Understanding mental health practitioners, who does what?

If you’re looking for mental health help, you’re not alone. But deciding when to see a therapist is only the first step to getting help.

Deciding who to see and when to see a professional can get tricky, says Valérie Legendre, a registered psychologist. 

Depending on your province, there are many professionals who could meet your needs:

• Family doctors
• Psychiatrists
• Psychologists
• Social workers
• Occupational therapists
• Psychotherapists and mental health counsellors

Legendre says you need to know your needs before you can choose the best professional to address them. There are several differences when it comes to training, what they can do, and the treatment they can offer, says Legendre.

• Training: The professionals above have specific degrees that need different education. Depending on the province or territory, their schooling, titles and license to practice can vary. It helps to know the requirements in your area for each professional before you choose.
• Licensing: Different provinces and territories regulate mental health professionals differently, Legendre says. Professionals can be members of a college or an association. The government creates colleges under a law that describes the professional code. 
  • Colleges:
    • regulate the competence and ethics of their members
    • watch and regulate the practice of the profession
    • manage the disciplinary process
    • advance the profession
    • prevent illegal practice
    • control the use of titles  

Those who want to use titles and practice a profession that’s regulated by a college must be part of that college.

Associations, on the other hand, are created voluntarily by their members with the goal of protecting their interests. Associations can pursue several different activities. The board and members define the mission. “Colleges protect the public and associations the members,” Legendre says.

• Prescriptions and diagnosis: In Canada, only medical doctors (M.D.) (general practitioners or psychiatrists) can prescribe medication, Legendre says. Only general practitioners, psychiatrists and psychologists can diagnose mental illnesses such as depression and anxiety.
• Cost: Professional fees vary based on several factors. Firstly, there are big differences across provinces and territories. The type of mental health professional is another element that affects rates. Fees can also vary based on a professional’s experience, education and level of expertise.

Now, let’s look the specific role of each of these professionals in more detail.

Your family doctor is a valuable ally to diagnose mental illness and build a treatment plan to meet your needs, Legendre says. They can also help you choose the best professional to treat you. That’s why it’s always a good idea to ask your family doctor any mental health questions.

Family doctor treatment: Your family doctor can rule out, with blood samples, for example, any physical causes of your symptoms. They can prescribe medicine or refer you to a mental health professional.

Family doctor training and licensing: Family doctors have a medical degree. Their university education covers general medicine. To practice as doctors, they need to meet the requirements to get a medical license. Every province and territory regulates doctors.

Family doctor cost and insurance coverage: Provincial health insurance covers visits to family doctors.

Psychiatrists are physicians who specialize in treating mental disorders, according to the Canadian Psychiatric Association.

Psychiatrist treatment: Psychiatrists can prescribe medicine to treat patients with conditions such as schizophrenia and depression.

Psychiatrist training and licensing: Psychiatrists have a medical degree with extra training in psychiatry. Like family doctors, they need a license to practice medicine.

Psychiatrist cost and insurance coverage: You’ll need a referral from your family doctor to see a psychiatrist. Once you have a referral, provincial health insurance will cover the cost of your appointments.

Note: Concordia's Health Plan will only cover therapy performed by a Quebec licensed psychologist. Employees covered under the Health Plan can always validate with Sun Life before starting therapy to ensure that the health provider they have chosen is accepted by the insurance provider.

Psychologists can evaluate, diagnose and treat mental health disorders, Legendre says.

Psychologist treatment: Psychologists can use assessment instruments or psychometric tests to help them make a diagnosis, Legendre says. These can include intelligence and personality tests. They use other tests to measure the progress of psychological treatments. They don’t prescribe medication.

Psychologists use different approaches to psychotherapy, such as:

• cognitive-behavioural therapy (CBT)
• interpersonal psychotherapy (IPT)
• psychodynamic psychotherapy
• emotional focus psychotherapy (EFT)
• and more

Psychologist training and licensing: Psychologists have an advanced degree in psychology. Depending on the province, that could be a PhD or a master’s degree. Every province and territory regulates the professional obligations of psychologists, Legendre says. That means you need a license in your province to practice.

Psychologist cost and insurance coverage: The cost to see a psychologist can vary by provider and province or territory. For example, the Psychologists’ Association of Alberta suggests $200 per session for one-on-one therapy. Provincial health insurance doesn’t cover psychology appointments through a private practice.

If you have private health benefits, check your plan to see what coverage you have. Most of the time, you don’t need a referral from your doctor. But check if your health benefits require it. Some psychologists work in public clinics or hospitals. Provincial insurance covers their services with a referral from your family doctor.

The difference between a psychologist and a psychiatrist is in their training and focus. Psychologists assess mental health using psychological tools and they offer psychotherapy. Some psychiatrists offer psychotherapy as well. However, as medical doctors, they often treat conditions that need medication.

Social workers help people within the context of their community, family and other environments.

Social worker treatment: Social workers can offer one-on-one psychotherapy if they meet the criteria of the regulatory body in their province. They often work with families or in group therapy settings. Their studies also touch on psychosocial issues such as poverty and violence. Social workers can also help people find resources within their community. They don’t diagnose mental illnesses or prescribe medication.

Social worker training and licensing: All provinces and the Northwest Territories regulate social workers. Depending where they live, social workers can have a bachelor’s degree or master’s degree in social work.

Social worker cost and insurance coverage: Social workers can work in different settings, including hospitals, schools, agencies and other community organizations. In public settings, there may be no charge for their services. They can also work in private practice just like psychologists. An hour session can range from $70 to $130, according to the Canadian Association of Social Workers. Check if your health insurance covers social workers.

Occupational therapists (OTs) can help you overcome challenges that interfere with your everyday life. These could be physical issues, like getting dressed, or mental health support, such as coping strategies. OT’s help with a range of situations, including aging at home and workplace mental health.

Occupational therapist treatment: Occupational therapists don’t diagnose or prescribe medication. Some occupational therapists may also offer psychotherapy if they have the right training and licensing.

Occupational therapist training and licensing: All provinces regulate OTs except for Yukon, Northwest Territories and Nunavut. OTs need to meet the educational requirements of their provincial college. In Ontario, they need is a Bachelor of Science or Master of Science in Occupational Therapy. They also need supervised experience, like a practicum, before they can register.

Occupational therapist cost and insurance coverage: OTs can work in public settings such as hospitals and rehabilitation centres. Your provincial health insurance may cover these services. If you’re working with an OT in private practice, the fees vary by province. In B.C., for example, fees for rehabilitation services range from $75 to $250 per hour. You can ask about cost before your appointment and check if your private health insurance covers OT.

Different provinces use the terms psychotherapist and counsellor differently. Both are front-line mental health professionals who can support your mental health.

Psychotherapist and mental health counsellor treatment: Psychotherapists and counsellors can offer psychotherapy to treat stress, relationship difficulties, and various mental disorders. They can offer cognitive behavioural therapy, marriage counselling and other types of psychotherapy. Outside of Quebec, they don’t diagnose mental illness or prescribe medicine.

Psychotherapist and mental health counsellor training and licensing: Only some provinces regulate psychotherapists or counsellors. That means only those registered with their provincial colleges can use the titles below. In the following provinces, you must meet the education requirements to register for the provincial college:

• Ontario, using the title Registered Psychotherapists
• Quebec, which issues a psychotherapist’s permit to family doctors, psychologists, social workers, occupational therapists, and others.
• New Brunswick, using the title Counselling Therapists
• Nova Scotia, using the title Registered Counselling Therapists

In other provinces and territories, you can check someone’s qualifications using other ways. For example, your counsellor may be a Canadian Certified Counsellor. That means they achieved certification with the Canadian Counselling and Psychotherapy Association. It requires a graduate degree in counselling and relevant experience. You can also check if a therapist is a member of their provincial association.

Psychotherapist and mental health counsellor cost and insurance coverage: Costs for different types of therapy vary by province and provider. For example, the British Columbia Association of Clinical Counsellors recommends its members charge $120-$150 for a one-on-one session. Ask about costs up front. Don’t forget to check your private health insurance coverage to make sure your plan covers psychotherapists or counsellors.

You’ve looked at the options and you understand how to find a qualified therapist. What’s next?

Legendre says to start by speaking with the therapist you’ve chosen. “Ask if they have the skills to deal with your problems,” she says. “What’s their experience with cases similar to yours? And find out how they work so you know if their approach to therapy meets your expectations.”

Consider practical aspects of your treatment as well. For example:

• Is the office convenient for you?
• Are virtual sessions available?
• What hours and days can you see them?
• What are the rates for your treatment?

“For psychotherapy to work well and bear fruit, you need a bond of trust between you and your psychotherapist,” Legendre says. After an initial conversation, think about how you feel. You want to choose a mental health professional you can build a strong relationship with. Sometimes, that could mean trying out a few different therapists before you decide.

The most important thing is to reach out for help as soon as you need it. Search now for a mental health professional near you.

Concordia’s Employee Assistance Program (EAP) is here to support you whenever you need it, providing confidential and compassionate care to help you thrive in both your personal and professional life.