Psychiatry for the futurePsychiatry for the future
All In The Mind
It could be that the profession of psychiatry needs a revolution. A UK medical doctor with experience in mental health feels that we’re still trying to understand and come to terms with mental health issues—and how best to provide treatment. He talks with two psychiatrists, a historian, and a service user. They all can imagine a different future for psychiatry.
29:06•23 Jun 2019
Imagining a Quiet Revolution in Psychiatry
Episode Overview
- Current psychiatry is described as overly focused on diagnosis, biology and promised breakthroughs that have yet to help patients in the way claimed.
- Digital tools, including online therapies and digital phenotyping from mobile phone data, are presented as promising ways to spot and respond to emerging mental health problems.
- Several speakers argue that human relationships, meanings and values are central to mental health, and cannot be captured by science alone.
- Service users call for a major shift in power, respect and training so psychiatrists work with people as intact minds rather than objects to be fixed.
- A long‑term social change towards inclusivity and rethinking "normality" is seen as vital, with some imagining an eventual world where formal mental health systems are no longer needed.
“"The happy ending is where there's no need for it, where people, when they're having difficulties, get the attention they need, the loving support and attention they need."”
Gain insights from experts and survivors on how psychiatry might change in the years ahead. This conversation centres on big questions: what is mental health care actually for, and who should hold the power in that system? UK medical doctor Dr Joe Rally, now working in Australia, brings together psychiatrist and philosopher Pat Bracken, historian of psychiatry Ivan Crozier, mental health researcher Professor Helen Christensen, and long‑time "mental health system survivor" Kathy Piconi.
Together they sketch out very different futures for psychiatry, from high‑tech innovation to quiet social revolution.
Helen Christensen argues that respect and choice should be at the heart of care: "Somebody who has a mental health problem walks into an environment where they're treated with respect and offered a range of opportunities… which have an evidence base." She’s excited by digital tools, especially "digital phenotyping" using data from phones to track behaviour and flag early signs of trouble in real time.
Pat Bracken is blunt about current practice, saying psychiatry is "stuck in a rut" of diagnosis and biology that "has helped no patient" in the way promised. For him, the real work lies in human relationships, meanings, and values, not just scans and genetics. He imagines a future where "service users start to become the experts" and the doctor‑patient relationship becomes more democratic.
Kathy Piconi offers a raw account of harm and disrespect in the system, yet she still sees the potential for what she calls a "quiet, velvet revolution" led by both workers and "inmates" paying deep, genuine attention to one another. Her ultimate dream? "The happy ending is where there's no need" for a formal mental health system at all.
Ivan Crozier adds historical and social context, arguing that real change will require society to rethink ideas of normality and be more inclusive of difference. If you’re interested in how future mental health care might look beyond pills and labels, this conversation raises challenging questions worth sitting with. What kind of psychiatry would you want for yourself and the people you care about?
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