Perspectives on the future of psychiatry: treatment and training

Increased national and global recognition of the importance of mental health, a refinement and reduction in the adverse events of treatment, an enormously promising increase in our knowledge about the brain and greater respect for the human rights of people with mental illness – these are among the achievements making Norman Sartorius (Geneva, Switzerland) optimistic about the future of psychiatry.

Among the challenges he identifies is demographic change: a rapidly aging world population will greatly increase the physical comorbidities faced by people with mental health problems, and threaten to amplify their already large excess mortality.

In an aging population, comorbid physical ill-health is a growing challenge

Changes in family structure and functioning will reduce our capacity for care outside institutions and formal services, he predicted, while rapid urbanization brings social dislocation. And he lamented the commodification of medicine that may result in a culture in which we know the price of everything and the value of nothing, including the wellbeing of more vulnerable people in our communities.

Prevention and treatment both critical

If these challenges are to be met, primary prevention of mental illness will have to assume a far more important role, he suggested. 

Peter Falkai (Munich, Germany) took up the theme of treatment, with a view of the future in which genotyping will combine with phenotypic profiling to enable more accurate prediction of outcomes and personalization of therapy. And treatment will increasingly be based on a more developed understanding of disease mechanisms.

Genotyping will combine with phenotyping to more accurately predict outcomes and personalize therapy

Both speakers described the need for training to adapt to changing circumstances, and Peter Falkai emphasized the value of the clinician scientist – someone with time and training in both aspects of psychiatry and the ability to use clinical insights to inform meaningful research.

Back to the future

Andrea Fiorillo (Naples, Italy) looked back at successful programs, in which the EPA has had a major role, to nurture the development of early-career psychiatrists. Key elements include leadership and mentoring, networking and the cross-fertilization of ideas made possible through membership of professional societies.

We’ll need all the creativity we showed with the pandemic to meet unexpected future challenges

The future success of training – which will need us to promote recruitment into the specialty - requires continuity along these lines, he suggested. 

In terms of treatment strategy, he suggested relevant themes will be the rediscovering of psychopathology, early intervention, the integration of treatments, adapting to changing mental health targets, and – given the conjunction of physical and psychological comorbidity -- being physicians first and psychiatrists second.