Mental illness should be a health priority as it is the major cause of community morbidity and untreated illness is a major community cost.

Effective medicines have allowed the community management of patients who previously required prolonged hospitalisation. This process is dependent on developments in psychopharmacology, improved community support and changed attitudes regarding the role of hospitalisation which is now predominantly used for crisis intervention. There has been a major change from the past of shamanism through to alienists and humane therapy with few effective treatments, to a better understanding of the biology of mental illness and its treatment. There is hope for major improvements in treatment with the results of gene studies and the human genome project, better understanding of molecular biology, more effective drug design and improved drug evaluation. However, in the immediate future there is no indication that newer medicines will have greater efficacy than those currently available. Better community awareness and more widespread psychological and social interventions may improve outcomes with available treatments.

Psychiatry is a part of medicine. It can integrate knowledge from psychology and sociology with the new biology. This will lead to a better understanding of the processes of disease and recovery and ultimately improved treatments.

John W. G. Tiller

Associate Professor and Reader, University of Melbourne, Royal Melbourne Hospital

Director, Academic Psychiatry Unit, Albert Road Clinic, Melbourne