Clinical Practitioners

Clinical practice careers in Global Mental Health focus on diagnosing, treating, and supporting individuals, couples, and families experiencing mental health conditions across diverse contexts. Professionals in these roles may deliver direct care, provide psychotherapy and counseling, prescribe medications, train and supervise other counselors, and collaborate with community leaders, families, and health systems to improve mental health outcomes globally. Their work frequently involves diagnosing patients, creating treatment plans, developing and delivering mental health interventions, adapting evidence-based treatments to local contexts, supporting task-shifting models (training lay counselors or nurses to deliver care), and addressing social determinants of mental health, such as poverty, stigma, trauma, and access to care. Training requirements differ vastly across countries, and even between states in the United States. What we have provided below is an overview of possible training and career pathways; however, these requirements are often changing, and we recommend checking all requirements with relevant professional organizations and the entities that manage licensure requirements. 

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Psychiatrist

Psychiatrists are medical doctors (MDs) or doctors of osteopathic medicine (DOs) with specialty training in psychiatry who diagnose and treat mental disorders. They can prescribe medication, and may or may not provide other treatments, such as psychotherapy, brain stimulation, and other procedures. Psychiatrist often aim to coordinate care across medical and social support systems. Psychiatrists can work in hospitals, outpatient and integrated care clinics, community mental health centers, academia, private practice, long-term care facilities, and global health programs. Neuropsychiatrists specialize in the overlap between neurology and psychiatry. Learn more about the two Psychiatry Residency programs offered at Duke here.

What It Requires in the United States

  • Bachelor’s degree from a 4-year college 
  • Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree earned from an accredited medical school in the United States or Canada or an approved international medical school 
  • Residency in Psychiatry (~4 years)  
  • Become a licensed physician  
  • Complete board certification in psychiatry  
  • Optional: Board certification in a sub-specialty of psychiatry 
  • Maintain a record free from potentially disqualifying criminal offenses 
  • Strong skills in diagnostic assessment, psychopharmacology, patient care, and interdisciplinary collaboration.

Physicians who were trained outside of the US typically must complete an additional accredited residency training program (~3 years) in the United States or Canada, regardless of prior training outside of the US, in order to apply to become licensed to practice in the US. However, requirements differ by state. 

US-trained physicians may be qualified to provide clinical services in certain countries, but pre-requisite trainings, practice guidelines, and licensure requirements differ by country.  

Physicians in the US who are interested in receiving training in clinical practice in international settings can take part in specialized training, such as Duke’s global health pathway for residents and fellows. Learn more about each of these programs here.

Steps to Get There

  1. Earn a bachelor’s degree (typically with pre-med coursework) (4 Years) .
  2. Take the MCAT and apply to medical school.  
  3. Attend an accredited medical school in the United States or Canada or an international school listed by the World Health Organization (4 years). 
  4. Complete a psychiatry residency (~4 years, including inpatient and outpatient rotations). (Also complete a residency in Neurology or a combined Neuropsychiatry residency for neuropsychiatry pathways.) 
  5. Become a licensed physician (~one year after starting residency training) after passing required examinations 
  6. At the completion of residency or the beginning of fellowship, become board certified in psychiatry (pass board examination) 
  7. Pursue optional fellowships for specialty training in psychiatry  

Clinical Psychologist

What It Requires in the United States

Clinical psychologists are individuals with a PhD or PsyD in clinical psychology or counseling psychology and with an active state-based license to practice psychology who diagnose and treat mental health conditions using comprehensive psychological assessments and evidence-based psychological therapies. They work with individuals, couples, families, and groups and often specialize in specific therapy modalities (e.g., cognitive behavioral therapy, acceptance and commitment therapy), populations (e.g., adolescent/child, family), sub-specialties (e.g., health psychology, forensic psychology, neuropsychology), treating specific mental disorders (e.g., trauma, depression, anxiety, substance use, eating disorders), and other areas. Clinical psychologists differ from master’s level counselors in that clinical psychologists can perform comprehensive psychological assessments, intelligence testing, and neuropsychological testing and may also be university faculty, lead research studies, and teach in university settings. They also may engage in consulting, advocacy, and leadership, and contribute to global mental health interventions. Clinical psychologists often collaborate with psychiatrists and other integrated care teams, and can work in hospital settings, private practice, community-based settings, schools, long-term care settings, industry settings, and in academia. Unlike psychiatrists, clinical psychologists typically do not have prescribing privileges, although this can vary state-to-state in the United States. Learn more about the clinical psychology program at Duke here.  

 

School psychologists (PhD, PsyD, Ed.D) follow a similar pathway with specialty training in school psychology, including completing training at programs accredited by the National Association of School Psychologists (NASP), completing supervised clinical training in school settings, and completing the Praxis School Psychology exam to obtain licensure. Specific requirements vary by state. 

  • Doctoral degree: PhD (research-focused) or PsyD (practice-focused) from an American Psychological Association (APA) or Canadian Psychological Association (CPA)-accredited program, including an accredited supervised clinical internship  
  • Post-doctoral supervised clinical training (1-2 years, varies by state) 
  • Pass the national licensure examination (Examination for Professional Practice in Psychology) and state-specific licensure requirements (additional examinations, training requirements, fees, background check)   
  • Obtain Psychology Licensure (varies by state) and complete annual continuing education requirements to maintain licensure 
  • Maintain a record free from potentially disqualifying criminal offenses 
  • Skills in psychotherapy, assessment, and patient care  

Steps to Get There

  1. Complete a bachelor’s degree (often psychology or related field).  
  2. To strengthen PhD application, recommended to obtain research experience (e.g., undergraduate research position, honor’s thesis, working as a research coordinator) 
  3. Program dependent: take the GRE  
  4. Apply to APA-accredited doctoral programs in clinical psychology (PhD or PsyD) and complete coursework and clinical practica (4-6 years) 
  5. Complete a one-year predoctoral internship (APA-accredited in the U.S.) during graduate school 
  6. Earn supervised postdoctoral hours (required in many states, typically 1-2 years).  
  7. Pass licensure exams (e.g., EPPP in the U.S., state-based examinations, background checks).  
  8. Optionally specialize through postdoctoral fellowships in global mental health, trauma, or related areas.  
  9. Optional: become board certified in a clinical specialty area (e.g., addiction psychology, behavioral and cognitive psychology, clinical child and adolescent psychology, clinical health psychology, counseling psychology, group psychology, school psychology, serious mental illness) 

Counselors and Clinical Social Workers (Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, Licensed Alcohol and Drug Counselor) 

There are a variety of mental health-focused counselors who can practice at the master’s level, including individuals with master’s degrees in counseling, social work, and psychology who complete supervised clinical training, pass national and state-based licensure examinations and other requirements, and obtain a license to practice counseling in specific areas, often under the direction of a clinical psychologist or psychiatrist. These providers often offer assessment, diagnosis, therapy, and case management for individuals, couples, families, and groups. They often focus on the connection between mental health and social determinants such as poverty, housing, family systems, and community resources. Social workers in particular focus on helping individuals access and obtain social services, while licensed alcohol and drug counselors focus on substance use. They play a key role in providing integrated care and promoting social justice within and across communities.   

What It Requires in the United States

  • 4-year bachelor’s degree 
  • MA or MS or MSW or M.Ed in Counseling degree in selected area  
  • State/program-dependent: 1-year clinical internship  
  • Supervised clinical experience (typically 2,000-4,000 hours)  
  • State-specific licensure  
  • Strong advocacy, counseling, and systems-navigation skills  

Steps to Get There

  1. Earn a bachelor’s degree (social and behavioral sciences). 
  2. Complete an accredited MA/MS/MSW/M.Ed program (1-2 years, w/600-700 hours of supervised clinical practice).  
  3. Complete supervised clinical hours (typically 2,000-4,000 hours).  
  4. Pass state counseling licensure exam .  
  5. Optionally specialize in areas like behavioral health, child welfare, or substance use 

Mental Health Nurse

Mental health nurses support individuals experiencing psychiatric conditions by providing assessment, medication management, psychotherapy (for advanced practice nurses), crisis intervention, and patient education. They work in inpatient units, community clinics, schools, primary care, and integrated care settings. Learn more about the Duke PMHNP program here. 

What It Requires in the United States

  • Psychiatric-Mental Health Registered Nurses (PMH-RNs)
    • Nursing degree (ADN or BSN)
    • RN licensure
    • Psychiatric training and experience
  • Psychiatric-Mental Health Nurse Practitioners (PMHNPs)
    • Master’s or Doctor of Nursing Practice (DNP) with PMHNP specialization
    • NP licensure and certification
    • Ability to diagnose, treat, and prescribe medications 

Steps to Get There

  • For RNs:
    1. Complete an ADN or BSN.
    2. Pass the NCLEX-RN exam.
    3. Gain experience in psychiatric or behavioral health settings.
    4. Pursue certification as a PMH-RN (optional).
  • For PMHNPs:
    1. Become an RN.
    2. Complete a master’s (MSN) or DNP in psychiatric–mental health.
    3. Pass the PMHNP board certification exam.
    4. Obtain state licensure as an NP. 

Non-Licensed Mental Health Support Roles

There are many roles available to non-licensed individuals to support mental health of communities and individuals. These roles do not include providing mental health diagnosis or treatment, but they are critical nonetheless for offering non-clinical practical assistance, advocacy, resource access, and empathetic support. Many of these roles are designed to build on the skills of individuals with lived experiences with mental health challenges. These roles can include peer navigators, research study interventionists, outreach workers, facilitators, educators, resource navigators, and recovery support workers. The required training for these roles varies by position.