Literature Collection

The last quarter century has seen a clear move internationally towards greater integration between healthcare service types - including across mental and physical health - as well as with social care. The drivers include growing population complexity and clinical need, and a recognition that the broader evidence base supports better outcomes and cost effectiveness through tackling social determinants of health in a more joined-up and preventative manner. Challenges have included a lack of granularity about which approaches work best at a local level, which data might support learning from these, and how we might disseminate this between often very different systems and populations. The next 25 years will see renewed efforts towards greater integrated and preventative community approaches. However, we still lack a consensus about inpatient provision and need to optimise this through clinically led learning and care models. Technology is at a point where we can have digital infrastructure that pulls large-scale population-level clinical effectiveness data. The opportunity is to anchor this as our key tool to grow and refine better care models, augmenting more traditional process and governance data-sets, and therein also leverage research findings into measured novel implementation in practice.

OBJECTIVE: The American Psychiatric Association (APA) issued a 2023 report on the future of psychiatry, focusing on how the organization should position itself in relation to coming developments over the next 10 years. Here, we follow up with a discussion of how the psychiatrist's role needs to evolve to adapt to the changes ahead. METHODS: We drew on senior experts and junior trainees within the APA's Council on Healthcare Systems and Financing, along with additional content experts, to choose areas of focus and discuss their interrelationships. Literature review focused on publications with implications of these areas for future training and practice. RESULTS: We are only ∼5% of the mental health work force, and we have unique strengths, including training providing us the ability to discern the varied factors contributing to distress, and direct and apply interventions across all available modalities. Psychiatrists make best use of our capabilities when we lead the process of comprehensively formulating patients' problems and generating a multi-faceted treatment approach. We have chosen six areas where we envision new developments impacting how psychiatrists will practice and residents should train: digital data and precision medicine, measurement-based care, artificial intelligence (AI), psychotherapy, integrated care, and care for the seriously mentally ill. We provide suggestions regarding next steps that will allow us to make the best use of our training and expand access to high quality diagnosis and care. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: We will need to handle the most challenging cases: the most psychiatrically complex, medically complex, and treatment-resistant. We must preserve our skill, unique among physicians, in psychotherapeutic approaches, even as we manage psychiatric illness. We must also adapt and become more tech-savvy, as digital data, mobile and computer-based treatments, electronic medical records, and AI algorithms take on increasing prominence in our field.