Taking Issue: Are We Built to Last?

As part of Psychiatric Services' 50th anniversary celebration, this issue features an interview and panel discussions with some of the leading thinkers in our field as they look forward to the next 50 years. It is both challenging and exciting to imagine where the accelerating forces of social change and scientific progress will take psychiatric services over five decades. Sadly, it is by no means guaranteed that we will be better off.

In their 1994 best-selling business book, Built to Last, James Collins and Jerry Porras analyzed why certain companies have been able to withstand internal and external challenges not only to survive but also to attain lasting greatness. Their analysis showed that the success of these "visionary" companies was based on their ability never to waver from their core purposes and values while always being prepared to alter their operating strategies and practices if conditions warranted. They knew what to keep constant and what to be ready and willing to change.

The next 50 years will prove whether we can build psychiatric services to last. The major risk is not that we will lose sight of our core values and purposes. Values such as compassion for those with mental disorders and the desire to see them live and work productively as parts of their families and communities are firmly held among mental health professionals.

The issue is whether we truly are prepared to challenge—and, more important, to change—existing practices when they no longer serve those core values. Our track record over the past 50 years in this regard has not necessarily been stellar. How readily did we see the conflict between institutional care of those with chronic mental illness and our values of commitment to family? As biomedical science blossomed, how quickly did we expand our perspective beyond psychological mechanisms to embrace biological mechanisms of and treatments for mental disorders as well? As patients present an increasingly complex matrix of needs, how consistently have psychiatry, nursing, psychology, social work, and other disciplines unified as effective teams to meet these diverse needs?

The mental health professions make a basic assumption that people are capable of change. The next 50 years are certain to test our readiness to change accepted practices in the organization and financing of care. Only such a willingness to change will prove that we are capable of building psychiatric services to last.