The new social contract and future of psychiatry

Healthcare systems across the developed world face unprecedented changes, and shifts in demands from the patient populations they seek to serve. Here we discuss the suggestion this is more true in psychiatry than other fields; we examine the nature of changing demands on the profession and what this might mean for the realities of future mental healthcare. As we are faced with unprecedented and evolving expectations of services, what can psychiatrists do to help their services adapt? In discussion of the history of this evolving issue, and with some background from literature reviews and international comparisons, we aim to understand what the problem is with the fraying social contract. From this base, we here pose some questions for us all to consider on the future of practice, as well as offer reasons for hope in the face of some a discouraging professional outlook.