Navigating the Different Types of Mental Health Professionals

When it comes to accessing support for mental health issues, relationship difficulties, or other personal problems, many people have the sense that they may benefit from talking to a professional of some sort. It’s not always clear, however, as to which type of professional would be best to consult with for any given concern.

Some professional titles and designations differ depending on where you live, with regulatory bodies and professional associations varying between different provinces/states/regions and countries. In Ontario, Canada, anyone is allowed to call themselves a “counsellor” or a “therapist,” but there are other titles that are controlled and governed by the Regulated Health Professions Act, and as such are held to higher legal and ethical standards by their respective regulatory colleges.

In addition to registrants of the College of Registered Psychotherapists of Ontario (CRPO), registrants of the College of Psychologists of Ontario (CPO), Ontario College of Social Workers and Social Service Workers (OCSWSSW), College of Nurses of Ontario (CNO), College of Occupational Therapists of Ontario (COTO), and College of Physicians and Surgeons of Ontario (CPSO) are legally permitted to use the title “psychotherapist,” provided they meet certain requirements from their own college.

Psychiatrists, Psychologists, Psychotherapists, etc…What’s the Difference?

There are many similarities between the roles and approaches used by different types of helping professionals, but there are also some important differences in training, education, and overall treatment philosophies (several of these are highlighted below). It’s important to note, however, that there is also tremendous variation within each profession regarding theoretical orientations, approaches, and techniques used in therapy. The degree of fit between a client/patient and their therapist, and the strength of the therapeutic relationship (sometimes referred to as the therapeutic alliance) are important factors that affect therapeutic outcomes – regardless of the professional designation of the therapist.

Registered Psychotherapists

Registered Psychotherapists (RPs) specialize in providing psychotherapy and are regulated by the College of Registered Psychotherapists of Ontario (CRPO). Psychotherapy is a process that occurs within the context of a supportive, therapeutic (healing) relationship in which one person (the therapist) helps another person (the client/patient) to increase self-awareness and in doing so create positive change in themselves and their life. The process usually involves confronting and overcoming some particular challenges that the client/patient is facing, which may involve examining and modifying patterns of thinking, behaviours, ways of relating to self and others, and processing emotions. The CRPO defines psychotherapy as: “Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”

The fees for seeing a psychotherapist in private practice are not covered by the Ontario Health Insurance Plan (OHIP). Some extended healthcare plans offered by private/third party insurance carriers or Employee Assistance Programs (EAPs) may cover the costs of seeing a Registered Psychotherapist. If you are able to see a psychotherapist through a program or organization that receives funding through the government or other granting bodies, then it may be possible to access psychotherapy without being charged for it. For example, some family health teams (FHTs), community health centres (CHCs), or non-profit organizations may employ psychotherapists and offer their services to their clients/patients. However, these services are unfortunately usually limited, sometimes difficult to access, and often have long wait-lists.

Psychiatrists

Psychiatrists are medically trained doctors who have specialized in identifying and treating mental disorders. They are trained to use lab tests, brain scans, and other tests to see if other medical conditions, such as low hormone levels or a brain injury, could be the cause of mental health issues. Like all medical doctors (MDs) in Ontario, they are regulated by the College of Physicians and Surgeons of Ontario (CPSO).

In Ontario, all psychiatrists are trained in both the use of medications for treatment and in multiple forms of psychotherapy. It should be noted, however, that due in large part to heavy workloads, limited resources, and being trained from a predominantly biomedical perspective, many psychiatrists focus on conducting assessments, diagnosing disorders, and making treatment recommendations (e.g. medications, psychotherapy, or other treatments) rather than on providing psychotherapy themselves. The cost of seeing a psychiatrist is covered by OHIP, whether they work in a hospital, clinic, or in a private office. A referral from your family doctor or another GP (General Practitioner) is usually required to make an appointment with a psychiatrist. Many psychiatrists have long lists of patients waiting to see them, and waiting times can sometimes be up to several months.

General Practitioner (GP) Psychotherapists

GP psychotherapists are medical doctors who have undergone additional training and education to practice psychotherapy. One of the benefits of seeing a GP psychotherapist is that since they are medical doctors, they are covered by OHIP. Some GP psychotherapists will incorporate some psychotherapy into their practice, while others will do psychotherapy with patients on a full-time basis. The Medical Psychotherapy Association Canada website has more information and a listing of GP psychotherapists.

Psychologists

Psychologists study how people think, feel and behave from a scientific viewpoint and apply this knowledge to help people understand, explain, and change their behaviour. Counselling and Clinical Psychologists use an assortment of evidence-based treatments (often psychotherapy) to help people improve their lives. Psychologists are sometimes called “doctor” because they have a PhD or a PsyD (Psychological Associates must have at least a Masters Degree). Psychologists are not trained as medical doctors, however, and as such they cannot prescribe medications. For some conditions, therapy and medication may be a treatment combination that works best, and in these cases psychologists work with medical doctors (primary care physicians and/or psychiatrists) to help their clients. Psychologists can diagnose mental illnesses, conduct psychological assessments, and recommend what type of therapy their client might need. In Ontario, psychologists are regulated by the College of Psychologists of Ontario (CPO).

The fees to see a psychologist in private practice are not covered by OHIP. Psychological services are usually covered by public funding, however, if a psychologist is employed by a hospital, correctional facility, community health clinic, social agency, or school. Their fees may also be partly covered by health insurance plans, the Workplace Safety and Insurance Board (WSIB), or other private insurance programs.

Social Workers

Social workers help individuals overcome mental health or substance abuse issues by providing counselling as well as helping with issues such as housing, employment, and other social determinants of overall well-being. Depending on their particular role and where they work, they might facilitate individual and group therapy sessions, arrange for special living accommodations, and investigate long-term assistance programs for people with chronic disorders. Social workers practice in a number of different clinical settings, such as hospitals, substance abuse treatment centers, inpatient and outpatient mental health clinics, and private practices. Social workers often focus on assisting people to use their own and community resources to resolve problems and enhance their own well-being. Many social workers in private practice, however, may exclusively focus on providing psychotherapy (much like Registered Psychotherapists). In Ontario, social workers are regulated by the Ontario College of Social Workers and Social Service Workers (OCSWSSW).

In general, social work services are not covered by OHIP; however, the services of social workers who work in agencies are often available at no charge to clients or on a sliding scale (fees geared to income/what a client can afford). Examples of publicly-funded organizations are schools, hospitals, community agencies, children’s aid societies, and family service organizations. Similar to other private practice psychotherapists, social work services provided are billed by the hour, and they may be covered under a private health plan or employee group benefits plans.

Occupational Therapists

Occupational therapists (OTs) address the daily lives (i.e. activities of daily living such as meal preparation, banking, hobbies, work, etc.) of the people whose daily activities and social participation have been compromised by health conditions. In community mental health, occupational therapists work to enable a successful balance of meaningful self-care, leisure, and productivity among people experiencing (or at risk of experiencing) mental health problems. The training of occupational therapists prepares them to understand, evaluate, and intervene to address the multiple underlying factors that are responsible for successful and satisfying occupational roles and activities. OTs have a particular interest in minimizing disability and social marginalization. In Ontario, occupational therapists are regulated by the College of Occupational Therapists of Ontario.

Occupational therapists work collaboratively with their clients to establish goals and assess the factors that can facilitate or challenge these goals. Occupational therapy interventions typically focus on “doing” as a means to support change. Interventions may include: building skills and resources in activities of daily living including budgeting and meal preparation; receiving feedback from employers and managing social conflicts; evaluating a workplace environment to develop reasonable accommodations to support employment; improving specific personal capacities such as remediation for cognitive impairments that are interfering with performance at school; and functional and safety assessments around the capacity for independent living. Occupational therapists may also provide psychotherapy provided they meet the requirements of their regulatory college.

OHIP covers the cost of occupational therapy when it is provided through hospitals and rehabilitation centres, Family Health Teams, Assertive Community Treatment (ACT) Teams, Community Health Centres, and Community Care Access Centres that provide access to OTs for eligible clients in their homes, schools, or long-term care facilities. People can pay a direct fee to hire an occupational therapist in private practice, and some extended health insurance plans pay for OT services.

Mental Health Nurses, Psychiatric Nurses, and Nurse Specialists

In Ontario, Registered Nurses (RNs) and Registered Practical Nurses (RPNs) who meet the requirements laid out by the College of Nurses of Ontario (CNO) may practice psychotherapy. The profession of Registered Psychiatric Nurse is not currently regulated in Ontario, however it is in the western provinces. In Ontario, RNs and RPNs may specialize in the fields of mental health or addictions. Nurse specialists or Advanced Practice Nurses (APNs) are nurses who have specialized training in a particular area of healthcare. For example, Behaviour Nurse Specialists are trained in Behavioural Therapy techniques. The clinical practice of psychiatric mental health nursing occurs when nurses work with individuals, families, groups, and communities to assess mental health needs, develop a nursing diagnosis and a plan of nursing care, implement the plan, evaluate the plan, and continue to revise the plan with the client. They often work in hospitals as members of interdisciplinary treatment teams that provide well-rounded medical care.

Peer Support Workers

Peer support workers are people who have experienced emotional difficulties in their lives and are interested in helping others with similar difficulties. By listening empathetically, sharing their experiences, and offering suggestions, peer support workers are able to help others who are dealing with mental health issues or other challenges (such as coping with grief/bereavement, struggling with addictions, or adjusting to medical diagnoses). In general, peer support workers operate from a framework of “recovery” from mental health issues rather than clinical treatment of mental illness. Peer support workers may provide counselling support, although they are not permitted to provide psychotherapy in Ontario.

Peer support workers working in mental healthcare are sometimes referred to as peer counselors or peer support specialists. They have direct, personal experience with mental illness and may provide non-clinical services and supports as part of a mental health team, including: information and referrals; skills training; emotional support; goal setting; advocacy; role modelling; and interpersonal skills development.  Peer support can take place either formally or informally. Informal peer support often occurs in peer support groups, where people with similar experiences with particular issues meet to share their experiences and engage in mutual support. Formalized peer support occurs when a peer support worker is in a professional role in which they focus exclusively on helping others, rather than receiving support for themselves. Peer support work is not currently a regulated profession in Ontario, although guidelines for peer support have been developed by the Mental Health Commission of Canada.

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