South Mumbai-based clinical psychologist Alina Philip is clear about one professional decision: she will never prescribe medicines to her patients. Whatever be the ailment.

This is not because Philip, who has had a private practice for 13 years, doesn’t believe in medicine as a tool to improve mental health. As a clinical psychologist, she is just not qualified to prescribe them. Only a psychiatrist can do that, she stresses. Philip says, while most patients remain confused about the difference between a psychologist and psychiatrist, their roles are radically different and well defined.

Psychologist vs Psychiatrist

While anyone with a post-graduate degree in psychology can be called a psychologist, to practice as a clinical psychologist, the practitioner needs a masters degree in clinical psychology, and an additional course in counselling on his/her resume.

As one herself, Philip’s primary responsibility is to diagnose her patient’s problem, and follow it up with therapy. Clinical psychology, she points out, is a branch of psychology concerned with the assessment of mental health problems.

Clinical psychologists like Philip use tests - Rorschach (a series of ink blots on sheets of paper are shown to the patient to assess underlying thought patterns), Thematic Apperception (a diagnosis based on a person’s construction of a story around a visual image) and IQ - to diagnose the problem. If the prognosis reveals a mild problem that can be solved with counselling (verbal and nonverbal communication to alter maladaptive patterns of coping, relieve emotional disturbance, and encourage personality growth), a clinical psychologist can take on the patient. If the ailment is severe - acute depression, bipolarism or schizophrenia - it becomes the psychologist’s responsibility to direct the patient to a psychiatrist.

Psychiatrists are physicians with a master’s degree in psychiatry, the medical speciality devoted to the study, diagnosis, treatment, and prevention of mental disorders. As per international guidelines, also followed in India, they are the only doctors authorised to conduct a basic physical examination, interpret laboratory tests and order brain-imaging studies for diagnosis.

They are also the only ones authorised to prescribe psychiatric medicines.

Through years of practice, a clinical psychologist could have gathered knowledge about medication or may even hold a doctorate (PhD) in his field, but according to marine Lines-based psychiatrist Dr Ashit Sheth, “S/He will not take the physical condition of a patient into consideration since s/he is not trained to do that. We (psychiatrists) are the ones with eight years of academic study into understanding the effects of medication on the human body.”

Read between the lines

Head of the psychiatric department at Vile Parle’s Cooper Hospital, Dr Vishal Sawant points out why it’s important to ensure that the pill you have been prescribed is from a psychiatrist.

“These medicines can lead to serious drug interaction problems and have long-term side-effects.” He warns that commonly available anti-depressants like Selective Serotonin Reuptake Inhibitor (commonly known as SSRI), should not be prescribed to a patient who is on blood thinners.

Often, patients are hesitant to consult a psychiatrist, observes Dr Sawant, because of the stigma attached to the term. Visiting a psychiatrist means they are saddled with the ‘mad’ tag. Some believe it means they will be put on pills for life. “It all depends on the diagnosis,” explains Dr Sawant, “Depression, for instance is not always a psychological disorder. It can be caused by physical conditions, too.”

Thyroid, low blood pressure, hyponatraemia (low sodium in the blood serum) and a Vitamin B 12 deficiency can easily cause depression. “Once the root of the problem is treated, the depression subsides.” This makes it vital for the psychiatrist to work closely with a physician in order to rule out a physical condition as the main cause of depression, and to ensure there are no interdrug related problems.

Talking it out

Psychiatrists and clinical psychologists depend on each other during the course of a patient’s treatment. Even after a patient has been referred to a psychiatrist, psychologists often continue their consultation, to check how the patient is progressing and reconfirm the diagnosis. Dr Sheth adds, “We also work with counselling psychologists, since along with medication, patients with mental health problems need therapy too.”

While psychiatrists are trained in counselling, they often refer their patients to counselling psychologists for simple therapy. Counselling psychologists have a postgraduate degree in counselling and are not qualified to diagnose ailments. They counsel their patients, helping them come to terms with and overcome problems ranging from anxiety to depression that arise from struggles including bereavement, relationship difficulties, domestic violence or childhood abuse. They also deal with mental health problems such as eating disorders and post-traumatic stress disorder (PSTD). They too aren’t allowed to prescribe medication.