Early intervention for psychiatry itself: the invisible hands for future psychiatry

This narrative review probes the future trends of psychiatry from the perspectives of professionals working in the field of early intervention for psychosis and youth mental health. The review is co-constructed by a diverse group of clinicians and researchers, including those with lived experience, working in high- to low-resource settings in the Asia-Pacific. Grounded in the consideration of psychiatry as a medical discipline. When the early intervention lens is applied to the state of psychiatry itself, several 'at-risk' factors have been observed: dilution of the doctor-patient relationship, lack of a robust integrated model of the human person and psychopathology, increased commercialisation, excessive reliance on other professionals, disconnection of knowledge generation and transmission, and tension between the healing and public safety roles of psychiatry. The complexity of mental illness, coupled with high stigma and low resources (even in relatively affluent populations), continues to undermine the proper functioning of psychiatry as a medical speciality. These challenges are likely to intensify in the future. Psychiatry as a profession needs to consolidate a robustly integrated medical approach to mental illness that resists splitting into 'biomedical' and 'psychosocial' perspectives, in the form of a biopsychosocially-informed medical psychotherapeutic practice. It will need to work with other stakeholders in the broader landscape of public mental health without diluting the healing roles in treating mental disorders. Behind a number of recent changes, the 'invisible hand' of the market economy is potentially driving psychiatry towards more inequity and escalating costs. Some of these have been fuelled by decreased effectiveness of the conventional academic platform and the rise of new information platforms that are increasingly challenging to manage. A thoughtful, prudent, and coordinated approach by the profession is essential in ensuring a healthy trajectory for the future of mental health care.