More than one billion people globally live with a mental-health condition. Collectively, these disorders are now the world’s leading cause of disability. Depression and anxiety alone cost the global economy an estimated US$1 trillion every year.
The grand plan to transform psychiatry — by personalizing mental-health care
Conventional pharmacological approaches to improving mental health are falling short. However, two Nature News features this week report on innovations that indicate a shift is under way. One describes the personalization of psychiatric care; the other discusses developments in psychedelic medicine. Although neither effort will provide a complete solution for the mental-health crisis, both are bringing much-needed ingenuity to the field.
To ensure that these ideas translate into improvements in mental-health care, they must be pursued with rigour and in a way that ensures they have the widest possible reach. As psychedelic-development programmes move towards regulatory approval, the US Food and Drug Administration has rightly clarified what types of evidence and outcome it expects to see in trials (see go.nature.com/4bstrh2). Funders and regulators must now ensure that approaches that prove successful actually reach the people who need them. This will not be straightforward because many psychedelics and proposed personalized treatments are expensive. They are developed with small groups of people with a specific condition in mind and therefore do not benefit from economies of scale. At the same time, personalized treatments can be out of reach for people from low-income backgrounds, who are more likely than others to have a mental-health condition.
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Under the current psychiatric model for mental-health conditions, two people with the same diagnosis of depression can have distinct symptoms, different underlying biology and divergent responses to the same treatments. That heterogeneity is reflected in clinical outcomes. A substantial proportion of people don’t respond to the first antidepressant drug that they try, and around 30% remain symptomatic after trying several treatments (C. Njenga et al. BMJ 386, e073823; 2024).
In practice, conditions are more complex than conventional diagnostic categories suggest. One reason for this is that classifications have relied on subjective reporting of symptoms. Now, precision psychiatry approaches aim to improve diagnosis and outcomes. The idea is to personalize treatments by cataloguing symptoms in detail and as objectively as possible, and identifying measurable biological indicators, or biomarkers. The expectation is that this can help to match people with more-effective treatments, and do so faster by shortening the process.
Methods include the use of genetic and blood-based biomarkers; measures of brain activity such as functional magnetic resonance imaging and electroencephalograms; and ‘digital phenotyping’, in which smartphones and other sensors record sleep and movement, for instance. But these assessments have yet to consistently yield improvements for people with mental-health conditions, as one of the features reports. Some researchers say that another approach would be to gather as much data as possible on how people respond to specific treatments and which responses correlate with mental-health improvements. Those data can then be fed into artificial-intelligence models to predict how individuals might fare. It is unclear, however, whether the benefits of such tools would outweigh their costs.
Psychedelics: concerns and opportunities
As reported in the other feature, psychedelics might tap into the brain’s capacity to reorganize its connections and circuits, potentially disrupting rigid patterns and enabling psychological changes — even for some people for whom conventional treatments haven’t worked.
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Outcomes could be optimized by personalization. But, as with precision psychiatry more broadly, this approach comes with a duty to prioritize research into treatment responses across diverse populations. The use of psychedelics introduces additional concerns. Adequately trained health-care workers are needed to bolster the drug’s efficacy and safety, especially during potentially intense, unpredictable and lengthy psychedelic experiences.
Existing treatments for mental-health conditions, including psychotherapy and antidepressants known as selective serotonin reuptake inhibitors, can be extremely effective for some people. But their full therapeutic benefits can take time to emerge. The rapid relief provided by psychedelics could complement such therapies.
However, even the most sophisticated and effective treatment strategies will have limited impact if people can’t access them. That’s why funders and regulators must work out who is going to cover the cost of a brain scan (if they are found to be clinically useful) or pay for a hours-long session so people can take psychedelics safely. Someone will need to assess whether these approaches have enough benefits to offset the spiralling costs of mental-health care — and whether those benefits can be provided equitably.
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There are ways to reduce upfront costs as well as expand reach, for example, by using low-cost biomarkers and therapy sessions in which participants take psychedelic substances together in a supervised setting. Several studies have found that such group sessions can even enhance the therapeutic effects in some cases (A. L. Back et al. Psychedelic Med. 4, 209–221; 2026). Psychedelics with briefer hallucinogenic effects, currently under development, might be an alternative, too.
However, progress on diagnoses and treatments should be paired with innovation on another front: preventing people from developing a mental-health disorder in the first place. No medical breakthroughs can substitute for a society that supports good mental health — and more could be done to reduce the factors that contribute to mental illness, such as economic insecurity, sleep disruption, environmental pollution and social isolation.
The field’s willingness to consider how to reinvent psychiatry is welcome. Proponents of the ideas must now ensure that all who can benefit have access to these therapies and that the highest standards of quality and rigour are adhered to.