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Muddying the Mental Health Waters

By R. Collin Middleton
August 01, 2003

Psychiatry is far from being the only mental health profession. A review of the statutes in just this author's state of Alaska reveals separate professional licensing boards for social workers, marital and family therapists, nurses, professional counselors, psychologists, psychological associates and, of course, physicians. AS 08.03.010. Psychiatry is indeed not even the only subspecialty among physicians who treat mental health problems. Far more prescriptions for selective serotonin re-uptake inhibitors (SSRIs, used to treat depression) originate from family medical practitioners than from psychiatrists. And, increasingly, nurse practitioners – who recently, in this state and others, received prescription powers within narrow confines (“advanced nurse practitioner” AS 08.68.410) – also prescribe psychotropic drugs solely to treat mental health problems.

Not all this seeming confusion is harmful: Alliances are often formed between different mental-health professionals for the treatment of a common patient. The most common alliance is the joint treatment by a psychiatrist and a psychotherapist, such as a psychologist, marital and family therapist, or social worker specializing in individual therapy. The arrangement allows a patient to receive individual therapy from a licensed therapist – which is necessary because insurance companies, by often refusing to reimburse psychiatry expenses, have eliminated the exclusive therapy province of psychiatrists. It also allows the patient to receive drug therapy and, if needed, hospitalization, from the only mental health care provider able to provide those services, the psychiatrist.

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