Generalist or Specialist: A Career Crossroad For Mental Health Professionals

Published on: 2 Nov 2023

Career Crossroad

Author: Dean Malpass

Most mental health professionals will, at some stage, have to make a career decision as to whether they should become a generalist or specialist practitioner.

This decision can significantly impact your career trajectory, job satisfaction, and the care you provide to your patients. Exactly how it impacts will vary depending on your professional background, so the considerations for a registered nurse will be slightly different to those for an occupational therapist.  

Generalisation in mental health care refers to a broad-based approach where you treat a wide range of mental health conditions.

Specialisation involves focusing on a specific area or population, such as children, secure (forensic) services, or those with specific disorders like schizophrenia or eating disorders. One path isn’t superior to or more complex than the other; it is finding the best fit for you.  


The generalist path

As a generalist, you'll work with a diverse range of patients and conditions. This can be incredibly rewarding and provide a broad mental health perspective. Generalists can be in high demand, particularly in rural areas or in roles where they work within or alongside other generalist services such as GP surgeries. 

Those who become generalists will be able to use a variety of mental health approaches, call upon broad experiences to help patients and work holistically.

A generalist approach can help improve service delivery in areas where services are overburdened, and generalists are likely to transition well into leadership/management careers.


The specialist path

Becoming an expert in a specific area of mental health can lead to opportunities for research, teaching, and expert roles. Career paths are often much clearer for specialists, and specialists can have higher earning potential as their in-depth expertise is seen as valuable. 

However, it's important to note that specialisation also requires additional training and education, which can be time consuming and costly. As there are often fewer specialist roles available, competition for jobs may be more intense.

The decision to generalise or specialise is deeply personal. It depends on your career goals, personal interests, the types of roles available when you are applying and the field you work in. The decision will also impact future career opportunities.

Consider the occupational therapist who chooses to specialise in learning disability and autism spectrum disorder (ASD). It is unlikely, although not impossible, that person will become an older adult specialist later in their career.

The challenge here would be that the occupational therapist would need to undertake further training and education and have to take a more junior position, even though it is more of a generalist role. The advantage of doing so would be their increased ability to understand and help older adults who may have ASD or learning difficulties.

A similar switch would be less problematic for registered nurses, who often change clinical areas of interest over the course of their careers. In nursing, there tends to be greater parity of roles and recognition of the transferability of skills.

Naturally, there are exceptions to these assumptions, but taking time to consider your long-term goals, when making decisions about whether to specialise or generalise, is always time well spent.

Make good use of coaching, mentorship, insight visits and networking to learn about different areas and specialities. This will help you to learn about your interests, set career goals, and make decisions about your career with greater insight.       

Remember, whichever direction you choose, your career is never set in stone. The most important thing is to choose a path that aligns with your passion and allows you to provide what you believe is the best care to your patients.


Dean Malpass is a Registered Mental Health Nurse, Chartered Manager, and East Midlands Clinical Senate member. He owns Dean Malpass Consulting Limited ( and is co-founder of Virtue Investigations Limited.