Careers in Mental Health (Abridged)

There are many career paths one may choose if one wishes to take an active role in mental health care. This guide is intended to help you decide which of these paths is right for you. Please note that this guide is not exhaustive, and that many FAQs (such as “How do I choose a program?” and “What are the different training models in clinical/counseling psychology?”) are not answered here. For a more exhaustive treatment of this content, see the Careers in Mental Health (Omnibus). Note that not all of these options involve direct, independent provision of psychotherapy. Those which (commonly) do have been marked with an asterisk (*). 

Requires, at minimum, a HS diploma and additional training:

1. Mental Health/Therapy Aide: A paraprofessional who assists patients in inpatient or other long-stay units with basic hygiene, dressing, eating, attending appointments, and other activities of daily living, and who assists with documenting patient behaviors under the direction of a licensed clinician.
2. Certified Nursing Assistant (CNA): Similar to mental health aides, CNAs assist patients with completion of activities of daily living. Furthermore, the CNA scope practice also includes duties such as cleaning bedpans and taking blood pressure. The content of specialized courses for CNA certification are generalist and can be applied to any kind of long-stay health setting, not just psychiatric settings. 
3. Registered Behavior Technician (RBT): A paraprofessional who is trained to follow the treatment plan of a BCaBA or BCBA and provide direct behavior therapy to client, typically (but not always) children and adolescents with autism spectrum disorder, ADHD, DMDD, IED, or other overtly behavioral conditions.
4. Substance Use Paraprofessional: Some states allow individuals with at least a high school diploma (or equivalent) to complete a certification course, plus a minimal number of practicum hours and examination, to be certified to work with individuals with SUDs. These opportunities vary widely from state to state and may or may not be available in your area. If you are interested in pursuing a career as a substance-use treatment paraprofessional, it is important that you seek training opportunities which place an emphasis on evidence-based methods of treatment, as SUD treatment is rife with pseudoscience.

Requires, at minimum, an undergraduate degree (and additional training):

1. Psychiatric Nurse: Psychiatric nurses can work in both inpatient (or otherwise long-stay) and outpatient mental health settings, and typically help participants engage in activities of daily living, as well as supervising CNAs and performing certain medical tasks under the direction of an independent, licensed healthcare provider (usually a physician, but less commonly an NP or PA). Can be a licensed practical/vocational nurse (LPN/LVN) or a registered nurse (RN), but it should be noted that the RN has a larger scope of practice which includes placing IVs, administering medications, and supervising LPNs/LVNs.  
2. Board Certified Assistant Behavior Analyst (BCaBA): A professional who is trained to conduct all the duties of an RBT, along with the additional ability to create and oversee client treatment plans under the supervision of a BCBA.
3. Social Worker (entry): Settings in which social workers may be employed include, but are not limited to: protective services (including child and senior protective services, etc.); rehabilitation programs; community health organizations; inpatient and outpatient psychiatric centers (as case managers); nonprofit agencies; policy agencies; and other systems-based organizations. Tasks which social workers might typically perform as part of their job include: basic psychosocial assessment; case management; connecting clients to relevant services/organizations such as group homes, service providers, welfare agencies, and vocational training organizations; community engagement and public health/outreach initiatives; child or adult safety investigation; compliance monitoring; and other tasks related to basic safety, psychosocial functioning, and client-system interactions.
4. Recreational Therapist: A professional who focuses on the use of recreational or leisure activity to support and promote psychosocial and physical well-being for those with mental or physical disabilities. Recreational therapists very often (though not always) work in inpatient units and other long-stay programs, such as substance use rehabilitation programs.

Requires, at minimum, at master’s or specialist degree, plus additional training:

1. *Licensed Counselor (LMHC/LCMHC/LPC/LPCC): Licensed counselors—not to be confused with counseling psychologists—are licensed to work as independent psychotherapists, and tend to work with individuals with less severe conditions, such as adjustment problems, interpersonal problems, depression, and anxiety disorders, but this is not universally true. Vocational/career counselors and substance abuse counselors are often, but not always, licensed counselors. 
2. *Licensed Marriage and Family Therapist (LMFT): As practicing therapists, LMFTs tend to focus on helping solve interpersonal struggles, but also work to help individuals with mental illness operate within their family units and promote healthy interpersonal relationships within these units.
3. *Licensed Clinical Social Worker (LCSW): At the master’s level, social work retains its significant breadth and flexibility. While many LCSWs simply practice individual and group psychotherapy, a large portion of them will focus their attention on individuals who experience significant problems operating within societal systems. LCSWs also commonly work in systems-based advocacy, working to use, amend, and implement societal systems and systems-based programs to help their clients.
4. Board Certified Behavior Analyst (BCBA): BCBAs supervise and train BCaBAs and RBTs, directly provide behavior therapy, and perform functional assessments to map out treatment plans. BCBAs typically work with individuals diagnosed with an autism spectrum disorder, but can also be found working with individuals with other overtly behavioral disorders or symptoms (e.g., ADHD/executive functioning, IED, DMDD, etc.). The typical work setting for a BCBA is in the client’s home or an outpatient clinic, though some may also work in long-stay settings.
5. School Counselor: School counselors—not to be confused with **School Psychologists—**enjoy a relatively broad scope of practice. School counselors help advise students on meeting graduation requirements, preparing for standardized testing, prepare for college admissions, and find areas of interest for future career pursuits. Though school counselors are not licensed as psychotherapists, they do work with students, parents, and teachers to help promote academic success, emotional wellbeing, and the solving of interpersonal problems. School counselors also often act as administrators in charge of students’ academic records, coordinating certain school events/activities, and working to develop curricula and academic schedules.
6. Licensed School Psychologist: School psychologists—not to be confused with Licensed Psychologists—do a lot of assessment work, particularly to help identify school-aged children with special learning needs, behavioral disorders, or those meeting requirements for gifted education. School psychologists also generally spend a lot of time with parents, teachers, and administrators to assist with implementing specialized education and behavioral plans for students requiring such support. They may also work with children in therapeutic settings with the goal of promoting students’ mental-emotional wellbeing. Note: School psychology is not not to be confused with educational psychology.
7. Psychiatric Nurse Practitioner (PNP/PMHNP): Nurse practitioners have the same scope of practice as RNs, with the added ability to act as prescribing medical practitioners either autonomously or semi-autonomously (i.e., with physician oversight), depending upon the state.
8. Psychiatric Physician’s Assistant (PA): A physician’s assistant is a mid-level medical practitioner who administers and prescribes medications, as well as other healthcare interventions, under direct or indirect physician oversight (depending on the state). Many of them may work in psychiatric settings.
9. Occupational Therapist (OT): An occupational therapist’s (OT) helps individuals learn skills which allow them to successfully engage in their activities of daily living. An OT is concerned with helping people with physical and mental disabilities develop the motor and cognitive skills needed to bathe, get dressed, tie shoes, feed oneself, etc. In the context of mental health, OTs are often part of the treatment plan of children with motor dysfunction related to autism spectrum disorder or other neurodevelopmental disorders, or individuals with neurological disorders such as Parkinson’s disease (which is often accompanied by significant psychiatric conditions such as psychosis and dementia).

Requires, at minimum, a doctoral degree, plus additional training:

1. *Licensed Psychologist: A licensed psychologist is a doctorate-level practitioner with competency in psychotherapy, standardized psychological assessment, and scientific research. With very few exceptions, becoming a licensed psychologist requires successful completion of all the following: an APA-accredited doctoral degree (PhD or PsyD) in clinical, counseling, or school psychology (with accompanying practica and dissertation requirements); an APA-accredited clinical internship (usually lasting one year); a minimal number of supervised practicum hours (numbering in the thousands); a post-doctorate (this requirement may vary); and licensure examination (EPPP). This route takes 6-8 years after undergraduate school. Psychologists can work in all mental health settings and have a large scope of practice (though many choose to specialize in certain populations) within the umbrella of psychosocial interventions. Psychologists also commonly work as academic instructors and/or professors, researchers, consultants, policy advisors or advocates, and health system administrators. Common Subtypes include Neuropsychologists and Forensic Psychologists.
2. Psychiatrist: A physician (MD or DO) who completed residency in psychiatry. Though some psychiatrists provide complex psychotherapy, more and more of them are moving toward implementing basic techniques and focusing on pharmacotherapy (and other modalities germane to general and specialized medical practice). Standardized psychological assessments such as cognitive batteries and IQ and achievement tests are not typically administered and interpreted by psychiatrists, but a number of medical assessments are. Like other physicians, psychiatrists are also able to work in research settings and as instructors or professors in academic departments, and as consultants and policy advocates.