Skip to Main Content

The changing world of mental health

The science behind mental health has long been one of Yale’s strengths. Robert J. Alpern, MD, dean and Ensign Professor of Medicine, talks about the direction of the field today and why society ought to do a better job of taking mental health issues seriously.

What are the key challenges facing people who need mental health treatment?
Mental health care has changed significantly since I entered medicine. Patients with significant mental health disorders were hospitalized for lengthy stays and the public probably envisioned those stays as being something like that described by Ken Kesey in the 1962 novel One Flew Over the Cuckoo’s Nest. Now, most are treated as outpatients and there’s more emphasis on medication, with less emphasis on psychotherapy.

What changed?
In the past, mental health was viewed as a problem on the periphery of medicine that most physicians could not fully comprehend and wanted to avoid. An understanding of the neuroscience wasn’t really there for drug development, nor was the technology sophisticated enough to image or treat chemical imbalances or physical trauma. We now realize that mental health is central to overall wellness. Mental health is a major concern for this country and the world. We don’t treat it well at all and I think we’re all aware of that now. We need to make meaningful changes.

Is there anything we can do to fix the system?
The entire system is underfunded, to begin with, but the cost that it would take to really treat mental health disorders as they should be treated would be very large. Still, the costs to society of not treating these conditions have been and will continue to be enormous. The question of how serious we want to be about treating mental health is one of the great challenges we face as a country.

Does technology hold any hope for improved accessibility or treatment?
The short answer is yes. The longer answer is that technology is always advancing, and the tools we’ve needed to diagnose underlying biological or chemical causes of mental health disorders are still being developed. Here at Yale we have an out-standing neuroscience program, an outstanding psychiatry department, and an outstanding neuroscience imaging program. I’m confident that our researchers will be playing a major role in making quality psychiatric care more available.

Will mental health be a right some day?
It’s hard to say that mental health is or will be a right. But I think it’s a right to have access to the best mental health treatment. We need to significantly improve our treatments and patient access to those treatments.