PORTRAIT Expert

Pierre Oswald

Mental health cannot be reduced to an isolated disorder or a biological mechanism. It engages a person’s trajectory, body, environment, and history. It calls for an integrative and personalized psychiatry: two people with the same condition, or facing comparable suffering, won’t necessarily need the same care. Depending on someone’s life context, the focus may fall on adjusting the environment, psychological support, or treatment — most often combining several approaches. This tailoring is especially critical during the transition age, between 15 and 25, when vulnerabilities first emerge and adolescent and adult services struggle to ensure continuity.

This personalization requires genuine interdisciplinarity: not a juxtaposition of professions but shared work. Psychiatrists, psychologists, nurses, social workers, and general practitioners, alongside patients and their families, build a shared understanding together. Interdisciplinarity is not merely an organizational choice: it is the condition for care that accounts for the whole person.

Yet this ambition runs up against the fragmentation of care. Actors often operate in parallel, each fulfilling their own role without the whole gaining coherence. Coordination mechanisms have multiplied, but that hasn’t given them direction: a network can multiply connections and still leave the patient to find their own way, or lost between conflicting opinions. What’s missing is an assumed clinical governance, capable of carrying a vision and making decisions.

Concretely: a designated clinical lead for each complex case, an organized handoff between adolescent and adult services, case formulations built together rather than juxtaposed opinions, and care pathways designed around the person rather than the institution. These are the paths to truly addressing the complexity of these situations.