President’s update: Strengthening evidence-informed psychiatry

Psychiatry is constantly evolving. New treatments emerge, evidence develops, community expectations change, and the environments in which our patients live continue to shape their mental health in profound ways.

A central responsibility of the College is to help our profession navigate that change thoughtfully and it being grounded in evidence, clinical judgement, ethics and the safety of the people we care for.

Recent work across our policy and clinical standards portfolios reflects that responsibility.

We have published new position statements on the social determinants of mental health and consultation-liaison psychiatry, updated guidance on the therapeutic use of medicinal cannabis and voluntary assisted dying, and added new resources addressing the treatment of schizophrenia, MDMA-assisted psychotherapy for PTSD, and long-term psychodynamic psychotherapy for mood disorders.

These topics are very different, but they share a common clinical challenge: psychiatrists must integrate evidence with formulation, diagnostic complexity, comorbidity, patient preferences, risk and clinical judgement which is often in areas where the evidence is still evolving.

Our new position statement on the social determinants of mental health recognises what psychiatrists see every day in practice: that mental health is shaped not only by illness, but by housing, education, employment, poverty, discrimination, social connection and the broader conditions in which people live.

These factors influence presentation, risk, treatment engagement and recovery. The statement considers how psychiatrists can respond through clinical practice, research, education, leadership and advocacy, while recognising that meaningful change requires sustained action well beyond the health system.

The new consultation-liaison psychiatry position statement focuses on another area central to clinical psychiatry: the intersection of mental and physical health.

Consultation-liaison psychiatrists work with some of the most complex presentations in hospital care, including delirium, self-harm, capacity concerns, severe mental illness alongside physical illness, and complex diagnostic uncertainty. Yet access to these services across Australia and Aotearoa New Zealand remains variable. Strengthening their availability, resourcing and integration is essential to providing safe, high-quality and genuinely holistic care.

Other areas of practice are changing quickly and require particular caution.

Medicinal cannabis continues to attract considerable public and clinical interest, despite insufficient evidence supporting its use in the treatment of mental illness and ongoing concerns about psychiatric harms.

Our updated clinical memorandum reinforces the need for careful assessment, consideration of established treatments, and appropriate monitoring where medicinal cannabis is being contemplated.

The clinical question is not simply whether a treatment is available, but whether it is appropriate for a particular patient, what evidence supports its use, what risks it carries, and what safeguards are required.

The College has also updated its position statement on voluntary assisted dying. This remains a complex and deeply considered area of practice. The statement acknowledges the diversity of views within our profession and communities, clarifies psychiatrists’ role in capacity assessment, and emphasises the importance of appropriate mental health care for patients, families and support networks.

Our Best Practice Resources library is also expanding to support clinicians in areas where evidence and practice continue to develop.

The international guidelines for the algorithmic treatment of schizophrenia bring together the work of 70 experts across 30 countries, alongside people with lived experience of schizophrenia. They provide a structured approach to pharmacological treatment, including antipsychotic initiation, optimisation, treatment resistance, adverse-effect management, cardiometabolic monitoring and the use of clozapine.

For clinicians, this is particularly relevant to one of the enduring challenges in schizophrenia care: recognising non-response early, avoiding prolonged ineffective treatment, and ensuring that people with treatment-resistant illness have timely access to evidence-based options.

We have also endorsed the Monash University Clinical Practice Guideline for the appropriate use of MDMA-assisted psychotherapy for PTSD. As novel treatments move from research settings into clinical practice, psychiatrists need balanced guidance that helps them understand both the emerging evidence and its limitations, identify appropriate patients, consider risks and contraindications, and support genuinely informed decision-making.

And, as highlighted in my previous President’s update, the Anna Freud Centre Mood Disorders Psychodynamic Psychotherapy Evidence Review is now available on the College website as a Best Practice Resource, freely accessible to members and the wider community.

As always, I thank the members, committees and people with lived experience who contribute their expertise, perspectives and time to this work. I would like to particularly acknowledge Dr Nicholas Burns, Chair of the Social, Cultural and Rehabilitation Psychiatry Committee, for his leadership on the social determinants of mental health position statement; Dr Carol Silberberg, Chair of the Faculty of Consultation-Liaison Psychiatry Committee, for her work on the Consultation-Liaison Psychiatry position statement; Dr Michael Daubney, Chair of the Committee for Evidence Based Practice, for his leadership on the clinical memorandum on the therapeutic use of medicinal cannabis products; and Prof Sathya Rao OAM for his contribution to the updated position statement on voluntary assisted dying.

I also thank College staff who support this work behind the scenes, coordinating consultation and bringing together expertise to develop these valuable resources.

Taken together, this work speaks to the heart of clinical psychiatry: making careful decisions in the face of complexity and uncertainty. It means integrating the best available evidence with clinical formulation, lived experience, patient preferences and sound judgement; remaining open to innovation without overstating certainty; and keeping safety, effectiveness and the therapeutic relationship at the centre of care.

Advocating for youth justice reform

Our responsibility as psychiatrists also extends beyond the consulting room.

The College has joined more than 200 organisations and leaders in supporting an open letter to Prime Minister Anthony Albanese calling for urgent national leadership on youth justice.

Across the College

This advocacy is happening every day across our Branches and in Aotearoa New Zealand.

Tū Te Akaaka Roa continues its work across workforce, legislation, service reform, cultural safety and digital mental health. Across Australia, Branches are engaging with governments and communities on workforce shortages, health-led responses to mental health emergencies, psychiatry training and access to specialist services.

These efforts often happen away from the national spotlight, but they are an important part of the College’s impact. We will continue to highlight the work of our Branches and Aotearoa New Zealand through Psyche and other College communications.

The strength of our College lies not simply in producing guidance or advocating for reform, but in bringing together clinical expertise, evidence and lived experience to improve psychiatric care and the systems in which that care is delivered.