Editorial

1878 www.thelancet.com Vol 381 June 1, 2013

A revolution in psychiatryThe furore surrounding new versions of the two major classifi cation systems in psychiatry (DSM-5 and ICD-11) is giving way to a more fundamental debate about the nature and origin of mental illness. While recognising the pragmatic benefi ts of symptom-based approaches, clinicians and researchers look forward to a new era of diagnosis and treatment based on underlying cause.

On May 23, two studies were published in the British Journal of Psychiatry, which add to the evidence of a genetic link between attention defi cit–hyperactivity disorder (ADHD) in children and schizophrenia and bipolar disorder in adults. These studies build upon genome-wide analyses published in The Lancet on Feb 28, which showed that fi ve childhood-onset or adult-onset major psychiatric disorders (autism, ADHD, bipolar disorder, major depressive disorder, and schizophrenia) share several common genetic risk factors. Variations in calcium channel activity genes were found to be important in the development of all fi ve disorders, leading to the hope of new molecular targets for psychotropic drug development.

The future of psychiatry looks set to change from the current model, in which ADHD, bipolar disorder, or schizophrenia are considered as totally diff erent illnesses, to a model in which the underlying cause of a spectrum of symptoms determines the treatment. The child with ADHD at 7 years could be seen by a child psychiatrist, but at the age of 18 often loses access to mental health services altogether, until he presents with a so-called adult mental health problem. Substance misuse and personality disorders may complicate the picture.

Continuity of care throughout a lifetime for those with mental illness and their families is required. Removing the historic barrier between child and adult services to recognise the continuity and evolution of mental health problems is necessary. At present, access to mental health services is often most limited for those most in need. Adolescents and young adults (those aged between 12 and 25 years) struggle particularly to access services, yet have the highest incidence of mental illness. A revolution in psychiatry is needed not only in nosology, but also in service provision. ■ The Lancet

For more on ADHD and schizophrenia see Br J Psych

DOI:10.1192/bjp.bp.112.117432

For more on ADHD, bipolar disorder, and schizophrenia see

Br J Psych DOI:10.1192/bjp.bp.112.120808

For The Lancet genome-wide analysis see http://dx.doi.

org/10.1016/S0140-6736(12)62129-1

For more on youth mental health services see Br J Psych

2013; 202: s30-s35

For the UK Humanitarian Emergency Response Review

see https://www.gov.uk/government/uploads/system/

uploads/attachment_data/fi le/67579/HERR.pdf

For more on the research programme see http://www.

elrha.org/work/R2HC

Earthquake in Haiti. Tsunami in Japan. Floods in Pakistan. When humanitarian crises happen, the natural response is to get help to those aff ected as quickly as possible. But when governments, agencies, and charities respond to a crisis, are they responding in the best way possible? In 2011, the UK’s Humanitarian Emergency Response Review, chaired by Paddy Ashdown, found that the evidence base for action in these settings was weak.

In response to this situation, on June 4, the UK Department for International Development and the Wellcome Trust, in partnership with Enhancing Learning and Research for Humanitarian Assistance, are launching a new 3 year initiative—the Research for Health in Humanitarian Crises programme. The collaboration aims to fund research to improve the evidence base for public health interventions in disaster situations and to reduce the mortality and morbidity caused by such catastrophes. Up to £6·5 million in research grants will be available. A key criterion for funding will be proposals that involve partnerships between researchers and humanitarian

practitioners. The initiative also hopes to fund rapid response teams that can be quickly deployed to do research in the early stages of a crisis, where evidence is most needed and is hardest to get.

The programme already has an evidence review underway to help assess knowledge gaps and guide funding. Preliminary results show that work is needed in all health specialties, but diff erent specialties have diff erent needs. For example, presently there is a limited evidence base to guide mental health responses in humanitarian crises. The initiative will also commission a review of the current state of ethical practice with the aim of developing an ethical review framework and guidelines for research.

More people are likely to be aff ected by emergencies in the coming years because of factors such as climate change and increasing urbanisation. Responses to these humanitarian crises should be grounded in high-quality evidence as well as in compassion. The new research programme will be vital to achieving this goal. ■ The Lancet

Improving the health response to humanitarian crises

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