Moving Beyond Community Mental Health: Public Mental Health as an Emerging Focus for Psychiatry Residency Training

Mental disorders and behavioral conditions represent a challenge to the well-being of communities throughout the world. This statement is bold, certainly, but not without basis. One in four adults in the USAmeets criteria for a mental disorder, and estimates from the World Health Organization indicate that mental disorders represent nearly 23 % of years lived with disability for all people globally [1, 2]. This level of disease burden is greater than that associated with HIV/AIDS, cancer, and diabetes combined.Moreover, the most common causes of death, including ischemic heart disease, stroke, chronic obstructive pulmonary disease, diabetes, HIV, andmultiple forms of cancer, are linked with at-risk behaviors and behavioral conditions. The number of completed suicides each year— nearly 900,000 worldwide and 37,000 in the USA—in rough terms represents more than twice the number of people who die annually from war or from interpersonal violence. By 2030, depression will be the top cause of disease burden globally, 1.01 million people will die from self-inflicted injury each year, and 1.85 million people will die from traffic accidents frequently associated with substance-related disorders, sleep deprivation, and co-occurring physical and mental health conditions [2]. The burden associated with mental illness and behavioral disorders will continue to be the greatest among certain vulnerable subpopulations, including socioeconomically disadvantaged children, certain underrepresented minorities, the homeless, rural and immigrant populations, and individuals with co-occurring, stigmatized, and severe physical illnesses. For these reasons, the impact of mental disorders and behavioral conditions can be characterized as one of the greatest concerns of our world. Mental disorders are the largest diagnostic category for those in the USA receiving disability, at a cost of $25 billion a year [3]. Even with decades of research, antipsychotic medication, and deinstitutionalization, evidence of improved prospects for recovery remains scarce. Of those with schizophrenia, 80% are unemployed; 60 % of individuals with bipolar disorder experience co-occurring substance abuse dependency; posttraumatic stress disorder is not less prevalent today than it was 50 years ago [3]. Together, these outcomes data demonstrate a concerning, sobering unmet need in public mental health. Are we doing enough in residency training to prepare future psychiatrists to address these grave realities? Do residency curricula offer sufficient exposure to the range of issues faced by the diverse communities and distinctly vulnerable subpopulations hardest hit by mental illness and related health conditions? Further, are we providing physicians-in-training—those who will be established in their careers by 2030—with the means to improve population mental health, as well as to enhance the well-being and resilience of their individual patients? Are we giving the field of psychiatry and our patients, as well as our physicians-in-training, a reason to be hopeful in light of the sobering facts on state of mental health?