The aim of this article is not to engage in crystal-ball gazing but to provide a broad environmental scan based on existing trends. The practice of medicine and indeed psychiatry is influenced by economic, political, and sociocultural factors. An understanding as well as anticipation of future trends in these areas will enable psychiatrists around the world to help shape the nature of psychiatric practice rather than being pushed from one direction to the other.

After the downturn in the Asian economies and the Russian debt default, the world economy is recovering. The growth is predicted to be near 3 percent globally, and inflation will remain low. Credit is expected to tighten and the growth in world trade to slow, but the labor market conditions will see slight improvement. Poverty in many countries will remain an intractable problem. This scenario will hold provided that the large current account deficit and high personal debts in the United States do not cause major hiccups.

Whether economic growth will translate into better health care especially for the mentally ill in many countries will depend on the introduction of a system of good governance and less corruption. In developed economies it depends on the ability of governments to balance the pressure to contain costs, increase efficiency, and raise service standards. While health care reform is in fashion internationally, there is widespread dissatisfaction with existing as well as emerging methods of financing and service delivery. The search for new policy instruments is still going on, and policies will remain in a state of constant flux. The expectation is that health care coverage will be a mix of public contract with voluntary insurance supplementing public finance.

Average life expectancy at birth will continue to rise, and this will be more rapid in developing countries with the exception of Sub-Saharan Africa and Russia. Even with these exceptions, the World Health Organization predicts that by 2025 there will be no country with a life expectancy at birth below 50. The challenge of providing pension funds and health care for a rapidly aging population will become greater. The trend in health care is to strengthen health promotion and primary prevention.

The literacy rate of women in developing countries will approach that of developed countries (97 percent). At present it is 83 percent in East Asia, 87 percent in Latin America. The literacy rate for women in China, Sri Lanka, and Zimbabwe has already risen to 70 percent. Women’s labor force participation is likely to rise to 60 percent to 70 percent. This will certainly have an impact on the family structure, the nurturing of children, and the care of the sick and elderly. A large proportion of children will grow up without the supervision of adults and with no alternative social support system in place.

The drift of the population from rural to urban areas will accelerate. As of 1995, there were 30 cities around the world with a population of more than 3.5 million. This mass internal migration will result in the gradual disappearance of cohesive communities.

The data presented by the World Bank on the global burden of disability unveiled the hitherto unseen burden of psychiatric disorders. It pointed out that the leading causes of disability are substantially different from the leading causes of death. Of the 10 leading causes of disability worldwide in 1990, five were psychiatric disorders: unipolar depression, alcohol use, bipolar affective disorder, schizophrenia, and obsessive-compulsive disorder. Unipolar depression alone accounted for one in every ten years of life lived with a disability worldwide. By 2020 psychiatric and neurological disease could increase from 10.5 percent of the total burden to almost 15 percent. This increase is proportionately larger than that for cardiovascular disease.

Changes in the neuroscientific knowledge base will continue to drive changes in psychopharmacology. New classes of antipsychotic, antidepressant, antianxiety, and even antidementia agents will emerge. Genetics will lead to a better understanding of the pathophysiology of psychiatric disorders and the complex relationships between biological and environmental influences. The new generation of neuroimaging technologies will eventually enable the in vivo study of functional histology.

Community psychiatry in many countries is developing vertically organized, integrated systems of care. New service models are multiplying, and the linkage of services with different agencies are growing.

In the past decade psychiatrists found the new environment too hostile and have retreated in a number of ways: taking early retirement, practicing along a narrow biological model, raging against change, fighting a rear-guard battle to maintain the status quo. The tragedy in all these is that other medical specialties have become more aware of the importance of psychosocial factors and are more willing to change. Other professionals like social workers, lay therapists, and alternative-medicine practitioners have taken up the vacuum left by the retreating psychiatrists.

As demonstrated by the environmental scan, the next millennium will present enormous opportunities for psychiatry. To grasp these opportunities, psychiatrists have to put themselves in strategic leadership positions to shape health care policies, medical education, and research directions.

There is a need to learn new management skills and to strengthen teamwork skills.

Psychiatrists have the knowledge and skills to help change behavior. New opportunities are opening up for the profession to take up an educative role in public health.

Equipped with the results of the "systematic study of multiple concerns pertaining to differential diagnosis, treatment, biology, and risk factors" achieved in the past two decades, child and adolescent psychiatrists can influence decision makers on how to provide better care for children.

The practice of psychiatry will have to change by adopting cost-effective and ethical treatments. The database on cost-effective treatment needs to be expanded and made available on a global basis.