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The future for the next 10 years of mental health in America will not derive from sudden breakthroughs in decoding our DNA or fashioning designer drugs that are categorically different from what we have now -- though either or both would of course be welcome. A sanguine future is possible if we do what we know now a lot better (quality) and deliver what we know now to a lot more people (access).
The greatest gains we can achieve in the next 10 years in public mental health will derive from closing the gap between what we know and what we do in both mental health and the addictions. The "science to practice" gap, as it has been called, is the (hard to imagine but real) fact that advances in medical practice (in general medicine as well as psychiatry) are typically years in going from "bench (lab) to bedside."
I offer this prescription for the future of mental health in America, in David Letterman style:
10. Intervene early, with family skill building and trauma-based treatment, for youth from 3-7 years of age who show evidence of Adverse Childhood Experiences(ACEs). (1)
9. Detect signs and symptoms of serious mental illness, psychotic illnesses like schizophrenia and bipolar disorder, in adolescence and deliver accessible, age-friendly First Episode Psychosis (FEP) services to alter the trajectory of illness and prevent disability, long-term suffering and social burden. (2)
8. Deliver mental health and addiction screening and clinical management in primary medical care, including internal medicine, family practice, pediatrics, and OB-GYN, as standard practices like we see diabetes, asthma, hypertension, and other common, chronic medical conditions now treated and managed. (3,4)
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