The RCPsych Article of the Month for September is ‘A better future for mental health science‘ and the blog is written by author Niall Boyce and the article is published in The British Journal of Psychiatry.

There’s no shortage of criticism of mental health science. Has it really changed anything for patients? Doesn’t it have a history of overpromising and overdelivering? Is it the right approach to understanding and treating mental health problems in the first place? While much of this criticism is unfair, this guest editorial—written by two staff members working on mental health solutions at Wellcome, a major global health research funder—argues that the field of mental health needs to acknowledge that there are many ways in which it could improve, building on its strengths and achievements to deliver rapid improvements for both populations and patients.

Some issues are foundational. The question of how mental disorders are classified is probably the most well-known and hotly debated. While attempts to introduce classification systems that are more scientifically grounded than the current diagnostic manuals are welcome, there is the risk that this will open up a divide between research and clinical practice. If the field can’t land on a single system that is scientifically valid and clinically useful, it needs to figure out how different systems, built for different purposes, can operate in harmony so that research findings can move seamlessly into practice. Less well-known, perhaps, is the issue of animal models; while these are vital for the early stages of treatment development, we think that a lack of understanding as to how animal models relate to the complex, subjectively reported experiences of human beings makes it hard to assess which new therapies show true translational promise.

Then there are questions of impact: the first of which is, what is impact? What outcomes matter most, and how can we measure them? Do we need to move beyond a focus on reductions in symptoms to an increase in functioning? Thoughtful inclusion of the voice of lived experience is key to figuring this out. We also need to focus as a field, seeing through the hype to identify the innovations that are most likely to make a difference, and ensuring that their scalability is built into development, not relegated to an afterthought. Other fields have done this—think of efforts such as the Cancer Moonshot—and we think it’s time for mental health to do so, too.

Finally, the field needs to pull together and shed the zero-sum thinking that is the result of years of relative neglect and underfunding compared with other areas of health. The mental health community of researchers, practitioners, people with lived experience, and other supporters should not have to choose between developing new treatments and increasing availability of existing ones, or between improvements in service delivery, and measures to improve population mental health. It can, and should, demand more and better.

At Wellcome, we are funding research to find solutions to several of the problems identified in this editorial. We hope that this piece provokes discussion and debate, and helps to catalyse a new phase of discovery, innovation, and progress in mental health science.

The article by Lynsey Bilsland and Niall Boyce begins with comments made by a well-known journalist who essentially states that psychiatry has a long way to go before it can be recognised as a scientific discipline. The authors argue against this position – correcting certain misconceptions – but also address the reasons as to why this perception has taken hold and why psychiatry continues to face challenges such as these as well as those that are inherent in research and clinical practice. The title of the Guest Editorial “A better future for mental health science” captures several important aspects. First, the aspiration for improvement (a better) and then, a focus on what lies ahead as opposed to dwelling on the failures of the past (future) and finally, a tripartite description of our work that gives it both depth and substance (mental health science). I for one like the use of both the terms ‘mental’ and ‘science’ as these resonate with the focus of the Journal and the term ‘health’ aligns with the goal of therapy. However, the importance of the article and why it is a must read is that it identifies the foundational issues and corresponding missions and most importantly draws attention to the need for research and mechanisms by which this can be achieved. In addition to offering some practical insights and a way forward perhaps most importantly if offers hope and counters the aspersions cast on psychiatry all too readily by one and all.

Professor Gin S. Malhi,
College Editor and Editor-in-Chief,
The British journal of Psychiatry