¹Benchmark Health, Co-founder, Pleasanton, CA, United States

Background: Over the past five decades, psychiatry has shifted as science has evolved. While some have complained that psychiatry went from “brainless” to “mindless”, it’s more instructive to track how changes in neuroscience, cognitive science, and biomedical science have influenced views of mental disorders and their treatment. Today while we are struggling to integrate the explosion of biological information into our understanding of individual patients, one can point to significant progress in the science of mental disorders over these past five decades.

Aims & Objectives: Where are we going? It’s a fool’s errand to predict where psychiatry will be (if it exists at all) five decades in the future, but there are a few trends that suggest some nearer term changes.

Method: This lecture will suggest three areas of opportunity.

Results: First, artificial intelligence (AI) may be for psychiatry what genetics was for oncology: a tool that improves precision for diagnosis and treatment. In terms of diagnosis, AI can shift us from categories based on subjective clinical observations to a data-rich process with objective measures of mood, cognition, and behavior integrated with biological, social, and historical insights. In terms of treatment, already AI is transforming drug development by accelerating timelines, reducing costs, and improving success rates. And Gen-AI chatbots are becoming more popular than human therapists for psychological support. As chatbots improve, they will provide an ever-present, non-judgmental partner in the treatment team that can track progress, enhance adherence, and measure outcomes. Many have noted that clinicians will not be replaced by AI, but clinicians who use AI may replace those who don’t. Second, the advent of new treatments that do not conform to the consultative 15-minute med check or the 50-minute hour will change the practice of psychiatry.(Sauve et al, in press) Ketamine, TMS, and psychedelics will require longer visits and diverse clinical teams. Interventional psychiatry, like interventional radiology and interventional cardiology, will require different training, new clinics, and modified payments. The psychiatric office of the future will likely include an array of procedures for both diagnosis and treatment.
Finally, the patient empowerment movement will grow in influence. The increasing role of peers and the emergence of patient voices has already begun to shift the focus from a purely medical model to a model of that looks beyond symptom relief to recovery, including the “3 P’s” – people, place, and purpose.(Insel, Healing: Our Path from Mental Illness to Mental Health, Penguin Random House, 2022) This movement reminds us that for serious mental illness there may be no magic bullet.

Discussion & Conclusions: The promise of the future will be better medications, better psychological interventions, and psychosocial rehabilitation to deliver the 3 P’s, ensuring a life of meaning and dignity.