Introduction: The Scope of Psychiatry

What is the scope of psychiatry as a medical practice? Is it just therapy or psychopharmacological modality of practice? Is it confined to the hospital or traditional outpatient clinical setting? Should it continue to just conjure up the image of a couch in a private practice room? Is psychiatry limited to urban centers or community clinics?

I would argue that psychiatry is all of these and much more. As a medical field, it is unique in that it can claim to be both a primary care and a specialty care discipline at the same time. Our scope can extend beyond our traditional roles in a medical setting and is well suited to be practiced in wide ranging collaborative, innovative, and integrated models of care. We can be contributors in the basic sciences laboratory and to society at large. The richness of how psychiatry can be applied and contribute in our community is the focus of our special issue.

With the rise of information technology, psychiatrists can provide evidence-based care to remote, underserved areas with ease. One of telemedicine’s first application was in mental health and we continue to push the boundaries in how psychiatry is delivered.

As discussed by Dr Saeed, psychiatry has moved beyond using telemedicine as just a tool in reaching distant areas. It is now being integrated in mobile personal devices, leveraging application tools and has linked diverse providers. It has also evolved into a specialized delivery system to support diverse clinical-care models. Allowing for more flexibility in how psychiatry can be delivered, telepsychiatry has blossomed into a potent tool in our drive to increase access to high quality care.

The positive impact of psychiatry can be found in places many may not expect. Our work is not just about dealing with mental illness but also promoting mental well-being. As such, our input is valuable in settings outside of traditional medical buildings and clinics. As illustrated by Dr Gabrielian’s article, involvement of psychiatrists in supported housing can lead to great improvements in success of a homeless client-this is truly a patient centered delivery of psychiatric care.

In looking at societal impact on health, psychiatry can contribute to the ongoing dialogue about poverty and mental well-being. In “Addressing Poverty and Mental Illness,” Drs Simon, Beder, and Manseau, use a case vignette to illustrate the ways in which a psychiatrist can best impact those in poverty. They don’t just focus on clinical outcome of an illness but take on the total human experience.

Finally, Dr Davidson and colleagues make an argument for peer support. As psychiatrists, we can partner with our patients in leveraging their strengths and experiences to help others. This collaborative approach with peer support should be encouraged and can serve to extend psychiatry’s reach to those who continue to be underserved and stigmatized.

In this Special Report, the topics may seem diverse and wide-ranging. However, this is precisely the point. Psychiatry can contribute in ways that some medical fields cannot. It comes down to the fact that our work boils down to alleviating the suffering of the human condition itself. As psychiatry evolves, we should be encouraged by the fact that our work is not limited by traditional confines of medicine.

In this Special ReportReflections on Psychiatry in Supported HousingAddressing Poverty and Mental IllnessUsing Telehealth to Enhance Access to Evidence-Based CareRevisiting the Rationale and Evidence for Peer Support

Disclosures:

Dr Koh is Associate Clinical Professor, Department of Psychiatry, University of California, San Diego. Dr Koh reports no conflicts of interest concerning the subject matter of this Special Report.