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The Mental Health Landscape: Who, What, Where, Why, and How

More and more people are seeking and receiving mental healthcare in America. This is generally a positive development; mental health access has historically been extremely limited due to insurance requirements and separation/stigmatization of mental health and people struggling with mental health problems. This great shift in attention on mental healthcare also poses some challenges. Lack of public health education about the importance of mental health screening and lack of trained mental health professionals have contributed to less access to effective mental health treatments, especially in rural states like New Mexico. The social media boom has largely

improved access to information on mental health resources but is also contributing to confusion and misinformation. As the mental health landscape continues to dramatically change in America, it is important that people understand the basics of our mental healthcare system. This series will shed some light on the major aspects of this often confusing and complicated system.

Who Provides Mental Healthcare?

In America, only licensed mental health professionals can diagnose and treat mental health problems. Mental health professionals include psychiatrists, psychiatric nurse practitioners, psychologists, licensed mental health counselors/professional counselors, and licensed masters-level/clinical social workers. Licensed drug and alcohol counselors can diagnose and treat substance use disorders. Let’s look at each of these professional groups, which are listed by their title and the letters that often show up after their name.

Psychiatrists (MD): These are medical doctors who specialize in treating mental health disorders. They have completed medical school and residency requirements. They can prescribe medications that help with mental health problems (for example: antidepressants, anti-anxiety medications, anti-psychotics, etc.). Some psychiatrists also provide psychotherapy. They can work in any setting, but often work out of hospitals and medical practices. 

Psychiatric Nurse Practitioners (PMHNP, CNP, DNP): These are advanced practice nurses who have received additional training in prescribing psychiatric medications. Some nurse practitioners also provide psychotherapy. They can work in any setting and can practice independently. 

Psychologists (PhD, PsyD): Practicing psychologists have received a doctoral degree. Some psychologists are research-focused and often work in academic settings. Others are clinically focused and work in private practices or hospital/medical locations. Clinical psychologists provide psychotherapy. Some psychologists also specialize in neurological and psychological assessments. Psychologists mostly cannot prescribe medications, although some states (including New Mexico) allow psychologists who have completed additional training to prescribe a limited number of medications.  

Counselors (LMHC, LPCC): Counselors have earned a master’s degree and have completed internship hours within their graduate program. Counselors provide psychotherapy and cannot prescribe medications. Counselors can work in any setting and can practice independently after having completed a certain number of hours of supervised counseling hours. 

Social Workers (LMSW, LCSW, LISW): Social workers have earned a master’s degree and have completed internship hours within their graduate program. Social workers are the primary providers of mental health services in America, but many social workers work in fields outside of mental health. Social workers work in many different settings and can practice independently after having completed a certain number of supervised hours. Social workers who provide mental healthcare often have specialized training in clinical topics and typically provide psychotherapy. They cannot prescribe medications. 

Drug and Alcohol Counselors (CADC, LADAC): These are counselors who have trained exclusively to work with people with substance use disorders. They cannot provide services to people with other mental health disorders. Some of them have master’s degrees; others have completed a bachelor's degree with additional specialized training. They often work in clinics and hospitals that treat substance use disorders. They cannot prescribe medications. 

There are other paraprofessionals who work in mental health (e.g., peer support workers, behavioral health technicians, etc.). I will discuss some of these professionals in more detail in other posts. 

Future posts will discuss who cannot provide mental health diagnosis and treatment, different types of treatment offered, insurance and mental health access, future directions in mental healthcare, and other aspects of mental healthcare. 

Written by Troy Weeldryer, LCSW

Thrive Counseling Services