Careers in clinical mental health

The public mental health service system in Victoria relies on a dedicated and highly skilled group of professionals.Professionals in mental health include nurses, psychiatrists, psychologists, social workers, occupational therapists, support workers, consumer and carer consultants, and Koori mental health liaison officers.

Nursing in mental health

Mental health nursing is a specialised field that focuses on biopsychosocial health assessment and meeting the mental health needs of people with a mental illness.

Mental health nursing's primary tool to understand a patient's inner world is the therapeutic nurse–patient relationship. Mental health nurses practise in ways that encourage and support people’s recovery journeys and improve thier experiences of mental health care. They work with and value the role of families, support people and significant others in assisting people’s recovery.

Nursing in Victoria

All nurses who practise in Victoria must be registered with the Nursing and Midwifery Board of Australia, which is overseen by the Australian Health Practitioner Regulation Agency (AHPRA)

Nurses are registered as either a division 1 or division 2 nurse on the General Nursing register.

Endorsements: endorsement of registration identifies practitioners with additional qualifications and specific expertise, for example:

• Scheduled medicines
• Nurse practitioner
• Supply scheduled medicines
• Eligible midwife
• Scheduled medicines for eligible midwives.

Mental health nurse credentials

The Mental Health Nurse Credential recognises the qualifications, skills, expertise and experience of nurses who are practising as specialist mental health nurses. The Credential for Practice Program is an initiative of the Australian College of Mental Health Nurses (ACMHN) and has established the only national consistent recognition for specialist mental health nurses.

The skills of a mental health nurse

Mental health nurses work closely with individuals, their carers and their families to establish rapport and to provide a therapeutic environment to promote biopsychosocial wellbeing and recovery and a sense of connectedness through family and social inclusion of people with all types of mental illness.

The ACMHN Standards of Practice for Australian Mental Health Nurses 2010 specify the minimum level of performance required for a registered nurse practising in any mental health setting.

Standard 1: The mental health nurse acknowledges diversity in culture, values and belief systems and ensures his or her practice is non-discriminatory and promotes dignity and self-determination.

Standard 2: The mental health nurse establishes collaborative partnerships that facilitate and support people with mental health issues to participate in all aspects of their care.

Standard 3: The mental health nurse develops a therapeutic relationship that is respectful of the individual’s choices, experiences and circumstances. This involves building on strengths, holding hope and enhancing resilience to promote recovery.

Standard 4: The mental health nurse collaboratively plans and provides ethically based care consistent with the mental, physical, spiritual, emotional, social and cultural needs of the individual.

Standard 5: The mental health nurse values the contributions of other agencies and stakeholders in the collaborative provision of holistic, evidence-based care and in ensuring comprehensive service provision for people with mental health issues.

Standard 6: The mental health nurse actively pursues opportunities to reduce stigma and promotes social inclusion and community participation for all people with mental health issues.

Standard 7: The mental health nurse demonstrates evidence-based practice and actively promotes practice innovation through lifelong education, research, professional development, clinical supervision and reflective practice.

Standard 8: The mental health nurse's practice incorporates and reflects common law requirements, relevant statutes and the nursing profession's code of conduct and ethics. The mental health nurse integrates international, national, local and state policies and guidelines with professional standards and competencies.

Standard 9 : The mental health nurse holds specialist qualifications and demonstrates advanced specialist knowledge, skills and practice, integrating all the standards competently and modelling leadership in the practice setting.

Work settings

Mental health nurses work in diverse roles and places, including:

• child, youth, adult and aged acute inpatient units
• residential and non-residential rehabilitation programs
• community-based teams that provide a crisis response, assertive outreach and continuing care
• emergency departments
• the forensic and justice system
• the primary care sector and community health centres
• training, education and research
• consultation liaison in general hospitals.
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Psychiatry in the mental health service system

Psychiatrists are medically qualified doctors who work with people with a mental illness such as depression, schizophrenia, eating disorders, anxieties, phobias, or drug and alcohol abuse.

They work in different places, including hospitals, people's own homes, residential centres for older people and people with special needs, as well as in prisons.

Medicine is a very competitive field. Successful candidates will need:

• excellent academic qualifications
• enthusiasm and good interpersonal skills
• a wide range of outside interests
• interest in a caring profession.

Psychiatrists hold a specialist qualification awarded by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and may work as clinicians or non-clinicians across the public and/or private sectors of Victoria's mental health system.

Psychology in the mental health service system

Psychologists learn about diagnosis, assessment, testing and treatment planning, and conduct and apply research to reduce distress and behavioural and psychological problems to promote good mental health.

Some psychologists undertake additional specialist training in specific areas, including family and relationships therapy, depression and grief, sexual therapy, child psychology and education, and techniques like cognitive behavioural therapy.

Becoming a psychologist
To work as a psychologist in Victoria requires four years of approved study in psychology. This normally comprises a bachelor's degree with a three-year accredited major in psychology, followed by an accredited fourth-year course in psychology.

As of 1 July 2010, psychologists must be registered with the Psychology Board of Australia, a single national registration scheme that will allow psychologists to work in any state or territory across Australia.

Specialist psychologists

Clinical psychologists specialise in assessing and diagnosing major mental illnesses and psychological problems.

They have a minimum of six years' university training, including approved postgraduate clinical studies and placements in psychiatric settings.

Clinical psychologists complete all the same basic training as other specialist psychologists but undertake a master's/doctorate in clinical psychology in order to be eligible for membership of the Australian Psychological Society (APS) College of Clinical Psychologists.

Clinical psychologists hold positions in private practice, hospitals, universities, general medical practices, community health centres and mental health services. They work with infants, children, adolescents and adults, and are also involved in designing and implementing a wide range of prevention and mental health promotion programs.

Clinical neuropsychologists specialise in assessing and diagnosing brain impairment and how this affects thinking skills, emotions, behaviour and personality. They are also involved in rehabilitating and managing the effects of brain impairment and often work with other allied health professionals. Most clinical neuropsychologists are employed in major hospitals, rehabilitation centres, psychiatric services and private practice.

Forensic psychologists work with people who have committed crimes, applying psychological knowledge to assessment, intervention and research in the forensic mental health system.

Becoming a psychologist

To work as a psychologist in Victoria requires four years of approved study in psychology. This normally comprises a bachelor's degree with a three-year accredited major in psychology, followed by an accredited fourth-year course in psychology.

Social work in mental health

Social work focuses on the social aspects of mental health problems. Social workers use a biopsychosocial model to inform their understanding of mental illness and to guide their practice.

Becoming a social worker

A social work degree is typically four years full-time study or part-time equivalent in an accredited social work course. In recent times some universities have introduced a qualifying master’s degree as an entry-level qualification.

The Australian Association of Social Workers (AASW) accredits social workers with specialist qualifications and training in mental health to work as service providers in the Commonwealth-supported Enhanced Primary Care for Mental Health Workers scheme and the Better Access to Mental Health Care initiative.

Social workers are not currently required to be registered. However, most employers require applicants to be eligible for membership of the AASW.

The work of a social worker

Social workers are the only mental health workers with social-science training that supports a unique sociological perspective and empowerment ethic.

This encompasses a wide range of theoretical perspectives and methods of intervention, underpinned by participative approaches, anti-oppressive practice and the principles of social inclusion.

Social workers look beyond the person's mental distress to important dimensions such as social inclusion.

They also address the mental health consequences of abuse and discrimination, including stigma arising from a mental health diagnosis, and relationships with family and informal carers.

Social workers are employed in treatment and rehabilitation services across the public, private and non-government mental health service sectors, including primary care.

They promote recovery and restore individual, family and community wellbeing to help individuals regain control over their lives, and to advance the principles of social justice.

This approach includes managing the dilemmas that can exist between enabling and protecting people who experience mental distress.

Occupational therapy in mental health

Occupational therapists (OTs) work with people of all ages who have a variety of conditions caused by injury or illness, psychological or emotional difficulties, developmental delay or the effects of ageing.

They help people improve their everyday functional abilities and enable independence, wellbeing and quality of life.

Becoming an occupational therapist

An occupational therapy degree is typically four years full-time study or part-time equivalent bachelor degree, in an accredited occupational therapy course.

Since 1 July 2012 all occupational therapists working in Australia must be registered to practise.

This registration process is the legislative responsibility of the Australian Health Practitioner Regulation Agency (AHPRA) and is operated through the Occupational Therapy Board of Australia (OTBA).

The work of an occupational therapist

OTs work with people of all ages who have conditions caused by injury or illness, psychological or emotional difficulties, developmental delay or the effects of ageing.

They help people improve their everyday functional abilities and enable independence, wellbeing and quality of life.

OTs work across the whole spectrum of mental health services, including inpatient and community settings and in hospital and non-government organisations, providing services for children, adolescents and adults.

OTs will have the opportunity to specialise in a variety of areas within mental health, such as:

• individual and group psychotherapy
• crisis assessment and intervention
• family therapy
• inpatient and community forensic services
• specialised occupational therapy assessment and intervention that facilitates a consumer's occupational performance (living skills, education, work and leisure) in the context of mental illness such as functional assessment or sensory processing
• psychosocial rehabilitation
• early intervention
• providing specialist consultation to other service providers
• supervision and leadership.

Most mental health OTs work in community-based positions involving case management. They work with people to assess how their mental illness impacts their ability to function in their everyday occupations and roles. They also focus on how a person's lifestyle can support their mental health and improve their quality of life.

Support work in mental health

Some mental health professionals move into support work in mutual support and self-help (MSSH) services. These services provide information, support and assistance to families, carers and people dealing with mental illness.

This can involve sharing experiences and coping strategies, providing information and referral services, and promoting community awareness.

The specialist, statewide MSSH workforce includes service managers, volunteer coordinators, support workers and administrative support staff. Their role is to address mental health conditions within a developmental approach.

They promote mutual support from others living with mental illness, as well as encouraging consumers to be active in their own recovery.

Caring for a relative or friend with a serious mental illness presents carers with many challenges. Carer support and resource workers (mental health) form an integral part of the model of the generalist carer service system that supports carers in this role.

They assist services by providing information resources, acting as community education and referral pathways and delivering carer support.

Consumer and carer consultants in mental health

Consumer consultants are an integral part of Victoria's clinical mental health services.

They are employed in adult area mental health services and work to ensure that a person-centred perspective is included in all aspects of mental health service planning, delivery and evaluation.

Their role is to improve mental health services' responsiveness to the needs of people with a mental illness.

Some consumer consultants have extended their scope to develop collaborative relations with aged people's mental health services, child and adolescent mental health services and Mental Health Community Support Services.

Carer consultants belong to a relatively new field that has arisen to recognise the important contribution carers make to treatment planning and mental health outcomes.

The consultants’ role is to provide support, information and referral to families and carers and to work collaboratively with area mental health services to develop improved service responsiveness to the needs of families and carers.

Working with Aboriginal communities in mental health

The Victorian Government funds Koori mental health liaison officers (KMHLOs), who are based in health services and Victorian Aboriginal Community Controlled Health Organisations.

These officers play a vital role in assisting rural clinical mental health services to provide culturally appropriate services, develop culturally sensitive policy and provide practical support to Aboriginal people engaged in these services.

In addition, the Koolin Balit: Aboriginal health workforce plan 2012-22 identifies Victoria's health workforce development priorities and the suite of initiatives that will ensure Aboriginal people have access to a range of career development and employment opportunities in health.

Through implementation of strategies in the plan, Aboriginal people will have increased opportunities to enter or remain in the health workforce via a range of development, recruitment and retention initiatives.

The plan identifies key workforce development priorities and initiatives to strengthen the cultural responsiveness of health services and the health workforce. Implementation of these initiatives will lead to the following outcomes:

• more health services providing culturally responsive service delivery that meets the needs of the Aboriginal community
• progress on the department’s commitment to increase Aboriginal employment in Victorian public health services
• more Aboriginal people working in clinical and non-clinical roles in mainstream and Aboriginal health services
• more Aboriginal people participating in professional development or upskilling opportunities in clinical and non-clinical roles in mainstream and Aboriginal health services
• more Aboriginal people working across a broader range of health professions in professional and clinical roles that include medicine, nursing, allied health, alcohol and other drugs, primary health, health promotion, management and leadership roles
• more career-pathway, traineeship and cadetship opportunities to develop and train another tier of workforce entrants
• improved human resources infrastructure, supervision, recruitment and retention within Aboriginal-community-controlled health organisations.