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The ‘Psych’ Assessment: Psychology, Psychiatry or Neuropsychology? Understanding the Mental Health Assessment Options

The burden of mental health conditions has a significant impact on overall health care and disability costs across Canada. In any given week, 500,000 Canadians are unable to work because of mental illness and 355,000 are on disability. One in five Ontarians experiences mental illness, including addiction, creating an estimated $40 billion of economic burden. More concerning is that only one in three people seeking help for mental illness actually receive it.

In many disability and medicolegal scenarios, addressing an individual’s mental health status can be an important part of determining the individual’s impairments, prognosis and requirements for further treatment. We frequently encounter clients that understand a Mental Health Assessment is required but that are not necessarily sure of the appropriate specialist to request: Psychologist, Psychiatrist or Neuropsychologist? Psychologists and Psychiatrists are both highly educated and highly qualified specialists that deal with the diagnosis and treatment of mental health issues, often working together to ensure individuals receive appropriate care. There are, however, some very important distinctions between the two fields related to the nature of their training and their current clinical scope of practice in Canada. A Psychiatrist is a Physician (M.D.) who has completed a post-graduate residency in Psychiatry, whereas a Psychologist is currently required in most provinces to have completed a doctoral level degree (Ph.D. or Psy.D.). Certain provinces (e.g. Ontario) have an additional category of a Psychological Associate for clinicians who have completed a Master’s level degree.

One of the important distinctions that results from these different training routes is that a Psychiatrist is currently able to prescribe medications whereas, in Canada, a Psychologist is not. What does this mean for you? In general terms, if an individual has a mental health condition requiring prescription medication, a psychiatrist is likely the optimal choice to directly address the need for the medication and/or specific recommendations for changing the dose or type of medication selected as the case evolves. In addition, there are additional subspecialties of Psychiatry including Forensic Psychiatry and Neuropsychiatry requiring additional training. Similarly, Psychologists may pursue additional training in Neuropsychology, a field focusing on the assessment and treatment of patients with cognitive impairment secondary to a host of conditions such as brain injury, dementia (e.g., Alzheimer’s disease), or psychiatric disease.

Another key distinction between the fields of Psychology and Psychiatry is the approach taken in determining a diagnosis. The Psychiatric Evaluation consists of an in-depth clinical interview and a Mental Status Examination of the client to determine whether observational data corresponds with subjectively reported complaints utilizing the Diagnostic and Statistical Manual (current edition is DSM-5). A Psychological and/or Neuropsychological Evaluation will also consist of an in-depth clinical interview and the use of the DSM-5, although it also employs standardized objective psychometric testing and includes symptom and performance validity testing so to collectively understand the breadth, severity, and objective validation of subjective complaints.

Therefore, if an individual’s cognitive abilities are in question, as may be the case following a significant concussion or traumatic brain injury or other psychiatric conditions, a Neuropsychology Assessment may be appropriate whereby objective psychometric testing and performance and symptom validity testing is also undertaken.