What are the differences between a psychiatrist and a psychologist in Kenya?

People often confuse psychologists with psychiatrists and vice versa. It can also be quite confusing for clients seeking help. Also for students seeking a career in this field, it is important to know the differences.

So what are the differences between a psychiatrist and a psychologist in Kenya?

Definition: Psychiatry means treatment of the mind while psychology means study of the mind; in practice, both professionals are involved in the treatment of the human mind although the psychologist focuses more on techniques of behaviour change that result in the prevention of or recovery from mental illnesses while the psychiatrist focuses more on alleviation of pain and dysfunction caused by mental illnesses.

Background (Psychiatrist): One becomes a psychiatrist following 12-15 years of training that include: medical training (bachelor of medicine and surgery), a non-mandatory but generally essential 1-5 years of post-internship practice as a medical officer (general practitioner); specialization at master of medicine (Psychiatry) at a university which takes 3-5 years; Post specialisation period of 2 years.

Background (Psychologist): A psychologist’s first degree is commonly a bachelor of arts (psychology), thereafter those who wish to practice in the healthcare sector will pursue either an MA in clinical psychology or an MSc in clinical psychology. The Kenya Counsellors and Psychologists act 2014 places the minimum qualification for registration for both counsellors and psychologists as “a diploma degree in counselling and psychology respectively from a recognized university.” In practice most Psychologists in Kenya, after completing their first university degree, practice as counselling psychologists.

Counselling: The term counsellor may refer to a counselling psychologist or someone with a certificate or diploma in counselling. In practice, counselling psychologists are referred to as psychologists thus making little distinction between them and clinical psychologists (whose qualification is at master’s level and above). Counselling concerns itself with problem solving, often using during a time of crisis and focuses on one problem and lasts for a day to a week (typically) such as the counselling of survivors of a terrorist attack. Counselling may also be carried out by other mental health professionals other than counsellors such as Clinical psychologists, Psychiatrists and Psychiatric nurses.

Therapist: This is an umbrella term that refers to a professional trained to provide Psychotherapy. The simplest form of psychotherapy is counselling (also called supportive psychotherapy). The other psychotherapies include cognitive behavior therapy, psychodynamic psychotherapy, interpersonal psychotherapy, Mindfulness based treatments (MBT) and so on. Cognitive Behavior Therapy (CBT) Is the commonest form of psychotherapy available in Kenya (after counselling of course). CBT is used in the treatment of anxiety, depression, PTSD and other mental disorders. The term therapist mostly refers to a psychologist trained in psychotherapeutic methods. While a psychiatrist may be trained to provide psychotherapy, he/she does not normally use the title of a therapist.

The Medical approach for a Psychiatrist: Psychiatrists prescribe medication to treat mental illnesses while Psychologists do not prescribe. The prescription of medication comes at the tail end of long a process of diagnosis that includes: the taking of history, physical examination, mental state examination, laboratory and imaging test (such as CT scan brain). The investigations are done to rule out other medical non-psychiatric disorders that may be responsible for the psychiatric symptoms. The psychiatrist can also make diagnosis and prescribe medications for other medical conditions (these may exist alongside psychiatric illnesses) as well as make referrals to other professional such as neurosurgeons, neurologists or physicians.

The biopsychosocial model: The psychiatrist is always guided by a biopsychosocial approach to etiology, investigations and treatment of mental illnesses.

Regulation: The Psychiatrists are regulated by the Kenya medical practitioners and dentist’s council (KMPDC) while psychologists are regulated by the Kenya counsellors and psychologists board. This board was set up in August 2022.

Workspace: The Psychiatrist works in hospitals, universities as lecturers, Programs (government and NGOs), research and ministry of health (policy and administration). A psychologist works in hospitals, research, universities, sports among others. Both the psychologist and psychiatrist work in substance use treatment centers (rehabs). Commonly a Psychiatrist and a Psychologist work as a team.

When to select a Psychiatrist or Psychologist: The Psychiatrist will be the best choice when a mental distress occurs in the presence of a pre-existing medical condition, suspected to be schizophrenia or bipolar mood disorder, substance use is present, there are suicidal thoughts or behavior, no improvement with initial psychotherapy, there’s a forensic angle to the illness. A psychologist is preferred in the case of a personality disorder, mild anxiety or depression, an episode of symptoms following a crisis such as a major medical diagnosis, accident, divorce, death and when a neurodevelopmental disorder such as autism spectrum disorder has been diagnosed. Cross-referrals between a psychologist and psychiatrist is an indicator of good practice and highly encouraged.

A mental health advocate: This could refer to a psychiatrist, Psychologist, a professional involved in health or mental health such as medical officer or psychiatric nurse or a person with lived experience of mental illness who is passionate about mental health and creates mental health awareness in the community or prompts policy makers to invest more in mental health. When the title of mental health advocate is used, it is good practice to include one’s background.

A Mental health expert: This term should be avoided because of its ambiguity and the risk of masking one’s actual professional qualification which could lead to quackery. Professionals should be encouraged to use their earned titles and qualifications.

Dr. Chitayi Murabula is the President of the Kenya Psychiatric Association (KPA).

Twiiter: @Dr_Chitayi

Email: [email protected]