[The future of psychiatric care--dreams and nightmares]

The paper aims to identify perspectives for future mental health care.

Personal reflection based on the history of mental health care, own experience and current developments.

Mental health care and the relationship between patients and professionals within it have changed significantly in the last five decades. Current developments may be seen as characterised by a) a widening remit of mental health care with an increasing clientele with non-severe mental disorders; b) re-institutionalisation for the severely mentally ill, e.g. with a rising number of forensic beds; and c) a tension between consumer orientation in a post-modern society and dominance of evidence-based medicine. Mental health care has always lived in a balance between social control and therapeutic aspiration. Yet, we now seem to witness a stronger split between the two with re-institutionalisation for patients with severe mental illnesses who might upset the public on one hand, and a growing private market of various treatment options for patients who actively seek treatment and can--directly or indirectly--pay for it on the other. This leads to the anticipation of positive as well as negatives scenarios for the future which are briefly described and contrasted.