From the time when the psychiatric illness was regarded as a reason for social outcasts, the field has taken a giant leap in the last century. Mental health has come through a long and tiring journey riding the back of psychoanalysis and serendipitous discovery of psychotropic medications in the mid of 21st century followed by rapid development in terms of new treatment options and biological understanding in last few decades.
In the journey, there have been multiple hindrances in the form of social stigma, lack of awareness, lack of manpower and different anti-psychiatry movements. However, the field has thrived and is moving forward at a rapid pace with the advent of newer therapeutic modalities, biological theories and research, multimodality approach to treatment for control of symptoms, if not a complete cure, and decrease in the stigma with awareness.
As per WHO Schizophrenia, depression, epilepsy, dementia, alcohol dependence, and another mental, neurological and substance use (MNS) disorders constitute 13% of the global burden of disease; so the problem statement is large. In an ideal setting, it would be proper to say that in the coming five years we would be to able decode the molecular mechanism of the psychiatric illness and know about the etiologic basis of the diseases with the development of new drugs that would revolutionize the field.
As the twin principle of “scientific research” and “human right” is on the rise, this has been able to decrease stigma as evidenced by people coming forth with their psychiatric problems in our day to day clinical practice. This has enabled hapless sufferers to lead a socially and economically productive life amidst changing family structures, social support patterns, and work culture and employment scenarios to some extent. So there is a ray of hope towards the future we dream of in a span of five years. Successful reintegration of patients within the mainstream society, striving toward de-institutionalization and a gender-neutral approach are few things we can believe will move in the desired path.
In the last decade, there has been a massive development in the field of neurobiology and genetics. The use of different technological acumens like functional imaging (fMRI), Diffusion Tensor Imaging (DTI), Magnetic Resonance Spectroscopy has added to our understanding of the neurobiological basis of the mental illnesses.
However, the hard scientific evidence is still in bits and pieces and they pose a major challenge for the researchers today in view of integration into a final common pathway in the search of etiology. On a lane of future years with technology providing us with immense opportunities to advance care for the mentally ill, we are closer than ever to finding the holy grail of psychiatry.
With effortless real-time multi-centric consultations and research, it has been possible to disseminate awareness and reducing attached stigma. With the identification of subtle genetic, structural, biochemical and neurodevelopment abnormalities in psychiatric patients and the ability to “read” complex data with better statistical tools and analyzing software, we expect to be able to lift the shroud of ambiguity obscuring psychiatry for ages.
In light of the recent findings, we believe the social and psychological factors will only become more and more relevant. The last decade also has given strong advocacy on community psychiatry as a need of the hour not only in the developing countries but also in the developed ones. So, seamless integration of the scientific knowledge, equitable distribution of the resources and an amalgamation with the primary health care delivery system in the spirit of “Health for All”, thus making it available, affordable, and adequate are other challenges. Another sphere is the advent of newer modalities of treatment.
The newer therapy models like transcranial magnetic stimulation and deep brain stimulation have established themselves as good find especially in the resistant cases of depression and OCD. So looking at five years from now we can be assured of further research giving more evidence to the established facts and extension of these findings to the newer horizons. The field of neurogenetics is on the rise. In the near future, we might hope to be able to develop designer drugs better suited to the patients’ pharmacogenetics as well as socio-occupational requirements.