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Alissa Briggs: My child is struggling with mental health — where do I turn?

Child and adolescent mental health professionals will tell you that as the honeymoon period of the school year wanes and the temperatures cool, the volume of children and families seeking mental health support increase.

If you are a caregiver to a child who is exhibiting sings of a mental health disorder, where do you turn? There are many different types of mental health professionals in different settings, with different degrees, licensure, and skills. It can be difficult to know where to start. I am going to stay within the realm of psych – as that is the sphere in which I travel.

Mental health issues? (UK photo)

Psychologist or Psychiatrist?

Let’s start with the origin of the root word, “psych” or “psyche,” which is of Greek origin and means “the human soul, mind, or spirit.” Both professions address mental health with a focus on how the mind interacts with the body to create well-being. Psychologists and psychiatrists both provide psychotherapy to address the health of the mind and spirit, although you are more likely to find a psychologist in that role as they do not spend time addressing medication.

Psychologists are licensed by psychology boards and have master’s degrees and doctorates. A psychology doctoral degree can be a Ph.D.or PsyD. In these degree programs, psychologists learn how evaluate (via semi-structured interviews, observation, and standardized assessment) and diagnose developmental disorders and mental health conditions and to implement behavioral health interventions to address these disorders. Psychologists with master’s degrees are receiving or have received extensive supervision by psychologists with doctorates  to practice psychology.

Psychiatrists are physicians who have gone to medical school and have received extensive training in behavioral health through their fellowships (post-medical degree training). Thus, they are prepared to prescribe medication that can improve mood and they are prepared to evaluate and diagnose developmental disorders and mental health conditions. They are also prepared to provide behavioral health interventions, although their training in and interest in applying these interventions (versus referring to a psychologist/therapist) varies. They can also provide psychological testing, although this is often something that a psychologist does instead.

What is confusing, and at times a subject of ethical debate, is that in some states psychologists can prescribe medication. In Kentucky, psychologists cannot prescribe medicines.

In Kentucky, the key difference between psychological services and psychiatric services are:

• Psychiatrists are medical doctors (M.D. or D.O.) who can prescribe and monitor medication

• Psychologists have doctoral degrees (Ph.D. or PsyD) or a master’s degree and are more likely to provide therapy and testing.

So who to you go to first?

That all depends on where you think you need to start and what you want to know or do. A good place to start is with a conversation with your child’s pediatrician. Pediatricians will refer children to a psychiatrist if they feel that further assessment is needed to provide a diagnosis and/or they cannot manage the medication your child needs to improve their mood or behavior.

Start with a psychologist if:

• You are concerned your child may have ASD, ADHD, or a learning disability

• Your child needs therapy – particularly if your child has a neurodevelopmental disability like ASD or ADHD. (There are other professionals – like licensed clinical social workers – who are also skilled therapists, but that is another article.).

Start with a psychiatrist if:

• You are pretty sure that you child has ADHD or anxiety or depression and you think medication is needed in order for your child to benefit from therapy.

• Your child already has a mental health diagnosis and the person who provided the diagnosis or the therapist recommended you discuss medication management with a medical provider.

For more information on how to tell the difference between a moody teen and one who needs a mental health evaluation, go here: https://ukhealthcare.uky.edu/wellness-community/blog/it-typical-teenage-moodiness-or-depression-heres-how-tell

Alissa Briggs, Ph.D., NCSP, Associate Professor and Licensed Psychologist is in the division of Pediatric Forensic Medicine at UK Healthcare.

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