How the Psychiatrist’s Role needs to Evolve to Adapt to Changes Ahead

Six developments envisioned that will impact practice

Researchers have envisioned six developments that will impact how psychiatrists should practice, and residents should train, over the next decade:

Digital tools—add value for psychiatric care, including through collecting data to fill in gaps between visits. These tools—smart phones, wearables, etc.—can provide richer data than obtainable only through clinical encounters, and lead to more informed decision‐making. Phone apps, such as mindLAMP and Beiwe, collect both passive and active data.

Digital data might be used, for example, to capture disturbed sleep patterns as a precursor to depression relapse, with the possibility that aberrant sleep signature could trigger an intervention such as increasing antidepressant dose. Digital interventions have been shown to mitigate suicide risk; one analysis of studies using cognitive behavioral therapy approaches found that suicidal ideation was significantly reduced.

Digital data can also be used for precision medicine, which aims to stratify disease categories comprised of patients with varied presentations into more homogenous sub‐types, ideally with differential response to treatments. Defining these subtypes requires large numbers of patients and consideration of various types of information, including that generated from mobile devices, electronic medical records, and biological assays, like genetic profiles, metabolomics, brain imaging, and EEG. This work includes the potential for developing blood‐ and saliva‐based, and imaging‐based biomarkers of types and subtypes of psychiatric illness, and of treatment response. Skills in medical informatics, bioinformatics, and biostatistics all come into play in generating the data, interpreting it, and using it to effectively guide clinical care.

Measurement‐Based Care—systematically assesses patients’ symptoms, functioning, and treatment response using instruments such as the PHQ‐9 and GAD‐7. It aims to enhance the precision and effectiveness of treatment by tailoring interventions to individual patient needs and monitoring progress over time. Measurement-Based Care represents a shift from practices based solely on clinical judgment to a more objective and data‐driven approach, aligning with the broader movement toward evidence‐based medicine. The framework allows clinicians to track changes in patients’ condition, identify treatment responses, and make timely adjustments to optimize outcomes.

Artificial Intelligence—”We must identify ways to work with and provide guidance in the deployment of these novel tools, to augment and improve our practice, and guard against the problems they could bring,” say the researchers. AI shows promise for improving practice efficiency and creating clinical value. Applications are being explored to optimize scheduling, coding, billing, note‐writing, and quality control.

“While many hurdles remain, a future strength of classification models will be their ability to identify patterns in large‐scale data of use to psychiatrists. Declines in cognitive functioning, early stages of decompensation, and biomarkers of illness might all be easier to detect through AI.”

Psychotherapy—Psychiatry has been increasingly divorced from psychotherapy, with some psychiatrists being siloed into prescribing medications without administering or even recommending psychological interventions, say the researchers. For the psychiatrist of the future, a solid foundation in psychotherapy skills will continue to be a cornerstone of effective care. “Strong psychotherapy skills empower us to better assess, diagnose, and address the complex interplay of biological, psychological, and social factors underlying psychiatric distress.”

Integrated Care—Fewer psychiatrists practice in isolation. This is the result of a shift towards physicians as employees, the consolidation of health care systems and their acquisition of smaller practices. Additionally, the industry is moving away from fee‐for‐service models towards value‐based approaches, prompting systems to adopt roles integrating psychiatrists with other medical providers. “Psychiatrists will need to adapt to this evolving landscape while advocating for a balance between efficiency, quality patient care, and our own satisfaction and well-being.”

Support of the Collaborative Care model by payors represents a significant shift towards integrated, team‐based approaches. The model, shown effective in treating depression, anxiety, and post‐traumatic stress disorder within primary care settings, breaks down the historic silos between primary care providers and psychiatrists.

Care for the Seriously Mentally Ill—Only 65% of Americans with a serious mental illness (SMI) receive treatment. Reasons include stigma, poor awareness of need for treatment, lack of available providers, and limited or unavailable care in justice and homeless service systems where many patients end up. Many with SMI need case and care management services to coordinate multiple service needs and optimize adherence. Novel approaches exist for providing this, although most rely on new cadres of mental health workers, who have much less training and no license or certification status. “These providers may not have the tools to adequately understand and manage patients’ needs.” Reimbursement models often fail to promote coordination and follow‐up care.

States have implemented a wide range of approaches to funding and treatment resources for SMI. Examples of evidence‐based models of comprehensive services include Coordinated Specialty Care for first‐episode psychosis, Assertive Community Treatment for the difficult‐to‐engage, and Certified Community Behavioral Health Clinics. These programs are typically funded using cost‐based or bundled payment systems and fill important gaps for specific populations using approaches that integrate medical, psychiatric, and recovery‐oriented services. “Psychiatrists must play a critical role in supporting these models and ensuring those with SMI receive adequate care as public systems evolve.”

The full report, by James Potash, MD, MPH, et al., professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, is published by Psychiatric Research & Clinical Practice.

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