with a supervising psychiatrist. (In the teaching hospital, this person is the attending physician.) In community hospitals, residents and fellows may be under the supervision of a psychiatrist from the community unless academic faculty are available.

Physician's Assistants

Most training programs for physician’s assistants (PAs) involve a rigorous multi-year curriculum in basic science and clinical training. Depending on the state, PAs may be allowed to perform many of the physician’s roles when caring for patients with mental illness. In addition, depending on the state, some PAs have prescribing privileges. As with other specialists, the PA’s role includes collaboration with other members of the team and maintaining a flow of communication.

Nurse Practitioners

Nurse practitioners are nurses with additional training in delivering health care normally reserved for physicians. Although some states view nurse practitioners as being similar to physician’s assistants, nurse practitioners differ in that they must have a background in nursing. In psychiatry, roles and responsibilities of the nurse practitioner may include:

• medication management
• patient and family education
• prescribing medications (in some states)
• psychological interventions under the direction of a specialist

Nurses

Nurses who work in a psychiatric setting — sometimes called psychiatric nurses — play an important role in coordinating patient care in the hospital setting and community. They also often help patients through crises until they can function independently, can be key contributors to long-term management, and may play a key role in ensuring that patients adhere to their treatment. Overall, nurses also play an integral role in the care of the patient with mental illness by providing patient education and building a "bridge" between the patient and physician.

Allied Clinical Therapists

Allied clinical therapists include occupational, social, physical, and recreational therapists. These specialists promote mental health by helping patients develop and improve a wide range of skills at home, work, or school, and in self-care or leisure activities. For example, occupational therapists provide skills training to help patients cope with the demands of a job or daily routine, while recreational therapists help patients develop leisure skills and promote recreational activities.

Social Workers

Social workers help patients form relationships, acting as links between the patient and family members and community resources. Social workers also help family members understand a patient’s needs, develop a supportive social environment, and cope with their emotions and concerns. In addition, they may be the first point of contact with the patient when the patient is experiencing medication difficulties (e.g., side effects or lack of efficacy). The social worker can also provide general counseling and psychotherapy, help patients and their families work through difficult times, and close the gaps between the patient and the health care team.

Case Managers

Case managers oversee all aspects of a patient’s care by coordinating service delivery and ensuring continuity and integration of services. Thus, it is important for these individuals to be familiar with all available resources. Their activities range from simple location of services to intensive roles in rehabilitation and clinical care. Case managers can be doctors, psychologists, nurses, social workers, or even people without professional degrees. Case managers should not be confused with social workers. For example, while social workers may take on the role of case management, case managers are not necessarily trained to take on the responsibilities of social work. In addition, case managers may have a more defined reporting structure.

Counselors

Counselors act on behalf of the treatment team to work with patients on specific problems. They are trained in interview and social management techniques and can help patients and their families through difficult situations. They may be aware of the patient's medication and indirectly influence medication management through contact with the patient and other members of the team.

Psychologists

Psychologists are non-physicians who usually have completed graduate education and training in research, testing, or therapy. They often work with patients and family members to assess and treat mental illness. When a patient’s treatment involves both psychotherapy and medication, the psychologist may provide psychotherapy, but refer the patient to a psychiatrist or family doctor for prescribing medication.

Pharmacists

Pharmacists may work in an inpatient setting (hospital pharmacists and clinical pharmacists) or an outpatient setting (community pharmacists). While any pharmacist may have a doctor of pharmacy degree (PharmD), the degree is required for clinical pharmacists. The role of hospital pharmacists includes dispensing medications (similar to a community pharmacist in a retail setting), attending rounds, and monitoring patients for possible drug interactions. Clinical pharmacists work outside the pharmacy and play a key role in drug decisions; for example, they attend rounds, monitor patient charts, recommend initial therapy, and help manage patients. Clinical pharmacists are also usually part of the Pharmacy and Therapeutics (P&T) Committee, and therefore play an integral role in getting new medications on formulary. Community pharmacists dispense medications, educate patients about medications, and monitor patients for adverse drug interactions and side effects.

Family Members/Friends

Family members and friends play a key role in helping patients, not only by providing emotional support, but also by:

• helping patients keep appointments
• monitoring medication use
• keeping records of medication dosing
• noting changes in patient behavior or attitude
• detecting signs of deterioration
• protecting patients during a relapse
• managing the patient’s life affairs