Who will you meet in the public system?

The GP is the gateway into the public services, and as such plays a key role in the recognition, assessment and care for their patient. The GP is ideally placed to offer the initial screening, to monitor and provide a baseline of the physical and medical needs of the person. The GP plays an integral part in the care and treatment plan for the person, no matter what level of care the person is at any one time.
A psychiatrist/ child psychiatrist is a medically qualified doctor who has specialised in the assessment and treatment of mental health conditions. Psychiatrists take a ‘bio-psycho-social’ approach to understanding mental health and eating disorders. They use this framework of understanding when they are assessing, diagnosing and treating eating disorders. Within the mental health service, the consultant psychiatrist is the clinical lead of the multi-disciplinary team (MDT), and is responsible for overseeing the patient’s care plan. When a person is referred for assessment, the psychiatrist is often the person to lead this. They will also screen for other physical or medical conditions, and then share their diagnosis with the MDT with a recommendation for bio- psycho- social treatments, including medication and hospital referrals if needed. Psychiatrists can prescribe medication as well as using psychosocial treatments, because they are both a medical doctor as well as a mental health specialist. The psychiatrist will continue to meet the person on a regular basis, to monitor their medial risk, treatment progress, medication and plan care. They may sometimes deliver psychological treatments for eating disorders. Trainee psychiatrists are called senior registrars, registrars or Senior House Officers (SHOs), and work under the supervision of a consultant.
The clinical psychologist has a specialist qualification in mental health and works as part of the mental health team in a unit or hospital and is involved in assessment and counselling therapy. So, it is quite likely that either the psychiatrist or a clinical psychologist will do the assessment of a person, and treatment can often be carried out by the clinical psychologist in the MDT.
It is quite likely, if you are being treated for an eating disorder, that you will have regular contact with the nurse on the MDT. Nurses provide both physical and psychological care to their patients. It is usual that a nurse will monitor the physical changes that occur during treatment, such as weight calculations and blood tests. The nurse is an integral part of the MDT and also can provide essential support and encouragement to the patients’ families.
A psychologist is trained in the study of human behaviour and usually is tasked with providing a person with some form of psychological therapy within the MDT. Psychologists can be trained in any number of different therapeutic interventions, and as such, will work with the service user in whichever way the treatment plan, assessment and diagnosis requires. Bringing a patient closer to an understanding of his or her illness is a key aim of a psychologist. When involved in the area of mental health, the psychologist usually works as a clinical, community or counselling psychologist, and unless also medically qualified, does not prescribe medication.
The key worker is a designated member of the MDT whose responsibility it is to co-ordinate the individual’s care and treatment plan. They are the person who is working most closely clinically with the person and their family or carer support. The key worker may change as the person steps up or down through the service.
Mental health social workers carry out a range of functions as members of a MDT. Individual counselling is one of their key tasks in assisting those with a variety of emotional difficulties. Another key function is ‘psycho-education’. Psycho-education refers to work with individuals and their families to explain aspects of the mental illness. Psycho-education also involves offering coping strategies appropriate to the specific mental illness. Given that mental health service provision is sometimes fragmented, mental health social workers are committed to ‘case management’ or ‘care management’. This refers to working with individuals with a view to ensuring continuity of care and the co-ordination of services. This helps to maximise their wellbeing and quality of life. Case management involves the integration of health services with a range of other services. Examples include, housing, social welfare, job training and employment, liaison with statutory and voluntary agencies, etc. All of these links may contribute to positive mental health.
Occupational therapists provide services to people whose ability to cope with everyday activities is threatened or impaired in some way by physical, psychological or developmental problems. Occupational therapists can assess and treat anyone (adult or child) who has practical difficulties due to mental illness, accidental injury, arthritis, cerebral palsy, learning difficulties, stroke, and other congenital, developmental, degenerative or neurological conditions. Occupational therapy aims to enable the person to have as independent, productive and satisfying a lifestyle as possible. Treatment can include self care, personal development, mobility and access, skills and training, home management, disability awareness, work preparation, directed play, stress management and compensatory techniques.
Dietitians can play a core aspect of an ED MDT providing nutritional advice, support and guidance for both adults and young people who are being treated for an eating disorder. The level of intervention by the dietitian with the service user varies depending on the severity of the eating disorder, the age of the person, the type and level of response to treatment that the person exhibits.

It is important to note that within a MDT the key roles are; psychiatrist, clinical psychologist, nurse, OT, dietitian, and social worker. It is not unusual for those using these titles to have specific

    competencies

within the field of psychological and talking therapies, that equips them to fulfill a dual role with regard to the treatment plan for the service user. For example, the nurse may also be trained in CBT-E., and therefore when assigned to work with a person with an eating disorder, this nurse’s primary role will be as a CBT-E therapist, and their nursing duties may take a secondary role, or may be fulfilled by another person within the MDT.

A psychotherapist is a person who has been trained to understand and treat mental health conditions of varying severity. Psychotherapists have training in understanding human development, and the various ways in which a person’s mental health problems can cause them to suffer and obstruct their ability to live their life as they wish. There are many forms of talking therapies and different therapies work for different people.