This is a lecture about what it is to be a psychiatrist in clinical practice for more than 30 years. It draws on my experience of treating patients across a range of settings. It is intended to offer a perspective on working within a large mental health system that cares for individuals at different levels of need.
We will examine the different systems of care that shape psychiatric practice: inpatient units, outpatient settings, community programs, and long-term care. We will reflect on how the treatment of severe mental illness has changed over the course of my career; what has improved, what remains limited, and what continues to challenge us.
A central theme of this discussion is continuity of care i.e. what it means to treat patients across different phases of their illness, from acute hospitalization to periods of relative stability. This work extends beyond the patient. We must work closely with their families, caregivers, and broader support systems. Our goal is to help patients achieve and maintain meaningful functional lives.
Finally, we will contemplate the importance of empathy. Successful treatment is equal parts knowledge and compassionate care.